LVMC Community Update, August 28, 2020

in LVMC News

Dear Lompoc Valley Community:

Now that we have gotten the DNC and RNC conventions out of the way, we can get some normalcy back in our lives by watching Wheel of Fortune. But seriously…no, I actually am serious.

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Dear Lompoc Valley Community:

Now that we have gotten the DNC and RNC conventions out of the way, we can get some normalcy back in our lives by watching Wheel of Fortune. But seriously…no, I actually am serious.

COVID-19 Information

  • Hospitalized Covid Patients. The downward (good) trend in Santa Barbara County has continued this week. The number of Covid positive hospitalized patients decreased from 55 last Friday, to 39 as of yesterday. LVMC currently has 1 confirmed Covid positive inpatient. The remaining 38 are split roughly equally between North County and South County. That represents a significant decrease for both ends of the County, particularly for North County.
  • Positivity Rate. The Santa Barbara County Positivity Rate has been declining over the past few weeks. We believe that the “real” current rate dropped slightly again this week, and is in the 4.5% range. However, the State figure for Santa Barbara County, which uses other source data, and rolling averages, is in the 7% range.
  • County Monitoring List. Today, the State of California is expected to announce a total revamp of the County Monitoring List program, as well as the metrics that will be used going forward. The announcement will go first to the Counties before it is released to the public. Although I am aware of what is expected to be included in the new program, I will need to wait until the official communication occurs. So, please look for more discussion about this next week.

Hospital Types

Please indulge me as I provide a brief primer regarding the various types of General Acute Care Hospitals:

There are several “categories” of acute care hospitals. Some of them are officially designated by the State and/or Federal government, while some are simply terms used to describe certain types of hospitals.

  • The smallest hospitals (by bed-size) are Critical Access Hospitals. “Critical Access” is a designation given by CMS (Centers for Medicare and Medicaid Services) and is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To qualify for Critical Access designation, a hospital must have 25 or fewer beds, and be at least 35 miles from the nearest hospital (with some exceptions). LVMC is not a Critical Access Hospital.
  • Sole Community Hospital is a designation bestowed by the Federal Government (CMS). The designation is based on a hospital's distance in relation to other hospitals, indicating that the facility is the only hospital serving a community. Distance requirements vary depending on whether a facility is rural and how inaccessible a region is due to weather, topography, and other factors. Sole Community Hospitals receive additional financial and other resources. LVMC is not a Sole Community Hospital.
  • Community Hospital is not an official designation but refers to hospitals that provide primary hospital services for residents of its surrounding service area. LVMC is a Community Hospital. LVMC has 60 acute care beds but provides services comparable to some community hospitals that have two or three times as many beds. In addition to the typically expected primary services, LVMC, in conjunction with its medical staff, provides the following services: Bariatric Surgery; Plastic and Reconstructive Surgery; Critical Care Tele-Intensivists for the ICU/CCU; Tele-Neurologists for the Stroke Program; Hospitalist Medicine Service; MRI services; Obstetric and Pediatric services (which many community hospitals have ceased providing); and other services.
  • Tertiary Hospital, likewise, is not an official designation, but refers to hospitals that are typically larger, and provide a wide array of specialty services, and have a wide array of physician specialists on their medical staffs. They often have academic affiliations. Although patients may be admitted directly to tertiary hospitals, they typically receive a significant portion of their admissions by way of transfer from Community Hospitals, when certain unavailable specialty services are needed. In Santa Barbara County, Cottage Hospital would be considered a Tertiary Hospital. Marian Medical Center, in my opinion, would be somewhere between a Community Hospital and a Tertiary Hospital.
  • Quaternary Hospital, also not an official designation, refers to hospitals that provide the greatest breadth of specialty and sub-specialty services. There are certain sub-specialty services that even tertiary hospitals are not capable of providing, and when the patient need dictates, transfers will be made to quaternary hospitals. Quaternary Hospitals are typically academic facilities, such as UCLA Medical Center, and Stanford University Medical Center.

Hospital Quality

One reason I chose to define the various types of hospitals, above, was to set a backdrop for this statement: Quality is not defined by the breadth of services provided, but rather, by the appropriateness and effectiveness of the services that are provided.

LVMC works diligently to ensure that for the services it does offer, they are every bit as high quality as one would receive at any tertiary hospital. LVMC, like all hospitals, strives to continually improve. When there is a situation in which the process, outcome, or patient satisfaction is not what we intended, we do our best to learn from it and do better the next time.

I am pleased to report that we just received the Hospital Quality Institute Quality Transparency Dashboard, below. It compares LVMC to State and National averages in the areas of:

  1. CLABSI-Central Line-Associated Blood Stream Infections
  2. Colon Surgical Site Infections
  3. NTSV- Primary C-Section Rate after 37 Weeks
  4. 30-day Readmission Rate

For number 4, above, LVMC was right at the State and National averages. For the other three metrics, LVMC was significantly better than the State and National averages. It also indicates that LVMC has implemented a Maternity Safety Program, Sepsis Protocol, and Respiratory Monitoring Program. I would like to thank our employees and physicians for their dedication towards providing the best possible care and outcomes.

1 Outcome Measure Definitions
CLABSI - Central line-Associated Blood Stream Infection: A serious infection that occurs when germs enter the bloodstream through a central line. A central line is a special intravenous catheter (IV) that allows access to a major vein close to the heart and can stay in place for weeks or months. The value shown above is a Standardized Infection Ratio (SIR), which is the ratio of observed-to-expected infections during the measure period. SIRs below 1.00 indicate that the observed number of infections during the measure period was lower than would be expected under normal conditions, whereas values above 1.00 indicate that the observed number of infections was higher than expected. Limitations: In the calculation of the Standardized Infection Ratio (SIR), the CDC adjusts for differences between hospitals.  However, patient risk factors are not taken into account. These patient-specific variables (e.g., poor skin integrity, immunosuppression) can increase the risk of developing a central line infection.  Hence, the SIR for hospitals that care for more medically complex or immunosuppressed patients may not be adequately adjusted to account for those patient-specific risk factors.
Colon SSI - Colon Surgical Site Infection: An infection (usually bacteria) that occurs after a person has colorectal surgery that occurs at the body site where the surgery took place. While some involve only the skin, others are more serious and can involve tissues under the skin, organs, or implanted material. The value shown above is a Standardized Infection Ratio (SIR), which is the ratio of observed-to-expected infections during the measure period. SIRs below 1.00 indicate that the observed number of infections during the measure period was lower than would be expected under normal conditions, whereas values above 1.00 indicate that the observed number of infections was higher than expected. Limitations: Some, but not all patient-specific risk factors are included in the adjustment of the SIR for these types of infections.  However, not all relevant risk factors are included (e.g., trauma, emergency procedures).  Hence, the SIRs for hospitals performing more complex procedures or with larger volumes of trauma or emergency procedures may not be adequately adjusted to account for those patient-specific risk factors
NTSV - Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate: The percentage of cesarean (surgical) births among first-time mothers who are at least 37 weeks pregnant with one baby in a head down position (not breech or transverse). Lower values indicate that fewer cesareans were performed in the hospital among primarily low risk, first-time mothers.  Limitations: NTSV rates do not take into account certain obstetric conditions, such as placenta previa, that may make Cesarean delivery the safer route for both mother and infant.
Sepsis Mortality: Percent of patients, with a severe infection, who die in the hospital. Most sepsis cases (over 90%) start outside the hospital. Lower percentage of death indicates better survival.  Limitations: Use of discharge/administrative data is limiting since such data has lower specificity for diagnoses than clinical data.  In addition, without risk adjustment for differences in patient-specific factors, comparing rates among hospitals is difficult.
30-day Readmission - Hospital-wide All-Cause 30-day Unplanned Readmission Rate: The percentage of patients who were unexpectedly readmitted within 30 days of discharge from the hospital for any reason. Lower values indicate that fewer cases were unexpectedly readmitted after discharge. Limitations: Some, but not all patient-specific risk factors are included in the adjustment of the readmission rate.  However, not all relevant risk factors are included (e.g., trauma, emergency procedures).

Donations

To be listed every other week, starting again next week.

I continue to be impressed, grateful, and proud of our frontline healthcare workers, support staff, physicians, and allied health professionals; their dedication and selflessness are truly inspiring.

Thank you, Lompoc Valley Community, for your tremendous support of LVMC and our healthcare workers; it means a lot to all of us!

As always, please feel free to contact me at This email address is being protected from spambots. You need JavaScript enabled to view it. or (805) 737-3301. Until next time, be well and stay safe!

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Steve Popkin

Chief Executive Officer

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Author: Steve Popkin, Chief Executive Officer

Stephen D. “Steve” Popkin became Chief Executive Officer of LVMC in February 2019. Mr. Popkin has more than 32 years of experience in senior health care management, including 18 years in Chief Executive Officer positions.

Learn more about Steve Popkin, CEO

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