HomeMy WebLinkAbout20191906.tiffNCMC Board of Trustees
Regular Session Minutes
Monday, April 29, 2019
12:00 Noon
The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday,
April 29, 2019, in the Richard Stenner Boardroom located at North Colorado Medical Center.
Mark Lawley, Chair, declared a quorum and called the meeting to order at 12:00 p.m.
ATTENDANCE ROSTER
NCMC Board of Trustees: Mark Lawley, Michael Simone, Catherine Davis, Kay Kosmicki, Kevin
Mullin, Jason Yeater, and Sean Conway (Commissioner, non -voting member), with Brian
Underwood being Excused
Banner Health: Margo Karsten (NCMC CEO) -Excused, Derek Strader (NCMC COO)
Staff: Jeff Carlson (INC. Board Exec. Dir.)
Recording Clerk: Esther Gesick (Weld County Clerk to the Board)
PUBLIC COMMENT - There was no public comment.
APPROVAL OF MINUTES
It was MSC (Yeater/Simone) to approve the minutes from the March 25, 2019, Regular
Session meeting.
NCM CEO/COO REPORT
Derek Strader reported working on plans to retain a trained, skilled medic workforce, while
recognizing the need to have more staff in training when vacancies arise due to posted
positions with other agencies. He noted the Trauma Center worked very closely with the
family that was affected by the tragic loss within the Greeley Fire Protection District last week,
which is a close-knit community of emergency responders. He stated they are continuing to
work to address the needs of the team. Financially, he reported the first quarter ended strong
and ahead of budget, which he attributed to increased patient volumes. The M.D. Anderson
Center volume is 80 patients ahead of last year, although the McKee facility growth is not as
rapid. He stated M.D. Anderson has added a second partner in the State, which is located
south of Denver at the Centerra location. Ms. Davis commented she received a personal
reference who commended the facility on their high quality of care. In response to
Mr. Mullin, Mr. Strader explained the agreement is very limiting as to marketing, therefore,
they are restricted to Weld and Larimer Counties, and the eastern plains (Logan, Sterling). He
stated M.D. Anderson is more referral based, and he confirmed they are unable to use mass
media marketing, nor can they extend into Wyoming.
Page 1 of 3
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April 29, 2019 NCMC Board of Trustees
2019-1906
COMMISSIONER'S REPORT
Commissioner Conway reported there are only five days left in the legislative session, and the
Board of Commissioners has been dealing with the anticipated effects of SB-181. On
Wednesday, the Board passed a Resolution directing the Clerk to publish a Notice scheduling
a hearing for June 10, 2019, to consider the Board's Intent to Designate the Unincorporated
Areas of Weld County as a Mineral (Oil and Gas) Matter of State Interest. He commented this
is a big deal because the State has promoted SB-181 as a means of allowing more local
control; therefore, this is a means of establishing a local process and creating more certainty
regarding oil and gas production in Weld County. Commissioner Conway also noted the
assessed valuation for Weld County makes Weld the second highest valued county, behind
Denver County. He commented the tax revenue generated by oil and gas is critical to school
districts, fire protection districts, and municipality funding. He stated the Board met with
Director Robbins of the Colorado Oil and Gas Conservation Commission (COGCC) last week,
and currently they do not have new members appointed to the COGCC to deal with the 6,500
pending permits (4,500 of which are from WC). He stated they have been assured that the
State will be bringing on more staff; however, Weld County intends to exercise its local
authority and begin processing them internally. He stated the Board wants to bring certainty
to the industry and the marketplace and alleviate employee concerns. Last week the Board
passed a Proclamation expressing its appreciation and support of oil and gas workers. Lastly,
he reported the Board will be hosting a Vietnam Veterans Welcome Home Pinning Ceremony
at the Fort Lupton Recreation Center, on Saturday, June 8th at 9:00 a.m. In response to
Mr. Mullin, he acknowledged the County has been contacted by local municipalities and the
Board is exploring options to assist with administrative support or boiler templates for the
1041 designation and oil and gas permitting process. Any ordinance changes will be reviewed
by the Planning Commission and open to the public for input during the three -reading
process.
VISITATION REPORT FOR APRIL 29, 2019
PRIMARY STROKE CENTER AT NCMC, BANNER NOCO: Laurie Hamit, Clinical Resource
Leader/NCMC Stroke Coordinator, and Dr. Meredith Frederick, C/P Neuro Clinic, were
present and provided an overview of the Primary Stroke Center. Following the meeting,
Catherine Davis submitted a summary of the presentation and related discussion, a written
copy of which is attached as a part of these minutes. Michael Simone prepared and delivered
a note of thanks.
VISITATION REPORT FOR MAY 20, 2019
Kevin Mullin and Brian Underwood (rotation switched due to schedule conflicts).
NCMC, INC. REPORT
Jeff Carlson reported 14 agencies have submitted letters of intent to apply for additional grant
dollars to be used for philanthropic efforts and the full applications are due tomorrow.
Mr. Strader added the legislative session has also had a significant impact on health care,
Page 2 of 3
April 29, 2019 NCMC Board of Trustees
specifically, a Bill which aims to increase transparency but hinders the ability for a facility to
have privileged discussions. He stated Banner is opposed due to fear of patient safety and
has joined with other health systems in the state to bring in a consultant firm and they plan
to be more involved at the State capital to educate legislators regarding the unintended
impacts resulting from efforts to reduce costs. Commissioner Conway commented the
County has a contracted lobbyist and he offered use of those services through
communications to see if there is a way to address any local issues or concerns. Mr. Strader
agreed that may be useful and stated until every aspect of the medical field is involved, the
efforts to reduce costs will not be successful.
NEW BUSINESS — None.
ADJOURN
There being no further business to come before the Board, it was MSC [Simone/Davis] to
adjourn the meeting at 1:10 p.m.
Respectfully submitted,
Esther Gesick
Page 3 of 3
April 29, 2019 NCMC Board of Trustees
NCMC Trustee Report
Primary Stroke Center at NCMC
Presenters: Dr. Meredith Frederick (C/P Neuro Clinic)
Laurie Hamit (Clinical Resource Leader/NCMC Stroke Coordinator
Report: Catherine C. Davis, PhD, MPH
May 14, 2019
Stroke is the leading cause of disability in the United States and the fifth leading cause of death.
A stroke occurs when a blood vessel is blocked by a clot or ruptures. When that happens, blood
flow to the brain is impacted, and brain cells start to die. Every 40 seconds someone in the
United States suffers a stroke.
North Colorado Medical Center has successfully completed a survey to earn the Primary Stroke
Center certification from a national accrediting organization. The Joint Commission's
certification means NCMC's stroke response team follows the best methods to care for patients
suspected of having a stroke. This allows brain -saving treatments such as tissue plasminogen
activator (tPA) to begin more quickly.
A hemorrhagic stroke (aka - bleed) occurs if an artery in the brain leaks blood or ruptures. The
first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then
control it. Some of the options for treatments include surgical clips or coils inserted in aneurisms,
controlling high blood pressure, and surgery to remove the bleeding vessel and blood that has
spilled into the brain. There is only one Food & Drug Administration (FDA) approved drug
treatment for acute ischemic stroke. tPA is given via intravenous therapy (IV) and works by
dissolving the clot and improving blood flow to the part of the brain being deprived of blood
flow. tPA should be given within three hours (and up to 4.5 hours in certain eligible patients)of
the time symptoms first started. It is important to determine that the stroke is associated with a
clot and not a bleed and this is determined with a CAT scan before the drug can be administered.
Meredith Frederick, MD, Banner Health neuro-hospitalist at NCMC, said the certification should
provide comfort to community members who can be confident that the hospital is providing
exceptional care for stroke patients. "We already have been providing excellent care and tracking
those outcomes," Dr. Frederick said. "This reassures the community that we will continue to
perform at a high level."
As mentioned above, treatment for stroke varies depending on whether the blood vessel has been
blocked or has ruptured. Patients who have a blocked vessel often might receive a drug to break
up the clot and restore flow. If the clot is larger or if a blood vessel has burst, the patient will be
flown to another hospital for an endovascular intervention. The decision on treatment must be
made quickly and accurately to minimize damage to the brain and improve the patient's chance
for the best recovery possible.
Dr. Frederick and Jessica Williams, MD, fill the neuro-hospitalist role at NCMC, covering the
hospital from 7 a.m. to 7 p.m. seven days a week. After hours, the hospital contracts with Blue
Sky Neurology to provide care via televideo when needed. This allows rapid access to neurology
specialists 24 hours a day.
Laurie Hamit, RN and NCMC stroke coordinator, said the certification is for two years. Staff
members will report results to The Joint Commission quarterly to demonstrate that the hospital
continues to meet requirements. The Joint Commission is an independent nonprofit organization
that accredits and certifies health care organization and programs nationwide.
Dr. Frederick and Ms. Hamit reviewed a powerpoint presentation, attached that summarized the
outstanding progress the Center has made in delivering stroke care to residents of Northern
Colorado. Great success has been achieved in forming a multi -disciplinary dysphagia
management team when working with diagnosed stroke patients and their families.
A reminder regarding stroke prevention that all can apply in our daily lives:
The letters in the word "fast" will help you spot stroke signs and know when to call 9-1-1.
• F — Face drooping
• A — Arm weakness
• S — Speech difficulty
• T — Time to call 9-1-1.
If you are unsure, call 9-1-1.
North Colorado Medical
Center:
Journey to Stroke
Excellence
*Balmer
North Cokxio
Medical Center
Benefits of Certification
• improves the quality of
patient care by reducing
variation in clinical
processes
Provides a framework for
program structure and
management
• Provides an objective
assessment of clinical
excellence
• Creates a loyal cohesive
clinical team
,,ti
Banner Estrella
• Promotes a culture of
excellence across the
organization
• Facilitates marketing,
contracting and
reimbursement
• Strengthens community
confidence in the quality
and safety of care,
treatment and services
1
3 Hospttal Employees
viedalta of :49
Pintictritlr-ic and 14A AIliar,
1 + I y t .J %A t t k.t t F r /\ 1 1 1 V %rt
Health and Ancillary Providers
• 400 volunteers
to ;twine!
North Colorado
Medical Center
• Total employed RN's at NCMC = 697
• National Nursing Certifications = 14%
• Education/Degrees
-- ADN - 23%
- SSfv - 45°10
29,0;
ent0
Banner
North Colorado
Medical Center
-4a J allisanta ME,yX•
atoms rams :'M
strist
Via Mn'I.w nis ;t a.R.•MT,-1,Twt •.r
_ :rr one
15 TOP
i r.
M YTD Aug 2018
• Total Admissions 7064
• Observation Cases'. 3758
• OBS Days: 5671
• Emergency Department visits in: 35,336
• ED Stroke Alert consults: 130
• Total Stroke Volume: 149 (includes IP
Code Stroke)
Hamlet
Noah Colorado
;Medical Center
NCMC Community Demographics
Gender
49.4% Femal.
50.6% Mate
ADHS Raci
Am Indian: 1.2%
Asian: 3.4%
Black: 11.1%
CoatIn3
Hi Native/Other Pacific
Islander: 0.4% '' "' aa as
Unknown: 2.7% e.
White: 81.3%
91
Banner Estrella
'wtnciirni Crntp;
sat
a
*gins
• AtHS Ethnicity
-- Hispanic/Latino:
36.3%
- Non-
Hispanic/Latino:
62.8%
- Unknown: 0.9%
• Age
- 017: 1.2%
-- 18-44: 8.3%
3Rrh 45-64: 37.0%
- 65+: 53.5%
Source: ADHS State Inpatient Data
3
•
Weld County Demographics
• Gender
en ern' r- }_ ..•_ _ f
a-- fI p v V r Vf i ;d=e
- 49.2% Male
Ethnicity
- White Non -Hispanic: 60.4%
Rln^lk Ainn Wicnnnir• 1') AO/
r•vve♦ • w• • • ►.vv�w� I I • n. . r ry
- Hispanic,: 18.3%
- Asian & Pacific Is_ Non -Hispanic:
5 8%
— All Others: 3 2%
jr manner
Nonh Colorado
Medical Center
• Age
- 0-17: 22.6.6%
--- 18-44: 35.8%
- 25-34: 15.2%
-- 44--84 25.8%
-- 1S Poin
Source: Sg2 Market Snapshot
2016 2017 2018Q1 2016 2017 2018011
•
Stroke
patient
volume
by zip
Code
Runner
North Colo
Medical Center
Banner NCMC Stroke Patient Origin
2 9C}
•
t 4 .^.«
r-- 80550_
_,.._
i 70%_
.3 )%
0 �.7i..}k
1 5
1
.3
_
80611
1;_
0. 7G%
0 70%
' 0.00°1-.
806
6
w
S
4.40%
3.60%
0.00°ir:
iii1t) ..:
8
13
5.90%
9.30%
0.00%
_ 8a t+
1
0.00%
0.70%
0.00%
0.00%
80624
1
3
0.70%
2.10%
80631
38
38
6
28.10%
27.10%
30.00%
80634
56
57
12
41.50%
40.70%
60.00%
80642
1
1
0.70%
0.70%
0.00%
80644
5
1
3.70%
0.00%
5.00%
80645
5
4
1
3.70%
2.90%
5.00%
80648
1
0.00%
0.70%
0.00%
Grand
80650
Total
1
135
2
140
20
100.00%
0.70%
100.00%
1.40%
100.00%,
0.00%
Source: Banner internal service data
4
North Colorado Medical Center � 2018
Stroke Program � Organizational Structure
Onme_
T
Margo K
CEO
•
Derek Strader
Chief Operating
Officer
I. atiri≥ Hansit, M5.
RNNE•BC
Clinical R' noureci
1.eac9r
Jason Collins,
MS RN
Director ED
and EMS
Dr K Per
Dr A M
Jr i. L'.1
t
Banner Heath
Neuroscience
Clinical
Consensus
Group
Stroke At nsrrJ
roam Multi
Di fit.:p$tflary roan)
b Banner
North (Amain
Medical Center
Stoke Support Jo!vac s F.rner4snc,y
Modica! Svcs Admitting. Radi.c$ocry.
Laboratory. Pharmacy. Rehab Si therap-ti
S+ica. Quality Mpirte °as►se MgrnttSoc►at
,c rJutn►ttn nal S'r`-arc?
irk
Stroke +;ora Team
Stroke Workgraup+ tell
North Colorado Medical Center
Core Stroke Team
*Banner
North Colorado
Medical Center
Dr. Meredith Frederick. MD
Neurohospitalist
Strike Medical Director
Laurie Hamit, MS RN, NE -BC
Clinical Resource Leader
Stroke Coordinator
• 'er re. nil" a arbrOist er stswrt M-
4 1rJ! .lea
STAGE
5
t
Stroke Program Mission
MISSION; North Colorado Medical Center Stroke
Program promotes positive patient outcomes through the
«sC of co f tpr Ct lCt si e evidence -based care 101 adult
patients with stroke
The stroke care team at NCMC strives to provide age
appropriate culturally sensitive optimal care to patients
• 'c strnkcz and to inrlr�il l.!all�A r`drA In order to meet the
• ♦ . �v • v • .� and v V t r N Y �/� 7 �✓ V I 1 / order \.d Lr i lJ meet L the
l�
needs of each patient and family.
*Banner
North Colorado
Medical Center
Stroke Program Vision
•
• VISION: NCMC Stroke Program will be
recoanized for clinical excellence through
exceptional patient outcomes for our
community.
iianner
North Colorado
Medical center
b
Program Time Line
t;iirritihrwistsnic77;•, 777011r-
2012- Stroke program began and Stroke Team meetings initiated
wpir
along
2016 Received GVVTG sliver plus and target stroke and began
utiltzing Tele-neurology through Blue Sky Neurology!
Adding the tele-neurology provided 24/7 coverage as well as
additional education and support services which helped elevate
our program and helped our progress toward improved outcomes
on our PSC journey
• 2017- Implemented transfer agreement with Swedish Medical
Center Did not attained GVTG Silver plus status so looked at
processes to improve stroke outcomes.
• 2018 - Set goal to apply for Primary Stroke Center Certification.
Implemented Stroke Coordinator lead for the team. Hired
Neurohospitalist who also became Stroke Medical Director.
*Banner
North tl )#cam
Medical Center
• IMPROVE CARE FOR THE STROKE PATIENT
ACROSS THE CONTINUUM OF CAFE
From the pre -hospital setting through the
emergency department, inpatient and transition
to appropriate level of care beyond the
hospitalization by optimizing all levels of care.
NCMC strives to offer the most current, timely,
efficient, evidence based care and education to
the patients, families and community.
*Banner
North Colorado
Medical Center
7
�r t rill0r
North (.ratio
Medical Center
2018 Focused Stroke Program
Goals
• Timeline of PA admin to 60 min 85% of time
for patients
• Review and Improve Triage Process sn that by
4th C 2018 Door to tPAc= 45 min least 50%
of time
• Performance swallow assessment prior to PO
in 8°/5of patients w th 2 rule nut of c,+rnkn
1 ►�' 1 patients �! ! ! �) C{:{ 1 �! ! ! 1!C l I! 3 3 i f 3 '�1 3 3 ! t
• Stroke education materials provided during
stay to
a
—
Not al." Itt
_l at a4;,a
• Create a process to identify stroke specific
patient satisfaction by Q 3 2018
I
MOW
NOW NNW
7 WI
fir
Goals
.
.
.
.
increase % of tPA eligible patients who receive
tPA in 45 min or less
Goal 50%
Stretch 55%
Door to CT Read time 45 min at least 85% of
time
Education to First Responder Paramedics and
EMT's Review Patient Satisfaction process and identify
action items
* Manner
North Colorado
Medical Center
8
tr.,&a� • e vci
I Time to Intravenous Thrombolyfc Therapys dimes)
Time to Intravenous rhrombotyhc Therapys
iV r1 -PA Arrive by 3 5 Hour Treat by 4 5 Hour
cases of pre -notification by EMS
pahents'Mih Reported NIHSS Stroke Scale
'rb of Diabetics • neWy dx receiving Diabetes tx al dic
3* r.
North Coluiraido
Medical Center
Oar t
MIDAS
MIDAS
MIDAS _ NC
'MIDAS
'MIDAS
GWTG
GWTG
iGWTG
GWTG
'GW TG
GWTG
NC tutl.t
4S i% tau
ttsu i5'% 9
34 1% ;; • -
WQ0 W* V Woti.0
unlit-
Th 44 tt
lots..:. ..
88.9% 100.0% ; 100.0% ?4.:: t 100.0% 100.0% 100.0%
17 3 i'r c.-• 10.0, ;^5 85.1% 404%
2018 Dashboard at time of
Survey
Stroke Quality Scorecard 2018 North Colorado Medical CE
Quality Indicators
';iU: 414 ,. NNW/ :'fit! 440
.Matta Wait i
'1sha y 4,
SIX -6 Stahn Prescribe Discharge f .DL.
iTf1 ttW:olriev�i kiateri,a Nu3Et! ' ;uigig
i 'li si1Lir8‘. a. SS4' / •iti:A.
Time to Intravenous Thrombotybc Therapys (lines)
Tine to Intravenous Thronbolytic Therapys
UUV 4 -PA Arrive by 3 5 F -bur, Treat by 4 5 Hour
t% of cases of pre -notification by EMS
% patients •.Mth Reported MHSS Stroke Scale
LDL Documented
Smoking Cessation Counseing
it amines -
North Colorado
Medical Center
Data
coLoty
MIDAS
MIDAS
MIDAS
MIDAS
MIDAS
MIDAS _
GWTG
GWTG
GWTG
GWTG
GWTG
GWTG
GWTG
100 -tai 47 •414,
NC ttta d% SS% r NC
NC 100.4% i1.a NC
si7t?_JJe4 45 1% 100.4% 100.0% IS.7'% ,\ 4.b,5y
100.0% is ' 41 1x
1.:0,:e% 1.00.0% ti)I.uPic. 36,1%
IOM% 172%was tea
ix
tilt~ i11Q a II Ii. 1t;i3.ti%
WU r lie NC
OSA *44% 10041%
NC d$.@ st
NC IOC7%
ID0.09t. t3321%
100.0%' 85.7% 66.7% 39, j 100.0%
%% r4.&% it.a.
43.8% 4d 1%
NC IRO a1 '.?;
rid 4 Si.11
M.^ i4 e
IOW* 33.5%
>8y..
_a5 E
th5e.R
:185%
?75%
9
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I
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