Hello, welcome to the 2022 Quality Summit. I am Lisa Smith, director of cardiovascular services at Texoma Medical Center in Denison, Texas. We face many challenges yet made it through the storm as we work through our accreditation process. The Texoma Heart Institute is located in the main campus of Texoma Medical Center, which is an acute care hospital with 350 beds. Our hospital is owned by Universal Health Services through its subsidiaries and operates 26 acute care hospitals, 334 behavioral health inpatient facilities, and 39 outpatient facilities, as well as inventory care centers in 38 states of the United States. Texoma Medical Center was founded in 1965 in Denison, Texas. The previous location closed and this facility opened in 2009. It is located an hour away from Dallas and roughly 25 to 30 minutes from Durant, Oklahoma. This is a very unique location on the Texas-Oklahoma border. Approximately 50% of our patients are Oklahoma patients. TMC was sold to Universal Health Services in 2006 and built this new facility in 2009. Since 1965, TMC has forged a special relationship with the people of North Texas and Southern Oklahoma. Each day, TMC's leadership and employees work to carry out the hospital's mission of providing quality care, delivering innovative services, and exceeding expectations. With our unique location, we offer services at many of the surrounding counties and cities around us. Outside of the main campus, we actually have two freestanding emergency rooms. One is located about 10 miles from us in Sherman, Texas, and the other is located in a Texas, which is about 30 miles south of the main campus. We also have a 25-bed critical access hospital in Fannin County, which is approximately 30 miles from the main campus. We're really proud to have a rehab hospital and a behavioral health hospital. The rehab hospital is the TMC Rita McIntyre Center for Rehabilitation. Rita McIntyre actually is from Oklahoma and she brought life to the TMC Foundation when she would do benefit concerts in our area for charity and to support the rehab hospital. The rehab hospital is named after her, as well as we have a Rita's Ranch House. There's a hospitality house, which opened this door for families who need to be near their loved one in 1992, which is still in operation. Every year since opening, we have seen tremendous growth with this new facility. On the immediate horizon is a new outpatient ambulatory surgery center that is opening this month, and what we're most excited about is a hybrid OR for the cath lab that is planned to be open in early 2023. We have over 3,500 employees and a medical staff of greater than 450 physicians. We have been participating in the ACC NCDR registry since April of 2006, which is over 16 years. We now have two accreditations, both chest pain and cardiac cath lab. We also participate in three registries, PCI, STS-TBT, and the LAAO registry. One of the main reasons we decided to pursue accreditation in cath lab is to apply for a heart care designation. We also plan to start working on our TAVA registry within the next couple of months. As a team, we felt that we were offering quality care, but we also knew we needed to make improvements in utilizing evidence-based guidelines, quality initiatives, and best practices to improve cardiovascular outcomes and reduce variations in care. The Texoma Heart Institute was established in 1982. We were actually the first hospital in the region to start a cardiac program. Previous to that, all patients and families had to travel at least 60 miles south from us to the Dallas-Fort Worth Metroplex. We started out doing cardiac caths, progressed to PCI, open heart surgery, and now perform a vast array of services, including a structural heart program. We perform over 1,500 cardiac caths per year, as well as over 500 PCIs. We have three cardiac cath labs, and on staff we have seven interventional cardiologists, as well as three cardiovascular surgeons. We have a very collaborative team of cardiovascular surgeons and interventional cardiologists, as well as OR staffs and cath lab staff. One of our biggest endeavors was starting a structural heart program. We started this approximately two years ago, about the same time we decided to apply for accreditation in the cardiac cath lab. Even though we just started a structural heart program, we thought we could achieve the cath lab accreditation also. We have an entire year, so why not? We can do it all, and it surely cannot be that hard. We, as a team, decided to apply for our cath lab accreditation for various reasons. We found out from the ACC that we had to have two accreditations before applying for the heart care designation. We had continual improvement in our NCDR metrics. We had a very collaborative team. Studies have shown that accreditation improves the overall quality of care and health care facilities. Accreditation also improves a patient's perception of your program. We were doing a lot of marketing for structural heart, and that is why we decided that now was the time to apply for cath lab accreditation. After all, we had been participating in the registry since 2006. We were starting to recover from COVID, and again, we had an entire year. We have plenty of time, so we decided the time was now. Who would have ever guessed we would be faced with challenge after challenge as we worked through this accreditation? September 2020, we were excited to begin and start our preliminary meetings with Kim Pfeiffer, our accreditation specialist. I will never forget September 27, 2020, when my cell phone started going off with messages to come to the hospital immediately. The unimaginable and unexpected happened. Our entire health care system had a cyber attack. These are things you just read about, and never ever did we expect this to happen to us. After all, we are in a rural area, and why would we have a cyber attack? When all of us arrived at the hospital and found out it was all UHS systems across the country, we were in absolute shock. We had absolutely no idea how this would impact everything we do every single day, and what it would take for every single person in this health care system to overcome this horrific event. Again, we do have an entire year to get the accreditation done, so we'll just put that on hold right now and focus on the cyber attack. Universal Health Services, which operates 400 hospitals and behavioral health facilities in the United States, suffered a cyber attack that wiped out all IT systems, affecting its hospitals and other health care facilities across the country. When we were all called back emergently to the hospital, we had no idea what we were walking into. We had no phones, no electronic charting, ambulances were being diverted to alternate facilities, elective procedures were canceled, or they were also diverted. Anyone that works at a hospital knows that you have downtime meetings on a routine basis, what you're going to do if this happens and that happens, but nothing could ever have prepared us for this cyber attack. At this point, I realized I need to delay the accreditation because all we could do is work on our manual processes until all systems were back online. Our cardiologists were mainly running out cath reports, EKGs, echo reports. There was no way for me to abstract any data for our registries with all the paper charts. I recall contacting Kim Pfeiffer, my accreditation specialist, telling her that I was going to have to delay this accreditation on my cell phone as all phones were still down. Finally, at the end of October and part of November to December, I was able to start spending a few hours on the accreditation until all of a sudden our COVID numbers doubled and everyone knows the nursing shortage that was happening, as well as there were many employees out with COVID. So once again, I had to postpone spending any time on the accreditation. In December, I finally started worrying about the clock ticking down and thought surely I could start spending more time on the accreditation. Most of our systems were back up, but the COVID surge was hitting us again, utilizing the majority of our hospital beds. Every day we're working on staffing, adding rack nurses, agency nurses, and more and more staff were out with COVID. Also at this time, my TAVR structural heart coordinator was involved in a major motor vehicle accident and would be out indefinitely, so I would need to fill that role since there was absolutely nobody else to do that. We had just started our structural heart program and I had to start spending all of my extra time taking care of that program also. When I look at this slide, I start thinking about the definition of resilience. Resilience is the capacity to recover quickly from difficulties and toughness. The ability of a substance or object to spring back into shape. Elasticity. We have gone through a lot during this ACC accreditation and then January 2021, COVID spikes again for Texas Medical Center, which is located in Grout, Grayson County. We hit record highs. Our emergency room was at capacity. Most of our floors were at capacity. Staff members were very limited. We had a lot of employees out with COVID, not just in nursing, but in all ancillary areas. At this time, we also started vaccination clinics to assist our county as we felt that would help with decreasing our COVID numbers from the hospital. So once again, now we're in January. I only have a few months left, it seems like. Will I be able to get this accreditation done or will we have more disasters happening? How are we going to ride out this storm? I am not kidding. We have another disaster here at Texas Medical Center. A winter storm, unlike anything we have ever experienced, happened in our area. Most of us had no water or electricity at our homes. We were having power outages at the hospital. We were still dealing with COVID. We needed every person that could make it to the hospital to get here and stay here. We were at crisis level, not just in the ER, but throughout the entire hospital with our census climbing. By the hour, it seemed like. We were once again canceling all elective procedures. Patients were unable to get to the hospital and all of our EMS services were over max capacity. We had never seen a winter storm like this. This is a slide of what our winter storm looked like for everybody to view. As you can see, Texas was shut down by the storm. So we think about riding out the storm, resilience through accreditation. So when will we be able to start working on the accreditation? Right now, it's all hands on deck. We have high assistance in every area and we need every single employee to help out with patients. So once again, accreditation is put on hold as we get through another disaster. Crisis after crisis during this very short time frame to get this accreditation done. A year was not very long as I thought at the very beginning. I was never worried about completing it until we started having disaster after disaster. Between cyber attacks, COVID, and a major winter storm, I definitely started to worry about the deadline and I knew I had to make this my focus and get busy on this. My accreditation specialist, Kim Pfeiffer, worked with me every step of the way, always encouraging me and giving me resources to assist. December 2021, accreditation granted. After countless hurdles and obstacles, our accreditation tasks were completed, approved, and accepted. Tech Summit Medical Center's cardiac cath lab accreditation with PCI was granted December 15, 2021. I would like to also thank Mr. Ron Sill, our CEO of Tech Summit Medical Center. As you will note in his article, he was very proud that we were recognized by the American College of Cardiology in the U.S. News and World Report's Best Hospitals Ranking for commitment to hospital care for heart patients. Also, you will see we got our accreditation certificate. We were very, very proud that we had completed our accreditation. I have no doubt right now the question for most of you is, would we do this accreditation again? The answer is absolutely yes. Would I do things differently this next time? Absolutely yes. Healthcare is a very rewarding yet stressful career. Most of us have so many priorities, it is difficult to prioritize. It was very difficult for me to prioritize during all of our disasters. The things I learned, start on the accreditation process early because you never know what is going to happen. That long year sure did shorten fast with all of our disasters. Your accreditation specialist is there to help you listen to them. I spent a lot of time typing up new policies when most of the time I already had them. Several times Kim said to me, you should have this policy. You just need to upload it. Don't create another one. Physicians and staff care more about quality and work harder to make sure our patients have a great experience. Every patient now has a flea risk calculated on them to prevent complications. This has become part of our timeout process. We've also increased our radial access to around 92% with our highest month ever. Every PI project we did for the accreditation, the physicians were very involved in and most, if not all of their metrics increased to a hundred percent. It became their standard. We have CV services every other month as well as accreditation meetings. We have a great attendance with administration, nursing, and SRE departments. All metrics are discussed in a cohesive environment and new goals are determined based on our metrics. We also calculate the dose of contrast the patient should receive. These are all new processes we learned during the accreditation process. Our quality has improved. We would absolutely do our accreditation again and we have every intentions of maintaining our accreditation. We are a great hospital. We have a great heart program and we want to keep it that way. Quality, standardization, patient experience, and cohesiveness within our cardiovascular service line is what we aim for. Knowing we all have the same goals has made our program stronger and better. Thank you for your time. Please reach out to me if I can be of further assistance. At this time, I want to give a special acknowledgement to my accreditation specialist, Kim Fiker. Her support, friendship, and knowledge is why we succeeded. Thank you, Kim. You are beyond amazing. you

Lisa Smith

cardiovascular services

Texoma Medical Center

accreditation

healthcare facilities