George Bischalaney, President and CEO, Eden Medical Center

By George Bischalaney, President & CEO, Eden Medical Center

Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.

Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.

With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.

Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.

We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.

By Digby Christian, Project Team Leader

We are proud to tell you that on April 7, 2009, the Sutter Medical Center Castro Valley (SMCCV) project team received the 2008 FIATECH CETI Award at the award gala held in Las Vegas.

FIATECH is an industry consortium within the building industry. Its primary mission is to get all the “players” involved in capital projects to adopt new ways of thinking and new technologies to deliver higher value for the funders and end-users of construction projects.

Here is why our team won the award…

As most of our readers know, California’s deadline for retrofitting or building earthquake-proof hospitals from scratch is 2013, less than four years from now. The hospital project in its current form was validated as viable in August 2007, and design work was authorized to start in October of that year, leaving us just over five years to have the building be ready and open for business. Typically, in California, it takes at least seven years for a project of this magnitude.

So the team had to throw out all historical concepts of how design is done and come together as a wide-ranging, multi-company team involving the owner, the designers and the builders, and transform the design and construction process to drive two years out of the schedule. The team is now on track to achieve just that and did it primarily by redesigning the design process in a rigorous and unrelenting fashion, so that it no longer bears any real resemblance to tradition!

If you are familiar with the classic design process, you’ll know that it’s typically abbreviated as “SD-DD-CD”: Schematic Design (broad concepts typically discussed and agreed to by the owner and the architect exclusively); Design Development (often a General Contractor might have some involvement in this); and Construction Drawings (some trades might be brought on board to inform how these are put together). Then, the work goes out to the building community and those companies develop what are known as Shop Drawings. These drawings show in detail how every little and large item in the building will be fabricated, i.e., the structural elements, including steel, metal, glass, concrete, etc.

On the SMCCV project, all of the people who typically are brought in at the end are already on board, and most of them have been on board since August 2007. By the time this project completes its approval process through the County and State we will already be at the Shop Drawing stage. The building is being designed for fabrication now, while the design approval process is underway.

While this concept has been discussed for the last few years within the industry, and parts of the above have been implemented on other projects, no project has implemented this concept as broadly and as deeply as the SMCCV project; certainly not on a project this large and this complex. It is one of the reasons our project won the FIATECH award!

The other primary reason we won the award is because of how thoroughly the building has been designed in three dimensions (as opposed to the typical two dimensional paper drawings we are used to seeing). There are many very attractive shots of 3D design that you can find on websites, and in trade magazines but you can’t tell if the designs are any good—all you know is they look “cool.” But on the SMCCV project, we bring the entire team together at least every two weeks to work through the coordination effort. It’s painstaking and difficult, but utterly critical to a successful outcome in a shorter timeframe.

What is not often understood outside the industry, and to some extent even within the industry, is that different design disciplines use different software, and they can’t see each other’s work in real time while they are designing. Each company has to either import a converted file of each other’s work or send both files to a third package, such as Autodesk Navisworks, to see both designs at the same time. So it’s all too easy to have a poorly coordinated, unbuildable, three dimensional design—no different in fact than having a poorly coordinated, unbuildable, two dimensional design.

In addition, we have focused the team on the larger goal of designing for fabrication rather than the industry convention of designing to produce the construction documentation, which is then coordinated by the construction team. The team’s goal to design for fabrication means we are swimming against the tide. We are allowing our companies to each use their own best-in-class software and then developing a process that allows a high level of coordination and constructability to ensure that what is being designed is actually what we will build.

The above might seem dry and technical; however, by a) having a multi-company team involving all the construction trades from day one; b) throwing out the baggage of a poor design process and starting from scratch to build a better one; and c) having a goal of designing for fabrication will allow us to build a new hospital on schedule, within budget, and without any last minute compromises on the finished product.

On the Sutter Medical Center Castro Valley project, we are breaking new ground ahead of any other project in the country in the way such projects are handled. That, in essence is the reason why the team that is building your hospital won the 2008 FIATECH CETI Award.

In addition to the Sutter Health project team, I want to personally thank The Devenney Group, DPR Construction, Capital Engineering, The Engineering Enterprise, TMAD Taylor & Gaines, GHAFARI Associates, J W McClenahan, Morrow Meadows, Superior Air Handling, MPS Project Management, Navigant Consulting, Greenwood & Moore Engineering, Herrick Steel, Otis Elevators, Strategic Project Solutions, Royal Glass, Clark Pacific, Candela, Sparling, and numerous other specialty trade vendors for making it possible to receive this award—and to meet our 2013 deadline!

For all you construction buffs, or for anyone who is interested, check out FIATECH at http://www.fiatech.org/.

I welcome your questions and comments!

By Todd Peterson, Vice President of Information Technology, Eden Medical Center

My name is Todd Peterson and I’m Vice President of Information Technology at Eden Medical Center. Castro Valley has been my home for the past 26 years, and I’ve worked for Sutter Health for ten years, joining Eden 2 ½ years ago.

My team is responsible for making sure all computer systems are up and fully functioning 24/7; and while computer repair is a significant part of our business, we are responsible for implementing new technologies that are now vital to many aspects of our patients’ care.

One major project underway that will be a cornerstone of the new Sutter Medical Center Castro Valley hospital is Electronic Health Records (EHR), a project conceived when I was still at Sutter. Basically the new hospital is being designed with minimal use of paper. That’s right… no more clipboards and illegible handwriting.

The EHR will facilitate all clinical documentation and reporting; all medical disciplines will be recorded. What does this mean? Our physicians will get a full view of a patient’s care at any given time, from any location, once their patient has been admitted to the hospital. So the patient’s medical history as it relates to diagnostics, drug therapy, procedures, diet, rehabilitation and notes generated by physicians and nurses will all be available online. This also includes previous visits to any Sutter Health-owned facility or physician office.

The EHR will ultimately be integrated with biomedical technology. That means much of the clinical equipment in patient rooms—heart monitors, blood pressure cuffs, IV pumps, and even the beds themselves—will feed information directly into the patient records. With real time monitors of the patient’s vitals, a physician can be alerted if a trend in their medical condition warrants medical attention well before a critical threshold is met. So the EHR will be a documentation system and much more; it will provide clinicians with a wider view of what is happening with a patient at all times so they can quickly take action.

Patient records will also show a correlation of clinical events, a true cause and effect. For example, a physician may order medications in response to laboratory test results. Subsequent laboratory tests can then be correlated to the timing of the medication and will demonstrate the degree of effectiveness. This constant correlation gives the entire care team the information they need to deliver the best care at the right time.

The critical exchange between the doctor who is on call and the nurse on duty will also be enhanced by EHR. Without delay, a physician can access the patient’s record from home, while the nurse views the same information from a workstation in the patient’s room so rather than just rely on a verbal exchange they are both viewing the patient’s record.

One of the key benefits of EHR is patient safety. In the area of medication management, physicians will use computerized order entry to address legibility issues and alert the physician to any contra indications, such as allergies, food or other medications that the patient is on. The process of administering the drug involves the nurse scanning the barcodes on the patient’s wristband and medication bottles. The system will confirm the patient’s name, medication name, correct time, correct dose and proper route (oral, or otherwise).

We will provide full accessibility to patient data. All this information, all images, reports, etc. will be available at the patient’s bedside. Every patient room, alcoves between rooms and nurses’ station will be furnished with a computer workstation so patient records can be accessed throughout the hospital. Physicians will also have wireless devices such as PC tablets to provide the most flexibility and mobility throughout the hospital.

Down the road, our patients who see Sutter Health physicians will be able to see their own clinical results online; they’ll be able to email their doctors and arrange appointments, and more importantly, track their own history and take responsibility for their own health. We may even use EHR to work in concert with our county and state health departments to track health trends in the community.

The prospects for EHR are endless. Our patients and clinicians become real partners in the delivery of care over the long term.

Your input is very important to us. I invite you to ask me any questions about the EHR system by either commenting beneath this post (click on the title of the post, if you are on the blog’s front page, and you’ll see the comment box below), or by emailing me.

Dr. Sidney Wanetick

Sidney Wanetick, M.D.

My name is Sidney Wanetick. For 26 years, I was in practice as an OB-GYN in Castro Valley, and I delivered more than 3,000 babies at Eden Medical Center.

In 2008, I retired from practice to accept the position of Vice President of Medical Affairs at Eden Medical Center. Today, I serve as the administrative liaison between the medical staff and administration, helping to support our physicians as they provide high quality care to our patients now and as we look to the future of Eden.

In addition to other duties, I am actively involved in assisting our physicians in recruiting new physicians to the community.

I’m very excited about the new Sutter Health hospital that is replacing Eden. Several major benefits stand out. In particular, having all private rooms for patients will make a huge difference, bringing more services to their bedsides and giving them more quality time with their doctors.

From the physician’s standpoint, this is a much better way to take care of patients and have important conversations with family members in private, as well as offer patients the privacy and rest needed for recuperation. The nurses’ stations will have a view of every patient’s room for faster response to patient needs.

The whole atmosphere of the new hospital will feel less institutional and more supportive, soothing and restful.

Today, even though Eden has 176 beds, we are unable to utilize all of these beds. Most rooms are semi-private, with very few private rooms and even a few four-bed wards. Yet, we can’t put men and women together, and we can’t mix patients with infections in with the general patient population. So even though Eden is larger, the Sutter replacement hospital will end up with a much better capacity for utilization of services.

Moreover, we are seeing a steady decline in the number of patients admitted to the hospital for more extended periods of time. When I first started my practice we admitted twice as many patients for surgery as we do today. My patients stayed in the hospital for five days or more! Also, if patients were scheduled for surgery, they would be admitted the night before. Today patients often have surgery and are discharged the same day, or, if they are admitted, the average length of stay is much shorter.

In addition to the 130 acute care beds, we’ll have a 34-bed, multi-purpose Universal Care Unit (UCU), which also supports the shorter hospital stay. Let’s say an Emergency Room patient has been treated and needs to stay for observation, but not necessarily be admitted. He or she can rest comfortably in the UCU. Or, if a patient is recovering from same-day surgery, we could have him assigned to a UCU bed where he’ll get the attention he needs.

There will also be vast improvements in our information technology systems that just aren’t possible at Eden; our current system has reached capacity. With the new electronic medical records system, our clinical staff will have access to lab reports, x-rays, medication, etc., right at their fingertips. Recent studies have demonstrated improved outcomes and fewer errors in centers that have electronic records, and the new hospital will have innovative, secure electronic records and data systems.

I welcome your comments and questions. Please feel free to leave a comment by clicking on the title of this post (if you are on the front page of the blog), and a comment box will appear below.

Yesterday, one of Eden Medical Center’s neurosurgeons, Dr. Dickinson blogged about what’s in store for neuroscience at the new Sutter Castro Valley hospital. Coincidentally, Eden was also mentioned in an article in the AARP Bulletin on February 2, which it picked up from the Contra Costa Times.

The article basically said that the State of California through its Office of Statewide Health Planning and Development (OSHPD) had released statewide data on “hospital death rates.” This data has been collected for some time and the most recent release includes data for 2007.

Eden was identified as having a “Better-Than-Average” rating for patients who undergo craniotomies, which is a procedure for removing brain tumors. The statewide average was 6.7%, while the rate at Eden was measured at 0.7%. We were one of 25 hospitals, among 400 hospitals statewide, with better than average results, and one of only three in the Bay Area. These results do not come about by accident or good fortune.

Eden has been a designated trauma center in Alameda County for over 20 years. The experience and training of our trauma center staff has helped strengthen the services we offer in surgery, critical care, diagnostics, rehabilitation and general medical care. The methods used by the trauma center surgical team have carried over to every patient treated at Eden.

Building upon the trauma center’s effectiveness and with the support of Sutter Health, Eden established the Sutter East Bay Neuroscience Center several years ago. One of the mainstays of these programs is neurosurgery (brain surgery). Eden is blessed with a core of very highly regarded and skilled neurosurgeons as part of its medical community. It is because of their expertise and our joint commitment to excellence in neurosciences that we have been able to have such outstanding results with this critically ill patient population.

OSHPD has a website with a link to all of the recently released data (go to www.oshpd.ca.gov and click on AHRQ). OSHPD points out that this data is risk adjusted, to ensure that all hospitals are treated fairly and that evidence suggests that high mortality may be associated with deficiencies in the quality of hospital care provided.

Public reporting of hospital data will become more common, and its use by consumers greater over time so that they can be better armed when making important decisions about where to seek their health care services.