VA Pittsburgh Healthcare System. 2004 Annual Report. The cover image shows a doctor examining a patient. Jump to next link to skip additional information for assistive technology users. This document is best read using Adobe Reader 7.0 along with screen reader or other software capable of reading tags in PDF files. To navigate this document, use the Bookmarks panel. To read individual articles aloud in Adobe Reader, you can use the Article Bookmarks, which are also functional in many screen reader software. A link to the VA Pittsburgh Healthcare System website is provided in the Bookmarks. This PDF file has checked and validated as compliant with Section 508 per the standards described in 36 CFR subsection 1194.22. The agency validating compliance is Document Solutions, Inc., the provider of the compliance service for this PDF content. Document Solutions may be found online at www.document-solutions.com.VA Pittsburgh Healthcare System Page Two. Our Values. Teamwork, Caring, Innovation, Customer Focus, Excellence and Integrity are the values on which we build our future. A handshake. Undeniable Momentum. Michael E. Moreland, Director, VAPHSDear Fellow Employees, Volunteers, Veterans and Friends of the VAPHS, I am thrilled and honored to be part of the tremendous health care team here at the VA Pittsburgh Healthcare System. We are in an enviable position -in every regard. At a time when many major health care institutions are facing declining patient enrollment and extreme budget shortfalls, the VA Pittsburgh Healthcare System remains strong, ending the 2004 fiscal year on budget. We also enjoyed a continued strong growth in patient enrollment in 2004 with over 55,000 unique patients seen and 450,710 outpatient visits, which represents an increase of several thousand over the previous fiscal year. I credit the entire VAPHS Staff -guided by our leaders, Pat Nealon, Rajiv Jain, MD, and Ira Richmond -for that success. Today, all major health care systems in the country are confronted with daunting challenges. However, the numerous strengths and stability of the VA Pittsburgh Healthcare System, the dedicated workforce and the clear and present need of our veterans makes our future both challenging and exciting. Our institutional commitment and focus on improvement of health care for our patients and their families has never been stronger. This annual report offers just a glimpse of the people and programs that not only make us special, but which have propelled us to becoming one of the leading health care systems in the country. I’m especially pleased to have this opportunity to recap 2004 for you -and to share just a few of the most significant achievements that took place in what was an extremely important year for the VA Pittsburgh. I am grateful and blessed to have the opportunity to lead one of our nation’s best health care systems. Signature of Michael E. Moreland, Director, VA Pittsburgh Healthcare Systemwww.va.gov/pittsburgh VAPHS 2004 Snapshot 55,231 unique veterans served 692 operating beds Over 450,710 outpatient visits 40 liver transplants 11 kidney transplants $9,729,705 in construction 201,347 bed days of care 2,449.30 FTEE 1,405 regular volunteers Page Three. Top Ten Accomplishments in 2004. Logo of the Pittsburgh VA Healthcare System.Major Construction Project Construction plans by division University Drive (UD) Division University Drive will begin construc- tion of a new 1,500 space parking garage at the east side of the existing medical center in the spring of 2005. Infrastructure improvements to the surrounding campus may include new traffic lights, turning lanes, expanded roads, new roads, etc. New construction at the UD campus will include: 208,000 square feet of new construction for new behavioral health outpatient clinics and psychiatric inpatient nursing units in a stand-alone mental health pavilion. New construction will also include a new Audiology Clinic, educational facilities, pharmacy, and new space for research. 24,000 square feet of renovation will consist of: Renovations to the existing ECC into an urgent and psychatric care admissions area. Relocation of the Eye Clinic for improved access to patients. Expansion of the pharmacy to accommodate increased workload and improved access to patients. Other smaller renovations to accommodate relocated programs include: administrative and lab space for research, police, and business services. H.J. Heinz Division The H.J. Heinz Division may begin construction of new and renovated space as early as 2006. Infrastructure improvements to the surrounding campus may include improved access, turning lanes, etc. Planning the location of buildings and parking space is nearly finalized. A total of 1,200 parking spaces will be available after the construction to accommodate the increase in veterans and employees. Upon completion of construction, the H.J. Heinz campus will include 264,000 square feet of new construction for: A new ambulatory care building for Audiology, Dental, Prosthetics, Primary Care, Adult Day Care, Rehab Medicine, Social Work, and an outpatient pharmacy. State-of-the-art domiciliary will be built to include a central building with 8 home-like residential villas, Center for the Treatment of Addictive Disorders (CTAD), and the Health Care for Homeless Veterans (HCHV) program. An administrative building will be constructed for human resources, fiscal operations, and other administrative services. New engineering space. A new laundry building to replace the facility at Highland Drive. Stakeholder Feedback Over 70 employees participated in over 150 hours ofFocus Review Groups 1,500 fliers and 700 direct invitations were distributed to veterans, veteran service organizations, returningOEF/OIF soldiers, and active duty military soliciting theirinvolvement and input into the design in December 2004. CONSTRUCTION TIMELINE Winter 2004 Design funding 2005 Parking garage at University Drive 2005 Demolish Heinz quarters 2006–2011 Mental health pavilion at University Drive Ambulatory and Business Services at Heinz Residential villas at Heinz Laundry at Heinz From left to right, US Senator Specter, Secretary of Veterans Affairs Principi, and Director of the VAPHS Moreland answer questions about the construction project award at a press conference May 7, 2004.Independent liver and kidney transplant program established In January 2004, the VA Pittsburgh Healthcare System began the first independent, in-house VA transplant center in the country. This means that the VAPHS has its own United Network for Organ Sharing (UNOS) charter for liver and kidney transplants. The VAPHS independent transplant center’s first year has proved to be an amazing success. Forty liver transplants were successfully performed between January 10 and December 21 this year. In addition, since becoming an independent program, the VAPHS has performed 11 kidney transplants, of which eight involved living-related donors. Prior to becoming an independent transplant center, the VAPHS existed as a Deans Committee hospital of the University of Pittsburgh/University of Pittsburgh Medical Center and their UNOS charter. The independent UNOS charter has allowed the VA Pittsburgh to focus its program specifically on veterans’ issues. With the establishment of this independent charter, the VA Pittsburgh has performed over twice the number of liver transplants this year than were performed here last year (19). Surgical Clinic wait times have also been substantially reduced since the inception of the independent program. The goal of the liver transplant program is to eventually perform 40-50 liver transplants per year. To accompany its innovative, independent liver transplant program, the VAPHS hired a team of highly experienced and dedicated surgeons. Dr. Thomas Cacciarelli is the Medical Director for the VAPHS Transplantation Program and is accompanied by transplant surgeons, Dr. Mohamed Akoad and Dr. Ivonne Daly. The independent kidney trans plant program has also been initi ated this year and it is anticipated that there will be substantially larger volumes of kidney transplants performed each year. VAPHS made the strategic decision to enter into a contractual agreement with AlleghenyGeneral Hospital for kidney trans plant physician services. However, the VAPHS had dedicated significant resources in support of renal trans plant patient care, including nurses, units, support staff, etc, for renal transplant patients. Dr. Carlos Vivas and Dr. Dai Nghiem join Dr. Nabeel Aslam, Program Director for Kidney Transplantation, in managing kidney transplants from both living donors as well as deceased donors. The VAPHS transplant program also includes: four nurse coordinators, two physician assistants, three administrative support staff, as well as a foundation of dedicated inpatientnurses. - Liver Transplant Medical Director Dr. Thomas Cacciarelli, and Kidney Transplant Medical Director Dr. Nabeel Aslam.Operating room in action.www.va.gov/pittsburgh Page 3. Top Ten Accomplishments for 2004, continued.Additional telemetry capacity In 2004, four additional telemetry beds were added to 4W Surgical Enhanced Care/Telemetry area. This brought the surgical telemetry capability to a total of 8 beds. All patients admitted to 4W Surgical Enhanced Care/ Telemetry are now continuously monitored for cardiac arrhythmias via a computerized arrhythmia analysis system. The nursing staff is immediately informed of any cardiac arrhythmia the patient may be experiencing by way of a computerized alarm system. In addition, new equipment was purchased to permit non-invasive blood pressure and continuous pulse oximetry monitoring on any patient who requires a higher evel of monitoring. In order to implement this additional telemetry capability, extra nursing staff were hired and trained in cardiac arrhythmia monitoring and interpretation. Nurses also attended additional training in the care of patients undergoing high acuity surgical procedures. As a result, 4W Surgical Enhanced Care/Telemetry is now able to care for patients recovering from open heart, renal transplant, and bariatric surgical procedures. Added digital radiography The VAPHS Department of Radiology has achieved a milestone in modernization, efficiency and cost savings. Computerized and Digital Radiography has been implemented at the VAPHS, resulting in the capability to produce images that can be electronically accessed throughout the hospital, transferred to CDs and archived to electronic media for permanent retention. This enables the department to function more economically and efficiently. As of December 6, 2004, the department has become “filmless.” Radiology is no longer printing x-ray films. All studies are now obtained digitally, transmitted to a large high-resolution computer screen to be read by the radiologist. The addition of voice recognition as the dictation system of the reports has increased the efficiency and decreased any delays. This has markedly improved patient care and increased the efficiency of the department. Tests that would take 30- 40 minutes are now performed in 10 minutes. The quick turn around time has allowed us to see more patients, markedly decreasing the waiting time for Radiology studies with immediate access. The Radiology Department has met and exceeded the National Standards for performance measures. This was accomplished without adding any new staff, and has allowed file room staff to assist in scheduling efforts for more efficient and friendly customer service. Nuclear medicine capacity added Nuclear Medicine sees a variety of patients, many of who have a course of medi cal care, which is dependent on the results of a Nuclear Medicine scan. In November of 2003, this service set a goal to increase capacity, reduce wait times and ultimately allow the patient to proceed on with their medical care. At that time, waiting periods for all tests combined were close to fourteen weeks for outpatients and one to three days for inpatients. A plan was formulated to add an additional nurse specialist, a nuclear medicine technologist and three stateof-the-art scanning cameras at a cost of slightly over one million dollars. In October and November of 2004, two new scanning cameras were installed with the third installation being set for February 2005. With the commitment of the staff, and the backing and cooperation of the leadership, wait times have already dropped to slightly over four weeks. There is no wait time for inpatients, our daily capacity has doubled and cuttingedge technology is now available to all our veteran patients. Renovation of inpatient psychiatry and specialty clinics, including hematology/ oncology Striving to improve patient care outcomes for our veterans, the VAPHS extensively renovated space for the Acute Inpatient Psychiatry Unit at the Highland Drive Division. Previously housed in Building 2, the busy unit was moved early in 2004 to Building 1 after a major renova tion to an existing medical unit. The improvements included reconfigur ing walls and room space for better patient/staff interaction, innovative safety features in bedrooms, bath rooms, and even ceilings to help prevent injury, and new computer equipment for staff documenta tion. The renovation also included a dayroom with satellite TV and a diningroom that overlooks the Allegheny River. The unit has been well received by staff, patients, and their families; the unit is larger, brighter and more conducive to therapeutic intervention which well serves the patient population diagnosed with major depression, anxiety disorders, and substance abuse issues. The Outpatient Hematology/ Oncology Clinic at the University Drive Division was renovated and opened in February of 2004. This unit provides state-of-the-art care in the management of patients who are receiving chemotherapy. The unit provides a larger and more pleasant environment for the patients. The unit is staffed by three nurses trained and certified in oncology. It was developed recognizing the importance of providing a pleasant environment for patients who are sick and anxious. The increased space allows families to be present with the patient and provide support. VAPHS staff at work. Page Four. Top Ten Accomplishments of 2004, continued.Palliative care program A palliative care program was estab- lished at the Heinz Division to provide a multidisciplinary approach to the treatment of patients at the end of life. This new program is divided into two units, providing 30 palliative care beds, 38 geriatric palliative care beds and six hospice beds. These units are staffed by health care personnel who elected to work on the unit and care for patients at the end of life and receive end-of-life care. By providing a specialized unit for these patients, the VAPHS is able to provide comprehensive quality care for the patients and their families. Care includes symptom management, spiritual support and bereavement for families. An awareness by the medical profession about the importance of palliative care and what it can provide has resulted in an increase in the number of consults for moving patients to this unit. Homemaker/ home health aide program expanded One of the goals identified by the Quality Steering Team of Community Based Care Service is to double the number of veterans enrolled in the H/HHAide Program. The H/HHAide census is steadily increasing. At the beginning of FY04, there were 164 enrollees. At the end of FY04, there were 266. This is largely due to newly identified goals and having another clinical social worker assigned to the program. The goal of the H/HHAide Program is to enable the veteran to remain in their home, resulting in a higher quality of life. The VAPHS strives to provide aides for these veterans who care for them with respect and dignity, and enable the veteran to have confidence and trust in their aide. This year, the H/HHAide Program implemented a new program entitled the ‘Homemaker/Home Health Aide In-Home Respite Program.’ These services are authorized on a short-term basis for the purpose of providing relief to a caregiver of a functionally impaired veteran. Adult dayhealth care capacity increased The Adult Day Health Care Program (ADHC) at the Heinz Division reached maximum capacity last year. After renovations, the ADHC relocated to Building 6 of the Highland Drive Division. The new location more then doubled the space of the ADHC with two large and roomy dayrooms, one secured for dementia patients, one open, recreation room for crafts and ceramics, and a large outdoor secured patio with planters. Three additional staff were hired and oriented. In January of 2004, the ADHC expanded into two separate programs, a dementia program and a general program that run simultaneously 5 days a week. Since the expansion, the total enrollment has climbed from 48 patients to 81. The average daily census has grown from 17 patients a day to 30 patients a day. Patients, families and/or caregivers indicate they are very pleased and impressed with the new location and expansion of the program. Images from home health and adult day heath programs.Operating rooms renovated The VAPHS completed architectural renovations of ORs 5 and 6, to include new wall and flooring surfaces designed to minimize opportunities for infection. These improvements made in 2004 were part of a larger scale, $1.8 million project to improve the operating room area in its entirety. The OR project commenced in January 2003 with improvements made in ORs 8 and 9. A new air handling system was also installed and cosmetic improvements were made to the OR front desk and back hallway. Concurrent with this project, the VAPHS is in the activation phase of a new endosurgery room. With the addition of state-of-the-art surgical, video, and communications equipment in OR 5, surgeons will be able to perform a wider variety of procedures utilizing minimally inva sive techniques. This equipment will also enhance the VAPHS’ ability to fulfill its educational mission, as surgical residents and attending physicians from other centers will be afforded better viewing opportunities while learning surgical techniques. Operating room in action. Research Accomplishments Dr. Shirley Fitzgerald, Research Scientist in VAPHS Human Engineering Research Laboratory (HERL), received an award from Rehabilitation Research and Development to study the role of service dogs to aid disabled veterans. Frederick DeRubertis, MD, received a 1 million dollar award from the Department of Defense to establish a telemedicine quality improvement initiative at VAPHS. The project will utilize home-based telemetry units to communicate blood glucose and blood pressure medicine measurements of patients directly to practitioners. This initiative will improve the treatment of diabetes and hypertension in veterans with hard to control diabetes and hypertension. The Center for Health Equity Research and Promotion received three new career development awards to fund new investigators to begin their research careers in this area. Newly renovated biomedical laboratory space opened on 1-West and 2-East/2- Center at UD. The 2-East space has been occupied by David Roodman, MD, an internationally known VA- and NIH-funded cancer specialist. Dr. Roodman and his group study multiple myeloma and other diseases of bone. The laboratories on 1-West are occupied by Dr. Mark Wilson, Chief Surgeon at VAPHS. Dr. Wilson is funded by the Department of Energy to develop implantable micro instrumentation systems to monitor organs in critically ill patients. The 2-center space has been used to recruit two outstanding new clinician pathologists to VAPHS, Rafael Medina-Flores, MD and Dmitriy Gutkin MD, PhD, who will conduct research and practice at VAPHS. Rory Cooper, PhD, Director of the Human Engineering Resource Laboratory, was appointed by the University of Pittsburgh to be the first holder of the Federation of Independent School Alumnae Foundation Paralyzed Veterans of America Chair for Rehabilitation Engineering. Dr. Cooper’s appointment to this endowed Chair, is the result of a dynamic career in the field of rehabilitation engineering and assistive technology. As a researcher and a veteran, Dr. Cooper has dedicated his career to helping veterans with spinal cord injury live to their fullest potential. Dr. Rory Cooper, Director of HERLFor fiscal year 2004, we had 109 active investigators performing 246 projects. Our research funding breakdown: VA $10,316,270 Non-VA funding $14,218,367 Foundation $3,401,768 Total $27,936,405 Page Five. Financial Report. Total Medical Appropriation and MCCF * $307,357,379 ** Reflects funds transferred to CMOP Operating Expenses Pie Chart. The chart contains the following information:Salary and Benefits $178,415,958 Drugs and Medicine $15,652,545 Other Supplies $43,505,099 Services $32,668,832 Consolidated mail out pharmacy. Reflects funds transferred to CMOP. $26,983,969 Other Expenses $10,130,976 Total Operating Expenses $307,357,379 Collections MCCF Collections $16,242,723 Extended Care Collections $117,809 Total Collections $16,360,532 Community Gifts & Donations Cash Donations $427,826 In-Kind Donations $515,716 Total Donations $943,542 * Excludes NR Capital Expenditures Statistics Workload Statistics Total Operating Beds Hospital 291 Nursing Home Care Unit (NHCU) 336 Domiciliary 65 Total 692 Admissions Hospital 6,984 NHCU 946 Domiciliary 497 Total 8,427 Unique Patients 55,231 Hospital 74,851 NHCU 103,576 Domiciliary 22,920 Total 201,347 Patient Days Average Daily Census Hospital 204.5 NHCU 283.0 Domiciliary 62.6 Total 550.1 Acute Length of Stay (days) University Drive 6.6 Highland Drive 3.6 Total Average 5.1 Number of Inpatients Treated Hospital 7,187 NHCU 1,264 Domiciliary 562 Total 9,013 Outpatient Visits St. Clairsville 10,800 Greensburg 11,035 Aliquippa 7,515 Washington 6,951 University Drive 267,479 Heinz 32,111 Highland Drive 114,819 Total 450,710 Staffing Statistics Employees 2,605 (does not include Research, VISN, Canteen) FTEE 2,449.30 Full Time Physicians 81 Volunteers 1,405 Volunteer Hours 152,899 Chart of Unique Patients. FY 2000: 45,501, FY 2001: 49,085, FY 2002: 53,642, FY 2003: 52,990, FY 2004: 55,231.Outpatient Visits. FY 2000: 373,596, FY 2001: 404,903, FY 2002: 408,678, FY 2003: 434,243, FY 2004: 450,710.Obligations per unique patient. FY 2000: $5,102, FY 2001: $5,083, FY 2002: $4,958, FY 2003: $4,205, FY 2004: $5,563.LeadershipFrom left to right: Ira Richmond, RN, CNAA Associate Director for Patient Care Services Rajiv Jain, MD Chief of Staff Michael E. Moreland Director Patricia Nealon Acting Associate Director“All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence” MLK, Jr. Back cover of the Annual Report. Arial views of VA Pittsburgh facilities From left to right: H. John Heinz III Progressive Care Center University Drive Division Highland Drive DivisionThe VA Pittsburgh Healthcare System University Drive Pittsburgh, PA 15240 1-866-4 VA PITT www.va.gov/pittsburgh VA Pittsburgh Healthcare System logo.Setting New Standards in Healthcare