Sally Potts, RN, MS, PNP Director Therapeutic Services & Professional Services

1. Therapeutic and Professional Services Sally Potts, RN, MS, PNP Director Therapeutic Services & Professional Services Diane Andrews, MS, CCL SLP Speech Therapy Manager Ann Benton, OTR/L OT Manager Donna Bolus, RRT, RCP Manager, Adult RT Jeanine Gage, MS, RN Psychiatric Nurse Coordinator Lisa Langdale, MS, RN Manager, Center for Educ. and Best Practice Melissa Martin, RN, MBA Manager, Radiology Nursing, Dialysis and Pheresis Marian Miller, RRT, NPS, RCP Manager, Pediatric RT Erica Rouvalis, PT, MHS Manager, PT JoAnne Sandefur, RRT, RCP Manager, ART Adult, RT Steve Schaer, RN, MS Manager Meduflex Barrie Tyler, MA, RRT, RCP Manager Sleep, PICC, Bronch and Vain Team Terry Wilson, D. Min Manager Pastoral Care

2. Tab 1 • COM Departments involved in Therapeutic Services • TS Strategic Goals (3-5 year big bets) • 2010-2011 Progress towards Strategic Goals • What is going well in Therapeutic Services? • Opportunities for improvement in Therapeutic Services • Input on Service Lines as a structure Tab 2 1. TS Dashboard • Tab 3 – Therapeutic Services Goal (LEM) Performance • Executive Summary – Annual LEM Performance • Executive Summary – 2011 Pillar Performance YTD • 2011 LEM Monthly Report Card • Tab 4 – Therapeutic Services 5% and 10% Cost/Unit Reduction Projects • TS 5% and 10% cost/unit reduction summary • IMPROVE Projects

3. COM Departments involved in Therapeutic Services • Significant -Trauma/Critical & Acute Care - Children’s & Perinatal - Musculoskeletal - Neurosciences - Heart & Vascular - Hollings Cancer Center - Digestive Disease Center - Transplant - Nephrology - Psychiatry - Radiology - ENT Others - Anesthesiology - Laboratory - Pharmacy

4. Therapeutic and Professional Strategic Goals ( 3-5 year Big Bets) Therapies - Physical, Occupational, Speech • Maximize inpatient and outpatient productivity • Strategically locate outpatient sites to provide one stop services • Develop system to measure outcomes Respiratory Therapy • Streamline inpatient care model to maximize productivity, reduce cost • Maximize Pulmonary Function Test revenue Peripherally Inserted Central Catheters (PICC) RN bedside placement • Increase early recognition of need for PICC • Cost savings - Grow bedside PICC volumes, decrease suite placed PICCs

5. Big Bets continued.. Sleep Medicine Program • Strategically relocate sleep MD clinics and sleep lab locations • Coordinate sleep services between departments • Maximize sleep study revenue Meduflex Staffing Office • “ Right size” staffing pool for ability to flex staff up quickly • Reduce overtime • Eliminate high cost agency nurses Center for Clinical Education and Best Practices • Assist with achievement of Magnet Status • Develop outcome measures for success of education initiatives Multidisciplinary Inpatient Pain Resource team • Develop multiprofessional team

6. 2010 – 2011 Progress towards Big Bets Rehab Therapies • Outpatient business plan in progress. Outpatient site plans in progress. All outpatient therapies to be located in same location • Researching cost effective tools for outcome data collection Respiratory Therapy • IMPROVE project completed to streamline top heavy care model • Productivity improvements in PFT lab to maximize testing Bedside PICC Team • Expansion of PICC team by two nurses to cover 7 days per week • Creating a central triage to most appropriate setting from patient service and cost effectiveness perspectives for placement of all PICCS

7. Big Bet Progress Continued Sleep Medicine • Investigation of possible site location - hotel vs. free standing model • Interim medical Director in place • Study reimbursement will be cut in near future - Business plan in progress to determine impact Staffing Office • Recruiting Meduflex nurses with new salary structure and innovative new grad RN program • Overtime reductions occurring - Hospital supervisors actively managing overtime with new scheduling tool

8. Big Bet Progress Continued Center for Clinical Education • Accountability project in place to measure success of clinical education initiatives with outcome data Multidisciplinary Inpatient Pain Resource Team • A nurse practitioner and clinical nurse recently hired • Dr. Sachs collaborating MD • Meetings in progress to define mulitprofessional team

9. What is going well in Therapeutic and Professional Services? Respiratory -Geographically consolidated ventilators on inpatient units - PFT bay opened at ART - Bronchoscopy suite opened at ART SLEEP - Sleep Lab accreditation - No show rate for sleep studies decreased from 10 % to 3 % PICC - Development triage system to improve access to nurse bedside PICC team OT/PT/Speech - Increased outpatient therapy productivity and volumes - Expanded Athletic Trainers in Sport Medicine Program • Community outreach • Marketing for MUSC PAIN Resource Team - inpatient pain resource nursing team established with medical director

10. What is going well in Therapeutic and Professional Services? continued IR - Assumed leadership of interventional radiology Speech - Excellent collaboration between Speech Pathology and ENT Staffing Office - Increasing nursing pool - New Graduate RN Program - Decreasing overtime by 5% with flex pool staffing growth MUSC Wellness (grant) -Shared service with university Falls Prevention “Firm Ground” - Bed alarms - Accountability

11. Opportunities for improvement in Therapeutic and Professional Services Respiratory Therapy - Streamline care delivery model Rehab Therapies - Establish strategic plan for out patients- - Align hospital and physician goals for therapy strategic plans SLEEP - Improve coordination of sleep services between departments (neuro, pulmonary, and psychiatry) - Determine new reimbursement for sleep studies - Complete 5 year pro-forma to determine viability of sleep program from clinical and business perspectives - Locate appropriate location for sleep labs in hospital and out of hospital PICC - Improve early recognition - Increase PICC insertion services - Consistently send patients to appropriate setting for PICC placements - Decrease transports from ICUs and wards to suites

12. Opportunities for improvement in Therapeutic and Professional Services Continued Bronchoscopy - Provide bronchcoscopy services for ART patients - Decrease costly transports from ART to Main hospital Psychiatric Liaison Nurses - Improve communication with psychiatry about mental health issues for inpatients - weekly rounding Pain Resource Nursing Team - Practicing MD leadership as part of the service for inpatients acute and chronic pain Interventional Radiology - Improve quality: timeouts, moderate sedation, contrast use - Team building between leaders, MDs, and staff - Improve workflow

13. Input on Service Line as a structure • Facilitates development of Service Line specific initiatives • Creates challenges in rolling out education content for clinical education • Improves communication when strategic partners are included in planning • Communication breakdown when strategic partners are not included in planning in some service lines • Hospital wide initiatives roll out inconsistently due to varied expectation at service line (ex. Fall Program, e-shift staffing tool) • Creates Silos – opportunities for efficiencies are lost

15. Tab 3Goal Performance • Executive Summary – Annual LEM performance • Executive Summary – 2011 Pillar performance YTD

16. Therapeutic Services Goal (LEM) PerformanceExecutive Summary - Annual Green – 4 Yellow – 3 Red - < 2.5 Scale 1-5; 4 is goal attainment

17. TS Goal (LEM) PerformanceExecutive Summary - YTD 3 - Labor 1 - Supplies

18. Tab 4 Therapeutic Services 5/10 Plans • Financial Performance YTD toward goal • 10% IMPROVE - Projects