Finding a Physician that is Right for You!

A lot of factors go in to finding the right physician. One of the factors is at which hospitals the physician works. Here at Texas Health Fort Worth there is a rigorous credentialing process that the physician goes through. The physician completes an application and privilege card listing the types of procedures/treatments they would like to do at the hospital.

Once the application is received in the Medical Affairs Office then all of the information from their medical school forward is verified from the primary source. This verification includes every hospital where they have practiced, any extra training programs, peer references, time spent away from the practice, and a case log from the last two (2) years showing what procedures/illnesses they have performed/treated. In order to be sure that the physician is qualified to perform the procedures or treat the disease processes they are requesting, a copy of the physician’s privilege card is sent along with the request to verify that they are competent.

Questions are asked about the physician’s:
• Basic medical knowledge
• Professional judgment
• Clinical competence
• Technical skill
• Ethical conduct
• Cooperation/ability to get along with others
• Timely response to patient care needs
• Patient management
• Relationship with patient/patient’s family
• Relationship with nursing/hospital staff

Once all of these questions are answered and it is determined that the physician is competent then the physician is allowed to practice at THFW.

If you want to find a physician that is right for you, I encourage you to go here.

And if you want more information – such as what insurance they take, hours, locations, etc. you may contact Well Call – 1-888-442-7747.

Another good source of information on physicians is the Texas Medical Board. Individuals can chose to look up information on their physician. The profile will list where the physician practices, where they went to school and whether there have been any sanctions against the physician’s license. That website can be accessed at: http://www.tmb.state.tx.us/

It is important that you find the right physician for you. Take advantage of the opportunities you have to find the physician that you can have a long-standing relationship with.

- Dr. Karen Reed
Director of Medical Affairs

Trauma - an Orchestra of Life-Saving Care

Over the past three months, my time here at Texas Health Harris Methodist Hospital has been eye opening to say the least. Through clinical rotations and executive management meetings I have seen first hand the necessary composure for handling difficult situations.

One of the more astounding events I have witnessed is a “trauma situation”. THFW is designated as a Level 2 Trauma Center. This designation, like many others, requires the facility to meet numerous requirements. There are four levels of trauma with Level 1 being the highest and Level 4 being the lowest.

A Level 2 Trauma Center requires a facility to be on alert at all hours of the day. Trauma centers were established because hospitals realized that such life threatening events needed multiple specialties that may not be on call. This requires THFW to provide on call specialists, including surgeons, orthopedics, neurosurgeons, plastics surgeons, radiologists, anesthesiologists, etc.. In additional to 24 hour coverage, THFW provides outreach programs, educational programs in an effort to reduce the number of traumatic events. These programs focus not only on trauma education but on injury prevention as a whole.

The intent of this blog was not to educate individuals on Trauma Centers, but to express my appreciation and admiration for the Trauma Team at THFW. It seems as though it’s an orchestra of individuals providing life-sustaining care in the up-most distressing events. When I arrive on site to witness the care of a trauma patient, typically the whole team is waiting unvaryingly for the patient to arrive. Patients can come by family members, ambulances, and air (the majority of trauma centers have helicopters pads). Before the patient arrives, work has begun. Registration has gathered information in addition to nurses and patient care technicians reading the room. The ER physician and the Trauma Surgeon head the table as the patient arrives and delegates orders to ensure that the patient gets necessary care as fast and as safe as possible. Other disciplines are called in as needed. For example, a patient involved in a motor vehicle accident will needed multiple tests and most often the x-ray technicians are on standby outside the room waiting for the nod to come in and perform the test. As care is provided the chaplain weaves in and out gathering personal information and alerting family members of the situation and status. Once family members arrive they are given a current status and get answers to any questions the medical staff can provide. As care continues the physician and charge nurse will find time to speak with the family. Once the patient is stable family members are permitted to come back into the trauma area to see their loved ones.

These situations evolve around high-stress environments when a necessity for level headedness and compassion. I express my utmost appreciation and admiration for the Trauma Team @ THFW – Thank you.

- Melissa Reichardt
Administrative Resident

More Magnet Moments....

- Photo credit: Glen E. Ellman

The call came in....and we celebrated!

The call came in at 11:05 this morning….. There were 200+ nursing staff, ancillary staff, and executives waiting to receive the much anticipated call from the American Nurses Credentialing Center. We have spent the last three years focusing on quality patient care, nursing excellence and innovation in nursing practice. We have built stronger teams, have constructed a strong culture of performance improvement, and have redefined our nursing model to ensure that the patient is at the center of everything we do. This is a defining moment for us. We were the first hospital in Tarrant County to achieve this prestigious award back in 2005 and are again the first seeking re-designation. Re-designation is not a given it must be earned and the expectation is that you are continually advancing and growing and that you are a leader in nursing and health care. There are 360+ hospitals in the state of Texas, and currently only 21 of them have achieved Magnet designation. So we all gathered in the auditorium, with positive energy flowing, and noise makers ready, we waited for the call…..
And then the phone rang and we received the excellent news that we had been expecting- we have been re-designated as a Magnet Designated Hospital. Let the celebration begin!! Congratulations to everyone for all of their hard work and dedication to patient care. This is definitely a team sport and we couldn’t do it without everyone doing their best everyday!

And now we will begin the journey for our next re-designation which will occur in 2013! More pictures to come tomorrow...

- Karen Robeano
Vice President of Patient Care Services and Chief Nursing Officer

Make your voice heard - politely!!!

Well, deep into the dog days of August, it’s hard to hear anything on the radio or television other than the bitter debate surrounding the health reform proposals. It wears me out. Too much anger…too much shouting…too much misinformation…make it go away! We all need to work together to make our healthcare system better!

Actually I don’t think that any reasonable individual has a clue about the content of the final legislation that may eventually be offered in Washington. Certainly, in my opinion, change will come. It has to come. Our current system, for all its strengths, has many flaws, and is slowly falling apart. Let’s get past the blame game: It’s not anybody’s fault. We’re getting older and needing more care. If we live longer, we consume more health care resources. (And we are living longer. This week a report showed our average life expectancy has risen to 78. Amazing as that is, we’re not the oldest living population in the world – Japan holds that honor at 81 years average).

Back to health care reform: while most of us are “satisfied” with our health insurance, most of us are also “concerned” that we could have benefits reduced. And yes, while many people choose to go “bare” and not carry health insurance, many more have lost their benefits, their jobs, their security. I am confident that everybody feels correct in their personal view of healthcare, and what they think needs to be done to improve the model. But I also think that everyone is behaving like the blind men and the elephant – they only see a small, personal part of the much bigger picture. This fact, coupled with the fact that the ongoing debate has morphed into bitter partisan politic, does more to raise blood pressure than to reassure.

Perhaps all the stakeholders - whether legislators, executives, health care workers, insurance companies, hospitals, pharmacies, insured individuals, or the uninsured, need to take a deep breath. There is much to loose if we can’t get health reform correct, and I think we need fresh discussions that will bring balance to the debate. Only through calmer discussion can the truths be manifest. Only through mature dialogue can we reach the compromises that will begin to move us in the right direction – ensuring that we have the resources to meet the health care needs in the communities we serve. Make your voice heard – politely.

Joe Prosser, M.D.
Chief Quality Officer

Growth Through Relationships

As a Patient Advocate for Texas Health Fort Worth, I’ve witnessed that proactive communication is one key in order to build trusting relationships between nursing staff and patients. Texas Health Fort Worth’s professional model of care is “relationship based” and like any relationship, proactive communication is pivotal to show patients what we already feel inside: that we personally care about patients therefore we’re taking the initiative to make their hospital stay excellent.

The following general scenario happens on a regular basis: I get a call to see a patient who has a concern. I talk to the patient’s nurse before going into their room who tells me that they have the patient’s medicine ready when I’m done speaking to them about their concern. I go talk to the patient whose concern is that they have not received their medicine yet.

Although not every situation is this simple, the underlying principle remains the same, proactive communication cultivates a trusting relationship between the caregiver and the patient. A patient’s hospital stay is usually a short term and unpredictable experience; therefore, every interaction with the patient is an important opportunity to nurture their trust in us. For example, when one nursing unit started to do daily morning rounds involving the unit manager, charge nurse, and other key members of the care team, their complaints decreased dramatically. In doing so, this care team sought after the patient’s questions before it became a concern and many patients felt empowered and safe to speak up as a result.

It’s always encouraging to see other proactive tools in action to help staff and patients facilitate communication like the hourly rounding technique to check on patients as well as giving a thorough nursing report during shift change. All caregiver relationships are challenging but the rewards of proactive communication makes it worthwhile for everyone involved.


- Craig Pomykal
Patient Advocate

Classic Cars and Prostate Exams...yes, Prostate Exams

Gorgeous classic cars shining in the sun, live music, good food, and prostate cancer screening examinations – yes they all go together! On September 19th, the Cowtown Cruisin for a Cure Classic Car Show will be held in downtown Fort Worth. This event was created by classic car show fans that were searching for a way to raise awareness about prostate cancer and raise money for research. Some of the proceeds are donated each year to the Prostate Cancer Resource Center at Texas Health Harris Methodist Hospital Fort Worth.

I remember the first car show screening in 2002 and chuckle when I think about it. We were skeptical when approached about having screenings at a car show. We sent one mobile unit and we enlisted Dr. Ace Thurman to do the screenings. The staff was overwhelmed with men seeking screenings and back up help had to be enlisted! 2003 was the first year the Prostate Cancer Resource Center was operational and as coordinator, I decided to make this our major screening event of the year. Its been a huge success, screening between 175 and 250 men a year. The costs for the screenings are underwritten by a grant from the Texas Health Harris Health Foundation and we will have up to 70 employees volunteering at the screening event tents or back in the lab processing the specimens.

Several men have been diagnosed with prostate cancer as a result of the information they received during the screening. Now there is a group of prostate cancer survivors that volunteer and help with educating the men waiting in line and encouraging men to get screened. Every year we get thanks from wives and girlfriends for having a non-threatening, fun event for their loved ones to attend. The car show is a free, fun, family event, with over 400 beautiful cars on Main Street from the convention center to the courthouse. So come bring that special man in your life, and encourage him to come learn about prostate cancer. The screening booth and mobile units will be on 5th street between Main and Houston (behind the stage) and screenings will be done from 10 am to 2 pm.

- Gayle Wilkins, MSN, RN, OCN

Prostate Nurse Navigator

Photo credit: Glen E. Ellman and Gayle Wilkins

The Job of a Lifetime

Pictured above (from left): Hugh Gittens, executive chef; Charles Jones, faithful food and nutrition services employee for 40 years and Lou Barth, director of food and nutrition services

At the monthly Nutrition & Food Service department meeting held in July, we honored our employees with their service awards. Time in service ranged from 1 year of service to 40 plus years right here at Harris Methodist Fort Worth. That’s right, 40 years here at Harris. What is most impressive is that they chose food service as a career and stuck with it for all of those 40 plus years.

One of the honorees was Charles Jones. Charles began here at Texas Health Harris Methodist Fort Worth back in 1969 in the Harris kitchen where he spent six years as a sanitation supervisor. He then moved to the patient services area, where he delivered patient meals as a runner for ten years after which, he returned to the kitchen for another 8 years. The opening of the Plaza café brought him an opportunity to try his hand at retail. The daily intimate contact with peers, staff and visitors grew on him and quickly became something he looked forward to. Charles serves more than 200 meals every day with a boisterous greeting and a friendly smile ever since.

Charles plans to be here “another 20 years the good Lord willing”; he went on to say “ thank God there is a Harris”.

The Art of Nursing

Today we are facing a major health care problem in America, too many in our community are without access to health care due to lack of insurance. Everyone has an opinion on how to solve the problem. I’m not professing to have the answer however I do believe that the Faith Community can play an important part. Prevention and early intervention is very important in maintaining good health.

Faith community nurses provide health educational programs, arrange preventive screening programs, and act as health advocates providing appropriate referrals to members of their congregation and the community. These are just a few examples of how a Faith Community Nurse (FCN) can make a difference. They do many things, from teaching the youth to comforting the hurting.
I don’t mean to make it sound as if faith community nurses are the only answer for health care change but I do suggest they can be a part of the equation. FCNs bring it all together, the body, mind, spirit for the entire community serving one person at a time, one church at a time.

If every church had a faith community nurse, just think about the impact we could have on the health of our country!

- Paulette Golden, RN

Manager of Community Health and Faith Community Nursing

Bubbles Help Preemies Breathe Easier

One of the first challenges that a newborn baby faces is making the transition from life inside mom, where all of the oxygen comes from the placenta, to life outside the womb, where the lungs take over that task. Often, infants born prematurely are not fully prepared for that transition. In past decades, that usually meant that premature babies had to have a breathing tube in place and a ventilator to breathe for them.

In recent years, strides have been made in the development of devices that can help premature infants to breathe easier without requiring a ventilator. One of the most common of these devices is nasal CPAP.

The lungs of a baby born prematurely are not fully developed, and the chest wall and its muscles are not yet strong enough to hold the lungs open. The lung is much like a balloon. When a balloon is completely deflated, it is much harder to blow air into it than if it is partially inflated already. Premature lungs have a tendency to deflate, making them inefficient and ineffective.

CPAP stands for Continuous Positive Airway Pressure. The device works by giving pressure through prongs that fit in the nose to help keep the lungs from deflating, so they can work better. The type of nasal CPAP we use in the NICU at Texas Health Harris Methodist Fort Worth is called “bubble CPAP.”

The bubble CPAP system is very simple. A tube through which air and/or oxygen are flowing (the INSPIRATORY LIMB) attaches to one side of special nasal prongs that fit into the nostrils of the infant. Another tube attaches to the other end of the prongs to serve as a “release valve” for the air/oxygen (the EXPIRATORY LIMB). The free end of the expiratory limb is placed 5 centimeters deep into a bottle of sterile water or dilute acetic acid. The pressure delivered to the baby can be increased or decreased by changing the depth of the expiratory limb in the bottle. As air travels through the system, it comes out the expiratory limb and bubbles in the bottle, hence the name bubble CPAP.

Since we started using bubble CPAP a few years ago, the average number of days that our premature babies need to be on a ventilator has decreased dramatically. When parents see their tiny infants breathing comfortably without the need for a ventilator, they breathe easier, too.

- Dr. Fran Lynch
Neonatal ICU Physician

Diagram credit: Aly et al Peds 2001

A Hidden Epidemic

Family violence can happen to anyone. It is an epidemic that crosses all socio-economic, ethnic and religious groups. In fact, 1 in 3 women have been victims of domestic violence at some point in their lives (Journal of American Medical Association, 2001). In addition, domestic violence is not limited to adults. Over 40% of male and female high school students reported they had been victims of dating violence at least once (National Center for Victims of Crime, 2004).

Signs and symptoms of family violence or dating violence
You are ridiculed, put down, made fun of or belittled
You are not free to come and go as you wish
Your possessions are damaged
You are verbally attacked or accused
You are spied on, followed or harassed
You or your children are emotionally deprived
You are isolated from family and friends
You are forced to have sex against your will
You are refused help when you are sick or injured
Your finances are restricted
You are left in a dangerous place
You or your children are pushed, shoved, slapped, kicked, strangled or threatened with a weapon


What you can do to protect yourself and your children
1. Call 911 if you are in danger or need help
2. If you are injured, go to a hospital emergency room or doctor and report what happened to you or your children. Ask that they take photos and document your visit in writing.
3. Know where you can go for help and tell someone what is happening to you. Have the phone numbers of friends, relatives and domestic violence programs with you.
4. Plan with your children and identify a safe place for the.: a room with a lock or a neighbors house where they can go for help. Reassure them their job is to stay safe and not to protect you.
5. Arrange a signal with a trustworthy neighbor. For example, if the porch light is on during the day, call the police.
6. Keep any evidence of physical abuse such as ripped clothes, photos of bruises and injuries, etc.
7. Keep important items with someone you trust:
spare set of keys
birth certificates
drivers license
social security card
some money
set of clothes
immunization records
insurance papers
prescriptions
passports
checkbook
food stamps

8. Plan the safest time to get away
9. Contact a local domestic violence program to find out about laws, shelters and other resources available to you before you have to use them. A local domestic violence program in Tarrant County is Safehaven 877-701-7233. To locate other domestic violence programs you can call the National Domestic Violence Hotline at 800-799-7233.

- Lisa Estrella

"Magnet"ic

Texas Health Harris Methodist Hosptial Fort Worth continues the Magnet Journey by completing the process for Magnet Re-designation. We recently hosted 4 ANCC Appraisers for a Magnet Site Visit June 29th - July2, 2009. This site visit was scheduled after the appraisers read and reviewed the 10 volumes of written documentation submitted to ANCC on February 1, 2009. This documentation demonstrated how we meet the 14 Forces of Magnetism and included over 160 sources of evidence. Based on the review of the written documentation, the Magnet Appraisers awarded THFW a site visit without request for further documentation, very few hospitals across the country are able to achieve this. During the 4 day site visit the appraisers toured all the nursing units and held meetings with nursing staff to verify, amplify and quantify the information submitted in the Magnet Document. The nursing staff that participated in the site visit stated that this was a great experience and loved the opportunity to brag about the magnetic work environment at THFW. Although we have not formally received feedback from ANCC we do expect to hear soon and the appraisers stated upon leaving that they could see that the 14 Forces of Magnetism are alive and well at THFW. So thank you and congratulations to all the staff as THFW continues to demonstrate that we are the leader in health care in Tarrant County and a great place for nursing! Remember Magnet Began with Me and Continues with Me...and stay tuned as we await the official survey results! More to come...

- Debbie Phillips, MSN, RN

Director of professional practice and community health

Third Rider

Part of my job with THR is to get a hands-on experience of all of the services we offer to our community. A few months ago I was in a fortunate position to get to spend time with some of our good friends with CareFlite. These individuals provide medical transport services to all of North Texas. CareFlite is a Texas, nonprofit 501(c) 3 corporation governed by a Board of Directors with representatives from Texas Health Resources, Methodist Health System, Baylor Health Care System, Parkland Health and Hospital System, and the JPS Health Network. Their transportation services include a helicopter EMS service, a fixed wing air ambulance, 911, specialty care, and ground services.

I met with Jim Swartz, the president and CEO, who was kind enough to give me an overview of CareFlite. He also provided a tour of their office and hangar in Grand Prairie, TX. After the informational overview, they set me up as a “third rider” with one of their helicopter EMS teams stationed here at Texas Health Harris Methodist Hospital Fort Worth. The Third Rider program is designed to give health care professionals an opportunity to ride with the helicopter crew and learn more about air medicine and operations.

I arrived at their office at the top of the Richardson Tower for an initial group meeting. Their team included the pilot, the RN, and the paramedic who gave me a tour of their work area and the helicopter. They warned me not to get my hopes up for flying a lot; third riders have a reputation of getting in on slow days. Soon after that conversation, things started to get a little busy. Our first call came in around 8:00 a.m. for a hospital-to-hospital transfer from United Regional Health Care Center in Wichita Falls (oddly enough my home town). It just so happens that my dad works at that hospital! I sent him a text to let him know I was “swinging by” and was able say hi to him before taking off back to Fort Worth. That was a great trip and I would have been completely satisfied if that was the only call for the day. However, we ended up flying to Abilene, Alliance, and Cleburne ending my day with them around 7:00 p.m. that evening. I had a great time with the crew. They were helpful in answering my questions and letting me know how they did their jobs. I was really lucky to get to experience such a busy day with them too. The CareFlite team is dedicated to providing excellent care to their patients and is an invaluable asset to our community.

To learn more about CareFlite, the “Third rider” program, or their Caring-Heart program, please see their website at http://www.careflite.org/.

- Scott Spencer
Administrative Resident

One Day at a Time

As I have embarked on this breast cancer journey as a survivor and a Breast Health Navigator, I have realized I have learned more from my patients than I ever could from reading about life.

As we all know, things happen in life that aren’t in our planning books or wireless handheld devices. We think our planned out day turns into a nightmare because we overslept and didn’t get to work on time, or you realized you forgot to buy more shampoo and cannot wash your hair before going to work.

These things sound so trivial and in the grand scheme of things, are very small.

Wake up some day to a phone call and the voice on the other end says, “You have breast cancer.” Now that is not a way to start any day. You are suddenly thrown into a talespin of fear, confusion and most of all, unknowns…

”I didn’t ask for this”…”the report must be wrong”…”do they have the right person???” “ I feel fine.” These are just a few of the questions and thoughts that go thru your mind as you are trying to process this new challenge.

Each and every one of the women that I have spoken with that have been diagnosed with breast cancer all have similiar thoughts. The one thing that I have noticed about all of them is that they are strong. Strong in their faith, their character, and their determination to beat this disease.

I admire each and every one of them. The journey is long. Each day is different. You must take “one day at a time.”

There is a poem that I read and love that reminds me of so many of my patient’s and what I try to convey to them:

"Life is like a day, the sun goes up, then down, and I figure, life is like that, you go up, and you go down, don’t give up though, for you’ll make it. Remember, sun up, sun down." Written by Jay Hendrickson (11 yrs. Old, who died of osteosarcoma in 2001)

Remember, One day at a time…sun up, sun down.

- Dana McGuirk, RN, BSN

Breast Health Navigator

Tough Medical Decisions

An interesting observation I have made after the opening of the Palliative Care Unit has been the increased awareness of palliative care in general. We, the Palliative Care Consult Team, are getting more consults for patients with advanced illness to help those patients consider comfort care or discuss end of life care. Discussions about palliative care usually focus on a few key decisions people face as they come to the end of life. Several tough decisions families face are:

Should my loved one be a "Do Not Resuscitate" patient?
Should we start or stop artificial nutrition and hydration for my loved one?
Should my loved one, who is in a nursing home, be hospitalized?
Is it time to shift treatment goals from cure to hospice or comfort care?

This decision can be difficult for families of patients who have previously expressed the wish not to receive aggressive life support. In times such as these, I am reminded that I deal with end of life care every day but this may be new for these families.

I also try to keep the focus of the discussion on the patient, “What did your mother want to have happen in times like this? Another example is “Your mother had an active life before this event would she want to continue life as she is now?” Sometimes this will help redirect the conversation, sometimes it just takes time. These questions can help relieve the families concerns because the patient has already made the decision for them.

Are you or someone you know struggling to make tough decisions on behalf of a loved one? If you have questions about end-of-life care or palliative care, please call (817) 250-4929.

- Alvin Mathe, D.O.,
Medical director of palliative care