Cook County Hospital Quality and Patient Safety Committee Meeting, August 21, 2012

This meeting served essentially as an orientation for the new members of the Committee, most of whom are also new to service on the Hospital’s Board. Dr. Mason, the new System Chief Medical Officer, gave a report prior to the arrival of the observer. 

Ms. Russell, System Interim Chief Nursing Officer, reported that the system is facing a wave of nurse retirements: in 2013, 196 nurses will be eligible to retire after 25 years of service and another 43 after 30 years of service.  While there are obviously pension consequences to this large group of retirees, Ms. Russell reported on it as something to be considered in maintaining the quality of patient care throughout the system.

Dr. Mason then showed the group a video explaining the responsibility of the CCHHS Board for the quality of care at the hospital.  The Board (like hospital Boards everywhere) was originally an honorific and philanthropic Board only, with quality and patient care concerns left to the medical staff.  However, a 1960s court decision (the Darling case) found that a mistreated patient could hold the hospital, and not merely its doctors, liable.  As a result, hospital Boards now have responsibility for overseeing the medical staff as well as hospital management.  These oversight responsibilities are discharged at CCHHS through its committees.  Committee member Driscoll asked why the Quality and Patient Safety Committee no longer received Mortality and Morbidity reports–are the Committee’s discussions discoverable in court?  CCHHS Associate General Counsel Helen Mason promised to research and respond to the question in writing.  She noted that those reports are discussed within a committee of the medical staff.  The Committee agreed informally that it doesn’t need to see details of individual cases but wants to know about processes for correction, perhaps through an annual or half-yearly event report.  Ms. Mason assured the Committee that the Board will see all public reports.

Dr. Das, System Interim Director of Quality and Patient Safety, then briefly reviewed the status of the hospital’s accreditation.  He explained that the accreditation process for public hospitals was new, and that Stroger had submitted its application supported by the hospital’s strategic plan and the WePLAN 2015, which prescribes actions in accordance with the strategic plan.  The Joint Commission will pay an accrediting site visit in July, 2013.  At the moment, only 80 of the nation’s 3000 public hospitals are accredited; Cook County intentionally submitted Stroger to the process early, and hopes to be accredited next year. 

Dr. Murray, Director of the Department of Public Health, then explained  that the Board of Health oversees all state-certified health departments.  In Cook County, there are 6 of these: Chicago, Evanston, Oak Park, Skokie, Stickney, and Cook County itself, which covers the rest of the county.   

She then reviewed a series of Health Department reports, offering the following details:

     •    The Department is now benchmarking indicators for lead poisoning.   In the coming year it will expand its role from screening and treatment to prevention and education.

     •    The Department handles food safety inspection for unincorporated Cook County and on contract for 34 suburban communities.  This is a revenue generator.  It doesn’t usually check farmers’ markets because it is worried more about meat contamination than about produce.

     •    The Department monitors syphilis and has reduced the extent of spread to 1 contact (.6 contact means no syphilis at all).  Its outreach efforts focus on young people.  The chair asked about drug-resistant gonorrhea, and Dr. Murray replied that the department informs doctors and tries to prevent the ailment through education about safe sex and through contact tracing.  Finding contacts is challenging, though, and the problem can only be solved through wider testing and education.

     •    The Department is identifying the zip codes with the highest-risk infants so as to concentrate its prenatal, neonatal and maternal care resources there.

     •    The Department monitors tuberculosis everywhere in the county but Chicago, and provides care for the entire county (by contract with Chicago).  The proportion of TB cases is up in the suburbs.

     •    The chair asked about pertussis, and Dr. Murray said that communicable diseases in general were not going down, and that she suspected pertussis was under-reported.  This demonstrates, she said, that the county’s vaccination coverage is not what it should be, pointing out that the legal requirement that children be vaccinated for school is ignored.
 
The Department meets with the state Department of Public Health (which can instruct local departments to test more frequently) and with its counterparts throughout the state. “We monitor specific diseases but we’re also concerned about process improvements.”

     •    Commissioner Munoz asked about the flu, and Dr. Murray reported that there has been no human-to-human transmission of swine flu; it has shown up only in children petting hogs at the state fair. 

The Committee approved four reports–Food Access in Cook County; The Suburban Cook County Food System: An Assessment and Recommendations; Communicable Disease Update, August 2012; and Annual Tuberculosis Surveillance Report,2011–which will now be posted on the CCHHS Website.

This fall the Department will update its report on the Strategic Plan and release a Quality Improvement Plan. 

Dr. Wakim then reported on the status of Provident Hospital: within 4 to 6 weeks it will be
prepared to take Stroger’s overflow, and able particularly to provide much more gynecological care. 

The Committee then approved medical staff appointments and the minutes of its June meeting. There being no call for a closed session, the meeting was adjourned.

--Submitted by Observer Kelly Kleiman