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Published by Valley Regional Medical Center, 2018-04-13 16:20:08

Q2 Physician Newsletter

Q2 Physician Newsletter

Valley Regional Medical Center News

A Medical Provider Newsletter

Valley Regional Medical Center News I A Provider Newsletter

CEO Message Table of Contents

A Message from Art Garza, CEO CEO Message
Executive Committee
Greetings Everyone. Physician Bulletin
Year after year, the reporting requirements for clinical Quality Update
practices and hospitals become increasingly challenging. Service Line Corner
These changes may be driven by governmental agencies, Clinical Documentation
regulatory agencies or insurance companies just to name Chest Pain Center
a few. There is a big push for healthcare organizations, IT&S Keyboard
whether hospital-based or clinic-based, to move in the
direction of establishing a culture of patient safety. You may have already heard
of the term “High Reliability Organizations” or HRO’s. These expectations are
focused on ensuring patients have the best possible experience and outcomes
during their visit to their doctor’s office or during a visit or admission to a hospital.
A few examples of the way Valley Regional is changing to meet key stakeholder
needs and expectations include: adoption of computerized physician order
entry; transparency in data as it relates to quality initiatives; the adoption of
evidence-based clinical protocols; and tracking/trending hospital and provider
performance over time compared to national standards. As a matter of fact,
much of this detail is shared in monthly medical staff meetings.

We are not alone in this mission. Hospitals and healthcare provider systems
across the country are aligning and adopting cultures in which hospitals and
physicians come together in traditional and in new and innovative ways to
reduce their adverse event rates.

Multiple systematic reviews or cross-sectional studies have been performed in Physician Events
live clinical environments to test the impact of patient safety interventions on
patient safety cultures in hospitals or to identify interventions associated with
improved patient safety cultures. One particular study done by Sora et al., (2012)
tested the relationship between patient quality of care and Agency for Healthcare Research and Quality (AHRQ) variables
that are routinely surveyed in hospital settings. In this cross-sectional study (evidence classification, Level 2), the results
demonstrated strong and positive correlations between AHRQ survey questions (expectations) and patient quality of
care. Amongst the more strongly correlated variables, communication with nurses, communication about medications,
responsiveness of hospital staff and hospital environment were noted.

It is for these reasons (and many others), that Valley Regional focuses on continuously improving the skill set of our
clinical staff and improving our environment. Countless educational offerings are available to our clinical staff each
year. Some of these educational sessions are mandatory, while other sessions are voluntary. Whether it’s our front line
nursing staff or any of the ancillary services staff, our employees are expected to have yearly competencies evaluated
in order to better serve our physicians and patients. Taking things a step further, additional professional development
requirements of our nursing staff include: all charge nurses completing charge nurse boot camps; all nursing department
directors being master’s prepared; and transitioning all of our nursing staff to having a minimum of a two-year degree. I
feel pretty confident that these expectations will help improve the disposition, communication and efficiencies needed
by a nurse in today’s healthcare setting. As it relates to our environment, I’m proud to say that we have done a really
good job at reinvesting into our facility. For the second consecutive year, we have invested almost $5 million dollars in
our hospital and already in 2018 we have invested nearly $400K.

As the hospital CEO, I’m always thinking about how I can strengthen the alignment between our physician community
and the hospital. I’m pretty certain that this will be necessary even more so in the future as both the physicians and
the hospital face added pressure to improve outcomes in a highly reliable fashion. Perhaps some of you have some
experience with this already in other places or through your training. If you have, I’d be interested in hearing your
thoughts; maybe there is a way to implement a new way to improve outcomes through reducing variability, all while
serving our community as a healthcare team.

Until next quarter,
Art Garza, CEO
Valley Regional Medical Center

Valley Regional Medical Center News I A Provider Newsletter

Irv Downing

Board Chairman

The Board of Trustees brings together community members and physicians, supported by a team
of professional administrators, to play a role in helping guide Valley Regional Medical Center. It is
my pleasure to serve as Board Chair this year. While the Board has a broad range of responsibilities,
our collective focus is about exploring, understanding and supporting measures to improve how
the hospital serves patients. The hospital successfully operates in an extremely challenging and
complicated health care environment subjected to ongoing, rapid change at many levels. We’re fortunate to be part of
this organization and its team of dedicated health care professionals that are making a major contribution to the quality
of life in our community.

Irv Downing

Jose De luna, M.D.

Medical Executive Committee
Chief of Staff

To all of my colleagues from Valley Regional Medical Center,
I thank you for all of the support I have received during the years of serving as a physician leader. I
hope this next year will be one of great team effort for the best of our patients and our community.
I am here to support you in the best that I can. I wish you and your family blessings. Keep up the
good work and know that I’m available to you at any time.

Jose De Luna, M.D.

2018 Medical Executive Committee

Chief of Staff Dr. Jose De Luna- Neonatology
Vice Chief Dr. Juan Rodriguez- General Surgery
Past Chief of Staff Dr. Laura Ceballos- OB/GYN
Secretary Dr. Edgar Moncada- General Surgery
Chief of Medicine Dr. Mark Cua- Cardiology
Chief of OB/GYN Dr. Ricardo Lemus- OB/GYN
Chief of Pediatrics Dr. Gerardo Sanchez- Neonatology
Chief of Surgery Dr. Veronica Guerrero- General Surgery

2018 Board of Trustees

Board Chair Irv Downing
Board Vice Chair Shanna Cox, M.D.
Past Board Chair Juan Gabriel Guarjdo, M.D.
Chief of Staff Jose De Luna, M.D.
Board Secretary Art Garza, CEO
Markus Villanueva
G. Robert Swantner
Dominique Vande Maele, M.D.
Ronnie Rodriguez
Guillaume Boiteau, M.D.
Lucy G. Willis, Ph.D.
Maribel Guerrero

Valley Regional Medical Center News I A Provider Newsletter

Welcome Corner

New Physicians

2018 New Appointments

Name Specialty
Julian Martinez-Tica, MD Anesthesiology

Nicole Grigg-Gutierrez, MD Gastroenterology

Nolan Perez, MD Gastroenterology

Courtney Tripp, DO Teleradiology

Mario Del Pino, MD General Surgery

Farha Sherani, MD Pediatric Hematology

James Lynch, NP- APP (Emergency Dept) c/o Dr. Panzer

David Rodriguez, NP-APP (Adult Hospitalist) c/o Dr. C. Ellis

Richard Rodriguez, NP- APP (NICU Dept) c/o Dr. G. Sanchez

Sergio Lopez, NP (Emergency Dept) c/o Dr. Panzer

Kristin Solaz, PA (Emergency Dept) c/o Dr. Panzer

Rastislav Osadsky, MD Teleradiology

Ranie Pendarvis, MD Teleradiology

Ngozi C. Agu, MD Pediatric Cardiology

Luis Albuerne, MD Radiology

Jorge L. Flores, MD Pediatrics

Fernando R. Gomez, MD OB/GYN

Jason Lee, DDS Pediatric Dentistry

Eder Hernandez, PA c/o of Benchmark Pulmonology

H. Kang, CRNA (Anesthesiology) c/o Dr. Myung


2018 OPIC (1st Wed) MEDICINE (1st Thur) C&E (2nd Wed) OBGYN (2nd Thur) SURGERY (2nd Fri) MEC (3rd Tue) PEDI (3rd Wed) GEN STAFF (3rd Thur) AMP (3rd Thur)
Monthly Bi-Monthly Monthly Bi- Monthly Bi- Monthly Quarterly Bi-Monthly Bi-Monthly
January 1/9/2017 2/8/2018 1/10/2018 1/11/2018 1/12/2018 2/20/2018 2/21/2018 1/18/2018 1/25/2018
February 2/12/2018 2/14/2018 2/15/2018 2/16/2018 3/20/2018 3/22/2018 3/22/2018
March 3/7/2018 4/5/2018 3/14/2018 4/17/2018
April 4/4/2018 5/22/2018
May 5/2/2018 6/7/2018 4/11/2018 4/3/2018 4/13/2018 6/19/2018
June 6/6/2018 5/9/2018 7/17/2018
July 8/2/2018 8/21/2018 5/23/2018 5/24/2018 5/17/2018
August 8/1/2018 9/6/2018 6/13/2018 6/14/2018 6/5/2018 9/18/2018 6/21/2018 7/19/2018
September 9/5/2018 11/1/2018 7/11/2018 10/16/2018 8/15/2018 9/20/2018
October 10/3/2018 11/20/2018 9/19/2018 8/23/2018 11/15/2018
November 11/7/2018 8/8/2018 9/13/2018 8/10/2018 11/21/2018
9/12/2018 11/8/2018 9/14/2018 10/18/2018
10/10/2018 11/15/2018
11/14/2018 11/9/2018


Valley Regional Medical Center News I A Provider Newsletter


Valley Regional Medical Center welcomes Mid-Valley Pathology (MVP) to our family. MVP consist of a local group of
pathologists that have been providing an exceptional general and subspecialty service throughout the Rio Grande
Valley for several years now. Managing partners for MVP consist of the following physicians; Dr. Rosemary Recavarren
(cytopathology) and Dr. Charles Zaremba (hematopathology). Valley Regional Medical Center’s new Laboratory Medical
Director will be Dr. Mark Dolz (GI/liver/cytopathology). The entire group consist of the following aditional physicians:
Dr. Christopher McPhaul (GI/liver), Dr. Alberto Gonzalez (dermatopathology), and Dr. Lawrence Dahm (general surgical
pathology). MVP offers a very comprehensive team of experienced pathologists with a combined 40+ years of experience.
MVP currently provides pathology services extending across most of the Rio Grande Valley including Mission, Weslaco
and Harlingen. In May 2018, MVP will offer this higher level of clinical pathology care to the community of Brownsville
at Valley Regional Medical Center.

Dr. Rosemary Recavarre Dr. Mark Dolz

Dr. Charles Zaremba

Valley Regional Medical Center News I A Provider Newsletter

Physician Bulletin

Luis Gaitan, M.D
How to Treat Stroke

By: Dr. Luis Gaitan- Stroke Program Medical Director- VRMC

Stroke is a sudden interruption of blood supply to the brain either, through a clot (ischemic) or spontaneous
rupture (hemorrhagic) of a blood vessel causing death of brain cells. It is currently the leading cause of disability
Almost every 4 seconds, someone suffers a stroke and roughly 795,000 cases are reported yearly, making it the
fifth leading cause of death in the United States.
Given these numbers, we are therefore faced with a huge challenge with regards to the best approach in treating
this medical emergency. Let us then answer the following questions.
1. What are the most common risk factors for stroke?
We live in an area where we have the highest incidence of Diabetes, Hypertension, High Cholesterol and Obesity
in the entire United States. A person having these risks is predisposed to having a stroke.
2. How do we recognize the signs and symptoms of stroke?
It is very important that we educate our community regarding F.A.S.T., which is a quick guide with a 78% sensitivity/
reliability in the assessment of stroke. F-ace, we check for uneven smile, A-rm, we check for weakness or drift,
S-peech, we check for slurred speech, and T-ime is when we need to call 911 to go to the nearest stroke hospital.
Anybody can help do this quick assessment.
3. Why call 911 than drive to the hospital?
The faster you get treatment, the better the outcome.
Paramedics are trained professionals, who can perform accurate stroke assessments at the scene. Moreover, they
also help accelerate the patient’s treatment by giving advanced pre-notification to receiving hospitals who can
activate the stroke code and prepare the team even before the patient arrives in the emergency room.
4. Why do we need to go to the hospital right away?
Just as the old saying goes, “time is brain”. The sooner you get to the hospital, the sooner treatment can be given.
Stroke care is a team approach and a close collaboration of all staff from EMS, and the hospital.
Acute ischemic stroke in particular is treated within the first hour the patient arrives in the emergency room. The
medication used for acute ischemic stroke is called TPA ( tissue plasminogen activator). It is a powerful drug that
dissolves a blood clot thereby re-establishing circulation on the affected part of the brain. It is recommended to be
given only within 3 to 4.5 hours from the time a patient was known without stroke symptoms and after meeting
strict criteria in order to prevent any chance of bleeding. In the case of an Emergent Large Vessel Occlusion
(ELVO), we work hard to safely and expeditiously transfer our patients to the nearest hospital capable of neuro-
endovascular intervention (mechanical thrombectomy).
Unfortunately, only 20-32% of stroke patients arrive in the hospital within 3 hours in time to get treatment, which
strongly indicates the importance and opportunity of properly educating our community.
Our hospital, Valley Regional Medical Center has successfully achieved the highest award for Stroke Care “ Gold Elite
Plus in 2017” given by Get With The Guidleines- American Heart Association. We are currently treating Acute
Ischemic Stroke patients with a Door to Needle Average of 44 minutes in 2017, faster than the recommended
60 minutes by the Joint Commission.
Stroke is a very challenging medical emergency, but with the proper education, training and collaboration of
everyone, we can be sure to provide the best care for our patients and achieve the best possible outcomes.

Valley Regional Medical Center News I A Provider Newsletter

Quality Update

Christine Hess, VP of Quality and Risk

Valley Regional Medical Center is focused on improving our accountability measures that are
reported to The Joint Commission. Evidence Based Practices are the key to reaching our goals.
We ask that you assist the Quality Department to improve our delivery care by approving and
implementing Evidence-Based Care.

TJC Hospital Accountability Measures

Accountability measures are evidence based practices that have demonstrated to have positive impact on patient
outcomes. The criteria for classifying accountability measures include:

• Research: Strong scientific evidence exists demonstrating that compliance with a given process of care
improves health care outcomes (either directly or by reducing the risk of adverse outcomes).

• Proximity: The process being measured is closely connected to the outcome it impacts; there are relatively few
clinical processes that occur after the one that is measured and before the improved outcome occurs.
• Accuracy: The measure accurately assesses whether the evidence-based process has actually been provided.
That is, the measure should be capable of judging whether the process has been delivered with sufficient
effectiveness to make improved outcomes likely. If it is not, then the measure is a poor measure of quality,
likely to be subject to workarounds that induce unproductive work instead of work that directly improves
quality of care.
• Adverse Effects: The measure construct is designed to minimize or eliminate unintended adverse effects.

Valley Regional Medical Center currently monitors and reports to TJC the following accountability measure sets.

Perinatal Care Measure
Health Care-Associated Bloodstream Infections in Newborns
Measure ID
PC-04 Exclusive Breast Milk Feeding
PC-05 Elective Delivery
PC-01 Cesarean Birth
PC-02 Antenatal Steroids

Venous Thromboembolism Measure
Hospital Acquired Potentially-Preventable Venous
Measure ID
VTE-6 Thromboembolism

Valley Regional Medical Center News I A Provider Newsletter


Measure ID Measure
SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock

Emergency Department Measures

Measure ID Measure
ED-1b Median Time from ED Arrival to ED Departure for
Admitted ED Patients
Median Time from Admit Decision to ED Departure for

Admitted Patients

Median Time to Pain Management

Measure ID Measure
OP-21 Median Time to Pain Management for Long Bone Fracture

Reference: COMET Dashboard


Infection caused due to hospital acquired microbes is an evolving problem worldwide and horizontal transmission
of bacterial organisms continuesMtoocnatuhselya Hhiaghndnwosoacsohminiagl inCfeocmtiopn lriaatne cinehealth care settings. Nosocomial
ihnof2esp0c0titi%oalnizseddupeattoiepnotos rwhoarnlddwhiydgeie(nT9re2a%amrepuazm, 2a0jo0r4c)a.uHseanodf inhcyrgeiaesniengismcoonrbsiiddeitrye,dmtohretasl9iint3y%galendmhoestalctohscta-ereffeccotsitvseapmuobnligc

hea1l5t0h%measure for preventing health care associated infection (HCAI). 90%

100% 80%

Va5l0l%ey Regional Handwashing Compliance

Hand0%washing Goal Numerator Denominator Rate
Physician 90%Jan 201 Feb 86%
Nursing 90% 173 92%
Physic7ia1n0 Nursing 774


A Trampuz, AF Widmer. Hand Hygiene: A frequently missed lifesaving opportunity during patient care. Mayo Clin
Proc. 2004; 79:109–16

Handwashing Audits: VRMC Internal Dashboard

Valley Regional Medical Center News I A Provider Newsletter

InInfefcetcitoiouus sDDiseisaeseasNeewNselwetstleertter
According to the Centers for Diseases Control (CDC, 2018), the country has seen more serious cases of the flu especially in

Infectious Disease NewsletterDistyarocibtuiuvnigttyiocihnnilt:dhreeMnUnaanitrdecdehlSd2tea,trel2ys0at1dou8kletsepthhisefalulthsecaarseonp.roDfre. sSsainondas,lsHaCbAr,eQCauhstieewsfitEtihpoitdnhesem:[email protected]p.odmate of influenza

In thisDisissturieb:ution: March 30, 2018 Questions: [email protected]

 InSethaissoisnsauleI:nfluenza 2017-2018 Activity in the US
 InflueSnezaas-oanssaol IcniafltueednzPae2d0ia1t7r-i2c0M18oArtcatilvitityyinintthhee UUSS
 PneumInoflnuieanazan-dasIsnofcluiaetnezdaPMedoiartraiclitMy oinrttahlietyUinSthe US

 Pneumonia and Influenza Mortality in the US
 Face masking end date for healthcare personnel declining influenza vaccine

 Seasonal Influenza 2017-2018 Current Status

CurrenSteUa.sSo.ninaflluInefnluzeanazcati2v0it1y7r-e2m01a8inCsuwrriednetspSrteaatudsper the CDC thru the March 2, 2018 update.
For HCA, 1C7uorfre2n0t sUt.aSt.einsfalureenezxapaecrtiievintycicnognmtinoudeesrtaotedetcorehaigsehpaecrtitvhietyC.DC thru the 2018 Week 12 update.
MissMHoiuogFrhdoi,erANrHMMHcaetCitgioiweAnvhdii,AmteHA6yrcacaaotStlmtifitveAva2ipicAtt0ttsyyecihsvtsSSt:iii:tatvrtayeaIitAdtte,tSyelaesOtasShas:as:kt:torkaCleAeCaatasalaeeh,:lanislxCfosi:dopfkComoIraeonTlnro,raldeniioSrea,iniraoa,naSannudGco,deatioNeunoh,s,otg,seKChGreFvemgaleeanCoiraoodtoraudiralardicgeonnakairadla,yainnI,taKddaeaInanan,UdtnhddoTstoViMeaaah,isxhrniLiggasoaihssnu,oaaiiKuascniaratidninvsaVita,yisrM.,gKiinsesiinastsuipcpkiy, ,NLeovuaidsaia, nNae,wMississippi,

MinHiammaplsAhcirteiv, iOtyklSathaotmesa:, TFelnonreidssaee, Texas and Utah
The most frequently identified influenza virus subtype reported by public health laboratories
remains InfInlufleuneznazaAA(H(H33NN22)). haInsfdlueeclninzeadAainsddIencflluineinnzgaaBncdasInefslucoenntzinauBectaosienscrceoanseti.nIunewteoekin1c2re, nausem.bers of
InfluenBzavivruascecsinraeltaiotinverlyemroaseintsotehxecemeodsAt setfrfaeinctsivanedstmratyecgoynttroibpurtevteonwteinefkl-utoe-nwzeaeiknfcehcatnigoenssi.n activity.

Local health departments may use the terminology of “a second wave of influenza” in describing the
ongoing rise in Influenza B cases.

Outpatient Illness Surveillance
During 2018 (Week 12), 2.5% of patient visits reported to the US Outpatient Influenza-Like Illness

surveillance network were due to influenza-like illness. This percentage remains slightly above the
national baseline of 2.2%; however, flu continues to rapidly decrease from prior weeks’ activity.

Valley Regional Medical Center News I A Provider Newsletter

 Influenza-associated Pediatric Mortality in the US

Pediatric children younger than 5 years old and especially younger than 2 years are at high risk for
developing serious influenza complications requiring medical care. Conditions increasing serious
influenza-related complications are age (less than 6 months who cannot be vaccinated) and chronic
health problems like asthma or chronic lung disease. Although rare, some children die from influenza
each year. A total of 137 influenza-associated pediatric deaths have been reported to the CDC for the
2017-2018 season.

2017-2018 Influenza Season Week Reported Pediatric YTD Total 2017-2018
Mortality Cases Pediatric Mortality
Week 2018-6 (ending 2-10-2018) 13
Week 2018-7 (ending 2-17-2018) 10 102
Week 2018-8 (ending 2-24-2018) 13 112
Week 2018-9 (ending 3-3-2018) 8 125
Week 2018-10 (ending 3-10-2018) 2 133
Week 2018-11 (ending 3-17-2018) 2 135
Week 2018-12 (ending 3-24-2018) 0 137

 Pneumonia and Influenza Mortality

CDC publishes National Center for Health Statistics mortality surveillance data weekly. As of March
29, 2018:

 7.7% of deaths occurring during the week ending 2018 (Week 10) were due to pneumonia
and influenza. Data source is from death certificates for persons of all ages.

Valley Regional Medical Center News I A Provider Newsletter

 This is the eleventh week of the 2017-2018 influenza season where the rate is slightly
above the 7.2% epidemic threshold. However, mortality is declining rapidly from the
prior weeks.

 Face masking end date for healthcare personnel declining influenza vaccination

Face masking ends April 1, 2018 for HCA healthcare personnel declining influenza vaccine in states
with minimal or low influenza activity. Face masking should continue for other states with current CDC
influenza activity at moderate to high activity until activity becomes minimal or low.


 Links to Resources

CDC Influenza Links: HCA Intranet Links:

CDC Influenza Information: Atlas Healthcare Acquired Infections Influenza Site:

CDC Influenza Guidance for Health Professionals: Prior Infectious Disease Newsletters

CDC Influenza videos, podcasts, posters, and brochures

Valley Regional Medical Center News I A Provider Newsletter

Service Line Corner
pharmacy department

Irwin Riezenman, R.Ph. Director

Automatic conversion of injectable narcotic analgesics to the oral form.
As you are all aware, there has been a national shortage of injectable controlled substances,
particularly Fentanyl, Morphine and Hydromorphone.
In order to reduce the risk of not having these products available when needed, we need to take a proactive stance
on reducing the use of injectable narcotic analgesics.
Based on approval from the MEC, January 15, 2018, the pharmacy will start to automatically convert injectable
morphine and hydromorphone to the oral route once patient is tolerating oral medications.
The conversion dosing is based on clinical potency equivalence that is documented in Medscape publication, January, 2018.
We need everyone’s help during this critical time to reduce injectable narcotic analgesic utilization and reduce the
amount of narcotic wastage as well.
If you need any additional information, please feel free to call me, or the pharmacy, at 956-350-7367.
Thank you for your time.

The Imaging Department

Jerry Hatley, Director

Valley Regional Medical Center is very excited to offer DEXA Scan. In the US approximately 40
million people suffer from osteoporosis. The standard test to diagnose osteoporosis is dual-
energy X-ray absorptiometry scan or DEXA scan.
What is a Bone Density Scan (DEXA)?
• Bone density scanning, is an enhanced form of X-ray technology that is used to measure bone loss.
DEXA is today’s established standard of measuring bone mineral density (BMD)
What are the common uses of DEXA?
• DEXA is mostly used to diagnose osteoporosis, a condition that often affects women after menopause
but may also be found in men and rarely in children. Osteoporosis involves a gradual loss of calcium as
well as structural changes, causing bones to become thinner, more fragile and more likely to break.
• DEXA test can also assess an individual’s risk for developing fractures. The risk of fractures is affected by
age, body weight, history of prior fracture, family history of osteoporotic fractures and life style issues
such as cigarette smoking and excessive alcohol consumption.
Bone density testing is strongly recommended if you:
• are a post-menopausal woman and not taking estrogen.
• have a personal or maternal history of hip fracture or smoking.
• are a post-menopausal woman who is tall (over 5 feet 7 inches) or thin (less than 125 pounds).
• are a man with clinical conditions associated with bone loss.
• use medications that are known to cause bone loss, including corticosteroids such as Prednisone, various anti-seizure
medications such as Dilantin and certain barbiturates, or high-dose thyroid replacement drugs.
• have type 1 (formerly called juvenile or insulin-dependent) diabetes, liver disease, kidney disease or a
family history of osteoporosis.
• have high bone turnover, which shows up in the form of excessive collagen in urine samples.
• have a thyroid condition, such as hyperthyroidism.
• have a parathyroid condition, such as hyperparathyroidism.
• have experienced a fracture after only mild trauma.
• have had x-ray evidence of vertebral fracture or other signs of osteoporosis.
Call the Valley Regional Medical Center Radiology Department at (956) 350-7525 to schedule your patients’ appointment.

Valley Regional Medical Center News I A Provider Newsletter

Surgical ServicesSDueparrtgmeinct al Services Department

Trey Colvin, BSN, TRNr,eCyNCOoR,lCvSiSnM, BSN, TN,CNOR, CSSM
Director of Surgical Services

Surgical Staff EducatPionreventing Surgical Sight Infections

RCheasRcluneoerdcgrneaipnctpolatylrvlyeis,adkpaoiCnnCihspehlt-rlooiehorpredaaapipsnrarureeteripaogptnrieecruepalismprleesrdisnkeefaisnontetrinanpmtgtrivoaeoestpvtivevaoirersfaiatolvletuibidsoraipnwtceatiuettdhirseiwaent.hdtiCset.fhhWVoloatrehlrlamehepyaorVveRseapetflgolioseiuof2ynno%daRuletCrMhgHapeiGtoadCntaichinaealdlolnMCr7taes0pe.n%rdtWeeipiscreoaisspulhmrrCaogoevpicrneyealtlfeaeosflrtfcuaeosfnchfut.doirCvlget.hihDlctohauaratralanpsPtrDreaeupfprfai.isPs rt0eh.p7e DuraPrep and povidone-iodine at eliminating overall bacteria.
Chloraprep is 2% CHG and 70% isopropyl alcohol. DuraPrep is 0.7 iodine with 74% isopropyl alcohol.

Source: Saltzman MD, Nuber GW, Marecek GS, Koh JL.

The staff learned how much skin each stick oJEfBffCiocnhaecloyJoroianf ptsuSruregrpigcAaclompu.rle2dp0a0er9fa-ft9eio1cn(t8is)vo:1elu9lt4yi9oc-nl1e9ina53nsh.oAulfduelrl sluerggemryi.ght require
up to three prep sticks. The staff also learned that safe dry time for a surgical skin prep without hair is
three minutes.
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pobsriutsivhesbwaicthte3r%iaC. hTlhoerosxkyliennporl e(PpCaMraXt).ioPCnMinX Cishthloerparperfeerpre,dCahgloenrht feoxriGdrianme-(pCoHsiGtiv)eisbeacftfeerciati.vTeheasgkaininpsrtepGarraamtio-n in
poCshitloivraeparenpd, Cghrlaomrh-enxeidginaetiv(CeHbGa),citseerfifaec. tiCvehaangagiensstwGerarme -mpoasditeivetoangdogfrraomm-nPeCgaMtiXvebbraucsthereias. tCohdarnygebsruwsehreems aanded

Valley Regional Medical Center News I A Provider Newsletter

Good Habits

Niobe Mendoza, R.N
Clinical Documentation Specialist

In ‘The Power of Habit’, the author Charles Duhigg, describes how, neurologically and biologically, we are
programmed to create little blocks of sequences that can be performed automatically. This built-in strategy gives
our brain brief episodes of rest, making thousands of small decisions each day more efficient. Once these sequences
are firmly fixed, they are almost invisible to us.
Dictation & documentation habits are understandably hard to change. Queries are time consuming &
annoying. No MD wants to get the same query repeatedly, and yet, when the situation comes up again, they will
probably document the same phrase automatically. This is especially true if the ‘coding rule’ or strategy has never
been explained in a way that ‘sticks’ for the physician.
Coding/billing rules update constantly, and data requirements are always evolving. Physicians who learn
new patterns of information collection and precise documentation have ‘GOOD DATA’ for Medicare Incentive
Payment for Medicare Incentive Payment (MIPS) and other incentive programs. We know that measurement and
reimbursement of practice and outcomes is all about documentation.
Clinical Documentation Improvement (CDI) can help you to modify patterns of unclear documentation to
Avoid Queries! We want to ensure the highest specificity & accuracy possible for your patients’ diagnoses and
procedures. Clear clinical notes help providers to create a collaborative, viable, and defendable care plan, and
that is better for everyone: the patient, insurers, and providers.
HIGH PRIORITY MIPS QUALITY MEASURE!! Valley Regional’s Clinical Document Improvement team reviews medical
records from across Gulf Coast Division. In January we noticed an interesting documentation pattern at one of the
Corpus Christi hospitals. The MD notes always include a reference to 1. Code status; 2. Presence or absence
of advance directives; 3. Identity of surrogate medical decision maker/next of kin with contact information.
Documented by the PMD or hospitalist in the first note or H&P, it then gets copy pasted and updated as needed.
It is the last comment before MD signatures in almost every progress note. For example:
“Full code, no ADs, discussed options, MDM/NOK Rudolf Rein son #705-356-1916”
This short entry satisfies the MIPS quality measure for ‘documenting advance care plan’.
It is not enough to note code status. The MD must note the presence or absence of a medical decision maker. This
is a ‘high weighted” quality measure. What a great habit to have! Because it appears in the same place in every
chart, it is easy for the MDs’ billers to find/record. This short entry also importantly reveals that the MD is attentive
to family, and prepared for crucial conversations.
We present this as a recommendation to adopt with your patients. CDI can be a resource as data requirements
continue to change. We are available to answer any questions about queries, documentation or readmission risks.
(956) 350-7375 or (956) 579-5886.

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Valley RegTionhal MeeTdicaOhl CeennterlNOyewsnICAlPyrhovideCer sNehwtsleePttesr atiPnaCinenCtenr tienrBinroBwrnoswvnilsleville

Valley Regional Medical Center Receives Full

Accreditation from the American College of

Cardiology as a Chest Pain Center

The Only Chest Pain Center in Brownsville

Thanks Ttohathnekseftfoorthtseoeffofourrtsexopf eorutrAecxcpredrtitAacticornedTietaatmio,n Team,
Valley RVeagliloenyaRl eMgeiodnicaallMCednitcearliCseonnteerstiseponcelosteerptoclboesaetrintogbeating
Valley Regional Medical Center Receives Fullheart dihseasrtediniseCaasmeeirnoCnaCmoeurnotny.County.
Chest PaCihneAsct cPraeidnitAacticornedTietaatmion Team
Accreditation from the American College ofOn JanuOanryJ1a9n,u2a0ry1189, ,V2a0lle1y8R, VeagliloenyaRl eMgeiodnicaallMCednitcearl Center
Julie BeJlluelri,eCBheelsletrP, aCihneAsct cPraeidnitAacticornedCitoaotridoninaCtooorrdinator
Cardiology as a Chest Pain CenterCardioloCgayr(dAiColCo)g.yTh(AaCnCk)s. TtohaHnekidsitJooHnesid, iCJaotnheLsa, bCaDtihreLcatborD, irector, Dr. Eric DPar.nEzreicr,PMaendziecra,lMDeirdeictaolrD, Eirmecetrogre, nEcmyeSrgeervniceysServices
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SeCrliJvnuilcieaelBsCSeltlialnefirfc,aClhSetsatffPain Accreditation Coordinator
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iaPmnlCctepdhoaorescloCehJoleoiuavnoarrnlebturdridiaPeidgmerroinlesriecneBoae,prdodaaleaanttroguesccliotttglncceoealoivyapoiarrmnezreto,(t,nemgiAdwoCesarcCistnhwaedotnohCiaesntrbgeduik)tfstlt.itnoelotohaaapTti.nczPchnhtoaetuicadatosehlerilsnstnnecehaf,eiksoobdmAeensAlriltclxte,oaattmacC.otifbcrtroraCeaicoeHaorldrkrleneAtaahiifhtniodtdcactoiegreoiictctiuinramJrcoroemdrteonwainseodndi,kCedftntiitohisotitnnec,rtaoagteuaaChrtttadohimciaeeoomieuotndAhnniwnsarCfftLtoohtioSCoanecraerrbuu,artkrohdsamDv,aeuniwierinscd,rexoefdcthtorrhstkaaorerrd, work AlaCnhdriseCLheizoenk, DDiirreecctotroorfoEfduCcaartdioino,panudlmStoanffary and
teaAmccrteodgitaatinonthSeisrvoicuetsstteaanmdtionggarinecthoigs nouittisotann.ding
Spreeccioaglntihtioann.ks to the Doctors involved - We need to

processes. Our acute coronary syndrome patients will

Whreactedivoeesstatthe-iosfm-theea-anrt?cWare.have integrated evidenced-

MeSliPssI aFirMe Doenptaarltvmoe,nCt/aErmeeArgsesnucryeMNeudircsael SNearvvicigesator
BroHwenidsivJiloleneFsir,eCaDredpiaacrCtmathenLta/bEmDireercgtoern/cPyCUM, eanddicSatlaSfef rvices
Los Fresnos Fire Department/Emergency Medical Services
Port Isabel Fire Department/Emergency Medical Services
SPI Fire Department/Emergency Medical Services
Heidi Jones, Cardiac Cath Lab Director/PCU, and Staff

Valley Regional Medical Center News I A Provider Newsletter

IT&S Keyboard

I am David Flores, your Physician Support Coordinator. My role is to provide IT&S support for
providers and office staff. Below are the applications available to you and your office staff. Our
goal is to provide state-of-the art technology for HCA physicians. I am available to meet with
you in the hospital or your office at your convenience for any IT&S support needs. My contact
information is 956-465-6139 (mobile) and email is [email protected]

Mobile – PK8 APP
• View lab values anytime, anywhere
• Glance at patient vitals before rounding
• Review orders in the palm of your hand
• Access clinical information for more timely patient care
• Available on iOS and Android devices
New Features
• View EKG Strips

- EKG Strips – Found under Clinical Notes
• View Radiology Images

- Radiology Images – Found under Test Results

To Log In:

Username: HCA 3\4 ID
Password: HCA Password

David Flores
Physician Support Coordinator

Valley Regional Medical Center News I A Provider Newsletter

Advanced Clinicals

Elizabeth Ortega, Director

Hello, I am Elizabeth Ortega, your Director of Advanced Clinicals, Telemetry, and Virtual Sitters. I
am excited to be part of HCA’s Electronic Health Record (EHR) initiative, Evidence Based Clinical
Documentation (EBCD). This a new way of thinking about clinical documentation. Nurses are
challenged with the task to capture and document clinical content that is meaningful to patient
care. EBCD is patient-centric, streamlined, meaningful, & concise clinical documentation. Most
importantly, EBCD will increase nursing time at the patient’s bedside!
Why is this Important to me as a Provider?
The week of May 1st, 2018
*You may see some changes in the nursing documentation, and the way your documentation is crossing over
into clinical review.
*If you need assistance, please call Advanced Clinical Office *01347 or *00347

EBCD Patient-Centric

Concise Clinical
What is EBCD? Documentation

Evidence-Based Clinical Documentation (EBCD) is a component of ────
HCA’s Electronical Health Record (EHR) initiative. Enhancements
in the documentation offer advanced features that increase clinical Streamlined &
efficiency, improve effectiveness and support safe, quality patient Shared


Increases Nursing
Time at the

Patient bedside!


Providers may see
changes in how
crosses to
Clinical Review

Go – Live
May 1, 2018

Valley Regional Medical Center News I A Provider Newsletter

2018 Doctors’ Week

We love our Doctors so much
entire week. No

Valley Regional Medical Center News I A Provider Newsletter

2018 Doctors’ Week

h that we celebrate them the
ot just one day!

Valley Regional Medical Center News I A Provider Newsletter

2018 physician gala

Valley Regional Medical Center News I A Provider Newsletter

2018 physician gala

Valley Regional Medical Center News I A Provider Newsletter

Physician Relations

Adrianna Justis, Director

It has been a busy first quarter of 2018. Thank you for joining us at the Physician’s Gala in
February and the entire week of Doctor’s Day celebrations.

At the March 20th quarterly Office Manager Luncheon we presented the following important topics to your
office staff:

• DEXA Scan roll out/Imaging Department
• Non-invasive Prostate MRI services/Imaging Department
• IT&S/ Remote Access
• Quality Measures in Pdoc
• Remote Electronic Order Entry

• Maria with Sunshine ACO asked the presenter about a strategy to determine how to satisfy MIPS quality measures
that have a historical component and how to gather the information.

• Blanca with Dr. Gumbel’s office asked the Imaging Director how to best schedule urgent Mammograms.
This quarter we hosted:

Hospital Events with Physicians
Dr. Veronica Guerrero
The Weight is Over – Bariatrics Event
January 23rd
Dr. Jaime Gomez
Love Your Heart Event
February 15th
Dr. Dominique Vande Maele
Colon Health Doc Talk
March 22nd
If you have a topic of interest or a question you think your staff would like to learn about please contact me
at (956)243-0261. Also, if you are interested in speaking at one of our “Doc Talk” events please call me or
Mariana Tumlinson, Director of Community and Public Relations.
Is there an article of interest you would like to share with the Medical Staff? We can share the information in
one of the following newsletters or in the physician lounge.

Art Garza, CEO
Sylvia Cisneros, Administrative Assistant

Notes: ___________________________________________________


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