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Welcome to St. David’s South Austin Medical Center

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Presentation on theme: "Welcome to St. David’s South Austin Medical Center"— Presentation transcript:

1 Welcome to St. David’s South Austin Medical Center
New Physician Orientation

2 Mission To provide exceptional care to every patient every day with a spirit of warmth, friendliness and personal pride

3 Values ICARE Values: Integrity Compassion Accountability Respect

4 Goals Exceptional Care Customer Loyalty Financial Strength

5 Comprehensive, acute care hospital including emergency, heart, and women’s services
Established in 1982 Member of St. David’s HealthCare and Hospital Corporation of America (HCA) 5

6 South Austin Medical Center was built in 1982
Many people did not see the need for a hospital “south of the river” Original planning meetings held at Hill’s Café The Goodnight family, local business owners, were very supportive and instrumental in the construction of the hospital 6

7 Hospital Services Blood Cancer Treatment &Bone Marrow Transplant
Robotic Surgery Freestanding Emergency Departments Urgent Care Clinics Wound Care/Hyperbaric Services Sleep Lab Transfer Center 7

8 Currently has approximately 40 beds
Observation area (called Fast Track) In 2008, a helipad was constructed immediately adjacent to the ED to receive critically ill and/or injured patients 8

9 Patients receive care based on a triage system
In 2010, SAMC had the busiest ED in Austin, with over 73,000 visits annually Patients receive care based on a triage system The majority of hospital admissions come through the ED Major SAMC goal is to reduce wait times in ED and the time to release or admit patients 9


11 Triage station Walk-in and ambulance entrances

12 Several areas dedicated to surgical patients
Orthopedic patients Post surgery patients Oncology patients Patients with illnesses All floors have telemetry or heart monitor capability if required by patients (except L&D) 12


14 Levels of care ICU – Intensive care unit (2nd floor) IMC – Intermediate care unit (7th floor) Full telemetry monitoring is done on these patients, according to their needs 14

15 Patient room with telemetry equipment

16 Nurses station Family waiting area

17 Heart–related areas include
Cardiac cath labs and Outpatient Heart Center Special procedures area and EP Lab CVRU (Heart-related ICU) on 4th floor Two open-heart operating rooms This unit has 8 beds 17


19 Procedure room & telemetry



22 Postpartum/2Central

23 X-Ray Machine Digital Mammography Suite

24 Nuclear X-ray Cat-Scan



27 Medical Staff Leadership
Chief Medical Officer: Al Gros, MD Chief of Staff: Robert Northway, MD Chief of Staff-Elect: Alex Esquivel, MD Secretary: David Savage, MD Dr. Al Gros CMO, South Austin Medical Center Office: (512) Mobile: (512) Fax: (512) With the exception of the Medical Director, Medical Staff Leadership at South Austin Medical Center is a group of elected physician leaders serving two-year terms for each position. These leaders are dedicated medical staff members who have actively served on various medical staff committees for several years and are well respected by their colleagues and the medical staff. Dr. Al Gros is the Chief Medical Officer (CMO). Dr. Gros has served in key medical staff and board leadership roles at South Austin Medical Center over the past two decades. Currently, he is president elect of the Texas Association of Obstetricians and Gynecologists.

28 Associate Administrator
Senior Leadership Todd Steward CEO Brett Matens COO/ECO Dan Huffine CFO The senior leadership at South Austin Medical Center includes five experienced professionals in the health care industry. Nikki Sikes Associate Administrator Sally Gillam CNO

29 Governance & Peer Review
There are two key committees involved in medical staff governance. The governing committee of the Medical Staff is the Medical Executive Committee, often called MEC. Membership includes the Medical Staff officers, immediate past Chief of Staff, Medical Staff Department Chiefs, Medical Care Evaluation Committee (MCEC) Chair and the CEO. The MEC is accountable to the hospital Board of Trustees and to the Medical Staff for the overall quality of medical care rendered to patients in this hospital. Key responsibilities include oversight of the Medical Staff Organization, credentialing functions, and Medical Staff Bylaws, Rules and Regulations. The Medical Care Evaluation Committee, often called MCEC, is comprised primarily of the vice-chiefs of the medical staff departments and is responsible for peer review and oversight of medical staff quality improvement activities. The MCEC may investigate, review and report on matters including the clinical or ethical conduct of any practitioner assigned or referred to it by the Chief of Staff, the Hospital Board or any individual responsible for patient care. The MCEC reports to MEC.

30 Medical Director / Vice Chief of Staff
BOT MEC (Chief of Staff) Peer Review Process Action MCEC (Chief Medical Officer) Rapid Review Team Egregious Event: (incl. Sentinel Events, In-House Physician Quality Issues) Medical Director / Vice Chief of Staff Department Triage (Med Dir & PIC) Clinical Issue: Competence, Core Measures, Outcomes Indicator 'Fall-outs' Compliance / Social Issue: (i.e., Complaints, Non-compliance, Behavior) Peer review at is designed to be an opportunity to review selected cases to improve patient care and physician performance. We have moved away from the previous grading model to a more open-ended approach to maximize the educational aspect of peer review and minimize the punitive connotations. Reviewers are usually Department Vice chairs and have a wide latitude of actions they may recommend. This may include presentation of selected cases at the department or Medical Care Evaluation Committee meeting in a collegial atmosphere. Variance Reports Physician PI Coordinator Prof. Liability Actions Patient Complaints Sentinel Events Failed Measures Employee Complaints Fall-out from Screens Compliance Issues Approved by MEC 2/08

31 OPPE & FPPE Review There are two key committees involved in medical staff governance. The governing committee of the Medical Staff is the Medical Executive Committee, often called MEC. Membership includes the Medical Staff officers, immediate past Chief of Staff, Medical Staff Department Chiefs, Medical Care Evaluation Committee (MCEC) Chair and the CEO. The MEC is accountable to the hospital Board of Trustees and to the Medical Staff for the overall quality of medical care rendered to patients in this hospital. Key responsibilities include oversight of the Medical Staff Organization, credentialing functions, and Medical Staff Bylaws, Rules and Regulations. The Medical Care Evaluation Committee, often called MCEC, is comprised primarily of the vice-chiefs of the medical staff departments and is responsible for peer review and oversight of medical staff quality improvement activities. The MCEC may investigate, review and report on matters including the clinical or ethical conduct of any practitioner assigned or referred to it by the Chief of Staff, the Hospital Board or any individual responsible for patient care. The MCEC reports to MEC.

32 AMI (Acute Myocardial Infarction) HF (Heart Failure) PN (Pneumonia)
Core Measures AMI (Acute Myocardial Infarction) HF (Heart Failure) PN (Pneumonia) SCIP (Surgical Care Improvement Project) As part of an ongoing process to improve delivery of patient care, South Austin Medical Center participates in four Core Measures: AMI (Acute Myocardial Infarction) HF (Heart Failure) PN (Pneumonia) SCIP (Surgical Care Improvement Project) The Joint Commission, in conjunction with CMS, requires hospitals to participate in Core Measures. Reports on hospital compliance to core measure indicators are available through the JCAHO website and publicly through the CMS Hospital Compare website. CMS provides payments to hospitals that meet certain core measure requirements which allow hospitals to purchase equipment, hire more staff, etc.

Prophylactic Antibiotic Received within 1 Hour of Incision (2 hrs for Vancomycin or fluoroquinolones) Recommended Prophylactic Antibiotic Selection for Surgical Patients Prophylactic Antibiotics Discontinued within 24 Hours After Surgery End Time (48 hrs for Cardiac Surgery) Cardiac Surgery Patients with Controlled 6 A.M. Post-op Serum Glucose (<200 mg/dL) post-op day 1 & 2 Surgery Patients with Appropriate Hair Removal (no razors) Urinary Catheter Removed on Post-op Day 1 or 2 Surgery Patients with Perioperative Temperature Management (active warming intraoperatively or one body temp. > 96.8o within 30 min. prior to 15 min. after Anesthesia End Time)

Recommended Venous Thromboembolism Prophylaxis Ordered anytime from hospital arrival to 24 hrs after Anesthesia End Time Recommended Venous Thromboembolism Prophylaxis within 24 Hours Prior to Anesthesia Start Time to 24 Hours After Anesthesia End Time SCIP CARDIAC QUALITY INDICATOR Surgery Patients on Beta Blocker Therapy Prior to Admission Who Received a Beta Blocker During the Perioperative Period SCIP HEART FAILURE QUALITY INDICATOR ACEI or ARB Prescribed at Discharge for Patients with <40% LVEF

35 Physician and Patient Communication

36 Why Should You Care? A 2004 Harris Interactive poll of 2,267 U.S. adults showed that “patients place more importance on doctors’ interpersonal skills than their medical judgment or experience, and doctors’ failings in these areas are the overwhelming factor that drives patients to switch doctors.” Physician conduct and communication, not necessarily clinical outcomes, appear to be the principle predictors of malpractice risk.

37 Hospital Consumer Assessment of Healthcare Providers and Systems
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems

38 HCAHP Survey Questions

39 Key Stakeholders The physician/patient interaction influences the patient’s experience and perception of care CMS surveys patient on physicians: Treating with courtesy and respect Listening carefully Explaining things in a way patients can understand

40 Management Best Practices
AIDET and Key Words Consistent approach to communication Acknowledge Introduce Duration Explanation Thank You Employee Forums Global communication and education Senior Leader visibility

41 Case for Service Communication skills can heavily influence patient compliance and will impact clinical outcomes Studies have demonstrated that when a physician is approachable, gives serious consideration to the patient’s concerns, and communicates well, better patient compliance is likely.

42 Case for Service Exceeding expectations with exceptional service keeps patients coming back. Loyal patients are greater revenue producers than acquiring new patients

43 Case for Service Physicians can improve staff morale, performance, and retention through: Investing in relationships Clear, constructive, respectful communication Specific reward and recognition Modeling behaviors consistent with the mission

44 RX Tool #1 – First Impressions
Knock, then pause two seconds prior to entry Smile, shake hands, and introduce yourself to the patient and everyone in the room Sit and sustain eye contact LOOK as though you ENJOY what you do! Use a consistent opening dialogue for established and new patients that creates comfort and approachability with you. Tell patients about your training, your experience, and your personal approach to patient care.

45 RX Tool #2 – Exam Room Preparedness
What you know and don’t know when you enter the exam room creates or undermines the confidence patients will have in you. Review interval events, consults, and what you did last prior to entering the exam room. Specifically reference your “plan” that was established during the prior visit. Communicate your awareness of interval medical events. Leverage the information available to convey you are attentive and aware of every element of their care.

46 RX Tool #3 – The Physician Exam
Providing information on physician exam findings conveys thoroughness and a diligent effort to find the cause of a problem. Review your physical exam findings as you perform the exam. The more information you provide to patients about themselves, the greater value for the visit in the eyes of patients.

47 RX Tool #4 – Providing Patient Information
Explanation of diagnosis and treatment is the most important element of the patient visit Effective communication improves recall of directions, compliance, and patient satisfaction. Every condition and plan must include a simple explanation. All explanations must be followed by query of the patients for their understanding. Ask patients to repeat the plan as they understand it to ensure their understanding and identify areas needing further explanation.

48 RX Tool #5 – Collaboration with Patients
Establishing collaboration with patients improves compliance, outcomes, and patient satisfaction. Collaboration can be established by asking patients if they have any reservations or concerns in regard to a treatment plan. Collaboration is about specifically soliciting patient input regarding the treatment plan going forward.

49 RX Tool #6 – Patient Follow-Up
All patients must leave a visit understanding exactly what it is that will happen next. Provide clear follow-up on the timing and purpose of patients’ upcoming visits. Provide information regarding the timing of laboratory and radiographic tests and how the results will get to the patient. Explain the purpose and timing for specialty consultation in terms of when, why, and who. Position specialty physician colleagues well.

50 Steps in Effective Service Recovery
Apologize Let the patient speak Validate Correct the issue Take action Follow up with the patient

51 There is a dedicated web site for the medical staff. The web site will provide current information about meetings, news updates, CME programs, bylaws, and other important information. Please take a moment to visit to see what information is immediately available to you. 51 51

52 Medical Staff Meetings
Monthly meeting calendars are posted on the MedWeb site, faxed, and ed to members. There is a 50% meeting attendance requirement for Active members in the departments of Medicine, Surgery, and Cardiology. There is a 25% meeting attendance requirement at the quarterly General Medical Staff meetings for all Active members. Monthly meeting calendars are posted on the MedWeb site and mailed to members. Meeting reminders are faxed to member offices. Please be aware of attendance requirements which exist to ensure medical staff participation in the necessary functions of the organization. There is a 50% meeting attendance requirement for Active members in the departments of Medicine, Surgery, and Cardiology. There is a 25% meeting attendance requirement at the quarterly General Medical Staff meetings for all Active members. 52 52

53 Credentialing and Medical Staff Services
St. David’s and HCA structure regarding credentialing Standardized market forms Individual facility approvals Qualification: Board certification or obtained within 5 years of initial appointment. Certification must be maintained. As a member of the St. David’s HealthCare, South Austin Medical Center participates in the centralized application and verification process. It is very important to understand that the application and verification process is the only function that is centralized. Everything else is facility specific. Therefore, once the HCA Credentialing Processing Center (CPC) completes and collects all necessary documentation regarding your application, it is forwarded to each facility where privileges have been requested. Each facility will then take the application through its own committee approval process. Final approval is granted by each facility’s Board. To keep up to date on the latest Medical Staff activities, new, and information concerning meetings there is a website for your convenience. It is If you have any other questions, feel free to contact the medical staff office at or stop by in Administration which is on the first floor by the North lobby of the hospital.

54 Physician Health Forms of Impairment Alcoholism and other drug use
Other psychiatric disorders Addressed by the TCMS Physician Health and Rehabilitation committee We are required by JCAHO to educate the medical staff about issues related to physician health. Our Medical Staff leadership normally engages the assistance of the Travis County Medical Society’s (TCMS) Physicians Health and Rehabilitation Committee in addressing physician health problems. More specific steps related to this process are addressed in the Medical Staff Bylaws. 54 54

SAFETY CODES SPECIFIC SIGNALS - GENERAL SIGNALS RED FIRE Hazardous Mat GRAY Tornado WHITE Disaster GREEN Evacuation Pull station/Extinguisher locations refer to safety charts/maps posted Rescue if possible Call Security with location of fire Activate alarm pull station Close doors & windows Identify fire doors & exits Evacuate if necessary If fire is in an adjacent department or above or below, respond with available staff with fire extinguisher Remain alert for further instruction or “ALL CLEAR” R.A.C.E. – rescue alarm, contain/confine and extinguish P.A.S.S. – pull pin, aim, squeeze and sweep the base of the fire Internal Clear the area/close doors Stop the leak/spill if it can be done safely Pull MSDS sheet Secure the area Call security with information Response team activated If there are victims, call ED Notify Director or supervisor Await further instructions External Direct patients to outside of ED – NO entry to facility Possible lockdown of facility Patients triaged and decontaminated WATCH Directors/Supv alert all staff Check for supplies (flashlights, blankets, etc) Close blinds and drapes Ensure critical eqpt is plugged into red plugs Remain alert and listen for further instruction WARNING Close all doors Move away from windows, as much as possible Move patients to inner hallway Report back to your department PBX will page directors with instructions Assess staffing needs Hand carry staffing form to HR Assess bed availability & other resources (blood, food, water, etc) Refer to staffing chart and assume your assigned role Partial Evacuation Supervisor completes quick head count of staff Report to your department if able. If not evacuate down, never go up Total Evacuation All available staff report to nearest clinical area to assist evacuate to designated staging area, ambulatory patients go first Take medical records if possible Do not re-enter unless told to SPECIFIC SIGNALS - ISOLATED EVENTS BLACK Bomb PURPLE Threatening Person YELLOW Person Down CODE ADAM Abducted Infant DR. LEO/CODE BLUE Cardiac Arrest Get all info you can from caller Try to keep caller on line while someone else calls Security Refrain from alarming patients and visitors DO NOT use cell phones or radios Search areas for anything suspicious, if found DO NOT TOUCH – call Security with exact location of object If object found, evacuate area When area has been searched and cleared, call Security Remain alert for further instruction or “ALL CLEAR” Call Security DO NOT attempt to challenge or disarm individual Remain calm and maintain eye contact and talk to individual NEVER attempt to physically restrain or remove by yourself When response team arrives relay information Call Security with exact location of person down Remain with the person until response team arrives Relay information Assist as needed Remain alert for further instructions Go to closest exit and prevent anyone from leaving until help arrives Report suspicious people to security If you see a person with an infant that looks suspicious, STOP THEM, or follow them and call for help If possible check outside doors Call the Code based on your Facility (Dr. Leo/ Code Blue) Bring the Crash Cart to the site If properly trained, begin CPR (check patient for consciousness etc.) Each facility has a designated Code Team If not assigned to Code Team, clear the area and manage traffic Have patient’s chart available

56 Physician Satisfaction Team
The SAH Physician Satisfaction Team commits to partner with the medical staff to improve the environment in which they work. We will strive to ensure that the highest level of service is consistently provided to the physicians. We will act as a liaison to foster open communication and will recognize our physicians as valued partners in the delivery of healthcare. MVP of the Quarter Doctors’ Day Celebration Veterans’ Day Celebration Direct Physician Concerns to appropriate leaders

57 Clinical Information Systems
Information Systems Access: Meditech hCare Portal Decide which type of training will work for you Web-based training (WBT) One-on-one sessions Or a combination of training methods Collect all of your clinical system passwords Plan to attend a training session to set up your account The clinician portal will also provide reference resources for physicians – including training modules for using the portal and facility and division-specific information And because it's web-based, physicians will be able to access the portal via simplified remote access. -the records and deficiencies are viewable by the physician in clinician portal hours from discharge under the “incomplete” tab. -the deficiencies are broken up into three categories (MISSING TEXT, DICTATION, SIGNATURE) -in each category, deficiencies are color-coordinated based of aging status - INCOMPLETE (0-15 days)= BLUE -WARNING (16-29 days)= RED -DELINQUENT (30+)= YELLOW -To avoid suspension, physicians need to make sure they complete their deficiencies in warning status before reaching “delinquency” . Dictations must be dictated and signed to be considered “completed” -As a courtesy-Notifications for suspension will be faxed to a physicians office every Wednesday with a 1 week reminder of pending suspension. -Suspension letters will be faxed the following Wednesday For questions about Incomplete Deficiencies- please contact Health Information Management at For questions about Portal or access- contact the help desk at 901-HELP or Ryder Bodoin at

58 Electronic Medical Record (EMR)
For questions about Incomplete Deficiencies- please contact Health Information Management at For questions about Portal or access- contact the help desk at 901-HELP or Ryder Bodoin at Electronic Medical Record (EMR) What is the Clinician Portal? Physician electronic access point for clinical information Integrated systems Simplified sign-on—one username, one password Simplified Remote Access – no more tokens User-friendly, intuitive interface Access to complete patient list Resources section Clinical references Training modules Facility-specific information Accessible from hospital, home, office, or while traveling The portal is a viewer that pulls together clinical information for patients. It provides a user-friendly, intuitive interface for physicians, making clinical data accessible from within the hospital or remotely via simplified remote access.

59 Meditech (Clinical Patient Care System)
PCI (Patient Care Inquiry) LAB, RAD, PATH and HIM reports Demographic/Insurance Info. Access from hospital, office or home Physicians MUST write Consult Orders so consulting physician will have access to the patient Electronically sign dictated reports remotely Software provided by the hospital for remote installation Physician Help Desk #: (HELP) Obtain Access, Schedule Training, & Report Problems 24/7 service To assist you with medical record documentation, Meditech, aka CPCS, is the electronic computer system used for patient care information. This system is used market wide within the St. David’s Partnership. In Meditech, we have a fully integrated Clinical, Administrative and Financial System. In addition, all the information you need regarding your patients, including an automated Rounds Report, is available to you In-house, at your office or home. Through the PCI Module of Meditech you have immediate access to Lab results, any transcribed HIM/RAD/PATH/LAB reports, as well as your patients' demographic and billing information. If you would like to know more about our system and receive training, information about the system and forms needed to initiate the process is included in your Welcome Kit. You may also contact the Physician Help Desk. 59 59

60 Health Information Management
Hours of Operation Monday-Friday 8:00 am to 4:30 pm. Dictation Timeliness Requirements Electronic Health Record and Chart Completion for Physicians Health Information Management, also known as Medical Records, is open Monday through Friday, 8:00 am to 4:30 pm. Records are scanned in to HPF 24 hours following patient discharge and viewable in Clinician Portal. Records can be completed via the Clinician Portal and physicians need to log in weekly to monitor their incomplete record status and avoid suspension. It is the physician’s responsibility to monitor their incomplete records in portal and to complete it before reaching 30 days delinquency. Notification of incomplete records by HIM is only a courtesy. Dictation stations are located in all patient care areas throughout the hospital. We provide a 12-hour turnaround on H&Ps, Consults and Operative Reports and 24-hour turnaround on Discharge Summaries. We do bill back our transcription service for reports that are outside the contracted turnaround times. Dictations are accessible and viewable on Meditech and Clinician Portal. The following rules and tips help to ensure accurate and compliant documentation: Verbal orders must be signed, dated and timed within 24 hours by the ordering physician. Dictate your H&Ps within 24 hours of admission and/or prior to surgery and operative reports prior to transfer to the next level of care. Discharge Summaries and signatures are due upon discharge of the patient. The use of Electronic Signature is strongly encouraged! Select Dictation 60 60

61 Privacy and Security Terms and Definitions
Health Information Management Privacy and Security Terms and Definitions HIPAA – Heath Insurance Portability & Accountability Act (est. 1996) HITECH – Health Information Technology for Economic & Clinical Health (est. 2009). PHI -Protected Health Information (Any information that can be linked to a patient) Name Address Dates (i.e. birth date, admission date, discharge date, etc.) Phone numbers; Fax numbers; Social security number; Medical record number; Health plan beneficiary number; Account number; Certificate/license number; Vehicle identifier and serial number; Device identifiers and serial numbers; URLs; Internet protocol addresses; Biometric identifiers (e.g.; fingerprints); Full face photographic and any comparable images; Any other unique identifying, characteristic, or code; and Any other information about which you have actual knowledge that could be used alone or in combination with other information to identify the individual

62 Health Information Management
Privacy and Security Terms and Definitions Need to Know (Only access information that is needed for your job and only sharing sensitive and confidential information with other that’s have a need to know and are directly involved in the care of the patient.) Minimum Necessary (access, use or disclose the minimum information necessary to perform his or her designated role regardless of the extent of access provided to him or her.) De-Identify (Health information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual) Pass code Policy (Release of information to a patient’s immediate family member, other relative, or a close personal friend of the patient, or any other person to whom the patient has given his or her password (numeric code provided to patient at Registration). Sensitive Information: information that poses a significant or financial harm/risk to the patient. Examples: protected health information, social security numbers, employee human resources files) and restricted data (e.g., cardholder information, company passwords Breach: Unauthorized acquisition, access, use, or disclosure of unsecured, unencrypted protected health information which compromises the security or privacy of such information and poses a significant risk of financial, reputational, or other harm to the individual. Wrongful Disclosure – wrongful release of protected health information (PHI) to an unattended recipient outside of our covered entity. Example: Faxing records to a church fax line instead of the attended physician office. Office of Civil Rights – OCR (Governing body for HIPAA & HITECH)

63 Health Information Management Privacy and Security Safeguarding Information
Safeguarding= (Reasonable steps to protect PHI) Following ‘need to know’ guidelines Employing ‘Minimum Necessary’ standards Verify documents are for the correct individual prior to providing services or releasing documentation. Not removing PHI from the facility Releasing of PHI = (Appropriate means for disclosing PHI) Utilization of the Pass code Policy Obtaining a valid authorization for uses and disclosures outside of treatment, payment, and healthcare operations. Refer these requests to the Health Information Management Department. (also see SAMC authorization on e-demand) Verbal Disclosure Verifying appropriate audience (i.e. receive patient consent prior to discussing PHI in front of family members). * Clinicians should not assume the patient has agreed to have PHI verbally shared in front of their family members, friends or other visitors just because the patient did not request these individuals to leave when the clinician began speaking. Closing Curtains in semi-private locations Use low voices & do not discuss PHI in public areas Verifying identity when speaking via phone When leaving messages do not disclose PHI or diagnostic information. You can however leave your name, callback number, purpose for the call (e.g. “to discuss his or her treatment results”)

64 Health Information Management Privacy and Security Safeguarding Information
Accessibility Chart handling Chart must not be left unattended in public areas Chart must not be readily available for unauthorized viewing (i.e. any customer, employee or physician without need to know) Electronic Access Screens/Monitors must be positioned away from direct view of general public Privacy screens should be used in areas accessible to the public Passwords must not be displayed or viewable Must log-out or lock workstation when leaving unattended (especially in public areas such as corridors and patient rooms) Disposing securely Documents must be shredded or disposed of in designated container. FISO – Facility Information Security Officer = Covers Security (“Access to”) – e.g. Passwords, Encryption, Portable Media, etc. SAMC FISO is Richard Lear – FPO – Facility Privacy Officer = Covers Privacy (“Appropriateness of Access”) ­– e.g. ‘Need to know’, ‘Minimum Necessary’, Confidentiality, SAMC FPO is Barbara Howard – Custodian of Medical records – HIM Director/FPO

65 Health Information Management
Notification Process Deficiencies color coordinated in portal for your convenience BLUE: Incomplete 0-15 days RED: Warning days YELLOW: Delinquent 30+ days Notification and Suspension letters are faxed to physician offices every Wednesday, as a courtesy only. Coding Query Process Process Incompletes by selecting Process or Process All We are proud to maintain a delinquent record count at less than half the percentage allowed by JCAHO standards. You may probably be all too familiar with the Physician Query process which is sometimes needed in order to adequately substantiate your documentation for coding purposes. When are asked to answer a query, we will make every attempt to obtain your response as soon as possible for billing purposes. Physician Queries are generated to clarify documentation for coding purposes. The diagnosis needs to be documented on the form for policy. Queries are presented as Missing Text deficiencies Press the PgUp key or click Page 1 to reference the coding question 65 65

66 Unacceptable Abbreviations
Intended Meaning Misinterpretation Expected Action U Units O, “4” Write out entire word “Units” IU International units Misread as IV (intravenous) or the number 10 Use the word “units” Trailing Zero (i.e. 1.0 mg) 1 mg Misread as 10 Do NOT use trailing zeros after a decimal point Lack of a leading zero 0.1 mg Misread as 1 or 11 mg ALWAYS use a zero before a decimal point MS MSO4 MgSO4 Morphine sulfate or magnesium sulfate Confused for one another. Can mean morphine sulfate or magnesium sulfate Write “morphine sulfate” or “magnesium sulfate” Q.D., q.d., qd Q.O.D, q.o.d, qod “Daily” and “every other day” Mistaken for each other. The period after Q can be mistaken for an “I” or the “O” can be mistaken for an “I” Write “daily” and “every other day” Your role in good record documentation includes using acceptable abbreviations. Health care practitioners widely use abbreviations with the intent of facilitating communication and simplifying documentation. However, the use of abbreviations can result in misinterpretations and actually contribute to medication errors. A review of the MEDMARX error reporting program from January 2000 to August 2004 found nearly 19,000 error reports from 498 facilities that cited abbreviations as a cause of error. Fortunately, only a very small percentage (0.55%) of these errors was categorized as harmful. The “do not use abbreviations” identified on this slide have also been listed as high-risk by several national organizations including, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Institute for Safe Medication Practices (ISMP). The goal is to reach 100% compliance in adhering to the “do not use” list. This is a very important multidisciplinary initiative that supports patient medical safety and takes a proactive approach. Your support and adherence to not using these abbreviations is strongly encouraged.

67 Clinical Documentation Improvement
Clinical Documentation Liaisons: Betsy Woodhouse RN Shawna Huskey RN Juan Patino, RN

68 Insufficient, Incomplete, or Illegible Documentation
How’s this patient doing? Good! Dated & Timed What is the medical complexity of this visit for billing? Understand the Plan?

69 Accurate Documentation
Precise and detailed documentation reflects the complexity of our patients and the excellent care we provide Helps prevent HAC and RAC recoupment Improves physician and hospital profiles (MEDPAR, Healthgrades, CMS, etc.) Comply with CMS rules and regulations Receive proper reimbursement through correct MS DRG assignment

70 DRG classification is not only for purposes of reimbursement…
Physicians Note DRG classification is not only for purposes of reimbursement… But captures the documentation necessary for quality of care analysis and mortality predictions for both you…and the hospital!

71 Keep in Mind: Accurate representation of patients helps to justify cost, length of stay, and mortality statistics Coders have rules to follow. They cannot assume anything – they must code from what the physician has actually documented. Coders cannot use information from telemetry strips, lab reports, radiology reports, pathology, diagnostic reports, or nursing/ancillary notes for coding. The physician must address these findings in the medical record.

72 Clinical Documentation Liaisons’ Role
Concurrently review Medicare charts and query physicians for documentation clarification prior to patient discharge Provide education to physicians and appropriate clinical staff about documentation improvement methods as indicated Bridge the gap between clinical language and coding language

73 Physician Role Focus on patient care
Review any education from CDLs and apply to documentation Respond to all inquiries from CDLs - Appropriate, timely responses will prevent post-discharge queries from the coders - Physicians do not need to agree with the inquiries, just respond

74 Clinical Language vs. Coding Language

75 APR DRG Medical diagnoses and procedures are used to determine a patient’s APR DRG (All Patient Refined Diagnosis Related Group) – includes Severity of Illness (SOI) and Risk of Mortality (ROM) sub-classes There are 4 sub-class levels for SOI and ROM: - Level 1: Minor - Level 3: Major Level 2: Moderate - Level 4: Extreme SOI and ROM are driven by secondary diagnosis.

76 Secondary Diagnoses Definition – conditions that are monitored, evaluated and/or treated during the hospital stay. Three classes: ▪ Major complications and comorbidities (MCC) ▪ Complications and comorbidities (CC) ▪ Non-complications and comorbidities (NCC) MCCs and CCs affect the DRG assignment The difference between an MCC, CC and NCC can be the specificity of documentation

77 Be as specific as possible…
● Congestive Heart Failure Acuity – acute, chronic, acute on chronic Type – systolic, diastolic, combined Please indicate both the type and acuity of CHF, if it is unknown please indicate that it is unknown. When type and acuity is determined, after testing, please make this note the chart. ● Malnutrition Acuity – mild, moderate, severe Type – protein, protein calorie, marasmus, other unspecified ● Anemia Specific type and cause – acute blood loss anemia, iron deficient anemia, chronic blood loss anemia, anemia due to chronic disease, aplastic, etc. ● Hypertension Essential, benign, accelerated, malignant FYI – hypertension “urgency” or “emergency “ both code to plain hypertension

78 More Tips… ● Home medications
Please provide corresponding diagnoses for ordered home medications. Remember that secondary diagnoses show the complexity of each patient and can affect SOI/ROM. ● Catheter associated UTIs (CAUTI) Coders and CDLs are instructed to query for CAUTI anytime a UTI is diagnosed after a Foley catheter has been placed. This applies both to newly placed Foleys and chronic Foleys/suprapubic catheters. Please document whether or not the UTI is associated with the Foley. ● The attending physician is the one who will be queried for clarification even if the conflicting documentation originated from a consultant or partner. Once discharged, the coder will query the discharging doctor. ● Positive cultures (e.g. blood, urine, wound, respiratory) Please link the organism to the infection (e.g. E coli UTI, MRSA sepsis, Pseudomonas pneumonia). Please indicate the location of pressure ulcers and wounds as well as their etiology. Coders can take stages of wounds from nursing documentation.

79 Tips to Prevent a Renal Failure Query
CHRONIC: CRI = chronic renal insufficiency CRF = chronic renal failure CKD = chronic kidney disease CRI = CRF = CKD to coders If possible, please provide the stage of kidney disease. If not possible, please document that staging is being deferred at this time.  CKD stage V = ESRD to coders Please document the stage of CKD. If unknown-document unknown and later when determined document stage. ACUTE: ARF = acute renal failure AKI = acute kidney injury ARF = AKI to coders ARI = acute renal insufficiency = disorder of kidney and ureter to coders ARI ≠ ARF to coders ARI ≠ AKI to coders

80 More Sepsis Tips “Urosepsis” codes as “UTI.” The coder will query to clarify the doctor’s meaning of “urosepsis.” Septicemia or sepsis with a urinary tract source will code as sepsis as Pdx. Bacteremia due to a UTI will code as a UTI as Pdx. Please be specific-If a patient has a diagnosis of sepsis and a positive blood culture, link the sepsis to the organism – ex. Staphlococcal sepsis. Definitions of sepsis terms (in regards to coding): Bacteremia – positive blood cultures; there are no significant clinical symptoms; it will code to the underlying infection (not sepsis); physician can chart “bacteremia with sepsis (or septicemia or SIRS)” Septicemia – systemic disease associated with the presence of pathological microorganisms in the blood; the coder is advised to query for “sepsis” when the physician documents “septicemia” SIRS – systemic response to infection or trauma; not assumed to be sepsis Sepsis is SIRS due to infection

81 Up/Down Arrows From AHIMA Coding Clinic 1st Quarter 2011:
It is not appropriate for the coder to report a diagnosis based on up and down arrows. Diagnosing a patient’s condition is solely the responsibility of the provider. Up and down arrows can have variable interpretations and do not necessarily mean "abnormal." They could simply be indicating change (including improvement) over past results. Therefore the provider should be queried regarding the meaning of the arrows and request that the appropriate documentation of a condition or diagnosis be provided. For example, the coder cannot assume that “ ↑Na” refers to “hypernatremia” or “↓Mg” refers to “hypomagnesemia.” The entire word must be written at least once in the record. Subsequent documentation can contain up/down arrows.

82 End of Life Issues Please clearly state the cause of death in your final progress note and/or death summary. Please document “comfort care”, “hospice,” “end of life care,” or “palliative care” when further aggressive treatment is no longer appropriate and treatment is focused only on relieving pain and discomfort. Please document secondary diagnosis such as coma, malnutrition, agonal respirations, shock, malnutrition, pressure ulcers. These require nursing care and monitoring and very often will affect the patient’s SOI and ROM calculation.

83 Malnutrition Malnutrition is most simply defined as any nutritional imbalance. People can suffer from overnutrition or undernutrition. Malnutrition is a major contributor to increased morbidity and mortality, decreased function and quality of life, increased frequency and length of hospital stay, and higher health care costs. Even overweight or obese adults who develop severe acute illness are at risk for malnutrition. .

84 On admission many critically ill patients, especially elderly patients, already are, or may be at significant risk of developing malnutrition and its related complications due to inflammation and or infectious process.

85 Old Malnutrition Query Form.
The old malnutrition query form focused on protein / albumin levels. “Research analysis indicated that these acute phase proteins do not consistently or predictably change with weight loss, calorie restriction, or nitrogen balance. They appear to better reflect severity of the inflammatory response rather than poor nutritional status. These lab tests, while probable indicators of inflammation, do not specifically indicate malnutrition and do not typically respond to feeding interventions in the setting of active inflammatory response; therefore, the relevance of these acute phase proteins as indicators of malnutrition, is limited. “ A.S.P.E.N.

86 New Malnutrition Query Effective September 2013
Since there is no single parameter that is definitive for adult malnutrtion, identification of two or more of the following six characteristics is recommended for diagnosis: Insufficient energy intake Wt loss Loss of muscle mass Loss of subcutaneous fat Localized or generalized fluid accumulation that sometimes masks weight loss Diminished functional status as measured by hand grips. A.S.P.E.N. Albumin and prealbumin may still be used as an “other clinical indicator”.

87 Questions? Please feel free to contact a Liaison. We are onsite Monday through Friday. Betsy Woodhouse RN Shawnalee Huskey RN Juan Patino, RN

88 Infection Prevention Hand Hygiene – Most important tool in preventing infections. We follow WHO guidelines for Hand Hygiene: Both before and after touching patient Before performing clean/aseptic procedure After touching patient’s surroundings After body fluid exposure Can use alcohol based hand sanitizer except in following circumstances: Hands visibly soiled or patient has/or is suspected of having C. difficile infection. MUST use soap and water. Mechanical action removes spores from hands.

89 Isolation Precautions
Standard Precautions used for all patients. Contact precautions for those entities spread by direct or indirect contact: MRSA, VRE, C. diff, and other MDRO’s including ESBLs, localized Shingles, MDR Pseudomonas and MDR Acinetobacter baumanii. Must wear gown and gloves when entering patient room. Droplet precautions for patients suspected or infected with diseases spread by large particle droplets: Meningococcal (Neisseria) meningitis, influenza, Pertussis, and Mumps. Must wear surgical mask. Airborne precautions prevent the spread of infectious droplet nuclei which remain suspended in the air: TB, Chicken Pox, disseminated Shingles and Measles. N-95 mask and negative pressure room.

90 Preventing Device Related Infections Bundles help ensure care on a consistent basis
IHI (Institute for Healthcare Improvement) Bundles *Central line Bundle includes use of insertion checklist* 1. Hand Hygiene 2. Maximum barrier precautions during insertion 3. Use of CHG 4. Optimal site selection-AVOID femoral in adults 5. Daily review of necessity- REMOVE unnecessary lines

91 Preventing Device Related Infections
Ventilator Associated Pneumonia 1. Elevate head of bed 30 degrees, if possible maintain during transport. 2. Daily sedation vacation-assess readiness to extubate. 3. Peptic ulcer prophylaxis 4. DVT prophylaxis unless contraindicated 5. Oral care- including tooth brushing and CHG rinse

92 Preventing Device Related Infections
Foley Catheter Associated Urinary Tract Infections 1. Daily review of need-OUT as soon as possible 2. Sterile technique for insertion. 3. Maintain closed drainage system. 4. Drainage bag below level of bladder at all times, even during transport. 5. Secure catheter to prevent migration. 6. Daily catheter care.

93 What are Hospital Acquired ConditIons (HACs)?
Required by the Deficit Reduction Act (DRA) of 2005. The Hospital-Acquired Conditions payment provision is a step toward Medicare VBP for hospitals Conditions that are: high cost or high volume or both; result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and could reasonably have been prevented through the application of evidence based guidelines. Infection Related Patient Safety Mediastinitis after coronary artery bypass graft (CABG) surgery Falls and fractures, dislocations, intracranial and crushing injury and burns Vascular catheter-associated infections Pressure ulcers Catheter-associated urinary tract infection *Surgical site infections *Glycemic Control *Ventilator-associated pneumonia *DVT/Pulmonary embolism

94 “Serious Preventable Adverse Event” Policy
Intra operative or immediate post operative death of ASA Class I patient Wrong site/ body part surgery Wrong patient surgery Wrong procedure surgery Death or disability associated with device use other than as intended Death or disability associated drugs, devices, or biologics contaminated during use Suicide or attempted suicide with disability while in facility Death or disability due to elopement Discharge of infant to wrong person Death or disability due to spinal manipulative therapy Stage 3 or 4 pressure ulcers, not present on admission or a result of multi-system organ failure Death or disability due to kernicterus Retained foreign object during surgery Death or disability from hypoglycemia with onset while a patient Maternal Death or disability associated with labor and delivery Death or disability due to hemolytic transfusion reaction Death or disability due to medication error Death or disability related to restraints Death or disability from fall Death or disability due burn Wrong gas delivered to patient Death or disability due to electric shock Death or significant injury of patient or staff member due to physical assault Physical or sexual assault within or on facility grounds Abduction of patient Care ordered by or provided by person impersonating a licensed healthcare provider Jill

95 Vascular Catheter-Associated Infection
Diagnosing Short Term Catheter Infections in Adults CDC/NHSN Surveillance Criteria CLABSI For patients with suspected CRBSI: Collect blood cultures prior to initiating antimicrobial therapy. Two peripheral venous blood cultures (separate sticks) are preferred over paired blood samples drawn from the catheter and a peripheral vein. Do not routinely culture catheter tips on removal unless there are clinical signs and symptoms for infection. Interpretation of Culture Results A definitive diagnosis of CRBSI requires: The same organism grow from at least 1 percutaneous blood culture and a quantity of >15 colonies from the catheter tip. Paired blood cultures, either from two peripheral separate sticks or one drawn from a catheter hub and the other from a peripheral vein, growing the same organism in a patient with clinical signs and symptoms and no other recognized source. Growth of >15 colony-forming units (cfu) from a 5-cm segment of the catheter tip by semiquantitative (roll-plate) culture from short-term nontunneled catheters, without a positive peripheral blood culture, is not diagnostic by itself, and likely a contaminant. If a catheterized patient has a single blood culture that grows coagulase-negative Staphylococcus species, then draw additional paired blood cultures from the catheter and peripheral site to be certain that the patient has a true bloodstream infection and that the catheter is the likely source. If any organism, pathogen or skin contaminant grows from the line only and the venous culture is negative, this probably represents hub contamination. Treatment for CRBSI Empiric antimicrobial coverage should be reevaluated when culture and susceptibility data are available and de-escalation of the antibiotic regimen can be done. Criteria 1: Patient has a recognized pathogen cultured from one or more blood cultures (at least one bottle), and organism cultured is not related to another site of infection. Recognized pathogen excludes organisms considered common skin contaminants Criteria 2: Patient has at least 1 of the following signs or symptoms: fever (>38oC), chills or hypotension AND signs and symptoms and positive laboratory results are not related to an infection at another site AND common skin contaminant is cultured from 2 or more blood cultures (at least one bottle from each set) drawn on separate occasions within two days of each other. Organism sameness is defined by speciation or descriptive name, with or without antimicrobial susceptibility results Purulent phlebitis confirmed with a positive semi-quantitative culture of a catheter tip, but with either negative or no blood culture is considered a vascular infection CVS-VASC, not a BSI.

96 Catheter-Associated UTI (CA-UTI)
Diagnosing Catheter-Associated Urinary Tract InfectionsCA-UTI in Adults Patient has at least one of the following signs or symptoms with no other recognized cause: Fever (>38°C or 100.3°F) new onset or worsening Altered mental status Malaise or lethargy Flank pain Pelvic discomfort / costovertebral tenderness Acute hematuria Or where catheters have been removed within the previous 48h: Urgent or frequent urination Dysuria Suprapubic pain or tenderness AND Patient has a positive urine culture, that is >=103 microorganisms per cc of urine of one or more bacteria species. ADDITIONAL TREATMENT INFORMATION Neither presence of pyuria nor cloudy or odorous urine, in a catheterized patient, should be interpreted as a need for urine culture or antimicrobial therapy. Absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI. 7 day tx duration for CA-UTI when symptoms promptly resolve. 14 day tx duration for CA-UTI with a delayed response Consider 5 days of Levofloxacin in CA-UTI when patient is not severely ill Consider 3 day tx duration in women age 65 years and less that develop CA-UTI without upper urinary tract symptoms after an indwelling catheter has been removed. Antimicrobial prophylaxis with systemic or irrigation agents is not recommended Important: Accurate documentation helps to assure correct coding and billing. Please use these guidelines to assist with documentation and treatment.

97 Case Management Department
In existence at SAMC since early 1996 Drives the discharge process Coordinate the care across the continuum, services and resources for patients/families Education of patient/family regarding continuum of care Conduct concurrent insurance reviews Plans and implements discharges with the interdisciplinary team Consists of both RNs & Social Workers   Case management is responsible for coordinating the care for patients across all aspects of the continuum. The goal of is to reduce the length of stay while providing proactive, safe discharge planning. They coordinate services and help patients/families find the available resources that they need. Education is a big component of what the case managers do to help the patients and their families understand discharge needs as well as the resources available. Case managers also obtain hospital certification for insurance companies. Interdisciplinary team meetings are held once a week on each unit and this helps with the coordination of care. These team meetings include nursing, social services, the RN case manager for the unit, pastoral care, patient educator and physical therapy/occupational therapy if necessary.  Both clinical and financial outcomes are reviewed and evaluated on a regular basis. The case managers monitor LOS, cost/case, patient outcomes, and track variances.

98 Your Role in Case Management
Interqual Criteria Code 44 Keeping the case manager informed of plans for the patient Communication with case manager is key to timely discharge/movement to next level of care Daily discharge of patients by 11:00 a.m. Case Management Office Blackberry To ensure efficient patient care, the case manager will drive the discharge process. Your role is to keep the case manager informed of your plans for your patients so that delays in discharge do not occur. You may be asked to participate in a interdisciplinary team meeting or patient/family conference for those patients who offer greater challenges. Communication with case managers is key to moving the patients through the continuum in a timely way and to the next level of care. If you have any questions about case management please be sure and ask the director of case management for further assistance and clarification of the case manager's role.

99 Spiritual Care – Ethics
Mark Elder, Director SDSAMC employs professional chaplains Available 24/7 Provide information and assistance with Advance Directives Bioethics Committee is co-chaired by a physician and chaplain. Meets quarterly. Responsible for bioethical consults, education, and policy recommendation. Texas Organ Sharing Alliance DNR Order Sheets Digital Pager # , Office # To ensure efficient patient care, the case manager will drive the discharge process. Your role is to keep the case manager informed of your plans for your patients so that delays in discharge do not occur. You may be asked to participate in a interdisciplinary team meeting or patient/family conference for those patients who offer greater challenges. Communication with case managers is key to moving the patients through the continuum in a timely way and to the next level of care. If you have any questions about case management please be sure and ask the director of case management for further assistance and clarification of the case manager's role.

100 Nursing Structure Led by the Chief Nursing Officer – Sally Gillam
Over 700 nurses employed Each nursing unit consists of a Nursing Unit Director, Nursing manager, Unit Supervisors, and unit shift charge nurses Support staff to include Patient care Technicians and unit clerks on each unit

101 Service Lines SAMC consists of major service lines:
Emergency Department Surgical Services Medical Surgical/Telemetry Women Services Oncology

102 Nursing Units/Representation
2 North/Post partum Labor & Delivery NICU Tina Mendiola 2 Central Noel DeSapio 3 Central 5 Central Rick Claycamp

103 Nursing Units/Representation
3 South 4 Central Tricia Casler ICU CVRU IMC Toni Fuller 6th Floor - Oncology

104 24/7 Nursing Representation
The House Supervisor is available 24/7 by calling 68888 The House Supervisor is the Air traffic controller, aka Bed Czar, and is responsible for all patient placement and transfers All incoming and outgoing will be through the House Supervisor The House Supervisor in addition to each nursing floor charge nurse is available to assist with anything

105 Kathryn Scoblick, Physician Relations Director
The Physician Relations Director is here for you! To help you get to know the facility, where things are and how processes work Help you with special requests, issue resolution, answer questions Help you meet other physicians in the area Physician Referral Line CME/Grand Rounds Kathryn Scoblick, Physician Relations Director (cell) The Director of Physician Relations is an extension of the South Austin Medical Center(SAMC) directors and executive teams and is committed to working with physicians and their staff to ensure satisfaction within all areas of SAMC. Kathryn Scoblick is the director in this position and will meet your needs: By informing you and your staff of updates, changes and new additions within SAMC. By acclimating you to the facility, where things are and how processes work. By keeping the lines of communication open with you and your staff in order to continue a high level of satisfaction with SAMC's services. By developing and implementing networking plans for you to meet referral sources in the community. By assisting you and your staff with issue resolution in a timely manner and relaying any special requests you may have through the appropriate channels. By answering any questions you and your staff may have. By adding you to the physician referral line as a means to grow your practice.

106 Educational Programs Medical Grand Rounds Ethics Credit
CPR/ACLS Education Tumor Board Conferences Medical Grand Rounds Medical Grand Rounds is presented as needed on the second Thursday of a designated month from 12:30 p.m.-1:30 p.m. in the Physician Conference Room. Announcements will be sent to you by and/or posted on The Participants will receive 1 hour Category I CME for attending the presentation. Ethics Credit programs are offered on occasion and can also be obtained from various website sources. For more information, please contact Kathryn Scoblick at or (cell) CPR/ACLS Education For more information please contact the Institute for Learning at Tumor Board Conferences Tumor conferences are held on the first and third Mondays of each month from 12:30 p.m. to 1:30 p.m. in the Physician Conference Room. For inquiries regarding SAMC Tumor Board, please contact Linda Rang, CTR, SAMC Cancer Program Coordinator at or Leslie Dalton, MD, SAMC Pathology Department at 106 106

107 Admissions & Central Scheduling
Hospital‘s Main Number Central Scheduling Main Central Scheduling Physician's Line Hours: 7:30 to 5:30 pm (After hours, contact the Operating Room or House Supervisor) Registration/Admissions 24hrs/7day # Director of Patient Access: Beverly McFarland House/Nurse Supervisor Physician's Direct Line to PBX operators In order to take advantage of the services we can provide to you and your patients, all procedures and pre-op appointments are scheduled through Central Scheduling. Contact numbers are listed on this slide. The policy for scheduling is attached behind this slide. Information on afterhours is also included. All Outpatient, Emergency, and Inpatient Registrations and Admissions are completed in our central Registration/Admissions area. Direct admits are arranged by contacting the House Supervisor. Managed Care, Billing and Central Verification Services South Austin Medical Center participates in all major insurance Managed Care Preferred Provider Programs. If you have any questions regarding managed care providers or your patient would like to discuss their coverage with our facility, please call Sonia Alvarado at SAMC has a centralized Shared Services Center (SSC) for all billing and follow-up processes. This office is located in San Antonio. If a patient has questions about their bill they can call and a customer service representative can assist them. Our market Central Verification Office (CVO) verifies and precerts surgical and clinical procedures. It is located at 3601 S. Congress, Bldg. G, Ste. 600, Austin, TX Resource Corp of America (RCA)is available on site during normal business hours to assist patients with screening for governmental assistance programs. This service is offered free of charge and RCA can screen the patients prior to the service. If patients need assistance ask them to call Other Resources for Hospital Contacts For additional contact information on specific departments or person (s) refer to the South Austin Medical Center’s Phone Directory. For procedures on central scheduling see attachments, under the admissions and central scheduling section. With help finding or searching for a physician a “Find A Physician” link is available at

108 One Call Patient Transfer Center
OneCall Patient Transfer Team is comprised of Registered Nurses, Paramedics, and EMTs, all with critical care experience available 24 hours a day St. David’s HealthCare OneCall Patient Transfer Center is your one stop, one call resource for: Emergency Transfers or Direct Admits Specialty Consults IP admissions from physician office and/or referring hospitals for patients who need a higher level of care Facilitation of ground and air transport Housed at SDM at East 30th St.

109 One Call Patient Transfer Center
To Transfer a Patient: 1)Call 2)The One Call Patient Transfer Team will ask for basic patient information including: Patient’s Name Referring Doctor/Hospital Reason for Transfer

110 Thank you for taking the time to view this orientation program
Thank you for taking the time to view this orientation program. We want your experience at St. David’s South Austin Medical Center to be the best in the city and we want to be your #1 facility of choice for your patients. Thank for taking the time to view this orientation program. We want your experience at St. David’s South Austin Medical Center to be the best in the city and we want to be your #1 facility of choice for your patients.

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