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FirstHealth of the Carolinas
Know your hospital By Dick Broom

By Dick Broom

Let’s say you need to have a colonoscopy to check for early signs of colon cancer. Which hospital would you choose?

What about gall bladder surgery or a mammogram?

People generally go to the hospital that is closest to where they live. Or they choose the one they have been to before or one they have heard good things about from family or friends.

Those are often perfectly good reasons for going to a particular hospital. But sometimes your choices are limited by what you need to have done, and there may be other considerations, too.

The factor that trumps everything else is capability—what a hospital is able to do for you. For example, most community hospitals don’t offer heart surgery, so if that’s what you need, you obviously need to go somewhere else. On the other hand, if you need something that your local hospital routinely handles, there may be no need to go any farther.

Kerry Hensley, president of FirstHealth Montgomery Memorial Hospital in Troy, says small community hospitals such as hers can meet many of the health care needs of the people in Montgomery County.

“We can do nearly all of the basic surgical procedures and even some of the more complicated procedures right here,” she says. “But if you have two or three complicating health factors such as diabetes, high blood pressure or heart disease, your doctor might want you to go to a larger hospital because of the possibility that you might need intensive care after surgery.”

John Jackson, president of FirstHealth Richmond Memorial Hospital in Rockingham, agrees that you don’t need to go to the trouble of traveling to a larger hospital if your local hospital can take care of you just as well.

“Our physicians and staff are expert at treating all of the most common medical conditions, as well as some that aren’t so common, and performing a wide range of surgeries,” Jackson says.

For example, Richmond Memorial offers orthopaedic surgery including total joint replacements, which is something that many community hospitals are not equipped to handle. Other specialized services at Richmond Memorial include vascular surgery, gastroenterology, cardiology, cardiac catheterization and angiography. The hospital also has a state-of-the-art Women’s Imaging Center.

“Diagnostic testing, delivering babies, and doing gallbladder surgery and appendectomies are things we do every day and night,” Jackson says. “I think we do a lot of those things at least as well as the larger institutions.”

Size is relative, of course. Compared to the hospitals in Rockingham and Troy, FirstHealth Moore Regional Hospital in Pinehurst is one of those “larger institutions.” But it is small and downright homey compared to the big teaching hospitals in Chapel Hill, Durham or Charlotte.

Community vs. teaching hospital
If you need a kidney transplant or certain other highly specialized treatments such as burn care, a place like UNC Hospitals, Duke University Hospital or Carolinas Medical Center is where you need to be. But for heart bypass surgery, joint replacement, cancer treatment and just about anything else, you can go to Moore Regional.

MRH robotic surgery

Robotic surgery at Moore Regional Hospital

“I think the primary advantage of a good community or regional hospital versus a big teaching hospital is that your care is generally much more personal,” says George Bussey, M.D., chief medical officer for FirstHealth. “Here at our hospitals, you know who your doctor is and that he or she is the one who is actually going to be taking care of you.

“At a teaching institution, there is a whole hierarchy of interns, residents, fellows and junior attendings, and even medical students coming through. The doctor who is leading the team might be somebody you never actually see. In that type of setting, it’s easier to de-personalize the whole process of care.”

The difference in the way patients feel they are treated at community hospitals and teaching hospitals might be subtle, Dr. Bussey says, but it is something to consider when deciding where to go for treatment.

“Many times, I think, the physicians and the entire patient care staff at community hospitals have even more of an interest in doing the right thing and making sure people are satisfied with their care,” he says. “I think the people at our three hospitals have a pretty high sense of pride in what they do and feel very protective of their patients.”

Jackson agrees that the culture of a hospital can make a big difference in how satisfied patients are with their care and whether they would choose to come back.

“The healing process isn’t just the clinical treatment; it’s the spiritual and emotional aspects of it, too,” he says. “If you feel comfortable that the hospital staff is going to look out for your personal needs and your family’s needs, you are likely to have a more positive attitude and, overall, a better experience.”

The most important factor in choosing a hospital, of course, is whether the doctors and staff have expertise in providing the services you need. An example: At Montgomery Memorial, Dennis Devereux, M.D., has more than 30 years of experience in general surgery. Surgical treatment for breast cancer,
colon cancer and other malignancies are among his areas of specialization. Before establishing his practice in Troy and joining the medical staff at Montgomery Memorial last fall, Dr. Devereux was director of surgical oncology at the St. Francis Hospital Cancer Center in Poughkeepsie, N.Y.

One indication of competence is whether a physician is board certified in a particular medical or surgical specialty. Moore Regional requires that each member of its medical staff be board certified or earn certification within a certain period of time after becoming board eligible.

General surgery with Dennis Devereux, M.D., at Montgomery Memorial

Quality indicators
If you want to know about a particular hospital’s capabilities, its Web site might be a good place to start. You can learn about all the services the hospital offers, as well as any awards or special recognition it has received for excellence in a particular area such as heart or cancer care.

For two years in a row, Moore Regional was honored as one of the nation’s top 100 hospitals for cardiovascular care. Last year, the hospital was named a National Quality Leader in heart bypass surgery by CareScience, a company that helps hospitals improve patient care quality while increasing efficiency and reducing costs.

Also in 2006, the Bariatric Center at Moore Regional was named a Bariatric Surgery Center of Excellence by the American Society for Bariatric Surgery. Bariatric surgery is a treatment option for some people who are extremely overweight.

Moore Regional’s joint replacement program is one of the largest in the state and one of the most successful in the country. The hospital’s Cancer Center, first designated as a Community Hospital Comprehensive Cancer Center in 2002, has received “approval with commendation” from the Commission on Cancer of the American College of Surgeons.

Women & Children’s Services at
Richmond Memorial Hospital

Last year, Richmond Memorial received awards for patient satisfaction in two patient care areas. Press Ganey, a company that helps hospitals nationwide measure and improve their performance, cited the hospital as “most improved” in both inpatient and emergency care among hospitals in its size category. In all three areas of service that Press Ganey evaluated—inpatient, outpatient and emergency care—Richmond Memorial scored among the top 1 percent of all hospitals surveyed in terms of patient satisfaction.

An important consideration in deciding where to go for a particular test or procedure is whether a hospital has up-to-date or cutting-edge technology. For example, Richmond Memorial is one of only a few community hospitals in the state with a computer-aided detection (CAD) system for reading mammographies. A recent study found that radiologists using a CAD system were more effective in detecting early-stage breast cancers.

“FirstHealth has always been committed to staying at the forefront of where technology is going,” Jackson says. “So, as part of FirstHealth, we are able to offer diagnostic testing and other procedures that are more advanced than you find in most community hospitals.”

Hensley says convenience is important for hospital patients and for their families and friends. But she says people in Montgomery County shouldn’t choose Montgomery Memorial just because it’s nearby.

“You should choose us,” she says, “because you have confidence that we will take good care of you.”

Nothing can fill a hospital administrator with excitement and anxiety faster than these five words: “The Joint Commission is coming!”

Excitement because a visit by a Joint Commission survey team is an opportunity to show how well the hospital measures up against national standards for quality in virtually every area of operation.

Anxiety because, no matter how good a hospital is, the survey team nearly always finds something that could be improved.

The Joint Commission (TJC) is an independent body that evaluates and accredits about 15,000 health care facilities and programs across the country. TJC accreditation is regarded in the health care industry as an almost indispensable stamp of approval. It signifies that a hospital or other health care facility has met widely accepted standards for quality and safety in patient care.

To maintain accreditation, a hospital has to undergo a thorough inspection by a TJC inspection team at least every three years.

Hospitals usually have at least a few days’ notice before a survey team arrives, but occasionally a team will show up unannounced. Following the survey, which usually takes a couple of days, the hospital receives a report that points out areas in which it excels and areas in which it is not as strong as it might be.

“The survey team nearly always finds some area where you can improve, and that’s good because we want to know how we can be better,” says John Jackson, president of FirstHealth Richmond Memorial Hospital in Rockingham. “A Joint Commission survey is always a good learning experience.”

TJC used to rate hospitals and award different levels of accreditation based on their survey results. That injected the element of competition into the process, with hospitals trying to outscore each other. Jackson says he is glad the rating system has been abandoned.

“I think some hospitals started worrying too much about getting a high score rather than inviting the survey team in to really look at everything and identify areas where they could improve,” he says. “It’s always good to have another set of eyes looking at you objectively to see where there might be a weakness. It helps make us better.”

Most hospitals are TJC accredited, as are the three FirstHealth hospitals, so accreditation is rarely a factor in helping people decide which hospital in their area is best for them. But George Bussey, M.D., chief medical officer for FirstHealth, says that while some hospitals might see TJC standards as the ultimate benchmarks for quality, the three FirstHealth hospitals see them more as a baseline.

“We are always looking to go beyond that,” he says.