Only 50% of hospital staff have received the flu shot. Legal counsel is ascertaining whether this is a matter which must be addressed by collective bargaining or whether CCHHS can unilaterally make vaccination a condition of employment. Management attributes the low level of vaccination to "cultural barriers," its euphemism for African-Americans’ suspicion of medicine as practiced by whites in general and the government in particular.
Cermak Health Services (serving the Cook County Jail and the Juvenile Temporary Detention Center) gave a comprehensive account of its activities, including an 80% staff vaccination rate. Interim Chief Medical Officer Dr. Concetta Mennella noted in her report that "correctional medicine" once meant controlling communicable diseases but now means treating mental illness and substance abuse.
The Quality Assurance Department has finally created a report form which will show the System’s progress on each identified measurement. The report form likely was created without consideration of the STAR report, which was never mentioned.
The Committee adopted the FY 2014 Quality Assurance Plan after Dr. Das explained that it focuses on four High-Risk High-Volume priority areas: discharge transitions, procedural safety, medication safety and handling malignant pathology. The overall goal, of course, is to prevent "adverse events," and particularly "sentinel events," which are adverse events with catastrophic outcomes.
The plan also provides a smoother system of reporting, from internal committees to the Hospitals’ Executive Staff to the Hospital Board Committees to the full Hospital Board. Each internal committee will track three key indicators, and a combined quarterly report will show up or down arrows reflecting progress or lack thereof in each. Every department has responsibility for improving its own key indicators, and therefore for assessing the performance of physicians and contractors as well as front-line staff.
Overall, the three areas to be tracked are time to treatment, core measures (which vary by department) and patient satisfaction. CCHHS is above the median in patient satisfaction for safety-net hospitals. But now that patients have the option to go elsewhere, their satisfaction is paramount, so the System’s goal for the next year is a 10% increase in that measure, to 71%. Das reported that CCHHS was "near the median" for all hospitals, though that median is 75% and the System is now apparently at 61%.
The ultimate goal, achieved by the top 10% of the nation’s hospitals, is 100% satisfaction plus 100% in each core measure.
Collens suggested that the System communicate to the patients its new commitment to improved quality, as just knowing about the effort might improve their satisfaction.
Das stressed that improved data collection would help CCHHS identify opportunities for improvement. She said the System is implementing "six-sigma" to achieve consistent performance.
Flu: Dr. Shannon reported a minimal flu season thus far in the county and the state. Vaccine has been widely available to CCHHS patients and staff since the first week in October, but only 3000 employees (slightly more than half the workforce) has been vaccinated. To encourage vaccination, CCHHS has set up standing orders for vaccines, and offers them on-site 24/7 free to staff members. Still, the rate of vaccination has slipped since the historical high in 2009, the year of the H1N1 flu. 90% of pharmacy and CORE staff have been vaccinated. The Committee then discussed whether the Board could require vaccination.
Cermak Health Services: Dr. Mennella noted that prisoners were the only Americans Constitutionally entitled to medical care, under a 1976 Supreme Court case, so Cermak provides Constitutionally-required care; but she stressed the goal of improving the health of the most marginalized in society and of their communities. The 100-acre Cermak campus includes 17 buildings providing different levels and types of care, including the newly-opened 979-bed intermediate-care Residential Treatment Facility, which will be used largely for treatment of drug and alcohol problems and the mentally ill.
Menella provided statistics explaining Cermak’s size:
- It does 100,000 intake screenings a year; every detainee is screened, so Cermak is able to capture the 20% who are mentally ill.
- It sees 2,000 of the County’s 10,000 detainees every day.
- It provides 5 million doses each year, using a robotic pharmacy to reduce errors.
- It has produced 5% of CountyCare enrollees, and expects 9 out of 10 of its patients to have health insurance coverage under Obamacare, versus only 1 in 10 now.
- It cares for the 300-plus daily population at the Juvenile Temporary Detention Center (JTDC) with nationally-accredited services.
- Between 1985 and 2012 the jail population doubled because mental hospitals closed and the length of stay increased: 2 extra days adds 600 patients/month to the census.
- 57 days is the average length of a jail stay; 12 days is the median. Every month there are 250 detainees who have been there more than a year.
- Cermak manages chronic diseases including Hepatitis C and liver cancer.
- It handles 550 opiate and alcohol withdrawal cases at a time and is authorized to dispense methadone to those who have already had it prescribed.
- It offers more than the ten hours/month of programming required by the Department of Justice for mentally ill patients.
- It treats most patients on-site, with only 20 people transferred to Stroger each day, mostly for orthopedics (to treat incarceration-induced trauma). Detainees at Cermak are treated without shackles unless the Sheriff insists; at Stroger they are shackled.
- All detox at Cermak will be consolidated in the new Residential Treatment Facility, which has been open since June but is still awaiting necessary equipment. It should be fully operational by June 2014. 86% of its patients will be there for mental health issues.
- 80% of its staff has been vaccinated for flu, and while prisoners often opt out, "they bare their arms when they see others getting sick." Vaccination isn’t mandatory because detainees have the same right to decline treatment as anyone else.
Other goals for 2014: hire an orthopedist to reduce the need for transfers to Stroger; implement an Electronic Medication Administrative Record-keeping system. (Cermak already has EMR.)
Services are the collective responsibility of the Sheriff, the Department of Facilities Management and Cermak Health Services. Cermak is monitored by the Department of Justice under a consent decree; it’s considered "partially compliant" at 50%, and has no units which are noncompliant. In response to a question, no one could say how the residental treatment unit building was financed, though it costs $90 million.
There was no report from Provident.
From Stroger Hospital, Dr. Ochoa reported that the medical staff had approved the Quality Assurance Plan. It also changed the name and composition of its internal quality group; the new Hospital Quality and Patient Safety Committee will convene in February.
Submitted by Kelly Kleiman
