Our Quality Departments

Cultural Diversity Department

The Cultural Diversity Program aids staff and physicians to meet and better serve the needs of our culturally diverse population. MMH's Language Access Services includes the Medical Interpreter Program, AT&T Language Line Services, and ASL interpreters. A Medical Interpreter can be accessed at all hours of operation. To call for an interpreter between the business hours of 8:00 A.M. to 5:00 P.M., Monday through Friday, contact the office at 432-686-5298 or cell at 432-288-4842. After 5:00 P.M., weekends, or holidays call the hospital's operator and ask for the Medical Interpreter on call.

Infection Prevention and Control Department

The Infection Prevention and Control Department works closely with a pathologist to conduct surveillance procedures and control infections throughout the Hospital. Hours of operation are Monday through Friday, 8:00 A.M. to 4:30 P.M. Staff is available for reference by calling 685-1647 during normal business hours. Assistance can be obtained after hours by calling the Nursing Supervisor at 685-1111.

Patient Advocate Program

The Patient Advocate serves as a liaison between patients, families, hospital and medical staff, and serves as a point of contact for complaints and compliments while a patient is in the hospital. The Patient Advocate is available to assist you 24 hours a day, 7 days a week by calling the Patient Hotline number 522-2273.

Quality Management Department

The Quality Management Department is responsible for the coordination of all performance improvement activities, patient safety issues and accreditation activities. This department will also answer questions and address concerns that you may have about your hospital experience. Hours of operation for this department are Monday through Friday, 8:00 A.M. to 5:00 P.M. Assistance can be obtained after hours by calling the Nursing Supervisor at 685-1111.

The Quality Management Department has created a form to assist you in keeping track of medications that you currently take. By investing a few minutes, you can create your own personal medication record. You will then have a record of all your medications to take to your doctor's appointment or to the hospital, in case you require care.

(back to top of page)

Community Acquired Pneumonia

POWER POINT DOWNLOAD
(back to top of page)

Get with the Guidelines

The American Heart Association's collaborative quality improvement program, called Get With The Guidelines, is a way hospital can demonstrate adherence to evidenced-based care of patients hospitalized with coronary artery disease, heart failure or stroke. The guidelines range from simple processes such as counseling patients to stop smoking, to complex processes such as administering certain medications within a certain period of time for emergent situations. The goal of the collaboratives is to improve patient outcomes and reduce hospital re-admissions.

Midland Memorial Hospital joined the American Heart Association's "Get With The Guidelines-Coronary Artery Disease (CAD)" program in 2004, becoming the first hospital in the area to participate. Since then, the Hospital has joined the Heart Failure and Stroke collaboratives. Hospitals that consistently follow the guidelines can achieve recognition in one of three categories; Bronze, Silver or Gold. Midland Memorial is proud to announce that we have achieved the Gold Plus Award for Heart Failure in 2012.

AHA/ACC Secondary Prevention Guidelines
(American Heart Association/American College of Cardiology)

These guidelines have been adopted as secondary prevention. Secondary prevention refers to preventing any further heart damage after an individual has been diagnosed with heart problems or suffered a heart attack.

All patients are encouraged to know their disease process, which will enable them to be an active participant in their care. In order to help accomplish our goal, heart attack patients are provided with a Heartworks brochure. This informational guide educates the patient about the procedure and answers questions they may have after being diagnosed with a heart disease.

We are devoted to offering the best care to our heart patients and will encourage them to make lifestyle changes. Patients are also highly recommended to comply with therapies given at the time of discharge. Following this regimen will significantly reduce the chances of a reoccurrence.

(back to top of page)

Hospital Quality Initiatives

The Hospital Quality Initiatives is a snapshot of how well a hospital is caring for its patients. The quality measures on this website display the recommended care for some of the most common and costly conditions that hospitals treat, which are heart attack, heart failure, pneumonia, or having surgery. Getting the recommended care means you are more likely to have better outcomes, because they are based on scientific evidence about treatments that are known to get the best results. Midland Memorial Hospital and the Centers for Medicare & Medicaid Services (CMS), along with its collaborators in the Hospital Quality Alliance (HQA) are working together to create and publicly report hospital quality information. Data for each measure are compared to other hospitals in Texas and the U.S., and to the top 10% of hospitals in the country.

You should know, however, health care experts and researchers are constantly evaluating the evidence to make sure the guidelines and measures continue to reflect the most up-to-date information. Sometimes, the guidelines and measures are modified to reflect new evidence. The information you will find on this website is intended to help you start a conversation with your physician or hospital about how you can best get the care you need. There may be a specific reason you should not get a certain treatment. For instance, a recommended treatment to help prevent a heart attack is to take aspirin daily. However, you should not take aspirin if you are allergic to aspirin. Patients who should not get the recommended care are not counted in the specific measure that is contraindicated, but may be counted in other measures.

Listed below are the performance measures reported for Midland Memorial Hospital on the HQA’s website, http://www.hospitalcompare.hhs.gov. The first multicolored column represents how the Hospital performed during the same period of time as the period of time for the national average. The second multicolored column represents the Hospital’s performance for a more current time. If you click on each measure’s description, you can see additional details in graph form.

Legend

Risk-Adjusted 30-day Mortality Rates

The following tables display a comparison of the Midland Memorial Hospital’s mortality rate within 30-days of admission to a hospital to the U.S. National mortality rate for Medicare patients who were diagnosed with heart attack, heart failure or pneumonia. To make a fair comparison, the rates have been adjusted to take into account that some hospitals treat sicker patients. Hospitals are placed in the categories Better or Worse Than U.S. National Rate when there is 95% certainty that their rate is not due to chance. Hospitals placed in the category No Different Than U.S. National Rate are about the same as the national average or may be higher or lower than the average, but it is uncertain whether the difference is due to chance. The rates in the table reflect data reported for discharges July 2007 through June 2010.  

For more information about the 30-day mortality rate for Heart Failure, click here.

Risk-Adjusted 30-day Readmission Rates

The following tables display a comparison of the Midland Memorial Hospital’s readmission rate within 30-days after discharge from the hospital to the U.S. National readmission rate for Medicare patients who were diagnosed with heart attack, heart failure or pneumonia. “Readmission” is when patients who have had a recent hospital stay need to go to a hospital again. Hospitals are placed in the categories Better or Worse Than U.S. National Rate when there is 95% certainty that their rate is not due to chance. Hospitals placed in the category No Different Than U.S. National Rate are about the same as the national average or may be higher or lower than the average, but it is uncertain whether the difference is due to chance. The rates in the table reflect data reported for discharges July 2007 through June 2010.

(back to top of page)

Healthcare Associated Infection Rates

2011 Data.pdf

(back to top of page)

Pocket Medication Card

PDF DOWNLOAD

(back to top of page)