By Dr. Kathleen McGraw, CMO

2014 is whirling by as if it is attached to some of the snowflakes we continue to have swirling around us. Like the snowfall, some of it is steady, some a flurry of activity, and some of it is fresh and new. But as this happens I’m also looking back to see where I’ve been. It’s just past the one year mark since I arrived in the position of Chief Medical Officer here at Brattleboro Memorial Hospital. It’s been a busy year of new faces and challenges. Looking back, here is some of what I’ve seen happen at BMH.

Kathleen McGraw, MD
Kathleen McGraw, MD

Putting our patients first – This year we elected to take on the annual flu season with gusto. Evidence shows that vaccination helps prevent the spread of the flu, and who better to protect than our patients? For the first time we elected to implement a policy requiring vaccination for all of our employees. Those folks unable to get the vaccination have committed to wearing a mask while at work during the flu season. You can see our little stickers proudly displayed on our name badges verifying that we each have been vaccinated. Check them out. It’s our way of assuring you that we are protected and, therefore, so are you.

Another big change at BMH occurred on the second floor of the hospital. Previously a medical and surgical inpatient unit, we have now changed it to a Monday through Friday surgical patient unit. Nurses on that unit are better able to plan for the care of their anticipated surgical patients. The patients get to arrive in their rooms before surgery and get settled, meeting the staff who will care for them post operatively. Families now know where to find their loved ones once their surgical procedures are done. It allows the surgical nurses to focus more closely on the post-surgical needs of their patients. It also prevents the large amount of moving of patients from room to room that previously occurred depending on hospital census. This change could not have happened without a great deal of coordination and support from the surgeons, surgical staff, floor nurses, other support staff, and leadership working together. If you have had surgery here recently I would imagine you would agree this is working out nicely for all.

One of the most visible changes has been the changes in our emergency department (ED). When I arrived last winter, the work was already underway, but it was still very clear how much the change was desperately needed. The staff in the ED has continued to provide care for all their patients despite the sounds of drills and jackhammers and despite the cramped quarters with sections blocked off for renovation. Slowly the anticipated improvements have been revealed as sections of the work are completed. We opened the new front entrance last summer. I’d say the beauty of that is just being realized as folks are able to be picked up and dropped off under the shelter of the large canopy. The breathing space in the ED that is slowly being revealed is tremendous for an improved access and ability to treat our patients. We expect completion of the work to happen late in the spring. The support that the community and the staff of BMH have provided in both patience and actual dollars has been tremendous. Thank you to all who have made this possible!

At the same time that our ED space has undergone dramatic renovations, we have dramatically changed the workflow for those caring for ED patients by rolling out the implementation of an electronic medical record. As anyone who has gone through that transition can tell you, it can be a hair-raising experience. Changing from a pen and paper to a keypad while in the midst of caring for urgently sick patients requires lots of planning, testing, training and assistance. We had all of that, and the roll out was tremendously successful. We now have a medical record that we can send to your primary care provider that includes all the information they need, and far more legible too (no more quips about doctors’ handwriting!). This is ultimately a safer way to provide care with full communication.

Speaking of safety… that makes me think about yet another change over the past year. Last spring we started an initiative entitled “Creating a Culture of Safety”. It is an ongoing project that looks to put safety first and foremost in the minds of everyone taking care of patients. It also makes clear that everyone at BMH is either directly caring for patients or is supporting those who do. We have learned tools to better spot progress in tending to safety issues and reexamined some of our own ways of working with each other. All of this is being done with an eye for keeping to our goal of patient safety. We have reviewed and reworked handoffs of information between staff, the ways in which we work together to prevent falls, and how we gather and verify the medications that our patients are taking as they come in for surgery, just to name a few of the initiatives. Safety is so integral to what we do and creating a culture where everyone recognizes it as an essential part of their role here at BMH is our goal.

There have also been some activities at the state and national level this past year that have impacted our work here at BMH. First of all, as many may remember, last spring the Vermont legislature enacted the Physician Aid in Dying law. This was groundbreaking work as only a few states have taken this path before us. I think the legislation made many anxious, especially as it went into effect at the moment of signing. Since that time, however, healthcare facilities have been carefully looking at how it impacts the care they provide. The Vermont Ethics Network has been of great assistance in creating resources for both patients and physicians who are interested in understanding the law as well as those who may want to explore exercising the law. The actual use of the law has been extremely minimal thus far, but this is in line with other states’ experience in enacting such legislation. I have had numerous phone calls from patients in our neighboring states who are interested in participating, but given the writing of the law, this is only for Vermont residents.

Another of the prominent issues of the past year in Vermont has been our ongoing efforts to provide our patients with the psychiatric care that they need. We have designed the new Emergency Department with the increased frequency of patients with psychiatric issues in mind. We have been actively involved with those that also care for these patients across the state. We are all working to improve our care and to collaborate more in order to get these patients timely care. We still have a long way to go before this situation is resolved, but it is certainly an area of ongoing, intensive focus.

Lastly, although not last at all, the past year has brought the advent of the implementation of One Care Vermont, our statewide ACO (Accountable Care Organization). We have reorganized the ways we at BMH provide care, both in the inpatient and outpatient setting to provide a more coordinated approach. This includes making certain that patients have services set up and follow up appointments scheduled before they leave the hospital. In the outpatient setting it means the start of daily huddles to look at patient needs before they arrive for their appointments to insure we are not missing anything. This is all part of our goal of providing high quality personal care to the people of the Brattleboro area.

As I sit here finishing up this article for publication I hear the voices of staff cheerfully wishing each other good luck on their trip home. It is, of course, snowing again outside my window and I too have a treacherous drive awaiting me. The final thing I realize that I have seen in my first year at BMH, is that the staff here, both medical and non-medical, really do care about each other, our work and our patients. Over and over again we try to decide how we can do things better, because we care. Some folks have been here for decades and they speak with enormous pride about their work. Some, like me, are new and are excited about the vibrant upbeat energy that they find here. We are in an ever changing health care environment and we are moving right along with it. I’m glad to be part of this forward looking BMH team. It’s been a great year!

Dr. Kathleen McGraw is Chief Medical Officer at Brattleboro Memorial Hospital. She can be reach at 802-257-0341.

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