St. Luke's Cornwall Hospital (SLCH) has received the Healthgrades® Patient Safety Excellence Award, ranking the hospital among the top five percent in the nation. SLCH received this designation for three consecutive years. SLCH is the only hospital in New York State to be awarded such distinction.
In her role as a physician leader, Dr. Gina Del Savio has been instrumental in helping implement several key initiatives. She discusses these initiatives as a way to improve patient safety awareness.
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St. Luke's Initiatives for Improving Patient Safety
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Learn more about Gina Del Savio, MD
Gina Del Savio, MD
As Chief Medical Officer, Dr. Gina C. Del Savio is responsible for facilitating physician integration, development of service lines and providing clinical input for the development of organizational strategy. In addition, she is the director of the graduate student education programs working with Touro Medical College, NYCOM, Mt. St. Mary, Marist and others. Dr. Del Savio joined the St. Luke's Cornwall community in 1996 as an orthopedic hand surgeon after completing the Robert E. Carroll Hand and Microsurgery Fellowship at Columbia-Presbyterian. She graduated from Brown University with a BA in Biology before attending the University of Vermont College of Medicine after which she was selected for the orthopedic residency program at New York Medical College. She has held many elected leadership positions on medical staff since 2000 including most recently the President of the Medical staff from 2011-2014. In 2015, Dr. Del Savio completed the American Association for Physician Leadership qualifying program, became a Certified Physician Executive and joined the administrative team at SLCH. She is a founding partner of Orthopedics and Sports Medicine in New Windsor, New York and continues her clinical responsibilities as an Attending Orthopedic Hand Surgeon at SLCH with board certification in both Hand and Orthopedic surgery.Learn more about Gina Del Savio, MD
Transcription:
St. Luke's Initiatives for Improving Patient Safety
Melanie Cole (Host): St. Luke’s Cornwall has made great strides in improving patient safety in recent years. My guest today, is Dr. Gina Del Savio. She’s the Chief Medical Officer at St. Luke’s Cornwall Hospital. Welcome to the show, Dr. Del Savio. What do you feel, as the Chief Medical Officer, is the most important part about engaging providers, and patients, and their families, to create awareness of patient safety and involvement?
Dr. Gina Del Savio (Guest): Good morning, Melanie. Thanks, so much, for having me. Well, first of all, healthcare is about a partnership. Although it is the job of our physicians to make sure that our patients understand the importance of staying healthy, it’s also important for our patients to participate in taking care of themselves. And so, whatever we do around safety, we try to engage both our patients and our practitioners, so that together, we can make the community healthier and safer.
Melanie: Tell us about some of your initiatives at St. Luke’s that you have helped to implement that would create this awareness.
Dr. Del Savio: Well, first of all, the easiest and most straightforward thing is handwashing. It sounds silly, I know, but in today's day and age, handwashing is probably one of the best ways to prevent germs from being passed from one person to another. At St. Luke's, we have an absolute policy around using either hand sanitizers or washing hands before they enter a room or as they leave a room. We encourage our patients, as well, when they visit the facility, to do the same thing.
In terms of our surgical cases, we also have to be concerned about infection despite antibiotics and sterile operating rooms. Again, one of the most important things that we do is skin preparation. For instance, for our total joint patients, those patients are actually given wipes to use when they shower prior to actually coming to the hospital. That way, we make sure that the skin is thoroughly cleaned even before we get you to the operating room.
Also — around keeping the skin clean — there are mechanical ways to get rid of germs. One of the things that we've been doing now is the use of the Ultraviolet Disinfection Machine. This special device is planted in a patient room or a patient space. After a patient leaves that space and using ultraviolet will destroy germs on all surfaces so that the next patient to arrive in that room is not going to be potentially exposed to any of the germs, including multidrug-resistant organisms, such as C. Difficile, from the patient that was there prior. This is a new device, so it spans from something as simple as washing your hands as to using the new technology around the ultraviolet light to minimize the risk of passing infection.
Melanie: Wow, that’s really a cool bit of technology. Back to hand-washing for a second, Dr. Del Savio. Is it okay if a patient — because they may feel a little intimidated — if a physician walks into an exam room and does not wash their hands — or a nurse, or somebody, a caregiver — is it okay for the patient to say, “Hey, would you mind washing your hands,” or “I noticed you didn’t wash your hands”? That is something that could make a patient feel uncomfortable, and yet, is so important to speak out for yourself.
Dr. Del Savio: I absolutely agree with you. You know what? As with most things in life, you need to be your own best advocate. Practitioners don’t mean ill — I’m a practitioner myself — and at times, you get distracted, you get busy, and perhaps, you forget, as human beings do. A physician who takes that wrong, well, that’s their problem. If you have a concern about handwashing, please do speak up. Remember, it’s your health that’s important here.
Melanie: And let’s talk about self-advocacy while we’re discussing this right now, because as long as you want to feel comfortable speaking to your healthcare team and for patients being honest — because part of patient safety, Dr. Del Savio, is going to be being honest with your healthcare provider because they can’t help you if they don’t know all the details. Speak about patient advocacy, speaking up for yourself, and bringing someone with you if you can’t speak for yourself.
Dr. Del Savio: Well, absolutely. Again, as you have just said, it’s so important to make sure that you let your provider know everything about your healthcare. That may be drugs that you’re taking — and by the way, perhaps it means things that you shouldn’t be taking, but the physician does need to know about that. Our job is not to police; our job is to know everything about you so that we can take care of you. With that in mind, also, if you have a challenge in either understanding language or vocabulary. Perhaps, you don’t read as well as you would like, please bring a family member or a friend who can help you through that visit, to make sure that when you leave that interaction with your provider or your physician that you feel like you’ve gotten the most out of it and that you understand what was discussed at that visit, so that you can best act on that — or your physician can act on that in a safe manner.
We also discuss in healthcare now, about shared decision making, and part of that shared decision making means that although it is your physician’s job to speak to you about your diagnosis and your potential treatment, at the end of the day, the decision as to next steps — and that is what you are going to be embarking upon, as treatment — needs to be a shared decision process. That involves a conversation, not just a lecture from your physician. So again, if that’s a conversation that you don’t necessarily feel comfortable making, you must bring someone with you who can act as your advocate with you for that dialogue.
Melanie: And that’s so important, that it is a conversation — that it’s not just someone telling you something, that it’s part of a conversation that you have with your healthcare provider. And as far as medications — because we hear about the opioid epidemic, and people are afraid, now of antibiotics —and we hear about all of these things. What do you want patients to ask their doctors about medication safety and to know about antibiotic stewardship at St. Luke’s Cornwall? All of these questions that surround medication, how do you propose a patient go about discussing all of this with their provider?
Dr. Del Savio: Well, first of all, medications can be very, very complicated today. The number one thing that a patient can do to be their own advocate is to maintain a current list of all medication that they take on a regular basis, as well as medications that you might take intermittently. That should be a written list, because sometimes when you come to a provider, you're going to be sick, and sometimes you'll forget things, so please do keep it written down, and carry it in your purse or wallet so that you always have access to that.
In addition, allergies. We use allergies to describe oh, my tongue swells up or I have a hard time breathing, but also other reactions, such as nausea, vomiting, shortness of breath, a rash — again, a written down list of those drugs that you have some sort of adverse reaction to. That should be written down as well as what the adverse reaction is. In addition, when you get that list of medications, you yourself should know what each of those medications is for, what medical problems do you have that you take it for? And by the way, what are some of the potential side effects, like nausea, vomiting, light-headedness — by the way, when do you take that medicine? Do you have to take it in the morning, in the evening? Do you have to take it with food? Do you take it on an empty stomach? These are all really important questions that you need to make sure that you know the answers to for any drug that you take. You shouldn’t be afraid to clarify that with your provider before you leave a provider.
And to your point, right now, in our society, opioid addiction is a huge, huge problem for our society. It's cultural. We're busy people. We don't have time to be in pain, but unfortunately, that has led to narcotic pain medication overutilization and overprescription, and now we have challenges. Around that, if you're going to have a procedure done, you may or may not require opioids. One of the cultural things that we're looking for our society to look at is, do we really need opioids for every procedure that we do? We've slipped into the habit of doing that, and is it absolutely necessary? Again, have an open dialogue with your physician prior to having a procedure and discuss pain medication alternatives for the use of narcotics. If narcotics are determined to be necessary by you and your physician, well then, make sure that you get the least number of pills, and when you don't need them anymore, discard them. Do not leave them around the house. It's unfortunate, but unfortunately, those pills being kept in your possession, make them an easy target for folks who do have an addiction problem. You may inadvertently offer an opportunity for someone who is an addict, to have access to those medications.
Lastly, you mentioned antibiotics. Antibiotics fight bacterial infection, and in our society again, we have had a trend towards having antibiotics placed into lots of household products, including hand lotions, and dish soaps, and bar soaps. That is unfortunate because that has led to the development of resistant organisms. Antibiotics kill bacteria, but guess what? Bacteria mutate and change themselves to become resistant when they're exposed to these antibiotics over a long period of time. With that in mind, make sure that if you use an antibiotic, you take it properly, you take it for the correct amount of time, and not stop the antibiotics too soon. It also means that you shouldn't take antibiotics for conditions that don't require them, such as viral infections. The common cold is not going to be influenced by taking an antibiotic, and neither is the flu, and neither are most sore throats. Again, listen to your practitioner, take the antibiotics exactly as prescribed, to not pushing your physician to prescribe perhaps an antibiotic that's unnecessary.
In the hospital, here now, and to try to minimize this resistant organism problem that we have, we have taken very strict measures and very strict algorithms as to what very specific antibiotics are used for specific organisms. As soon as someone is responding to intravenous, we’re switching them over to oral antibiotics. That serves two purposes, it diminishes the risk of developing these very very resistant organisms that can then make other people ill, but it also can limit your time in the hospital and get you home sooner on an appropriate medication that you can take by mouth and not require intravenous.
Melanie: What amazing information, Dr. Del Savio. Please wrap it up for us, with your best advice about patient safety and health advocacy — being your own best advocate, bringing someone with you if you cannot, writing down your questions, your relationship with your provider so that you feel comfortable really being honest with them and telling them everything so that they can be the best at helping you be healthy.
Dr. Del Savio: Again, safety and medicine run hand-in-hand, so that when you work with your provider, remembering that around safety is communication. If you feel uncomfortable communicating with your physician one-on-one, it is always helpful to have an advocate with you. Either way, you and your family need to work with your provider in a collaborative way as a team to come together to decide what's necessary to not only make you well when you're ill but also to keep you healthy. To keep you healthy, that's all around preventing those things which are preventative, such as preventing infection, by being careful and washing your hands, and being careful about not exposing yourself to sick people without a mask.
Secondly, reducing your risk of injury. If you have problems with steadiness on your feet, please make sure that you get help when you’re doing things that are dangerous. Don’t climb up on ladders and things like that. Next, if you are being treated by a physician for a medical condition, certainly, take your medications exactly as they are prescribed and no other way, and again, if you have in your possession, opioids, make sure you take them the way they are supposed to be used. When you no longer need them, discard them. At the end of the day, speak up. You are your own best advocate, and if you have any questions or concerns about your healthcare — that means staying well, and taking care of yourself when you are ill, you need to be able to communicate with your healthcare provider honestly and openly about all of your concerns.
Melanie: Thank you so much, for being with us, today. Really, so important for listeners to hear. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit StLukesCornwallHospital.org, that’s StLukesCornwallHospital.org. This is Melanie Cole. Thanks, so much, for tuning in.
St. Luke's Initiatives for Improving Patient Safety
Melanie Cole (Host): St. Luke’s Cornwall has made great strides in improving patient safety in recent years. My guest today, is Dr. Gina Del Savio. She’s the Chief Medical Officer at St. Luke’s Cornwall Hospital. Welcome to the show, Dr. Del Savio. What do you feel, as the Chief Medical Officer, is the most important part about engaging providers, and patients, and their families, to create awareness of patient safety and involvement?
Dr. Gina Del Savio (Guest): Good morning, Melanie. Thanks, so much, for having me. Well, first of all, healthcare is about a partnership. Although it is the job of our physicians to make sure that our patients understand the importance of staying healthy, it’s also important for our patients to participate in taking care of themselves. And so, whatever we do around safety, we try to engage both our patients and our practitioners, so that together, we can make the community healthier and safer.
Melanie: Tell us about some of your initiatives at St. Luke’s that you have helped to implement that would create this awareness.
Dr. Del Savio: Well, first of all, the easiest and most straightforward thing is handwashing. It sounds silly, I know, but in today's day and age, handwashing is probably one of the best ways to prevent germs from being passed from one person to another. At St. Luke's, we have an absolute policy around using either hand sanitizers or washing hands before they enter a room or as they leave a room. We encourage our patients, as well, when they visit the facility, to do the same thing.
In terms of our surgical cases, we also have to be concerned about infection despite antibiotics and sterile operating rooms. Again, one of the most important things that we do is skin preparation. For instance, for our total joint patients, those patients are actually given wipes to use when they shower prior to actually coming to the hospital. That way, we make sure that the skin is thoroughly cleaned even before we get you to the operating room.
Also — around keeping the skin clean — there are mechanical ways to get rid of germs. One of the things that we've been doing now is the use of the Ultraviolet Disinfection Machine. This special device is planted in a patient room or a patient space. After a patient leaves that space and using ultraviolet will destroy germs on all surfaces so that the next patient to arrive in that room is not going to be potentially exposed to any of the germs, including multidrug-resistant organisms, such as C. Difficile, from the patient that was there prior. This is a new device, so it spans from something as simple as washing your hands as to using the new technology around the ultraviolet light to minimize the risk of passing infection.
Melanie: Wow, that’s really a cool bit of technology. Back to hand-washing for a second, Dr. Del Savio. Is it okay if a patient — because they may feel a little intimidated — if a physician walks into an exam room and does not wash their hands — or a nurse, or somebody, a caregiver — is it okay for the patient to say, “Hey, would you mind washing your hands,” or “I noticed you didn’t wash your hands”? That is something that could make a patient feel uncomfortable, and yet, is so important to speak out for yourself.
Dr. Del Savio: I absolutely agree with you. You know what? As with most things in life, you need to be your own best advocate. Practitioners don’t mean ill — I’m a practitioner myself — and at times, you get distracted, you get busy, and perhaps, you forget, as human beings do. A physician who takes that wrong, well, that’s their problem. If you have a concern about handwashing, please do speak up. Remember, it’s your health that’s important here.
Melanie: And let’s talk about self-advocacy while we’re discussing this right now, because as long as you want to feel comfortable speaking to your healthcare team and for patients being honest — because part of patient safety, Dr. Del Savio, is going to be being honest with your healthcare provider because they can’t help you if they don’t know all the details. Speak about patient advocacy, speaking up for yourself, and bringing someone with you if you can’t speak for yourself.
Dr. Del Savio: Well, absolutely. Again, as you have just said, it’s so important to make sure that you let your provider know everything about your healthcare. That may be drugs that you’re taking — and by the way, perhaps it means things that you shouldn’t be taking, but the physician does need to know about that. Our job is not to police; our job is to know everything about you so that we can take care of you. With that in mind, also, if you have a challenge in either understanding language or vocabulary. Perhaps, you don’t read as well as you would like, please bring a family member or a friend who can help you through that visit, to make sure that when you leave that interaction with your provider or your physician that you feel like you’ve gotten the most out of it and that you understand what was discussed at that visit, so that you can best act on that — or your physician can act on that in a safe manner.
We also discuss in healthcare now, about shared decision making, and part of that shared decision making means that although it is your physician’s job to speak to you about your diagnosis and your potential treatment, at the end of the day, the decision as to next steps — and that is what you are going to be embarking upon, as treatment — needs to be a shared decision process. That involves a conversation, not just a lecture from your physician. So again, if that’s a conversation that you don’t necessarily feel comfortable making, you must bring someone with you who can act as your advocate with you for that dialogue.
Melanie: And that’s so important, that it is a conversation — that it’s not just someone telling you something, that it’s part of a conversation that you have with your healthcare provider. And as far as medications — because we hear about the opioid epidemic, and people are afraid, now of antibiotics —and we hear about all of these things. What do you want patients to ask their doctors about medication safety and to know about antibiotic stewardship at St. Luke’s Cornwall? All of these questions that surround medication, how do you propose a patient go about discussing all of this with their provider?
Dr. Del Savio: Well, first of all, medications can be very, very complicated today. The number one thing that a patient can do to be their own advocate is to maintain a current list of all medication that they take on a regular basis, as well as medications that you might take intermittently. That should be a written list, because sometimes when you come to a provider, you're going to be sick, and sometimes you'll forget things, so please do keep it written down, and carry it in your purse or wallet so that you always have access to that.
In addition, allergies. We use allergies to describe oh, my tongue swells up or I have a hard time breathing, but also other reactions, such as nausea, vomiting, shortness of breath, a rash — again, a written down list of those drugs that you have some sort of adverse reaction to. That should be written down as well as what the adverse reaction is. In addition, when you get that list of medications, you yourself should know what each of those medications is for, what medical problems do you have that you take it for? And by the way, what are some of the potential side effects, like nausea, vomiting, light-headedness — by the way, when do you take that medicine? Do you have to take it in the morning, in the evening? Do you have to take it with food? Do you take it on an empty stomach? These are all really important questions that you need to make sure that you know the answers to for any drug that you take. You shouldn’t be afraid to clarify that with your provider before you leave a provider.
And to your point, right now, in our society, opioid addiction is a huge, huge problem for our society. It's cultural. We're busy people. We don't have time to be in pain, but unfortunately, that has led to narcotic pain medication overutilization and overprescription, and now we have challenges. Around that, if you're going to have a procedure done, you may or may not require opioids. One of the cultural things that we're looking for our society to look at is, do we really need opioids for every procedure that we do? We've slipped into the habit of doing that, and is it absolutely necessary? Again, have an open dialogue with your physician prior to having a procedure and discuss pain medication alternatives for the use of narcotics. If narcotics are determined to be necessary by you and your physician, well then, make sure that you get the least number of pills, and when you don't need them anymore, discard them. Do not leave them around the house. It's unfortunate, but unfortunately, those pills being kept in your possession, make them an easy target for folks who do have an addiction problem. You may inadvertently offer an opportunity for someone who is an addict, to have access to those medications.
Lastly, you mentioned antibiotics. Antibiotics fight bacterial infection, and in our society again, we have had a trend towards having antibiotics placed into lots of household products, including hand lotions, and dish soaps, and bar soaps. That is unfortunate because that has led to the development of resistant organisms. Antibiotics kill bacteria, but guess what? Bacteria mutate and change themselves to become resistant when they're exposed to these antibiotics over a long period of time. With that in mind, make sure that if you use an antibiotic, you take it properly, you take it for the correct amount of time, and not stop the antibiotics too soon. It also means that you shouldn't take antibiotics for conditions that don't require them, such as viral infections. The common cold is not going to be influenced by taking an antibiotic, and neither is the flu, and neither are most sore throats. Again, listen to your practitioner, take the antibiotics exactly as prescribed, to not pushing your physician to prescribe perhaps an antibiotic that's unnecessary.
In the hospital, here now, and to try to minimize this resistant organism problem that we have, we have taken very strict measures and very strict algorithms as to what very specific antibiotics are used for specific organisms. As soon as someone is responding to intravenous, we’re switching them over to oral antibiotics. That serves two purposes, it diminishes the risk of developing these very very resistant organisms that can then make other people ill, but it also can limit your time in the hospital and get you home sooner on an appropriate medication that you can take by mouth and not require intravenous.
Melanie: What amazing information, Dr. Del Savio. Please wrap it up for us, with your best advice about patient safety and health advocacy — being your own best advocate, bringing someone with you if you cannot, writing down your questions, your relationship with your provider so that you feel comfortable really being honest with them and telling them everything so that they can be the best at helping you be healthy.
Dr. Del Savio: Again, safety and medicine run hand-in-hand, so that when you work with your provider, remembering that around safety is communication. If you feel uncomfortable communicating with your physician one-on-one, it is always helpful to have an advocate with you. Either way, you and your family need to work with your provider in a collaborative way as a team to come together to decide what's necessary to not only make you well when you're ill but also to keep you healthy. To keep you healthy, that's all around preventing those things which are preventative, such as preventing infection, by being careful and washing your hands, and being careful about not exposing yourself to sick people without a mask.
Secondly, reducing your risk of injury. If you have problems with steadiness on your feet, please make sure that you get help when you’re doing things that are dangerous. Don’t climb up on ladders and things like that. Next, if you are being treated by a physician for a medical condition, certainly, take your medications exactly as they are prescribed and no other way, and again, if you have in your possession, opioids, make sure you take them the way they are supposed to be used. When you no longer need them, discard them. At the end of the day, speak up. You are your own best advocate, and if you have any questions or concerns about your healthcare — that means staying well, and taking care of yourself when you are ill, you need to be able to communicate with your healthcare provider honestly and openly about all of your concerns.
Melanie: Thank you so much, for being with us, today. Really, so important for listeners to hear. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit StLukesCornwallHospital.org, that’s StLukesCornwallHospital.org. This is Melanie Cole. Thanks, so much, for tuning in.