This is the third story in a series focusing on Dr. John Warner Hospital’s fiscal status. Acting CEO John Wood routinely prepares detailed reports for the hospital board of directors relating the hospital’s fiscal health to the strategic plan. The reports are so detailed the Power Point presentation is nearly 50 pages long. At the board’s most recent meeting, Wood focused on three areas: the emergency room, the Rural Health Center, and surgery. Today we look at surgery.



Surgeries at DJWH have

been dropping in volume for the last five years. One surgeon was doing the work despite the fact that several specialty docs were holding office hours at the hospital.

Specialists said one issue was the need for inpatient follow-up the next day (the specialists aren’t there the next day) and they were hesitant to do any surgeries with underlying issues. The specialists were advising patients to go to the specialists’ hospital, Wood said ironically “since we don’t do surgeries here.”

Of course surgeries are performed at DJWH, and many more could be.



Other issues:

• an equipment sterilizer has experienced quality assurance issues, giving too many false positives. Though believed fixed, it’s old;

• there is equipment that has been purchased and never used;

• equipment is becoming outdated;

• there was no full-time anesthesiologist support. There is a certified registered nurse anesthetist. Oddly, Wood said, hardly any critical access hospital can afford a full-time anesthetist, and once the patient is under anesthesia, it’s the CRNA who monitors the patient.

• Surgeries were scheduled days and some evenings, causing overtime

Further, Wood found there was a “stagnant” “status quo acceptable” environment, and said it’s a struggle on busy days coordinating resources to manage surgical flow.

Surgeries numbered as high as 267 and 264 in 2003 and 2004. Then came a decline to as low as 122 in 2007. In 2008 when there was a slight uptick, followed by 2009’s 186.

Thus far this year, 155 outpatient operations have been performed, down 16.66 percent. Lapband procedures peaked in 2008 at 151 and declined to 22 this fiscal year, down 71.43 percent. Inpatient stays thus far total 23, up 25 percent already over 2010 when there were a total of 18 inpatient stays. At the high point in 2003 and 2004 there were 149 and 132 inpatient stays, respectively.

Total surgery revenue for fiscal year 2010 (May 1-Sept. 30) is 202,429, minus expenses of $103,038 for a total gross margin of $99,391. In 2009, gross margin was 579,110. The highest came in fiscal year 2006 when it was 830,072.

To increase volume, Wood’s plan requires some internal public relations work to encourage a wide variety of expertise and to encourage surgeons to keep patients in Clinton. The action plan also calls for making sure staff competencies are up-to-date, keeping a positive attitude during stressful periods and down periods; update equipment, and update protocols.

The biggest step toward boosting surgery at DWJH, will come soon with the hiring of a a full-time surgeon. Woods said he hopes to have one on staff soon, perhaps signing a contract within days.



On Friday, the big picture.