Good Fundamentals

 

Over the past couple of months I have been working at St Barnabas Hospital in the Bronx as an advisor. The SBH leadership has a vision for a more community focused health system and recently embarked on a multiyear transformation project designed to achieve that goal. My perspective as a private practice physician from a very different geographic and socioeconomic setting was welcomed enthusiastically. I hope I've contributed some value. I am confident, however, that this committed group of individuals will be able to improve the care they deliver to their community because they are starting with such good fundamentals despite the hurdles.

Some of the challenges that a health system like SBH faces were an eye opener. For example, in the poorest Congressional district in the nation the community served by SBH is actually poorer and sicker than its Bronx neighbors. Speaking with Virginia Delgado -Torres, Director of Community Physician Relations, about how to communicate with the community most effectively I learned about SafeLink. This valuable program established (https://www.safelinkwireless.com) by the Stimulus Act of 2009 provides cell phone minutes free of charge to the poor. Unfortunately those minutes are delivered in bundles at the beginning of the month and once they run out it can be impossible to reach patients until they are topped put the next month. Thinking creatively about how to work around roadblocks like this will be a critical part of SBH's strategy.

An area of particular focus for me was the Breast Clinic run by surgeon Dr Bert Petersen. I worked with Burt to look for ways in which the ACR's Imaging 3.0 philosophy could help him and his team deliver more effective care. Imaging 3.0 relies heavily on Information Technology and we were able to identify several areas of opportunity. For example simply by restructuring the breast imaging order set in the Electronic Medical Record he could save valuable time previously spent hunting under different modalities.

What was really encouraging was to hear him commend the Radiology Department for their willingness to see add-on patients for procedures. A young woman with a breast abscess relaxed visibly when told that she could have an aspiration under ultrasound guidance performed the same day rather than miss school again tomorrow. That is definitely Imaging 3.0 in action. SBH made the difficult and controversial decision to discontinue its Radiology residency earlier this year. Knowing this it was important for me that the Institution recognize the value that high quality imaging can deliver. I saw many signs that that was the case and am delighted that leadership has expressed an interest in learning more about Clinical Decision Support through ACRSelect.

 My involvement with the transformation project at SBH is now winding down as I transition to a new position. It is an institution with which I hope I'll always remain connected. I mentioned the good fundamentals and those will be my abiding memories of my short time at SBH. The security guard who flashed me a huge smile and waved every time I drove in. The thoughtful way that the best parking spots are reserved for patients and visitors. The warm welcome from every person I met there. Whatever the challenges ahead, the culture embedded in the people at SBH will prove its greatest asset.