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Apogee Education: Staying Ahead of the Curve

Driving back home from New York City one Saturday evening, I received a call from a former resident student. He felt compelled to call because he was dealing with a difficult patient situation; similar to an experience we had together back when he was still my resident. As a result of that residency experience, he felt as though he could hear my guiding voice helping him make decisions for this patient. Thankfully, the patient did well and the family was very thankful. To date, this remains one of the proudest moments in my medical career.

Last month, about 2 years after completing his residency, this same physician was chosen as the medical director of a hospitalist group in Florida. He was selected over several older and longer serving physicians in the group because in addition to being a wonderful physician, he had the best leadership skills, knowledge of coding and documentation and understanding of HCAPHS, case mix index and DRG.

After he thanked me for imparting the knowledge of these important points during his residency training, a sense of gratitude came over me as I realized that some of my best learning experiences have come from Apogee University, Apogee Leadership Seminar and the Program Director Summits. I learn a lot of invaluable information through the many Apogee education opportunities and transfer my knowledge to my colleague hospitalists and my resident students. I cannot thank Apogee enough for being the only hospitalist group in the country that cares about the education of their physicians. Sometimes, as physicians we forget to fully appreciate the priority Apogee places on education.

Knowledge is like a fountain. Having the thirst for knowledge and then quenching it repeatedly is the secret to keeping oneself ahead of the curve. For a fountain to keep pouring water, it must have a source, like a spring. Any opportunity to read, learn or interact with other knowledgeable individuals is the spring that feeds water to the fountain of knowledge. By emphasizing commitment to continued physician education and by providing multiple platforms for physicians to interact, Apogee keeps feeding water to this fountain and has distinguished itself as a premier organization. No wonder I am extremely happy to be part of Apogee.

Mahesh Krishnamurthy, MBBS, MD, DM, FACP
Program Director
Easton, PA

A Great Day to Be A Doctor

I am accustomed to delivering bad news to families, but this one was especially difficult. A man sitting on the worn couch in the family conference room was in shock. Two hours ago he had just performed CPR on his wife. "I was about to fall asleep when I heard her breathing was not right. I tried to wake her up but couldn´t. She was gasping for air. I called 911 and then she stopped breathing. I tried to remember how to do CPR. I did the best I could," he said in despair. "Doctor, she´s never even been sick. How can this be?"

This was a young patient with a totally benign medical history. EMS arrived to find CPR in progress. However, she lived 15 miles away from the nearest EMS station, and the estimated time for return of spontaneous circulation was 21 minutes. That´s a long time for CPR, even by trained providers.

She was triaged by an outlying ER and sent to Archbold Hospital. When she arrived I was not optimistic. The endotracheal tube seemed so out of place in this delicate, non-traumatized young woman. Her cardiac status had stabilized, but other than intermittent spontaneous breathing she showed little signs of life. She was the victim of cardiac arrest due to primary ventricular fibrillation.

The patient underwent a new hypothermia procedure that involves lowering the patient´s body temperature in order to halt the body’s natural inflammatory response that can cause the death of brain cells. Time is critical and the goal is to achieve a temperature of 89.6 within four hours of arrest. The Apogee hospitalist team and ER doctors collaborated to form the hypothermia team at Archbold Hospital six months ago. This was the fifth patient we had treated with our new protocol.

I explained our treatment strategy to the patient´s husband. "She´s really sick, but the good news is we have a new way to limit the amount of damage," I told him. The husband looked at me with a mixture of fear and hope. "I am not sure how she will respond, but we´re going to do everything we can to get her through this," I explained. "I have to be honest. Some patients do well, but sadly many do not."

The first two days were challenging. She was ventilated, paralyzed to prevent shivering, and developed electrolyte problems commonly found in hypothermia patients. The aspiration pneumonia she acquired during CPR progressed; she had more arrhythmias and went into mild renal failure. We reversed her paralysis and sedation, treated the various other issues and hoped for the best. On day five she moved spontaneously. On day six she opened her eyes. On day eight she squeezed her husband’s hand.

I was off for several days, and when I returned the patient was out of the ICU. When I walked into her room she was talking with her husband about the kids. Two weeks after her cardiac arrest, she went to Tallahassee for an implanted defibrillator. About one month later, she walked into the ICU to visit those who cared for her and to say thank you. There was not a dry eye in the room. Some days you have bad news, some days you have good news. This was a really great day to be a doctor.

Rudy Hehn, MD
Divisional Director

Congrats to Dr. Sirisha Sesham, "Physician of the Quarter" by Valley Hospital!

Apogee Hospitalist, Dr. Sirisha Sesham was awarded "Physician of the Quarter" by Valley Hospital in Spokane, Washington. Dr. Sesham was nominated by her colleagues for outstanding doctor-to-doctor communication, patient satisfaction, and quality of care. "Dr. Sesham demonstrates a caring approach to coaching patients and their families throughout their hospital stay," a colleague expressed in the nomination. Valley Hospital is committed to rewarding outstanding effort and performance. The hospital´s newspaper stated, "Dr. Shesham´s dedication to Apogee´s hospitalist program at Valley is commendable and reflects her commitment to excellence." Thank you, Dr. Sesham for delivering the Apogee Promise of Safety, Service, Quality, and Value!

Patient Callbacks: A Win-Win Situation

A few years ago, I attended a Community Health Systems Chief of Staff conference at which one of the speakers, Stephen Beeson, MD from the Studer Group, gave a terrific presentation on patient satisfaction. I was especially eager to hear Dr. Beeson’s thoughts on the subject, as achieving high patient satisfaction scores is particularly important to me.

Dr. Beeson talked about making phone calls to follow up with patients after they had been seen. My personal response was, “That would be great if I only had time to do it!” I was still doing outpatient medicine at the time, and my tightly scheduled day made this difficult. I dreamt, “If only I could call patients instead of filling out disability, prior authorization, and insurance forms!”

When Apogee started its Patient Call Back system, I was excited. My first patient call was met with disbelief: “I can’t believe a doctor would call and check on me! Thank you so much,” the patient said. Excited responses like these are common. Patients are always greatly appreciative of the caring follow-up. I hang up the phone with a warm, fuzzy feeling, and I think the patients do, too. At Apogee, it turns out my wish came true after all! I was able to trade my mountain of paperwork for calling patients. What a win-win situation for us all!

Brian Reach, MD
Program Director
Anna, IL

Apogee Partner Hospital Named 2011 Summit Award Winner

Last week, Woodland Heights Medical Center in Lufkin, Texas was named a 2011 Summit Award Winner by Press Ganey Associates Inc.. This organization partners with 50 percent of the nation´s hospitals to measure and improve quality of care. Woodland Heights was bestowed this prestigious honor for sustaining the highest level of core measure performance for three consecutive years. Not surprisingly, Apogee has partnered with Woodland Heights for the last 3 years. Congrats to the members of the Apogee Lufkin team for helping your hospital garner this well-deserved recognition!

Vikram Suraparaju, M.D.
Program Director

Pratibha Deshpande, M.D.
Apogee Physician

Naaz Khan, M.D.
Apogee Physician

Monica Cherry
Patient Information Coordinator

Aimee Moore
Patient Information Coordinator

Apogee PD Passionate About Giving Back

Dr. Ed Miller Raises over $100,000 for Dream Come True

Lehighton/Palmerton PD, Dr. Ed Miller strongly believes in the importance of giving back to his community. That's why for more than 6 years he has been involved in fund raising for Dream Come True, an all-volunteer organization that seeks to fulfill the dreams for children who are seriously, chronically, and terminally ill. Each year, Dr. Miller heads a trap shooting fundraising event that has raised over $100,000 dollars in the last 5 years.

This month, Dr. Miller volunteered for a telethon that raised over $61,000 for the organization. Thank you, Dr. Miller for being a compelling example of the Apogee way!

For more information on Dream Come True, please visit: www.dreamcometrue.org

The Significance of Trust

Paul Richmann, MD, Chief Apogee Surgical Program

My Thanksgiving began watching a beautiful sunrise in a nearly cloudless Phoenix sky. In our household, anticipation swirled in the air as we eagerly awaited the day´s festivities. I was particularly excited to bring home my small sports car that I had been storing at my sister´s home. As always, our drive to celebrate with my family in Tucson began with a brief stop at the local gas station to top off the tank and check the tires. Per usual, all was well and off we went.

Seventy miles into our drive my wife´s cell phone rang. I dutifully obeyed her motioning to pull off at the nearest exit and when we stopped I learned that my mother in-law was unresponsive in her home. After making the necessary calls to 911 and family, we decided our best plan of action was to continue on to Tucson and have my wife return in my sports car to tend to her mother. When we arrived, my little car sat exactly where I had left it six months earlier. After giving the vehicle a jumpstart, I instructed my wife not to stop because the battery was likely on its last leg. With that, she sped away.

Roughly 90 minutes later my wife called, "Paul, something bad just happened…. There was a shimmy, a loud noise, and then your front tire just shot out into the desert. But, I am OK." After arranging to have her brother pick her up and take her to see her mother at the hospital, I contemplated my responsibility in this situation. I concluded that I had failed to properly protect my wife by neglecting to follow my personal safety checklist that would have ensured the tires were properly inflated. I consider my action (or lack of action) inexcusable because my wife was relying on me to keep her safe.

By Saturday, my mother in-law was anxiously ready to get home. All of her tests had come back negative and the only test left was the EEG. The nurse assured us that the test had been ordered Friday morning and once she had completed it she would be cleared to go home.

By three o’clock, however, my thoughts had become preoccupied with the possibilities of P.E., hospital acquired pneumonia, and decubiti. Thus, I decided to call the EEG Department and learned, to my disappointment, that her test had not been completed after three attempts by the tech because she was getting other tests done. I was told she would now have to wait until Monday since only STAT EEGs are done on the weekend.

This was unacceptable to me, so determined to get her home, I made several more calls and arranged to have the test completed and have her discharged in time for dinner at home that evening. I later pondered the events of the day and reflected on how both the situation with my mother-in-law and with my wife demonstrated how intensely important it is to never fail in the stewardship of care for those depending on us. Simple acts of neglect, when caring for another can have catastrophic sequela. Always remember the significance of trust when placed on you. Do not falter. Give Thanks.