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Parkland Hospital Analysis Shows Problems Continue

 |  By Margaret@example.com  
   February 22, 2012

Consultants for the troubled Parkland Health and Hospital System submitted on Friday a corrective action plan it hopes will resolve ongoing deficiencies identified during an intensive three-month review of the hospital by Alvarez & Marsal Healthcare Industry Group, a New York-based management consulting firm that specializes in performance improvement.

Officials in the Dallas office of the Centers for Medicare & Medicaid Services are reviewing the CAP document. If they approve it, the document will be released to the hospital. That could happen early next week according to a CMS spokesperson. At that time the hospital or CMS will be free to publically release the CAP.

The CAP addresses a scathing gap analysis report also prepared A&M, which details a laundry list of shortcomings affecting almost every department in the health system. Both the CAP and the gap analysis are part of the systems improvement agreement between CMS and Parkland that allows the storied facility to remain open while it attempts to correct deficiencies that have threatened its closure.

A&M has a multi-million dollar contract with Parkland to guide the beleaguered hospital through the SIA process.

According to A&M's analysis, the safety-net hospital still has deficiencies that are significant enough to affect its Medicare participation. "If the deficiencies catalogued in this report are not addressed and remedied Parkland could not pass a CMS hospital survey and would not continue as Medicare participating hospital," the report reads.

A&M's report has not been formally released, but has been posted online.  The report is currently under review by the CMS Freedom of Information Group office in Baltimore. No timeline for its release by CMS is available. Parkland officials cited legal concerns in declining to make the document available.

According to the document, serious deficiencies continue at Parkland in 20 broad categories, including nursing services, utilization review, infection control, discharge planning, lab, surgical and emergency services, and professional practice evaluation.

The analysis by A&M cites numerous specific incidences "that lead to an overall concern about the safety of the care environment at Parkland" such as:

  • An emergency department patient who was triaged and provided a medical screening exam but waited for 14 hours before a staff member noticed that the patient's care hadn't been completed.
  • House cleaning staff moved a patient to a hallway to clean the patient's room then took a lunch break without completing the cleaning or returning the patient to the room.
  • Some 250 medication errors over three months with 58% involving the wrong dose, wrong drug, wrong patient or wrong frequency.
  • Discharging psychiatric ER patients with only bus vouchers and instructions to call 911 in the event of recurring suicidal thoughts
  • Patients leaving the hospitals without having ports or other lines properly removed.
  • A patient whose surgery had to be terminated after anesthesia had been administered because of staff failed to obtain signed consent for the procedure.
  • Residents taking cell phone pictures of surgical procedures in violation of patient privacy rules
  • Missing supplies from crash carts that involved an eight minute delay in a code team's efforts to resuscitate a patient.
  • Lack of resident oversight by an attending physician that resulted in procedures being incorrectly performed. The report notes one incident when a resident made six failed attempts to place a peripheral arterial line.

Parkland has been under intense scrutiny by federal and state official since mid 2011 and the report authors expressed surprise at the number of negative patient events encountered there since Nov. 2011. "The frequency and number of potential trigger events suggest that self-corrective actions taken by the hospital in response to the CMS surveys…have not been effective in creating a safer care environment."

While Parkland officials have declined to comment on any specifics of the gap analysis, Tom Royer, MD, interim CEO of Parkland Health & Hospital System, told HealthLeaders Media in a recent telephone interview that he has already implemented several changes designed to address some of the consulting firm's concerns. Royer said the hospital has started

  • A daily huddle. The management team meets to review events of the past 24 hours to make sure any necessary corrective actions are taken, that the right policies are in place and that the staff is abiding by the policies. Royer says this has helped with what he calls "rapid cycle improvement."
  • Reorganization of nursing services. A new chief nursing officer is in place and charged with developing a systemic and consistent approach to nursing practices. Royer notes that about 75% of Parkland's problems involve inconsistent nursing practices across the system. He wants to see more empowerment for nurses and more team building among the nurses, lead physicians, department chairs, and administrators.
  • Reorganization of management team. The team now includes the head of human resources and the head of communications. Royer says human resources will make sure the hospital hires the right people, that employees are disciplined in a consistent fashion and that an accountable culture develops across the health system. Communications will help make sure that the health system has a consistent message across its departments.
  • Creation of a medical executive committee. This group has responsibility for physician improvement issues, including resident training. The gap analysis report is very critical of the resident training program and attributes the "current operation of Parkland's resident training program" as contributing to the hospital's deficiencies in meeting all standards of the conditions of participation."
  • Hiring of an Implementation officer. This position will be in place for the life of the SIA—six to 12 months—to make sure the improvement plan stays on track.


Royer says he plans to stage a mock CMS survey in a couple of months using two or three people familiar with the work of the CMS and Joint Commission. "Once we're satisfied that all of the improvements are in place we'll schedule a real survey," he said.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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