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Age of Interdependence 

Regional Medicine's Changing Landscape

These are not the hospitals of our youth. The "supermarket" model of hospital care, in which a standalone facility or campus served up all of the community's medical necessaries in one place, is as nearly as dated as the little white caps nurses used to wear. Burgeoning technology and its soaring cost, combined with the upheaval inherent in health care reform, have all been forces in play in creating a rapidly and dramatically shifting landscape.

What hasn't changed is the talent and passion that drives those who make a life in hospital health care, from the nursing assistant to the strategic planner. The shift away from all-in-one centralization toward "centers of excellence" and collaboration on a regional level can be disorienting, but the goal remains a user-friendly and healing experience and the provision of the best possible care.

Dave Ping, senior vice president for strategic planning and business development at HealthQuest, the parent organization that oversees Northern Dutchess Hospital in Rhinebeck, Vassar Brothers Medical Center in Poughkeepsie, and Putnam Hospital in Carmel, says the focus is on "quality, access, and tertiary services. Tertiary care is the kind of medicine you used to have to travel to New York City or Albany for. We're striving to make top quality tertiary care available in the Hudson Valley because it's beyond doubt that getting treatment close to home improves outcomes."

New developments this year include the Center for Healthy Aging at Northern Dutchess, at which a board-certified geriatrician—a specialist in the health concerns of older patients—oversees efforts to help experienced citizens age in place, healthy and active in their own homes. There is also a new wound care center under construction, at which those with diabetic ulcers and other troublesome chronic healing issues can be treated in a hyperbaric chamber with super-oxygenated air. It's slated to open this fall.

Major upgrades to the Northern Dutchess campus begun in 2005 are ongoing, and a three-story addition will feature offices on the first floor, inpatient nursing beds on the second, and a state-of-the-art operating suite on the third. And speaking of those inpatient nursing beds: "We're in the early planning stages of replacing 40 bed spaces that date back to 1928 with facilities that are strictly 21st century," says Ping, in what sounds like good news for caregivers and patients alike.

Down the road at Vassar, the ribbon's just been cut on 100,000-square feet of ambulatory surgery and office space, meaning outpatients will be able to access the minor surgeries and follow-up they need close to home. "That will have a major impact on serving the Poughkeepsie-area need," says Ping.

Vassar has been working to ramp up the quality of its various departments, including the addition last August of a pediatric "hospitalist" unit—a hospitalist being a physician who, besides their specialty, focuses on practicing that specialty on inpatients in particular. Surgeons from Westchester will be available to the little ones of the upper Hudson Valley round the clock, making it less necessary for families to add travel time to their stress factors.

In response to the area's increasing need for general surgeons, Vassar has added two already—Dr. Michael Choi and Dr. James "J.R." Nitzkorski. "They're very skilled oncologic surgeons who do the minimally invasive incisions and laparoscopy, working with TV cameras." Two more general surgeons will be added this summer.

"We are actively recruiting," Ping says. "It's estimated that the area will need 100 surgeons by 2015-16, as a result of the growth and aging of the population. There will be at least a 7 to 10 percent increase in demand for care. We have a new obstetric surgeon at Northern Dutchess, we've added several internists and we're going to add more. We are also looking to add a gynecological oncologist."

Quality is not being sacrificed. "Our cardiac care unit at Vassar has the best outcomes in the state, largely thanks to Dr. Mohan Sarabu and his team," Ping notes. And Vassar, like Northern Dutchess, has some dated beds that are due to be replaced somewhere in the near future. "When we add space, we are going to look at hybrid facilities that put the imaging technology—the CT scan, MRI, cardiac catheters, and such—right in the OR, so that the surgeon will have imaging at his fingertips.

Putnam Hospital has just added da Vinci robot technology, which Vassar has had for the last couple of years. The daVinci technology allows surgeons to perform operations that would once have required major incisions, with all the anguish that entails, with the assistance of robots that can turn some major surgeries into microsurgeries. Putnam is also noted for fine results in the area of bariatric surgery for the morbidly obese.

Finally, Ping says, "We've been working on it for so long that it almost seems old hat by now, but by the end of this year, all of our medical records will be electronic. If your doctor is on the beach on vacation, he'll still be able to get your test results and records on his smartphone."

It might surprise some, but over in the southwestern corner of Ulster County, the comparatively tiny Ellenville Regional Hospital is even closer to completely computerized records. "Every single department in the house is going live next Thursday [May 30], and that touches everything," says CEO Steve Kelley. "The access to information and the ability to measure—it can only improve quality."

Ellenville's quality of care has been trending higher and higher since Kelley took over several years ago. In February, Ellenville became the only hospital to win a NorMet (Northern Metropolitan Hospitals) Quality and Patient Safety award two years in a row. This year's was in the Small Hospital category for its Medication and Patient Safety Collaborative. In 2011, the hospital won for reducing the average ER visit time to under 100 minutes, a fact Kelley is especially happy about. "I can't think of anything that makes a bigger difference to the average person in the community—we have kept those times down two years in a row. We've added things like digital mammography for women and cardio stress testing that are big deals for a small place, and I'm proud of that."

The hospital also just took top honors from New York's major malpractice insurers' association for quality and risk management from a physician's point of view—given the interdependent nature of a hospital experience, good news for consumers too. "Top in the state," Kelley savors it. "The two runners-up were major medical centers. To be mentioned in the same sentence...and to be at the beginning of the sentence, at that...Better analytical tools, more metrics. Expect these trends to continue."

The last piece of major news Kelley cites speaks directly to the growing need for medical expertise mentioned by Ping. "We have residency programs throughout the hospital now," he says. "We train family practitioners, pharmacists, physical therapists, surgical and lab techs, nurse practitioners. Right now, we are the smallest teaching hospital in the country."

At Benedictine Hospital in Kingston, the new Fern Feldman Anolick Center for Breast Health will soon be the first in the Hudson Valley to offer advanced diagnostic and biopsy technology called Molecular Breast Imaging (MBI), a major advance in the care of patients with dense breast tissue, suspicious areas on a mammogram, lumps that can be felt but not seen on a mammogram or ultrasound, implants or other breast augmentation procedures, scarring from previous surgeries and/or a strong family history of breast cancer.

Benedictine's parent, the HealthAlliance of the Hudson Valley, manages not only Benedictine and Kingston Hospitals but the Margaretville General Hospital and two geriatric facilities, Woodland Pond in New Paltz and Mountainside in Margaretville, and provides a number of imaging, diagnostic and other services at other locations. Their 30-station dialysis center, operating only since 2011, just won "Five Diamond" status—the highest level of recognition available to such a facility in New York State. While adjusting to the results of the contentious hospital merger that was consummated in 2008 (HealthAlliance recently announced it would be closing one of its two Kingston hospitals), the alliance has continued to expand services, adding a sleep center, a physical medicine and rehab center, and an orthopedic center to its Kingston offerings.

Being a hospital patient is never much fun. No matter how hard anyone tries, it'll never be as relaxing as one's own home, and that fact can be jarring in and of itself when you're feeling ill and vulnerable. But there is, perhaps, some comfort to be found in the advances, innovations and awards that characterize hospital care around the region. Should you find yourself in a bad situation, the odds are you'll also find yourself in good hands.

RESOURCES

Benedictine Hospital Hahv.org/benedictinehospital

Ellenville Regional Hospital Ellenvilleregional.org

Kingston Hospital Hahv.org/kingstonhospital/

Northern Dutchess Hospital Health-quest.org

Putnam Hospital Health-quest.org

Vassar Brothers Medical Center Health-quest.org

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