Sunrise Hospital: Quality, Innovation, and Patient Safety

Introduction

Sunrise Hospital and Medical Center, including its affiliated Sunrise Children's Hospital, represents a nearly 55-year-old healthcare institution located in southern Nevada, serving the greater Las Vegas area and surrounding communities. The facility maintains a strong commitment to patient safety and comfort through direct quality initiatives such as safe medication dosing via smart pump technology and medication bar-coding. Additionally, Sunrise Hospital practices non-discrimination policies regarding HIV/AIDS status and employment, ensuring equitable treatment across all areas of admission, participation, and care.

Sunrise has earned distinction as the most popular area hospital in patient surveys for over 15 years. The institution has developed comprehensive community outreach programs addressing health education needs identified within the communities it serves. The CAMH 2000 Management of the Environment of Care initiative outlined critical protocols that Sunrise has implemented, including property and security measures for all patients, visitors, and staff; security incident investigation procedures; formalized security management programs and personnel; identification systems for staff and visitors; and protocols addressing additional security concerns.

The hospital has also positioned itself at the forefront of technological innovation. Pharmacy automation through bar-coding systems and the region's only Gamma Knife facility—a non-invasive Cobalt-60 radiation method for treating brain cancers such as metastatic melanoma—exemplify this commitment. Furthermore, Sunrise Hospital maintains compliance with all governmental regulations governing hospital funding and financing programs.

In the following manuscript, Sunrise Hospital and Medical Center is examined with particular focus on how this organization has addressed the fundamental criteria of providing the highest quality of care to patients. The report addresses health system technology and modern updates for such organizations, from needs assessment through workflow implementation. For modern healthcare systems, patients, their families, and the community represent the primary customer base, with high-quality healthcare delivery as the primary end goal. The broader customer base extends beyond patients to include families, local communities, and employees at all levels—from physicians and nursing staff to health trainees, support staff, IT personnel, janitorial staff, and administrative teams. Recent massive changes in information technology, emerging global infectious diseases such as Ebola and HIV/AIDS, and new legislation designed to improve healthcare have significantly shaped institutional priorities.

The Modern Hospital

Sunrise Children's Hospital and Sunrise Hospital and Medical Center have served as premiere healthcare centers in southern Nevada for over 55 years, with a focus on providing integrated healthcare services through comprehensive patient care while also addressing the needs of employees including physicians, nurses, clinical and laboratory staff, IT personnel, and support services. The institution seeks to deliver measurable quality, cost-effective, and comprehensive integrated healthcare. Sunrise views its physicians as partners in providing safe care to every patient. Safe medication administration and patient safety remain priority goals, addressed through smart pump technology and bar-coding systems for pharmaceuticals and intravenous solutions. As a foundational principle, Sunrise Hospital maintains non-discriminatory policies based on disability, age, race, color, sexual orientation, religion, gender, and health status including HIV/AIDS—policies applied consistently across employment, admission, treatment, services, and program participation (Sunrise Hospital, 2014a).

The hospital has received national recognition for programs including stroke management and heart care, with innovation and clinical excellence forming core institutional traditions. Over the last 15 years, Sunrise has been consistently rated as patients' most preferred hospital (Sunrise Hospital, 2014b). Physicians and staff possess considerable expertise and advanced training from leading global institutions, positioning Sunrise among the world's leading medical centers.

The Las Vegas community benefits from both Sunrise Hospital and Sunrise Children's Hospital through established on-demand and long-term community educational programming. Community outreach programs include support groups, disease-specific education, and staff development initiatives. Direct community programs encompass nutritional counseling, diabetic and prenatal classes, disease-specific and general health education, child safety programs, women's health programs, childbirth preparation, student educational activities, health fairs, and specialized training including pediatric advanced life support (PALS) and cardiopulmonary resuscitation (CPR). Educational opportunities are delivered in both Spanish and English as needed (Nevada Hospital Reporting, 2011).

Hospital business strategy depends upon and is shaped by diverse internal and external forces (Devers, Brewster, & Casalino, 2003). While hospital occupancy rates have generally declined, some communities report recent increases. Understanding how hospitals successfully compete provides insight into broader healthcare market developments. Because patients are customers, competition has led some hospitals to adopt retail business strategies to attract and retain patients and specialists. Hospitals may invest heavily in outpatient and inpatient services perceived as high-tech, though such investments can be substantial and may duplicate services already available elsewhere in the community.

Multiple external forces shape the business strategies of modern hospitals such as Sunrise. Major factors include labor supply; economic and demographic trends; medical technology; regulation; payment methods; behavior of private and public purchasers; and hospital and health plan characteristics including competitor type and number (Luke et al., 1999). Sunrise Hospital and its Sunrise Children's Hospital have implemented a Mission Plan to "achieve an unequaled level of measurable quality in the delivery of a continuum of cost-effective, integrated health-care services that are responsive to the needs of the patients, physicians, employees and community" (Nevada Hospital Reporting, 2011).

To achieve this mission, support staff, laboratory and clinical staff, dietitians, nurses, and physicians have committed to providing compassionate, high-quality care. This commitment includes monitoring initiatives focused on safety and quality, attentive listening to patient and family feedback during and after treatment, and implementation of improvements based on gathered information. Patient education and information access form important components of care. Sunrise works with the United States Department of Health and Human Services and the Nevada Hospital Association to voluntarily submit quality data accessible to patients (Sunrise Hospital, 2014).

Research Concerning Hospitals

To sustain successes and achieve broader institutional goals, Sunrise is implementing several development and implementation strategies. New sophisticated information technology systems for managing patient information are being deployed. Critical implementation requirements include vendor support and performance, user training and acceptance, interface and connectivity specifications, database management, downtime protocols and planning, and rollout strategies with pilot site selection (Protocare Sciences, 2001).

Nursing care represents an important topic often absent from discussions of cost control and hospital quality. Effective healthcare quality discussions must integrate nursing staff considerations, yet such integration frequently does not occur. Issues of cost control, care quality, nursing performance, and staffing levels should be integrated to achieve high-quality goals. Nursing—in both staffing and management—forms a critical component of hospital quality and cost efficiency. Nurse involvement in hospital quality processes is therefore essential for both clinical and operational success. Positive interaction between hospital management and nursing staff has been emphasized in research. However, a 1996 Institute of Medicine report titled "Nursing Staff in Hospitals and Nursing Homes" concluded that hospital care was not adversely affected by staffing pattern changes or hospital restructuring (Needleman & Hassmiller, 2009). Related topics include hiring and training of certified practical nurses or licensed practical nurses, who assist with routine tasks from bed changes to patient comfort measures. Many hospitals also employ volunteers who provide books, advocacy, and patient companionship.

The precise definition of "high quality" in modern hospitals remains subject to ongoing discussion. While quality is universally accepted as a goal, its specific meaning remains contested. The Hospital Quality Alliance (HQA) is a national public-private collaboration designed to assist hospitals in collecting and reporting quality evaluation information on a voluntary basis, though the relevance of such data remains controversial (Shih & Schoenbaum, 2007). Other organizations like Stoughton Hospital collect quarterly quality evaluation data from the United States Department of Health and Human Services and local hospital organizations, producing reports focused on patient satisfaction and care quality for hospital improvement, comparative analysis, and public access (Stoughton Hospital, 2014).

Research data strongly suggests that quality of care in teaching hospitals ranges from moderately to substantially better compared with non-teaching hospitals (Ayanian & Weissman, 2002). Research has also examined patient issues including web-based electronic health records (EHR), electronic charting records (ECR), personal health record management, and identity theft impacts. A second research study of healthcare providers found that information technology use in hospitals overlapped with security issues. Medical errors may be impacted or improved by IT implementation, which should more precisely identify patients. Additional areas examined include increasing telemedicine adoption and pervasive RFID (radio-frequency ID) use.

Health Care Innovations

In the present healthcare system, 66% of hospital revenues derive from government funding according to Foster (2000), with remaining funds from private payments, voluntary non-profit organizations, commercial insurers, and local government tax revenues. Government funding's substantial proportion means that hospital viability depends on funding for elderly, disabled, and poor patients through Medicaid and Medicare. Thus fiscal management depends on appropriate strategy and awareness of potential funding changes. Previous government funding changes have placed certain local and state hospitals at financial risk (Byington, Keene, & Masini, 2006).

Cost reduction for hospitals may involve hiring a management company for central oversight. Services may range from simple accounting and tax processing to comprehensive departmental streamlining, generally achieving cost-effective rate services. Such management companies typically receive monthly fees of approximately 6.5% of net hospital revenues. Services include government reimbursement management, filing and report preparation, capital planning, internal audits, managed care contracting, consulting services, budget control systems, financial reporting, accounts receivable management, legal services, and human resources including employee benefits. The corporate office handles taxes, appeals, audits, returns, and reports at local, state, and federal levels (Nevada Hospital Reporting, 2011).

Computerized system downtime represents a potentially serious consequence for hospitals. Downtime may result from routine backup or maintenance requirements, rendering important systems non-functional. Employees require training in downtime procedures; ideally, redundant systems remain available and operable. Familiarity with downtime protocols is essential for maintaining quality patient care (Fahrenholz, Smith, Tucker, & Warner, 2009).

Recent legislation has been enacted to avoid or offset upcoming tax increases affecting hospitals regarding Medicare and physician payment reductions. Legislative extensions include provisions for the Coding Offset for Medicare Inpatients ($70 million in Nevada), decreasing payments for fiscal years 2014–2017; Medicaid Disproportionate Share Hospital (DSH) payment cuts—a national $4.2 billion decrease over ten years, with Affordable Care Act DSH policy extension to 2022; a $300 million national decrease over ten years for Medicare Radiology outpatient treatment, with exemptions for rural and sole community hospitals; and a $4.9 billion reduction nationally over ten years in Medicare End Stage Renal Disease treatment payments, adjusting medications use in payment calculations.

Community Outreach

According to the Nevada Hospital Association (2013), Sunrise Hospital was recognized for excellent stroke care meeting evidence-based guidelines. The American Heart Association/American Stroke Association's Get With The Guidelines–Stroke Gold Plus Quality Achievement Award recognized Sunrise's quality success and stroke patient commitment (Nevada Hospital Association, 2013). The institution is proud of major investments in modern cutting-edge technology treating complex medical conditions, including: the da Vinci Surgical Robot assisting in minimally invasive surgical procedures that enhance recovery; the Gamma Knife surgical center using Cobalt-60 gamma radiation for non-invasive, precisely targeted brain surgery in invasive melanoma and other brain conditions; sophisticated PACS (picture archiving communication system) technology for real-time x-rays, CT scans, and MRI imaging, decreasing patient wait times and enabling speedier diagnosis and treatment; and pharmacy robots with medication bar-codes, improving patient safety and preventing medication errors.

According to Zaltman and colleagues (1973), innovation is critical for businesses to remain productive and survive in competitive environments. In healthcare, balancing quality with cost containment has driven significant innovation. Most recently, RFID (radio frequency identification) tags have become increasingly common, with approximately 10% of hospitals using them, according to the ECRI Institute nonprofit consultants. Recently, JAMA warned that RFID tags could potentially interfere with medical devices in use. Another concern involves inadvertent personal data release from tracking technology. Patient protection steps and high-tech equipment examples include: [1] videoscopes—high-definition camera signals on equipment used to navigate patient anatomy for tumor searches, gallbladder surgery assistance, and colonoscopies (Omachonu & Einspruch, 2010); [2] industry-standard data models and healthcare informatics technologies enabling access and storage via eCHR and ePHR; [3] ePHR (electronic Personal Health Record)—patient-accessible records enabling selective information sharing; [4] eCHR (electronic Clinician Health Record)—enabling healthcare providers to compile, access, and record patient-specific information; and [5] novel robot rehabilitation methods for stroke treatment and potential future applications, emerging from MIT scientist work.

Sunrise Hospital has established diverse community outreach programs, many accessible through its website (Sunrise 2014). These include the Consult-A-Nurse program for healthcare referral, featuring a cell-phone app for convenient access. The program employs nurses and referral specialists assisting individuals to make appointments, find appropriate doctors, answer healthcare questions, obtain hospital information, and register for events and classes. The Consult-A-Nurse program operates 24 hours daily.

Conclusion

Regarding physician selection, Consult-A-Nurse provides information about physicians associated with Sunrise Hospital and Sunrise Children's Hospital, including medical specialty, experience, and skills. The program informs individuals which physicians accept new patients, provides office directions and hours, and offers direct consultation on health-related topics. While Consult-A-Nurse cannot provide diagnoses, nurses and referral agents address specific health topics including orthopedics, spine care, sleep disorders, weight loss surgery, women's health, cardiac services, wellness seminars, children's health, family birthing classes, diabetes care, neurology, men's health, stroke, health screening, and community health fairs. This comprehensive approach enables patients to access information and support in navigating healthcare decisions and community resources.

The modern hospital encompasses considerable issues typically unconsidered by outsiders. These range from requirements for redundant and emergency electrical systems to the necessity of remaining current on Medicare and Medicaid legislation affecting hospital funding and physician payments. Pharmaceutical dispensation must be handled efficiently, timely, and safely—from pharmaceutical shelving through medication delivery to hospital departments and designated patients. Patient identification must be carefully maintained while concurrently addressing security and privacy concerns regarding records and critical information. All personnel require proper training in methodologies relevant to their respective departments, including emergency care. Novel and useful information technology methods must be implemented with downtime provisions ensuring critical information is not lost and important systems are not compromised. Surgical care requires sophisticated equipment, lighting, modern robotic assistance, and in some cases Cobalt-60 Gamma Knife surgery—each requiring specialized training and fail-safe backups. Yet the bottom line for any hospital remains patient care, which must be both safe and of the highest quality.