New Hospital Specialist Focuses on Quality Care
Posted on Thursday, January 13th, 2011
Danny Dvorak, R.N.
Is care from the hospital pleasing to patients and major payers, such as Medicare/Medicaid?
A new hospital specialist, Danny Dvorak, R.N., is in charge of analyzing quality and reporting results.
What Patients Think
“Satisfaction surveys can really help us improve the quality of patient care and treatment and I want their honest opinion. If there’s something they dislike, I want them to feel free to write it out and remain anonymous,” Dvorak said.
The survey lists every department the patient may have encountered, including emergency room, admissions, nursing, dietary, physicians, x-rays, and therapies.
The patient rates quality on a scale ranging from “totally dissatisfied” to “highly satisfied.”
Patients are not asked to sign the forms, simply to mail them back to the hospital in the return envelope provided at discharge.
About one-third do so, a “good” rate of return in the industry, Dvorak said. He charts the responses.
The overall results? “The people in the communities this hospital serves have been overwhelmingly pleased with the services and their treatment, overwhelmingly pleased. It’s an easy job to read the satisfaction surveys.”
Medicare/Medicaid Standards
Medicare/Medicaid, the major payer for hospital care, is especially interested in learning whether patients fall during their stay or acquire urinary tract infections, infections caused by intravenous needles, or pressure ulcers.
All of these hazards can make a hospital stay longer than it should be and add to patient discomfort and the cost of care.
Nurses record the preventive measures they take with each patient and also actual experience. Dvorak reviews the patients’ charts for completeness and tracks results.
For fall prevention, patients wear non-skid socks and are taught to press a call light to summon a nurse for assistance in getting out of bed.
Patients assessed as “at-risk” of falls are placed in rooms that are equipped with closed-circuit cameras and bed alarms connected to the nurse’s station to alert them when a patient may be attempting to get up.
“We treat quite a few elderly patients who have dementia or are in a weakened state and this figures into fall rates,” he said. “There may be combativeness and a need, on doctor’s orders, for restraints to keep them in bed so they will not fall,” he said.
Patients with urinary catheters and intravenous needles require regular attention to keep the affected area bathed and needles changed.
“Blood and urine are sterile, so we don’t want to introduce bacteria or germs into the cardiovascular or genitourinary system, but maintaining a “sterile field” around catheters or IVs can be challenging. Very sick patients will tug and pull on lines and it’s hard to prevent that. As soon as patients improve and don’t need fluids or IV antibiotics, the doctors will discontinue their use and put them on oral medications,” Dvorak said.
Pressure ulcers are places where the skin has broken down. They can be deep and painful. Elderly and very sick patients are more prone to them. Prevention involves providing good skin care and turning the patient frequently. All of these actions are charted.
A key to quality care, Dvorak said, is enough staff for the caseload.
With 25 beds and an average daily population of 8-10 patients, a small hospital like Mercy Health/Love County often provides more timely care than a large hospital.
“I’m very pleased to be working here because staffing is sufficient to meet patient needs,” Dvorak said.
Discharge Instructions
Another Medicare/Medicaid measure of quality care is whether patients treated for pneumonia, heart attack, or congestive heart failure go home with instructions about their medical condition and how to take care of it.
“They are in writing, and we read them to the patient while they are here and teach them how they can keep their medical condition in a healthy status to prevent another hospital stay,” Dvorak said.
The instructions cover management of symptoms, fall prevention, and other issues that will help the patient’s family maintain safe conditions for the loved one.
Quality Priorities Within the Hospital
Dvorak reports the hospital’s quality measure results to Medicare/Medicaid quarterly.
The hospital’s Board of Control, a public body, lists a quality control committee report on its monthly agenda.
Within the hospital, quality care is a standing topic at monthly meetings of the medical staff.
“We talk about the statistics on omissions on charts and on satisfaction, and each of the hospital units is part of it. Each has their own quality issues they are reporting on. These things have all been worked on long before I came aboard, but I am here to help all the units,” Dvorak said.
From Courtroom to Hospital Room
Dvorak joined the hospital last year with a newly-minted nursing degree, acquired following 30 years in supervision and management with the Department of Human Services and private social service agencies in Ardmore, Ada, and Lawton.
He helped rehabilitate teenagers in the juvenile court system, and he managed state contracts to perform child welfare services, find foster and adoptive homes, and assist youth aging out of the child welfare system find jobs, schooling, and housing.
A highpoint was statewide recognition for arranging 1,100 adoptions in the first year of Oklahoma’s “swift adoption” program.
Along the way, he earned a bachelor’s degree from Cameron University and a master’s of administrative studies from Southeastern Oklahoma State University. He also served four years in the Air Force.
“I’d reached a place where I could retire and wanted to do something a little different, but I couldn’t think of anything but helping people,” he said.
After getting acquainted with the first two male nurses he had ever met and receiving encouragement from a sister-in-law R.N., Dvorak entered the Murray State College nursing program.
He graduated in 2009 at the top of his class and received the Thelma Biddler Award as outstanding nursing student.
“We’re blessed to have Murray State College and its nursing program. They’re doing a great thing. I would hope that people recognize the need for nurses because baby boomers are getting older and will need medical services,” he said.
In addition to quality assurance duties, Dvorak fills in on the nursing floor and in the emergency room when needed.
He enjoys playing the guitar, attending church, and being outdoors on his in-laws’ family farm. Dvorak has been married since 1972 to Sherry (Gaither) Dvorak. They met as students at Marietta High School.
She is a retired child welfare worker. They live in Ardmore, as do their sons, Chris Dvorak and his wife, Christi, and Drew Dvorak and his wife, Lesley. Drew and Lesley are the parents of Lleyton Dvorak, 18 months old. Chris and Christi are expecting twins in March.