VA Pittsburgh Healthcare System 2004 Annual Report nnn n EAMWORK CARING INNOVATION CUSTOMER FOCUS nn nn XCELLENCE INTEGRITY TEAMWORK CARING INNOVATION n nn CUSTOMER FOCUS EXCELLENCE INTEGRITY TEAMWORK nn nn CARING CELLENCE NTEGRITY n TEAMWORK EXCELLENCE n NNOVATION CARING INNOVATION CUSTOMER FOCUS EXCELLENCE NTEGRITY n TEAMWORK USTOMER FOCUSINTEGRITYINNOVATION USTOMER FOCUSINTEGRITY NNOVEXCELLENCE n ATION CUSTOMER FOCUS EAMWORK nn CUSTOMER FOCUS EAMWORK nn nn CARING INNOVATION CUSTOMER FOCUS EXCELLENCE NTEGRITY n TEAMWORK n CARING n INNOVATION n CUSTOMERFOCUS EXCELLENCE n INTEGRITY n TEAMWORK n CARING n INNOVATION n nn CUSTOMER FOCUS EXCELLENCE INTEGRITY TEAMWORK Our nn nn CARING INNOVATION CUSTOMER FOCUS EXCELLENCE NTEGRITY n TEAMWORK n CARING n INNOVATION n CUSTOMERFOCUS Values EXCELLENCE n INTEGRITY n TEAMWORK n CARING n INNOVATION n nn CUSTOMER FOCUS EXCELLENCE INTEGRITY TEAMWORK Teamwork, Caring, Innovation, nn nn CARING INNOVATION CUSTOMER FOCUS EXCELLENCE Customer Focus, Excellence NTEGRITY n TEAMWORK n CARING n INNOVATION n CUSTOMERFOCUS and Integrity are the values on EXCELLENCE n INTEGRITYn TEAMWORK n CARING n INNOVATION which we build our future. n nn CUSTOMER FOCUS EXCELLENCE INTEGRITY TEAMWORK nn nn CARING INNOVATION CUSTOMER FOCUS EXCELLENCE NTEGRITY n TEAMWORK n CARING n INNOVATION n CUSTOMERFOCUS EXCELLENCE n INTEGRITY n TEAMWORK n CARING n INNOVATION Michael E. Moreland Director, VAPHS Undeniable MomentumUndeniable Momentum Dear 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. Michael E. Moreland Director VA Pittsburgh Healthcare System www.va.gov/pittsburgh page 2 VAPHS 2004 Snapshot n55,231 unique veterans served n692 operating beds nOver 450,710 outpatient visits n40 liver transplants n11 kidney transplants n$9,729,705 in construction n201,347 bed days of care n2,449.30 FTEE n1,405 regular volunteers EAMWORK nCARING nINNOVATION nCUSTOMER FOCUS nEXCELLENCE NTEGRITY nTEAMWORK INNOVATION nCUSTOMER FOCUS XCELLENCE nINTEGRITY TEAMWORK nCARING nINNOVATION CUSTOMER FOCUS nEXCELLENCE nINTEGRITY nTEAMWORK CARING nINNOVATION nCUSTOMER FOCUS nEXCELLENCE nTop Ten Accomplishments 2004 University Drive (UD) Division Construction plans by division 24,000 square feet of renovation Renovations to the existing ECC into an urgent and psychi- atric care admissions area. Relocation of the Eye Clinic for improved access to patients. Expansion of the pharmacy to accommodate increased work- load and improved access to nOther smaller renovations to accommodate relocated programs include: administra- tive 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 nnnMajor Construction Project nOver 70 employees participated in over 150 hours ofFocus Review Groups n1,500 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. Stakeholder Feedback Independent liver and kidney transplant program established 2 In January 2004, the VA Pittsburgh plant program has also been initi- Healthcare System began the first ated this year and it is anticipated independent, in-house VA transplant that there will be substantially larger center in the country. This means volumes of kidney transplants that the VAPHS has its own United performed each year. VAPHS made Network for Organ Sharing (UNOS) the strategic decision to enter into a charter for liver and kidney trans-contractual agreement with Allegheny plants. The VAPHS independent General Hospital for kidney trans- transplant center’s first year has plant physician services. However, proved to be an amazing success. the VAPHS had dedicated significant Forty liver transplants were success-resources in support of renal trans- fully performed between January 10 plant patient care, including nurses, and December 21 this year. In addi-units, support staff, etc, for renal tion, since becoming an independent transplant patients. Dr. Carlos Vivas program, the VAPHS has performed and Dr. Dai Nghiem join Dr. Nabeel 11 kidney transplants, of which eight Aslam, Program Director for Kidney involved living-related donors. Transplantation, in managing kidney Prior to becoming an independent transplants from both living donors transplant center, the VAPHS existed as well as deceased donors. as a Deans Committee hospital of the The VAPHS transplant program TEAMWORK nCARING INNOVATIONnCUSTOMER FOCUS nEXCELLENCE nTEAMWORK nINNOVATION CUSTOMER FOCUS EXCELLENCE nTEAMWORK nINNOVATION CUSTOMER FOCUS EXCELLENCE INTEGRITY nTEAMWORK nCARING nINNOVATION USTOMER FOCUS CELLENCE NTEGRITY nTEAMWORK nCARING nINNOVATION page Top Ten Accomplishments 2004 n 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: n 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. will consist of: n n n patients. 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. n New engineering space. n A new laundry building to replace the facility at Highland Drive. 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 establish- also includes: four nurse coordinators, two physician assistants, three administrative support staff, as well as a foundation of dedicated inpatient nurses. www.va.gov/pittsburgh page 3 www.va.gov/pittsburgh ment 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- 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 (L to R) 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. Liver Transplant Medical Director Dr. Thomas Cacciarelli & Kidney Transplant Medical Director Dr. Nabeel Aslam Renovation of inpatient n psychiatry and specialty clinics, 543NNOVATION nCUSTOMER OCUS nEXCELLENCE NTEGRITY nTEAMWORK CARING nINNOVATION CUSTOMER XCELLENCEnINTEGRITY TEAMWORK nNNOVATION OCUS nEXCELLENCE NTEGRITY nCARING nCUSTOMER FOCUS nXCELLENCEnINTEGRITY TEAMWORK nCARING nNNOVATION nCUSTOMER OCUS nEXCELLENCE nNTEGRITY nTEAMWORK CARING nINNOVATION CUSTOMER FOCUS nXCELLENCEnINTEGRITY TEAMWORK nCARING nNNOVATION nCUSTOMER OCUS nEXCELLENCE nNTEGRITY nTEAMWORK Top Ten Accomplishments 2004 In 2004, four additional telemetry beds were added to 4W Surgical Enhanced Care/Telemetry area. This brought the surgical telem- etry capability to a total of 8 beds. All patients admitted to 4W Surgical Enhanced Care/ Telemetry are now continu- ously monitored for cardiac arrhythmias via a comput- erized 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 level of monitoring. In order to implement this additional telemetry capabil- ity, extra nursing staff were hired and trained in cardiac arrhythmia monitoring and interpretation. Nurses also attended additional training in the care of patients undergo- ing high acuity surgical proce- dures. 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. Additional telemetry capacity 6for the Acute Inpatient Psychiatry 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, bright- er 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 devel- oped 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. Added digital radiography The VAPHS Department of Radiology has achieved a milestone in modernization, efficiency and cost savings. Computerized and Digital Radiography has been imple- mented 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 reten- tion. This enables the department to func- tion 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 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, mark- edly 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 accom- plished without adding any new staff, and has allowed file room staff to assist in scheduling efforts for more efficient and friendly customer service. added Medicine scan. In November of 2003, this service set a goal to increase capacity, reduce wait times and ulti- mately allow the patient to proceed on with their medi- cal 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 special- ist, a nuclear medicine technologist and three state- of-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 instal- lation being set for February 2005. With the commitment of the staff, and the backing and cooperation of the leader- ship, wait times have already dropped to slightly over four weeks. There is no wait time for inpatients, our daily capac- ity has doubled and cutting- edge technology is now available to all our veteran patients. including n FOCUS hematology/ oncology Nuclear medicine CARING n Striving to improve patient care outcomes for our veterans, the VAPHS extensively renovated space capacity n CUSTOMER Unit at the Highland Drive Division. Previously housed in Building 2, the n Nuclear Medicine sees a busy unit was moved early in 2004 variety of patients, many of to Building 1 after a major renova- TEAMWORK who have a course of medi tion to an existing medical unit. The cal care, which is dependent improvements included reconfigur on the results of a Nuclear INNOVATION 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 voice recognition as the dictation system CARING nINNOVATION CUSTOMER FOCUS www.va.gov/pittsburgh page 6page 5 www.va.gov/pittsburgh www.va.gov/pittsburgh page 8page 7 www.va.gov/pittsburgh 7891The VAPHS completed architec- tural renovations of ORs 5 and 6, to include new wall and flooring surfaces designed to minimize oppor- tunities for infection. These improve- ments 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- Operating rooms renovated Palliative care program 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, result- ing 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 confi- dence 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 func- tionally impaired veteran. n Frederick DeRubertis, MD, received a 1 million dollar award from the Department of Defense to establish a tele- medicine quality improvement initiative at VAPHS. The proj- ect will utilize home-based telemetry units to communi- cate blood glucose and blood pressure medicine measure- ments of patients directly to practitioners. This initiative will improve the treatment of diabetes and hypertension in veterans with hard to control diabetes and hypertension. n 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. n 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. n 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. Dr. Rory Cooper, Director of HERL For 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 n 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. Research ARccomplishmentsesearch AccomplishmentsA 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 impor- tance of palliative care and what it can provide has resulted in an increase in the number of consults for moving patients to this unit. OCUS EXCELLENCE INTEGRITY TEAMWORK CARING INNOVATION CUSTOMER FOCUS CARING n INNOVATION n CUSTOMER FOCUS n EXCELLENCE n INTEGRITY n TEAMWORK n C XCELLENCE n INTEGRITY n TEAMWORK n CARING n INNOVATION n CUSTOMER FOCUS n EXCELLENCE NNOVATION n CUSTOMER FOCUS n EXCELLENCE n INTEGRITY n TEAMWORK n CARING n INNOV Top Ten Accomplishments2004 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. 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, 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 Expenses Collections Financial Report Leadership Total Medical Appropriation and MCCF * __________________ $307,357,379 Salary and Benefits ____$178,415,958 MCCF Collections ______$16,242,723 ..... . ............ . ....... . ........ ...... ........ ......... ........ ........ . Drugs and Medicine_____$15,652,545 Extended Care Collections _ $117,809 ....... . Other Supplies_________$43,505,099 Total Collections ______$16,360,532 Services______________$32,668,832 Consolidated Mail-out Pharmacy **___________$26,983,969 Community Gifts & Donations Other Expenses________$10,130,976 Cash Donations__________ $427,826 Total OperatingIn-Kind Donations ________ $515,716 Expenses ___________$307,357,379 Total Donations _________ $943,542 * Excludes NR Capital Expenditures ** Reflects funds transferred to CMOP ....... . ....... . Statistics Number of Inpatients Treated Workload Statistics Total Operating Beds Hospital__________________ 7,187 Hospital __________________ 291 NHCU ___________________ 1,264 Nursing Home Domiciliary ________________ 562 Care Unit (NHCU) __________ 336 Total _____________________ 9,013 Domiciliary _________________ 65 Total ______________________ 692 Outpatient VisitsIra Richmond, Rajiv Jain, Michael E. Patricia Nealon St. Clairsville_____________10,800RN, CNAA MD Moreland Acting Admissions Greensburg______________ 11,035 Associate Chief of Staff Director Associate Hospital__________________ 6,984Aliquippa_________________7,515Director for Director NHCU ____________________ 946 Washington_______________ 6,951Patient Care Domiciliary ________________ 497 University Drive _________ 267,479Services Total _____________________ 8,427 Heinz __________________ 32,111 Highland Drive __________ 114,819 Unique Patients ___________ 55,231 Total____________________450,710 Patient Days Hospital_________________ 74,851 NHCU_________________103,576 Domiciliary ______________ 22,920 Staffing Statistics Total ___________________201,347 Employees ________________ 2,605 (does not include Research, VISN, Canteen) Average Daily Census FTEE __________________ 2,449.30 Hospital__________________ 204.5 NHCU___________________ 283.0Full Time Physicians ___________ 81 Domiciliary ________________ 62.6 Total _____________________ 550.1 Volunteers _________________ 1,405 Acute Length of Stay (days)Volunteer Hours___________ 152,899 University Drive _____________ 6.6 Highland Drive ______________ 3.6 Total Average_________________ 5.1 FY04FY03FY02FY01FY00Unique Patients 53,642 52,990 55,231 Outpatient Visits FY04FY03FY02FY01FY00434,243 450,710 Obligations/Unique Patient FY04FY03FY02FY01FY00$5,563 $5,102 $5,083 $4,958 404,903 408,678 49,085 45,501 373,596 $4,205 “All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence” MLK, Jr. page 9 www.va.gov/pittsburgh www.va.gov/pittsburgh page 10 H. John Heinz III University Drive Division Highland Drive DivisionProgressive Care Center The VA Pittsburgh Healthcare System University Drive Pittsburgh, PA 15240 1-866-4 VA PITT www.va.gov/pittsburgh DepartmentofVeteransAffairsDepartmentofVeteransAffairs Setting New Standards in Healthcare