Electronic Physician Orientation - Part 1 of a two part orientation for new members of the Medical Staff of Yuma Regional Medical Center

2. Administration Greg Beckman President & Chief Executive Officer Stewart Hamilton, MD Vice President Medical Affairs & Chief Medical Officer (CMO) Karen Jensen, MN Vice President Patient Care Services & Chief Nursing Officer (CNO) Pat Walz, CPA Chief Financial Officer Jim Hall, FACHE Vice President Professional & Support Services Mark Parston Vice President Planning & Business Development Sharon Gardner, SPHR Vice President Human Resources Gene Shaw, FACHE, FCHIME Vice President Information Technology & Chief Information Officer (CIO)

3. Board of Directors John Hudson, Major General Retired, Chair, Board of Directors YRMC sits on land owned by the Yuma County Hospital District #1. The district is governed by a five-member board elected at-large by popular vote. The district leases the land to the YRMC corporation. In exchange, YRMC must provide community benefits and hospital services. The support of the district also allows YRMC to issue tax-exempt revenue bonds for construction. Board Members: Doug Mellon, Vice Chair; Tom Thompson, Secretary; Ronald Brooksher, M.D.; Rick Dinsmore; Pamela Walsma, Esq.; and Serena A. Holthaus. YRMC is a not-for-profit corporation governed by a 12-member volunteer Board of Directors. The board is made up of unpaid community residents who have an interest in healthcare and a strong commitment to improving the health and well-being of their fellow citizens. These directors set policy for the hospital, provide direction for long-range strategic planning and monitor financial viability. Board Members: , Joann Linville, EdD, Vice Chair; Victor Smith, Secretary/Treasurer; Kathy Watson, EdD, (Chair Elect to replace Past Chair), Jeff Andrews (mentoring term begins 01/09); Russ Clark; Larry Deason; Roberto Garcia, M.D.; Louie Hirth; Mario Jauregui; Woody Martin; Sridhar Rajamani, MD; Phillip Richemont, MD; Tom Tyree; Ian Watkinson, PhD. Lynn O’Connor, Chair Hospital District Board Hospital District Board Governance

4. Medical Staff Officers and Chairs Kamal Ahmed, M.D. Chief of Staff Open Position Officer of Staff Relations Ismael Guerrero, M.D. Vice Chief of Staff Raul Castillo, M.D. Anesthesia Phillip Richemont, M.D. Emergency Medicine Roberto Garcia, M.D. Family Medicine Tsehaye Seare, M.D. Internal Medicine Emilia Matos, M.D. Pediatrics Not shown: Victor Alvarez, M.D., Pathology ; John James, D.O. & David Plone, D.O., Radiology John Brock Amon, M.D. OB/Gyn 2009 James Moon, M.D. Surgery

7. YRMC Culture The following slides define cultural expectations of Medical Staff members at Yuma Regional Medical Center Images of Yuma - Lifestyle Enjoying one of the many golf courses in Yuma Kayaking on the Colorado River

10. Regulatory The following slides define requirements and responsibilities of all members of the Medical Staff of Yuma Regional Medical Center Images of Yuma - Education Arizona Western College & Northern Arizona University / Yuma campus Gila Ridge High School Yuma Catholic High School

14. Yuma Regional Medical Center is committed to providing patients the best and safest care possible. Processes are in place to report, evaluate and take actions to address safety concerns of staff, members of the Medical Staff, patients, and family members. Quality Services & Patient Safety provides oversight for all processes related to Quality of Care, Patient/Staff/Visitor Safety and Infection Prevention. This team also coordinates the organization’s collection and aggregation of patient care data for quality improvement and regulatory reporting. YRMC strongly believes that efforts to improve quality of care must focus on process rather than individuals and promotes a “Just Culture” philosophy when managing “near misses” or actual patient harm. Quality Services & Patient Safety

15. Quality Services & Patient Safety 1. YRMC has developed numerous protocols and clinical pathways for the care of patients diagnosed with AMI, CHF, pneumonia as well as the SCIP project (Surgical Care Improvement Project) to help reduce variation and ensure that core care process are completed and documented. The use of these evidence-based pathways and protocols will help clinicians focus on other aspects of patient care. 2. Physician/Specialty level data is collected through MIDAS and is available to physicians to help review practice patterns and improve patient care processes. Please contact Quality Services at 336-7315 to discuss what data is available to you. 3. YRMC utilizes PRC (Professional Research Consultants) to conduct patient satisfaction surveys. These surveys include questions regarding physician interaction with the patient and others. 4. If you have any suggestions regarding improving patient care process please provide your name to the Director of Quality and Patient Safety at 336-7315 or the Vice President of Medical Affairs, Chief Medical Officer.

17. Reporting of Incidents What is a Reportable Incident? An incident is defined as any happening not consistent with the routine operation of the facility or routine care of a particular patient. Incidents include “near misses” and must be reported to Risk Management. Examples of reportable events include but are not limited to: Patient Injury; Pressure ulcers; Fall – patient or visitor; Behavioral actions/attitudes; Medication issues; Patient Identification errors When Do I Report an Incident? Once the patient care situation is stabilized, the individual who discovers, witnesses or is notified of the incident should immediately complete the incident report. Serious incidents require immediate verbal notification of the Risk Manager or Risk Coordinator. How Do I Report an Incident? There are two options: 1. Electronic: using remote data entry via the YRMC Intranet. 2. Verbal: contact the Risk Manager or Risk Coordinator. Use the name of the patient involved and document in the patient chart. NOTE: visitor injuries are tracked as non-patient entries. Why Report? Reporting incidents may result in changes in policies, procedures and processes to protect patients, visitors and staff from similar occurrences. The gathering of incident data enables YRMC to define trends, develop preventative actions and addresses educational needs. Risk Management

25. Yuma Regional Medical Center’s Patient Advocate researches patient concerns and/or complaints involving a patients’ hospital experience. Following Conditions of Participation Guidelines established by the Centers for Medicare Services, the Patient Advocate acts as a liaison as needed between staff, physicians, and patients when a complaint is noted. Unresolved complaints regarding physicians are forwarded to the Quality Services Department and are addressed according to YRMC Medical Staff Policy and Procedures. Patient Complaints Contact Numbers: 336-7002 or 336-3672

26. Patient Processes The following processes are designed to assist clinicians in providing efficient and effective care to patients of Yuma Regional Medical Center Images of Yuma – Health Care YRMC - Wound Care Center YRMC – Intensive Care Unit YRMC – Pharmacy Robot

27. Effective Hand Hygiene: There is no substitute! Yuma Regional Medical Center expectation is 100% compliance with proper hand hygiene protocols to reduce the incidence of Hospital Acquired Infections (HAI*). The single most important means of preventing the spread of nosocomial infection, including Multi-Drug Resistant Organisms (MDRO) is a personal commitment to effective hand washing. Hand Washing Protocol: Wash hands with warm, running water; add soap and lather well; rub hands vigorously (creating friction) for 15-20 seconds; scrub all surfaces – back of hands, in between fingers, wrists. Rinse hands and dry with a disposable towel. Use the towel to turn off the faucet. * HAI: infection acquired by patients while in the hospital, unrelated to the condition for which the patient was hospitalized

29. Patient Admissions (All) YRMC has adopted the SBAR (Situation, Background, Assessment, Recommendation) format for handing-off patients. SBAR ensures all pertinent information is shared. S – Situation Admitting & Secondary Diagnosis; Current Issues B – Background Pertinent Medical History; Physician & Ancillary Staff Consults Previous Tests & Treatments; Psychosocial Issues Allergies, Current Code Status A – Assessment Head-to-Toe Physical Assessment; Vital Signs IV’s, Drips, Line Site Assessment; Oxygen, Vent Settings Pain Status; Drains, Tubes, Wound Assessment & Care ADL’s, Diet, Activity; Restrictions; Isolation, Fall, Bleeding Precautions, Fluid; Labs, Diagnostics Response to Treatments Care Partner, Family Updates R – Recommendation Plan of Care; Needs to be Addressed Orders Pending Completion; Pending Treatment and Tests Discharge Planning, Issues, Barriers

30. Patient Admissions Information requested for ADMISSION : (please have the following information available) * Patient Name * Date of Birth * Medical Record Number (if known) * Diagnosis * Admitting Physician Name * Special Needs (e.g. Telemetry) * Type of Admission (e.g. Full admission or up to 48 hour observation) Medically Unstable Patients: - For patients requiring immediate medical intervention - Please send this patient to the Emergency Department Medically Stable Patients: Please keep the patient in your office until the House Supervisor or Resource Coordinator calls you back with a room number. Please keep in mind that during periods of heightened patient care, this process may take a bit longer. When the hospital is full, the House Supervisor/Resource Coordinator may request that the patient be allowed to wait in the comfort of his/her own home until a bed is available. If agreeable, please provide a home telephone number to the House Supervisors/Resource Coordinator. Please do not send patients to wait for beds in the Hospital’s main entrance. There are no trained healthcare personnel to monitor, assess, or access a patient.

31. Maternity Admissions For all MATERNITY admissions from the Physician Offices, please call Labor & Delivery Resource Coordinator at 336-3760 Adult Admissions For all ADULT admissions from the Physician Offices, please call House Supervisor at 336-3787 There are five (5) House Supervisors who provide coverage 24 hours a day, 7 days per week. The House Supervisor’s goal is to make the admission process smooth for the patient, and to place the patient in the most appropriate unit. Pediatric Admissions For all PEDIATRIC admissions from the Physician Offices, please call Pediatric Resource Coordinator at 336-3750 If the line is busy, call 336-7878 or House Supervisor at 336-3787

32. Patient Care Departments The following departments provide services to patients at Yuma Regional Medical Center Images of Yuma - Housing The Terraces The Dunes Winsor Park

39. Laboratory YRMC Blood Bank United Blood Services supplies 100% of the blood used at Yuma Regional Medical Center

41. Health Records Transcription & Clerical Support Services: Available 24 hours per day, seven days per week. (336 prefix): 7215; 2284; 2285. Pager for clerical support services is 376-4196. Clinical Documentation Team: Available on the floors to query for specific diagnoses documentation. Deficiency Analysis : Records are required to be completed within 30 days past patient discharge. Chartmaxx Support: Contact the Help Desk at 336-7290. For Patients: Records are available to patients with proper ID in two locations: The Heart Center Lobby or Main Lobby For Physicians: Health Records is located in the southern end of the ground floor at the base of Tower A, next to Physician Relations office.

43. Inpatient Cardiac Rehabilitation education is available by requesting “ Cardiac rehab ” on the physicians order sheet in the patient chart. Please indicate the subject matter preferred. The RN level staff providing inpatient education screen patients for referral to the outpatient cardiac rehabilitation program. YRMC’s Cardiac Rehabilitation services offer medically supervised and individualized outpatient exercise programs for people who have had a heart attack, heart surgery, angina, stent placement, angioplasty, or other heart problems. Our cardiac rehab health professionals assist each patient in setting goals and monitoring progress on a daily basis. A cardiac rehab nurse specialist and an exercise physiologist work with each patient and closely monitor electrocardiogram tracings and blood pressures during exercise sessions. Risk factor and lifestyle modifications are important to successful cardiac rehabilitation. Health education classes are available. A physician referral is required for services covered by Medicare and insurance companies. To make a referral, call 336-1015, or FAX 726-5476 Cardiac Rehab

45. Supportive Services The following departments provide support services for members of our Medical Staff Images of Yuma - Landscapes Breathtaking Sunsets Agriculture - Yuma’s #1 Industry Water Sports on the Colorado River

47. YRMC Department Information Systems – Help Desk Help Desk 24 hour technical service YRMC’s Information Services Department operates a 24 hour Help Desk for assistance with computer software applications and service to facility-owned hardware components. Help Desk Operators will strive to address technology concerns at the point of contact. If the issue requires more specific technical intervention, the Help Desk will initiate a service call to address the issue. Call 336-7290 Email: [email_address] Here for you, 24 hours per day, 7 days a week

48. Spiritual Care 24 hour supportive service The Department of Spiritual Care and Patient Advocacy supports a full-time chaplaincy service to address the spiritual dimension of health. Chaplains are available 24 hours a day, 7 days per week and are often called to assist families and staff who are in crisis, experiencing trauma and/or during various phases of illness and recovery. Chaplains are always available to support patients, families and staff through end-of-life circumstances. The chaplaincy service is non-denominational, but works closely with local community clergy to meet the special religious and sacramental needs of patients and their families. In collaboration with Yuma Regional Medical Center, the Department of Spiritual Care and Patient Advocacy offers an accredited Clinical Pastoral Education Program (CPE) to prepare master’s level ministers to serve in the unique environment of a healthcare setting. Referrals to the chaplaincy service are made through the admission process, by the physician or by a nurse. Patients may also self-refer to this supportive service. To reach the ‘on-call’ chaplain at any time, call 336-3673.

49. Medical Library The John F. Stanley Memorial Medical Library provides access to health care information to the Medical Staff, YRMC employees, health care providers in the community, and members of the public. The Library is staffed Monday through Friday, from 8:30 a.m. to 5:00 p.m. The Medical Librarian can provide research services and obtain copies of articles from other libraries. Members of the Medical Staff may access the library after business hours/weekends by use of their ID badges/proximity access reader outside the door of the library. The Medical Library contains books and journals in the health sciences. Many books may be checked out for a two-week period. If the book has not been requested the loan period may be extended. Recommendations for additions to the collection are always welcome. In addition to the print collection, users have access to a growing number of electronic resources, via YRMC’s membership in the Arizona Health Information Network. Two Internet access computers are available. The library subscribes to the local newspaper and the Wall Street Journal . To register for remote access to the Medical Library’s electronic resources (through Athens) go to: https://register.athensams.net/azhin/ . For more information about the Medical Library’s resources and services, call 336-7181 or e-mail [email_address] .

50. Medical Staff Services The Medical Staff Services processes applications for Medical Staff privileges at Yuma Regional Medical Center and coordinates background checks of practitioners. In addition, staff also: Provide notices of renewals (as applicable) for - Arizona State Licensure, - DEA, - Certification, - TB Attestation and - Professional Liability Insurance. Coordinate Department & Medical Staff Governance meetings e.g. Credentials Committee; Quality Monitoring Committee and Medical Executive Committee . Maintains medical staff roster of up-to-date names, addresses, telephone, fax, email, ( please forward changes as they occur to MSS ) Coordination of all CME programs

55. We’re Not for Profit, We’re for the Communities We Serve As a not-for-profit community hospital, Yuma Regional Medical Center seeks opportunities to enhance patient care, patient education, and access to healthcare in the local communities. Images of Yuma – At Play Stewart Vincent Wolfe Playground at Yuma’s West Wetlands City Park. Built entirely by community volunteers including YRMC staff, Medical Staff & Board Members

57. Medical Staff Orientation This concludes the electronic portion of the Orientation to the Medical Staff. Please contact the Physician Relations Office to schedule Computer Training at 928-336-7526 or [email_address] prior to providing patient care. Images of Yuma - Lifestyles Yuma Art Center Kayaking on the Colorado Year around Golf

58. Main Lobby Special Procedures Room Women’s Labor & Delivery Women & Children’s Entrance Main Entrance - YRMC