The University Medical Center of El Paso is no stranger to catastrophe. A surge in COVID-19 patients crowded the hospital's emergency department in late 2020, blanketing the space in a feeling reminiscent of the eerie quiet following the 2019 mass shooting to which the city fell victim. Undeterred by a challenge, even one as threatening as a global pandemic or as devastating as a terrorist assault, the anesthesiology team quickly adapted to meet the needs of some of the country's most vulnerable patient populations.

Striving for more

“UMC is considered the El Paso community's hospital,” Jasper Mesarch, DO, MBA, FASA, said. “A lot of our goals align with trying to make sure we're bringing the best quality care to the people here.” As a Level 1 Trauma Center, Level 1 Comprehensive Stroke Center, and Level 4 Maternity Center, the highest possible rating from the Texas Department of State Health Services, the hospital works tirelessly to improve its ability to care for patients. “We work to bring in specialists and advanced equipment that cannot be found in the rest of the city,” Dr. Mesarch said. “We focus on outcomes: better survival rates with fewer patient complications, a shorter length of stay, and decreased cost of care.” The impressive results have led to national recognition – UMC is the only hospital in El Paso to be twice named one of America's Top 100 Hospitals, among other accolades.

Jasper Mesarch, DO, MBA, FASA

Jasper Mesarch, DO, MBA, FASA

Of course, those achievements only make the team want to work harder – and hard work doesn't intimidate UMC's accomplished anesthesiology team. To positively impact team culture, leaders at UMC recently adopted the TeamSTEPPS curriculum, an evidence-based framework developed by the Agency for Healthcare Research and Quality to optimize team performance within the health care delivery system. “TeamSTEPPS strives to bring the tools for a systematic method of communication to all providers so that we can increase patient safety, increase efficiencies in the OR and perioperatively, and help to ensure that everybody has a voice – no one feels like they're being left out,” Dr. Mesarch said.

COVID-19 surge

“We were fortunate for the steady leadership of the hospital CEO, Jacob Cintron, and COO, Maria Zampini. Together they provided the forum for implementing TeamSTEPPS and other measures, allowing Dr. Mesarch and the team to create a culture change that embraced training and knowledge,” Marc Koch, MD, MBA, FASA, said. “With the support of hospital leadership, Dr. Mesarch and his team were able to train people, bring knowledge that created new competencies, and hold preparedness and planning drills that enabled the anesthesiology team to perform at peak levels.” That focus on innovation, identifying gaps in patient care, and increasing efficiencies of existing resources have all proven especially valuable as the region battles a seemingly insurmountable number of COVID-19 cases and deaths. In late 2020, the region remained one of the hardest-hit in the country, with nearly 90,000 positive cases in El Paso County in early December. As the state sent an additional 1,400 personnel to assist in area hospitals and the city was forced to request a fourth mobile morgue to temporarily store bodies of patients who died from the disease, the anesthesiology team worked relentlessly to discover the best methods for providing patient care.

Marc Koch, MD, MBA, FASA

Marc Koch, MD, MBA, FASA

Dr. Mesarch noted that as pressure mounted to identify COVID-19-related resources, members of the anesthesiology team stepped up to help secure sufficient personal protective equipment; contributed to decisions allocating specific floors to patients with the disease, later pushing into tents in the facility's parking lot; and worked collaboratively with leading clinicians on the east and west coast who had experienced similar surges earlier in the year. “We were able to increase what is normally a 298-bed hospital to around 515 available beds in a matter of weeks,” Dr. Mesarch said, allowing UMC to increase its patient care beyond an imaginable scope.

‘Code Hip’

Of course, COVID-19 patients make up just one population the team at UMC has adapted its care to better serve. The anesthesiology team recently developed “Code Hip” – an initiative that aims to reduce wait time between when a geriatric patient presents in the emergency department with a hip fracture and when they receive surgical care. “A gap was identified in the clinical process that might be improved,” Dr. Koch said. “Reducing the lag time from presenting in the ER to having surgery was a key differentiator in outcomes such as mortality, and developing a plan to remediate that gap translated to a protocol change that led to a reengineering of the perioperative process for hip fracture patients. Ultimately, collaboration with surgeons, nurses, and a highly supportive executive team were foundational.”

The team found that reducing that wait time by eliminating inefficiencies and refocusing resources to optimize modifiable risk factors led to fewer and less severe postoperative complications such as delirium, surgical site infections, acute renal disease, pulmonary disorders, high readmissions, and post-operative cognitive dysfunction. In 2015, just before the pilot program was introduced, UMC patients with a hip fracture waited 47 hours before receiving surgery, had an average hospital length of stay of 4.6 days, a 30-day readmission rate of 7%, and a cost of $15,885. After implementing the streamlined process, patients who suffered the same injury in 2018 waited 26 hours for surgery, had a hospital stay of 0.67 fewer days, a 30-day readmission rate of 5%, and a reduction in episode-of-care costs exceeding $1,500. “In the anesthesia department, we are typically last to see a patient before surgery,” Dr. Mesarch said. “We reversed roles for hip fracture patients and now put anesthesia at the forefront of the process, where we see patients within the first two hours of presenting in the ER and are able to give perioperative recommendations up front to optimize the patient's care as quickly as possible.”

Care for all

The anesthesiology team at UMC extends the same level of dedication to exemplary care to its entire patient population, including immigrants from the nearby U.S.-Mexico border and other vulnerable cohorts who may be unable to afford medical care. “UMC will care for any patient who presents to our hospital without regard to nationality or ability to pay,” Dr. Mesarch said. “We help everyone.” In addition to caring for patients who were injured while crossing the border, Dr. Mesarch said UMC works proactively to expand outreach to immigrants and patients with little or no access to health care to create clinics in areas that are underserved. For patients in areas too far from a clinic site, UMC provides transportation to urgent care centers.

For patients in the immigrant population, those battling COVID-19, geriatric patients suffering a hip fracture, victims of violent acts, or any other human seeking medical care, UMC's position is clear: “As clinicians, we share a serious oath and perennial obligation to be compassionate and to help all patients,” Dr. Koch said. “Our collective goal is to serve, to protect, and to improve clinical outcomes.”

Kelly Jong is a contributing writer.

For More Information

From small anesthesia practices to large academic centers, the PSH model has been successful in achieving the quadruple aim of bettering population health, improving health outcomes, improving patient experience, and increasing clinicians' professional satisfaction in different health care settings and countries. Learn how other institutions implemented the PSH model of care through free case studies, interviews, and more at asahq.org/psh.