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General Medicine: Cape Fear Valley Health Earns Merits of Excellence


When it comes to healthcare, nothing matters more than quality. Obtaining high quality care during a hospital visit can mean the difference between life and death or lingering health issues versus a speedy recovery. But quality doesn’t come easily or naturally.

There are approximately 5,600 hospitals in the U.S., each providing a different level of care to the public. U.S. News & World Report publishes an annual list of the nation’s Best Hospitals, as well as a state-by-state list, to let patients know what’s available in the marketplace.

Cape Fear Valley Health made the North Carolina list for 2016. The health system did it by earning five quality distinctions. No other hospital in the state earned more.

To the average person, rankings from national publications may seem insignificant. But industry experts understand what it takes to be mentioned alongside prestigious medical centers like the Mayo Clinic, Johns Hopkins Hospital and UCLA Medical Center.

So how did, Cape Fear Valley Health, the state’s 8th largest health system, pull off such an improbable achievement? By reinventing itself over the years in an effort to become a world-class hospital. The strategy involved greater teamwork, continually upgrading to the latest medical technology, and always putting patients at the center of everything the health system does.

CEO Mike Nagowski championed the transformation effort soon after joining Cape Fear Valley in 2008. It was a bold decision because of the imploding U.S. economy at the time. Hospitals nationwide were either closing their doors or contracting in size. But Nagowski bet that committing to greater excellence would pay off in the long run.

He was right.

The U.S. economy has rebounded, Cape Fear Valley has steadily grown its service footprint across southeastern North Carolina, and U.S. News & World Report’slatest Best Hospitals list has Cape Fear Valley’s name on it.

The health system has received a number of other recent quality recognitions, as well. They include a letter grade “A” in 2015 and 2016 for patient safety from The Leapfrog Group. The hospital watchdog group rates U.S. hospitals for patient care with a simple letter grading system.

Ranging from “A” to “F,” grades are based on research of each facility’s approach toward patient safety. Less than 30 percent of all hospitals nationwide received an “A” last year. Cape Fear Valley was the only hospital in southeastern North Carolina to receive the superior grade.

No one is happier about the “A” than Cape Fear Valley’s CEO.

“We earned that letter grade,” Nagowski said, “because over the last four to five years, our employees have been on a journey, making this grade of ‘A’ occur. I want to congratulate them. Very few hospitals accomplished what we did.”

The Joint Commission Recognition

The most important honor Cape Fear Valley Health received last year may have come from The Joint Commission. The national healthcare accrediting body ranked the health system as a Top Performer in six treatment categories: Heart Attack, Heart Failure, Pneumonia, Surgical Care, Stroke and Perinatal Care.

Top Performer status means Cape Fear Valley provides the most up-to-date, scientific evidence-based care, as compared to anywhere else in the nation. The recognition comes on the heels of The Joint Commission bestowing eight different Disease-Specific Care certifications upon the health system in recent years.

Launched in 2002, the Disease-Specific Care certification program evaluates hospital clinical programs across the continuum of care, not just for one or two areas of a patient’s stay.

To date, Cape Fear Valley has received certifications for Hip Replacement Surgery, Knee Replacement Surgery, Heart Failure, Advanced Stroke, Acute Myocardial Infarction (AMI, or heart attack), Pneumonia, Wound Care and Sepsis. Bladen County Hospital also received Sepsis certification. It is the first critical access hospital in the nation to do so.

All the certifications help rank Cape Fear Valley Health among the top 25 hospitals in the nation for patient care quality.

The certifications didn’t come by chance.

Over the years, Cape Fear Valley has created various Centers of Excellence that focus on the very treatment areas for which it received certifications. One of the first was for the health system’s award-winning hip and knee replacement surgery program.

Bradley Broussard, M.D., is an orthopedic surgeon and Cape Fear Valley’s Chief of Staff. He says joint replacement surgery is fairly standardized now, but every patient recovers differently. Having nurses, physicians and physical therapy staff on the same page when treating patients helps ensure the best outcome.

“Everyone strives for excellence here,” Dr. Broussard said. “Not only in the area of patient care, but also in the results. Our crew does a good job of providing personalized care to everyone who comes here for surgery.”

Jose Delgado, M.D., Associate Medical Director at Highsmith-Rainey Specialty Hospital, agrees with the teamwork sentiment. He works with the hospital’s wound care program and says the staff works closely together for a reason.

Treating extensive or lingering wounds can be extremely complicated. Everyone from dietitians and pharmacists to physical therapists and pastoral care staff may be called upon.

“These kinds of wounds are so complex they simply require a more intensive approach,” Dr. Delgado said.

Patients suffering from advanced diabetes, vascular disease or traumatic injuries can require months of treatment. Even more specialty care, such as wound vacuum or hyperbaric oxygen therapy, may be necessary if wounds are infected.

The staff’s goal is to ensure each patient can manage their wound on an outpatient-level before discharging the patient home.

Kelly Steere is Highsmith-Rainey’s Nursing Director. She said obtaining Disease Specific Certification for Wound Care through The Joint Commission has galvanized her staff.

“It’s taken our wound care program and the clinical services we provide to another level,” she said.

ED Gateway

Cape Fear Valley Medical Center’s Emergency Department is easily the busiest in the state and among the busiest in the nation. Many patients arrive suffering from pneumonia or sepsis. Both can be fatal if left untreated.

Most people have heard of pneumonia. The severe lung infection often kills older adults, babies and people with weakened immune systems. But sepsis can be just as deadly. It affects more than 1 million Americans annually. Up to half eventually die.

The serious medical condition is caused by an overwhelming immune response to an infection in the body. Chemicals released into the blood to fight the infection trigger a widespread inflammatory response.

The inflammation may cause organ damage and blood clotting, which reduces blood flow to limbs and vital organs. This robs them of nutrients and oxygen. Organs fail and blood pressure plummets in advanced cases, which can lead to complete organ shut down.

“It’s one of our biggest killers in our ICUs,” said Amanda Atkinson, M.D., M.H.A., an Emergency Medicine and Critical Care physician. “We really take things like sepsis seriously.”

Quickly recognizing symptoms, such as low blood pressure and lactic acid build-up in the blood, increases recovery chances. Sepsis patients are often dehydrated and require intravenous fluids. Clinicians can use bedside ultrasound to determine the level of fluids needed. Powerful antibiotics and other medications are then prescribed to reduce the source infection and the body’s corresponding response.

Pneumonia is treated in a similar fashion. Doctors work to find the source infection in the lungs using various methods, including X-rays, ultrasound and blood tests. It’s then treated with antibiotics.

Most people fully recover. But if the illness is severe enough, it can lead to lasting side effects – even if the condition was properly treated.

“In the ICU, many other organs beside the lungs can suffer when someone gets pneumonia,” Dr. Atkinson said. “That’s why it’s important to treat it as soon and as aggressively as possible.”

Heart failure and heart attack patients are frequent visitors to the Emergency Department. Cape Fear Valley has had a Chest Paint Center of Excellence for years, but it was originally accredited through the Society for Chest Pain Centers.

Michael Hodges, M.D., is the Director for Cardiac Quality and Chairman of the Clinical Performance Improvement Committee at Cape Fear Valley. He says the chest pain center designation was a way to show Cape Fear Valley could compete with any other hospital in the state when it came to cardiac care.

Cape Fear Valley still maintains the Chest Pain Center accreditation. But the health system has also pursued Disease Specific Care certification for Heart Attack and Heart Failure treatment through The Joint Commission, as an overall quality strategy.

Maintaining both accreditations means extra work for an already busy cardiac care staff. But it’s that commitment to continually pursue quality that defines what Cape Fear Valley Health is today.

“We now have a culture of providing quality care,” Dr. Hodges said. “We know we’re doing good work. We’ve known that for years. Now we’re just being recognized on a national level for our efforts.”

By Donnie Byers