By By JOHN EBY / Dowagiac Daily News
As one of Michigan's 37 critical access hospitals, Borgess-Lee Memorial Hospital of Dowagiac this month was honored with the Governor's Award of Excellence for improving emergency room transfers and pneumonia transfers in 2005.
Borgess-Lee was one of 109 hospital recipients statewide.
"Those are two indicators we picked to make sure we do the best we can with what we do," Chief Nurse Executive Marilyn White said Thursday.
"We could have picked heart attack, congestive heart failure, several different things. This is the second year we've won the award. Yes we can take care of all kinds of patients, but certain patients need to be transferred. So if we're going to transfer these patients, we want to insure they're stable and ready to be transferred before they go out our door, so nothing happens enroute to any of the hospitals, wherever they may be transferred to."
White, chief nurse executive for going on six years, explained that many critical access hospitals transfer almost all of their patients who come in to the ER (emergency room), "where our hospital is a bit different. We have a special care unit, we have intensive care and we take care of all kinds of patients.
"But there are some patients we do want to transfer – particularly those who may need a very long period of care," she said. "We have to make sure that we're appropriately transferring patients, that they have been stabilized, so when they get to the receiving hospital they can just continue on with the care at a higher level."
"We partnered with MPRO (Michigan Peer Review Organization) and they allowed us, as critical access hospitals, to be considered for the last couple of years. This is a great award for us. It shows all the great work that we're doing and making sure that the people in the community have quality health care when they come to our hospital," White said.
MPRO "is the organization that works with the Centers for Medicare and Medicaid Services to make sure you have appropriate and quality health care in your state."
Critical care hospitals have 25 beds or less. Average length of stay "annualized" can be no more than four days.
"We do have patients who may stay with us for two weeks or so, if they so need it," she said. "Those are some of the rules you work under when you go to the designation of critical access."
"It's a status you apply for so you get maximum reimbursement for your Medicare patients," White said, "because smaller hospitals have a very difficult time dealing with the money amounts that you have to have in order to keep a hospital running. We're a community hospital. We went from 74 down to 25 beds. We went for that designation about three years ago."
In evaluating an emergency room transfer, White said, "We look at the indicators, the criteria. First of all, vital signs need to be stabilized, IV's started. We look at care that is provided. A pneumonia patient, we want to make sure that we got their antibiotic into them within a four-hour period of time because that's one of the indicators, that we assess their oxygen. Were they able to breathe? Or did they need some help by being put on a ventilator? Certain criteria are set for no matter what size hospital you're in, whether it's a 1,000-bed hospital or a 25-bed hospital – this is the standard of care that you should be receiving. That's the information we send in to MPRO, which then looks at it for the whole year to see if you have been an exceptionally performing hospital that receives the governor's award."
White began her career more than 30 years ago at St. James Hospital in Chicago Heights, Ill. "I was part of that system for about 14 years. I took my first job as a chief nurse at a 174-bed hospital in Chicago called South Shore Hospital. From there I went to work at St. Anthony's in Crown Point. There was a nursing home, home health, parish nursing and so forth. In that system I worked at the corporate level as risk manager and in quality improvement.
"I've got a lot of different experience in different areas," she said. "My clinical experience, I've worked primarily in critical care, ER and OR (operating room)."
White came to Dowagiac through a lakefront home she and her husband Neil have owned for 25 years at Gravel Lake, between Marcellus and Lawton.
"We love Michigan," said White, who was born "in the southern tip of Illinois, down in what's now part of the Shawnee National Forest. My parents had a dairy farm. They moved to Chicagoland when I was small" to be nearer to her father's brothers.
"My husband and I wanted to find a place where we wanted to retire to. Florida was never what we were looking for," White said as snow swirled outside her office window in the second week of October.
"I was very surprised when my garage door came up this morning," she said.
Her husband was transferred to Elkhart, Ind., about seven years ago. They sold their house in Crown Point since their children were grown.
She worked for a short time at Lake View Hospital in Paw Paw.
Dowagiac "is a wonderful town," she said. "I hear a lot of people say, 'Oh, I was born in that hospital.' "
As her title indicates, White directs more than Borgess-Lee's 52 registered nurses.
"I also have laboratory, pharmacy, cardio-pulmonary," she said. "I am the risk manager and I was the quality person, but we just hired a new one so I can give that title to someone else."
Aunts influenced her choosing a nursing career. Her father, also.
"He was a World War II vet. He always said such wonderful things about when he was injured in the war and his nursing care. To him, nurses were just extremely special people. It's also interesting that a lot of nurses come from the farm community. I guess because we're a nurturing group and we kind of take care of things."
If only there were more of them. White just attended an MPRO conference with the state chief nurse executive.
"She was talking about the nursing shortage and the problems that are going to be encountered in the future, and it's not just nurses, but physicians also. There's still a big shortage. One of the problems is we don't have enough instructors. The average age of a nurse is 47 or 48 years old. It's probably because nursing instructor salaries are low" compared to house supervisors. "It really needs to be looked at because you have the applicants, but not the instructors."