Spring 2014 health news 2013 annual report

A Quarterly Publication of Harrison County Hospital • Spring 2014 / Annual Report 2013

Welcome Cameron Luo, M.D. Harrison County Hospital welcomes neurologist Cameron Luo, M.D. to the Specialty Referral Center.

Dr. Luo, of Luo Neurological Institute, specializes in treatments for Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), dementia, headaches, strokes, seizures, myasthenia gravis, and neuropathy. Dr. Luo also provides Botox injections for migraine headache, cervical dystonia, blepharospasm, and hemifacial spasm and manages seizure patients with vagus nerve stimulation (VNS).

Dr. Luo is available to see patients in the Specialty Referral Center, located in the HCH Medical Pavilion on the hospital campus. For an appointment with Dr. Luo, contact your primary care physician for a referral.

Harrison County Hospital Specialty Referral Center 1263 Hospital Drive NW, Suite 100, Corydon (812) 725-8621

Congratulations to Bogdan Nedelkoff, M.D. who retires after 54 years of dedicated service at Harrison County Hospital!

More recently, Dr. Nedelkoff & Mrs. Nedelkoff at his 50 year anniversary celebration.

In This Issue...

Dr. Nedelkoff & Mrs. Nedelkoff (pictured left) and Dr. Dukes & Mrs. Dukes (right) in earlier years.

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Heart Aflutter?

2013 Annual Report Calendar of Events

www.hchin.org

Heart aflutter?

Maybe it’s love. Or maybe it’s A-fib.

Atrial fibrillation, also known as A-fib, is a fairly common condition that causes the upper part of the heart called the atria to beat quickly and in an uncontrolled manner, known as fibrillation. Sometimes it causes palpitations, a sensation of fluttering in the chest. This irregular and often rapid heart rate can cause poor blood flow to the body and an irregular pulse. It is a serious condition that requires medical attention.

A-fib can be occasional (symptoms come and go over minutes or hours) or chronic (symptoms do not go away without treatment). Often there is no obvious reason for developing it; however, according to Kent E. Morris, M.D., cardiologist and electrophysiologist at Norton Healthcare, there are some factors that can increase your risk for it: • Heart disease • High blood pressure • Diabetes • Obstructive sleep apnea • Obesity • Excessive alcohol use • Thyroid disease “Treatment differs depending on the type of A-fib and the severity of the symptoms,” Dr. Morris said. “If episodes are mild, medications may take care of it. More serious cases or cases that don’t respond to medication may require surgery or an ablation procedure.”

If you have been experiencing heart palpitations (irregular or rapid heartbeat), shortness of breath, dizziness, chest pain, tiredness and weakness, don’t ignore it. Make an appointment with your physician.

– Joyce Retz

Top Baby Names for 2013

One of the ways that Harrison County Hospital demonstrates our commitment to providing quality care is through our partnership with Norton Healthcare.

Norton Heart & Vascular Center, located at our hospital, is a direct result of this affiliation, which provides a unique connection to some of the region’s most skilled heart and stroke specialists.

In addition, Norton Heart Care has established an Atrial Fibrillation Center of Excellence. Cardiac electrophysiologists, heart surgeons, nurse practitioners, physician assistants, sleep medicine specialists and coagulation specialists work together to offer expert, multidisciplinary care for A-fib. The center cares for patients who may require firstline therapies, as well as more advanced cases that require surgery or catheter ablation. For a free brochure on A-fib or to learn about a new support group for people who have been diagnosed with A-fib, call (502) 629-1234.

Meet the Maternity Center Physicians

BOY Logan Kaiden Xavier GIRL Ava Addison The Harrison County Hospital Maternity Center delivered 394 babies in 2013!

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Joseph R. Sauer, M.D.

KC Dunn, M.D., Ph.D.

HCH Obstetrics & Gynecology 1263 Hospital Drive NW, Suite 260 Corydon, IN 47112 (812) 738-6040

Women’s Healthcare of Southern Indiana 5300 State Road 64, Suite 103 Georgetown, IN 47122 (812) 923-6200

2013 Annual Report A Message to Our Community Welcome to our 2013 Annual Report, and thank you for your interest in Harrison County Hospital. Our modern facilities continue to exceed expectations for the delivery of quality healthcare. In addition to the modern facilities, a key element to the delivery of quality healthcare services is our staff’s commitment to competent and compassionate care. I believe that the success of an organization like HCH is driven by three basic concepts…..our People, Technology, and Commitment. To that end, patients continue to express satisfaction with the care they receive from HCH. As an example, over 15,000 patients have responded to our ER patient satisfaction survey to date. These survey results indicate that 96-98% of HCH ER patients are satisfied with their services and they would recommend the HCH ER to family and friends.

A major commitment in 2013 was the continued implementation and refinement of an integrated Electronic Medical Record (EMR) system. Our $5M+ (over 5 years) investment in the Cerner EMR system is substantially funded by the federal government with HCH meeting “meaningful use” criteria in 2013. The primary goal of an integrated EMR is to positively impact care delivery by allowing doctors and other providers to access patients’ health information in multiple settings and in real time.

An EMR should help to reduce medical errors by incorporating critical paths within the EMR and lead to more efficient and effective care delivery. So, no matter if you are a patient in the ER, Surgery, OB, an inpatient, or in one of HCH’s many clinics and doctor practices, your providers will have enhanced access to the information they need to best care for you!

Implementation of patient care initiatives through our enhanced Norton Healthcare affiliation agreement was also a key commitment this past year. A central principle of our affiliation is to jointly develop services to care for patients “close to home”, at HCH. When a more specialized level of care is needed, a coordinated process is in place to assure timely and convenient transfers. These transfers will allow “to and from” communications with a patient’s caregivers at both HCH and Norton.

Appropriately caring for patients close to home will be achieved through service development, shared expertise and resources, access to provider manpower, use of new technologies (including EMR/IT linkages and telemedicine), and an ongoing commitment to create better access to healthcare services for HCH patients. A good example of how our affiliation serves Harrison County well is Norton’s Louisville Oncology led by Dr. Thomas

Woodcock. This excellent cancer care service is a full time medical oncology program serving patients in the HCH Medical Pavilion.

Medical Staff development was a busy endeavor in 2013. Some key developments included the start of a full time dedicated inpatient Hospitalist program. Drs. Brent Murphy and Steven Perkins joined the HCH Medical Staff in 2013 to primarily care for inpatients and provide ongoing critical care services. Both Dr. Murphy and Dr. Perkins completed internal medicine residencies with extensive training and experience with hospital inpatients and critical care. To further develop our pediatric services, Dr. John Norton and Dr. Deborah Hall (of Kids First Pediatrics) joined the HCH Physicians Group as an HCH owned practice.

In addition, Dr. Emily Pittman (a pediatric trained Indiana Med School graduate) joined Kids First and the HCH Staff in mid-2013. Our Kids First doctors remain committed to high quality pediatric services with the added benefit of HCH’s infrastructure. We also added full time mid-level providers Jennifer Murphy (a board-certified nurse practitioner with Dr. Clunie’s Office) and Jake Chang, a full time Certified Registered Nurse Anesthetist (and several other part time CRNAs in Jake’s group). And, after valuably serving HCH since 1960, pathologist Dr. Bogden Nedelkoff is retiring. Norton’s affiliated Clinical Pathology Associates will be providing ongoing pathology services to HCH and our patients. Dr. Nedelkoff will be missed by many, and I certainly wish him a long and happy retirement.

Hospitals continue to struggle financially.

Several hospitals, including some of the State’s largest, reported staff reductions in 2013. Many hospitals continue to experience reductions in collectable patient revenue. At HCH, we are seeing unprecedented increases in charity care, bad debt, as well as Medicare and Medicaid write-offs. As an example, our Medicaid write-offs went from about $1M per year in 2000 to a DSH net of nearly $12M in 2013. Charity care and bad debt write-offs have increased from $2M in 2002 to nearly $11M in 2013.

Harrison County Hospital has been operated with positive financial statements for most of the past 30 years. In 2013, HCH registered approximately 115K patients, and generated a positive EBIDA (cash flow) of $3,750,000. This EBIDA level is more than 3 times HCH’s debt covenant requirement. Since the 1980s, our cash reserves have increased from ~$100K to $15M. Our current long term debt is approximately $8.5M; mostly attributable to the $51M new campus and facilities.

Besides our central mission of providing various needed healthcare services to our patients “close to home.” HCH is also a substantial economic engine for Harrison County and surrounding communities.

We are proud to be one of the largest employers in the County with ~ 550 jobs and a $25M+ payroll.

According to an American Hospital Association study, the local economic multiplier effect from a hospital is over $2 generated for every $1 spent by a hospital. With over 500 HCH employees purchasing various local goods and services, and paying various local taxes, HCH’s local economic impact is quite significant.

On a personal note, as I write this, I am concluding my 25th year at HCH. Looking back, I have enjoyed working here, gained many good friends and memorable experiences, and I am very proud of how we have developed as an organization to better serve our community. I want to express my sincere appreciation to the many contributors to HCH’s success over the past 25 years. Operating a hospital in today’s environment is very complex, is an ongoing struggle, and takes many bright people working towards the same goals. In order to serve our community in the future, we are committed to building on our many assets....including modern patient centered facilities, our competent and caring Staff, our Norton affiliation, and an organizational wide mission to provide quality care to our patients.

Best Wishes for Good Health,

Steven L. Taylor Chief Executive Officer

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2013 Annual Report

HARRISON COUNTY HOSPITAL FOUNDATION 2013 CONTRIBUTORS Individual partners in health (cont.)

Corporate Partners in Health ($500+ contribution) Benefit Planning Services, Inc. Bennett & Bennett Insurance, Inc. Cerner Duke Energy of Indiana Eckart, LLC First Harrison Bank General Surgery Associates Hall, Render, Killian, Heath & Lyman, P.C. Harrison REMC Horseshoe Southern Indiana Indiana Utilities Corp.

Irving Materials Inc. Logan’s Healthcare & Uniform Medline Industries, Inc. O’Bannon Publishing Co., Inc. Owen’s Machinery, Inc. Radiology Associates, Inc. Robertson Insurance & Financial, LLC SIHO Insurance Services Tyson Foods, Inc. UltraGroup, LLC Walker Architects, Inc.

ORGANIZATIONS/CLUBS ($200+ CONTRIBUTION) Kiwanis Club of Historic Harrison County

Individual partners in health ($100+ contribution) Hammad Bokhari, M.D. Mr. & Mrs. Earl Book Dr. & Mrs. Wilfred J. Brockman Dr. Richard Brown Anonymous Bob & Peggy Bursey Aaron S. Bye Diane & Neyland Clark JoAnn Cabell Scott Cobel, MD Mr. & Mrs. W. Ovid Collins Martin & Lisa Cook Frank N. Czeschin John & Cindy Daily Christi & Wayne Darnall Jeff & Becky Davis Roger & Qudsia Davis Dr. Chris & Ann Day Nina & Darrin Deatrick Brenda S. Donahue

For gifting information, please call the Foundation Development Office at 812-738-8762.

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Ruth A. Donahue Sarah & Ian Dougherty Kerrin C. Dunn, MD Dawn R. Durbin, DDS Laurie & Gerry Eckart Kristin & Willie Ems Charles & Bonnie Fessel Lisa Freeman Steve & Pat Gilliland Mark Glasgow, MD Sean Goddard, RN Don & Susan Gossman Monica & Larry Harmon Monty & Janna Hocker Eddie & Rowena Hoehn Michele Howard Wayne & Rosa Hutchins Diane & Jim Johnson Dr. & Mrs. Curtis A. Jordan Melvin M. King, Sr. Gary & Elena Kleeman Effie Kuhlman Charitable Trust Sharon T. Laufer, MD & John C. Laufer Tim & Chris Lawson Lisa Lieber Mary A. Lynch Max & Barbara Martin Paul & Lorine Martin Robert S. Mattingly, DMD Anne McMahon Mr. & Mrs. Harry R. Middleton Mohammed Adel Mohammed & Melinda Mohammed Bogdan Nedelkoff, M.D. The O’Bannon family Gordon & Christine Pendleton Don & Jerry Ann Piontkowski Anonymous Jerry & Lennie Reinhardt Mrs. Betty Robson Mr. & Mrs. Richard W. Rothrock Juanita Ruedinger Ed & Linda Runden Robert & Teresa Schickel Mr. & Mrs. Peter J. Schickel Mark & Kathy Shireman Ron & Sharon Simpson Lowell & Gloria Smith Michael & Patricia Tate Bill & Joy Taylor Steven L. Taylor Carroll Taylor Gaddie Bill Thomas – Edward Jones Investments Genarose Turner Danny & Doris Utz Carolyn Voelker Darrell & Sheryl Voelker John & Inez Voyles Damion S. Wagner family Matie Watts Courtney Whitehouse Chuck Wiley Kelley L. Wilkerson Michael & Jennifer Wiseman

Dr. & Mrs. Thomas Woodcock Kent & Joy Yeager Callie Zimmerman

Other donors Access Storage Now Air Methods Kentucky Dennis & Jeanie Albin Mrs. Jean Baumgart Christina Bean Vanessa Benson Gale & Billie Bilbrey Don & Betty Bilbrey Larry Bilbrey J.C. Bittner David Blevins William Blevins Stephen Bodney, M.D. Marie Brennan Bill Bruner Steve Bruner Rose Mary Bullerdick Greg & Lisa Burch Kenny Burkhart Butt Drugs, Inc. Jerry Byrd Centra Credit Union John & Phyllis Chitwood Michael Clark Steven Clark Amos Claycomb Heather Cloud Troy Cobb Corydon Elementary School Students Corydon Rotary Club Valerie Cox Eric & Veronica Croner Richard Dale Jetta Dauphinee Davis Davis & Layson, Attorneys at Law Tom Dear Richard P. & Paula Denbo Richard & Paula Dodge Ruth Donahue Steve & Zhanna Donahue Sarah & Ian Dougherty Eckart, LLC Mark Elrod Kristin & Willie Ems Barbara Fahimi First Capitol Liquors First Savings Bank Cheryl Fisher Mary Forbess Harold Gardner Gehlbach & Royse Funeral Homes, Inc. Ralph Goodwin John Gott Jessica Harrell Harrison County Community Foundation

Harrison County Health News • Spring 2014 / Annual Report 2013

MEMORIAL GIFTS (cont.)

Other donors (cont.)

Hickman Flowers & Gifts, LLC Rose Higazy Allen Hockman Hosparus Don Housman Martin Hunter Wayne & Rosa Hutchins ID&A Wayne Jacobi Donna Jacobs Lannie Keith Kindred Transitional Care Justin King David Kintner Kintner House Inn Susan Klinefelter Jim Koerber L & D Mail Masters, Inc. Lanesville Food Mart David Lawton Larry & Malinda Lee Jim & Brenda Lerud Gale Lewis Dave Long Jim Lucas Lucas Oil Products, Inc. Ron Magill Patti & Larry Mangin Brad Mattingly Jim Mattingly Robert S. Mattingly, DMD Aaron McKim Bryan & Jan McRae Thomas L. Monroe Wendy Morehead Michael Farrel Morgan Tim Myrick William J. Myrick Karen Nelson Angie Neuman Fred & Kay Owen Nikita Pedigo Precision Compounding Pharmacy Perry Probst Tamara Pursell Larry & Kathy Ragains Mr. & Mrs. Floyd R. Raisor Jerry Reed Jeff Reich RevOne Companies Betty Roberts Connie Routh Melvin Rudolph Harvey Lee Sanders Charles Schwab, Clarksville, IN – Michael E. Johnson CFA Karen Schwartz Bob & Patsy Scott George Shawler James L. Shireman, Inc. Mr. & Mrs. S. Paul Sides Simpson Thompson & Colin, LLC Rusty Sizemore Bill Smith Gary Smith Mike Smith Southern Indiana Rehab Hospital Johnny Spalding Charles Staser Steve & Sandy Stepro Stites & Harbison, PLLC Ray Stroud David A. Sturgeon Ron Tennyson

Debra Tharp Rachel Thomas LeRoy Tomes Charles Velt Damion S. Wagner family Steve & Wanda Wagner Carlton & Jeanette Watson Carl Whitman Walter Windell Michael W. Wiseman Rick & Missi Wiseman E.C. (Woody) Woodfin Larry E. Young Shawn Zimmerman

MEMORIAL GIFTS Cova Bates, Sr. John & Inez Voyles LeRoy Beavers Jeff, Sandy, Ryan, & Ross Schmidt Bud Bennett Monty & Janna Hocker Susan Book Mark Glasgow, M.D. Eddie & Rowena Hoehn Phil Whitlow Keith Burgess Cheryl Fisher Phyllis Carver Virginia McMonigle Pat Payne Barbara Day Dr. Chris & Ann Day Virginia C. Denbo Bennett & Bennett Insurance, Inc. Billy DeWeese Sarah DeWeese James L. Donahue Brenda S. Donahue Margaret Robb Dukes Bennett & Bennett Insurance, Inc. Mary Brockman Martin Dr. & Mrs. Wilfred J. Brockman The Bunco Girls Elizabeth Cato Phyllis Combs Frank N. Czeschin Janet Frederick Terry Haub Susannah Sample Hebert Eve Ann Jordan Sam & Barbara Lander Janie Mayrath Diane D. Miller The O’Bannon family Rodefer, Moss, & Co., PLLC Gordon & Christine Pendleton Mark Smithson Candace Stroud Steven L. Taylor Joy Wolfe

Ben Fisher Evelyn Taylor Rita Gettelfinger Bennett & Bennett Insurance, Inc. Steve & Pat Gilliland Steven L. Taylor Audra Haas Manubay, RN Mary A. Lynch Thomas W. Hutchins Wayne & Rosa Hutchins Diane Johnson Diane Clark Beverly Dodds Ruth Donahue Cheryl Fisher Carol Flamion Mary Holland Patti Mangin Wendy Morehead Ernest & Mary Killer Anne McMahon Jimmie King Melvin M. King, Sr. Diane D. Miller Mr. & Mrs. C. Henry Withers Joy Wolfe Marvin Kost Bennett & Bennett Insurance, Inc. Alan Martin Cheryl Fisher Judy Miller Bennett & Bennett Insurance, Inc. Paul Nelson Darrell & Sheryl Voelker Charlie Phillips Steven L. Taylor Charles Douglas Robson Mrs. Betty Robson Jim & Mary Shireman Sam & Becky Eckart Mark & Kathy Shireman Walter & Virginia Stumph JoAnn Cabell Fern & Leo Taylor Carroll Taylor Gaddie Merlyn K. Usher Steven L. Taylor Joellen J. Voyles Bennett & Bennett Insurance, Inc. Arthur D. Windell Glenna Windell Bart Zimmerman Callie Zimmerman

Honor gifts Norma Blank Gerald Blank Alice Fisher Diane D. Miller

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www.hchin.org

2013 Statistics

Financial Information

Note: 2013 unaudited figures; 2012 audited figures

Patient Services Delivered

2013

2012

1,949

1,842

1,921 Emergency Visits ........................................................................................................................... 13,799 Urgent Care Visits .......................................................................................................................... 6,400

2,050 15,730

Total Outpatient Visits ...................................................................................................................

51,958

57,099

36,121 Laboratory Tests ........................................................................................................................... 140,747

32,635 160,203

X-Rays & Imaging Scans .............................................................................................................. 24,250

29,513

2013

2012

Total Assets ............................................................................................................................. $59,665,045

$58,627,538

$8,751,758

$9,098,725

Net Assets ................................................................................................................................ $43,510,360

$44,023,914

Gross Revenue ........................................................................................................................ $107,612,854

$112,628,631

Uncompensated Care ............................................................................................................. $10,197,363

$10,724,823

Medicare & Medicaid Write-Offs ............................................................................................ $37,227,371

$39,034,853

Salaries & Benefits ................................................................................................................ $25,655,468

$25,394,572

Total Expenses ........................................................................................................................ $45,638,119

$46,791,479

$3,517,429

$4,330,690

Inpatient Admissions and Births ..................................................................................................

Surgical Procedures ......................................................................................................................

6,951

HCH-Owned Physician Practice Office Visits .............................................................................

Financial Information

(Preliminary Data)

Long-Term Debt Outstanding ...............................................................................................

Earnings Before Interest, Depreciation and Amortization .................................................

The above financial information does not include the activities of Harrison MOB, LLC, a separate legal entity, of which HCH is a partial owner.

2013 Board of Trustees

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Fredrick Owen

Nancy Zimmerman, RN

Carl Duley

Chairman

Vice Chairman

Secretary

Donn Blank

Richard Brown, M.D.

Ronald Haendiges

Lowell Smith

Calendar of Events

Harrison County Health News • Spring 2014 / Annual Report 2013

April

1 Free Blood Pressure & Bone Density Screening, HCH Main Lobby, 4:00-6:00 pm.

Registration opens for Safe Sitter Class, to be held June 9. Call 812-738-7869 1 8

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for more information and to register.

Diabetes Self-Management Class, Accredited by the American Association of Diabetic Educators, Capitol Room 2, 9:00 am-4:00 pm. Physician referral required; call 812-738-8713 for more information.

American Red Cross Blood Drive, Blood Mobile in HCH Parking Lot, 1:00-5:00 p.m.

HCH Foundation Scholarship Applications due, Scholarship applications available

on our website, www.hchin.org.

Kidney Smart Class, Capitol Room 1, 5:30-7:00 pm. Free class to learn about

kidney function, medications, lifestyle and diet and treatment options.

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Free Diabetes Support & Information, Capitol Room 1, 1:00-3:00 pm.

Registration is required by calling 502-494-5266.

MAY

5 & 12

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Childbirth Education Class, Parvin Baumgart Education Center, 6:30-8:30 pm. Call 812-738-7830, ext. 2012 to register. Class is FREE if delivering at HCH!

Free Blood Pressure & Bone Density Screening, HCH Main Lobby, 2:30-4:30 pm.

Free Community Health Screening, Rehab Services, 8:00-10:00 am. Registration is required by calling 812-738-7869. Must register by May 5.

Diabetes Self-Management Class, Capitol Room 2, 9:00 am-4:00 pm.

Physician referral required; call 812-738-8713 for more information.

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Breastfeeding Class, Parvin Baumgart Education Center, 6:30-8:30 pm.

Call 812-738-7830, ext. 2012 to register. Class is FREE if delivering at HCH!

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Free Diabetes Support & Information, Capitol Room 1, 1:00-3:00 pm.

Registration is required by calling 502-494-5266.

JUNE

3 Free Blood Pressure & Bone Density Screening, HCH Main Lobby, 9:00-11:00 am.

Safe Sitter Class, 8:00 am-4:30 pm. Call 812-738-7869 to register.

9 Registration open April 1 – May 12.

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Diabetes Self-Management Class,

Capitol Room 2, 9:00 am-4:00 pm. Physician referral required; call 812-738-8713 for more information.

Siblings Class, Capitol Room 1, 5:00-6:00 pm; registration is required; call 812-738-8708. A free class especially for the big brothers and big sisters of newborns prior to baby’s arrival at Harrison County Hospital.

Free Diabetes Support & Information, Capitol Room 1, 1:00-3:00 pm.

Registration is required by calling 502-494-5266.

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1141 Hospital Drive NW Corydon, IN 47112

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Nursing Staff Implements Color-Coded Uniforms

Seasonal Recipe to Enjoy

Harrison County Nursing employees working in direct patient care positions now dress in discipline specific, color-coded uniforms and scrubs.

Super Spring Salad

Spring is finally here. Asparagus, onions, and lettuce are some of the first vegetables of spring.

• Registered and licensed nurses wear navy blue.

• Nursing aides and techs wear khaki.

The decision to implement a color-coded uniform policy came about after extensive research of best practices at other top performing healthcare organizations. This research revealed:

• Patients and family members view uniformed employees as trustworthy, more capable, and competent.

• A consistent dress code has a highly positive impact on patients and their perception of the care provided, which can result in higher patient satisfaction.

• Patients and family members react very positively to being able to use standard uniform colors to distinguish each caregiver’s role and area of expertise.

• For nurses in particular, standard uniforms positively influence the nurse-patient relationship and first impressions, including the patient’s peace of mind that professional care is being provided.

• Professionals can easily distinguish one another in an emergency situation and identify appropriate personnel in nursing stations, medical rooms, patient rooms, and other areas during an emergency.

• Standard color-coded uniforms consistently have a highly positive effect on patient care experiences and resulting patient satisfaction scores in other organizations.

Ingredients: • 1 pound fresh asparagus, trimmed • 1 large ripe pear, sliced • 2 tsp. lemon or lime juice • 2 green onions, thinly sliced • ¼ cup chopped walnuts, toasted • 2 tbsp. prepared honey Dijon or low-fat honey mustard dressing • 8 romaine (or fresh spring) lettuce leaves In a large skillet, bring ½ in. of water to a boil.

Add asparagus; cover and boil for 3-5 minutes or until crisp-tender. Drain and immediately place asparagus in ice water. Drain and pat dry; cut into ½ in. pieces and set aside.

In a large bowl, combine pear and lemon juice. Add the onions, walnuts and reserved asparagus; drizzle with dressing and toss to coat. Arrange lettuce on four salad plates; top with asparagus mixture. Serve immediately.

Makes 4 servings.

Brittany, RN, OB

Jennifer, Aide, ICU/TCU