DENVILLE HOSPITAL SUSSEX COMMUNIT Y URGENT CARE DOVER

DENVILLE HOSPITAL SUSSEX COMMUNIT Y URGENT CARE DOVER HOSPITAL BEHAVIORAL HEALTH Saint Clare’s Health 2017 Medical Staff Orientation 1

Physician Orientation Table of Contents Page 3 Mission and Vision Page 35 Saint Clare’s Hospital Safety Score Pages 4 -5 Medical Staff Officers Page 36 Emergency Codes Page 6 Saint Clare’s Executive Team Page 37 2017 National Patient Safety Goals Page 7 Medical Staff Office Personnel Page 38 -41 Services located at each campus Page 8 Membership Expectations Page 42 Hospitalists – Vital Medical Forces Page 9– 11 Education 2017 Calendar Annual Meetings & Page 43 Nursing Page 44 Emergency Services Page 12 -15 Clinical Documentation Improvement Page 45 Central Scheduling – Call. One Page 16 -17 Physician Documentation Requirements Page 46 Pharmacy Page 18 Length of Stay/Observation Reduction/ 2 Midnight Rule Page 47 -48 Radiology Page 49 Laboratory Page 19 Patient Status of Care Page 50 Cardiology Services Page 20– 21 CMS Requirement for Inpatient Stays Greater than 2 Midnights Page 51 Center for Wound Care and Hyperbaric Page 22– 23 Stroke Protocol Page 52 Center for Sleep Medicine Page 24 -25 Nuance Dictation Instructions Page 53 Bott Family Surgical Pavilion, Denville Page 26 Inpatient Electronic Medical Record/Cerner Page 54 Surgical Scheduling and Preference Cards Page 27 Health Information Exchange Page 55 Center for Robotic Surgery Page 28 Physician Support Page 56 Outpatient Behavioral Health Services Page 29 -31 Patient Satisfaction Page 57 Emergency- Saint Clare’s Behavioral Health Urgent & Outpatient Services Page 32 Ethics Committee Page 58 EMR Electronic Medical Record/Cerner Page 33 -34 Sustaining P. O. L. S. T. (Physician Orders for Life. Treatment Paradigm) Medicine 2

Our Mission and Vision OUR MISSION To deliver compassionate, quality care to patients and better healthcare to communities OUR VALUES Quality We are committed to always providing exceptional care and performance. Compassion We deliver patient-centered healthcare with compassion, dignity and respect for every patient and their family. Community We are honored to be trusted partners who serve, give back and grow with our communities. Physician Led We are a uniquely physician-founded and physician-led organization that allows doctors and clinicians to direct healthcare at every level. 3

2017 Medical Staff Officers President Lawrence Friedman, MD Vice President Michael Blick, MD Secretary-Treasurer Edward Mc. Manus, MD Executive Committee Members-at-Large Rhuna Shen, MD Gilbert Poon, MD Rocco Simmerano, MD Anesthesia Chairwoman Vice Chairwoman Jill Young, DO Maggie Ho, DO Emergency Medicine Chairman Vice Chairman Rohan Somar, MD Vasilios Diamantopoulos, MD Family Practice Chairwoman Vice Chairwoman Richard Schweitzer, MD Kathleen Saradarian, MD Medicine Chairman Vice Chairman Seth Levy, MD Keith Leibowitz, MD 4

2017 Medical Staff Officers Obstetrics-Gynecology Chairman Vice Chairman Patricia Dreyfuss, MD Daniel Ferrante, DO Pathology Chairman Leonid Li, MD Pediatrics Chairman Vice Chairman Maurice Elias, MD Jarrod Kucharski, MD Psychiatry Chairman Sarabjit Singh, MD Radiology Chairman Neil Freeman, MD Surgery Chairman Vice Chairman Ih-Ping Huang, MD Adam Berman, MD 5

Meet Our Executives Brian Finestein Hospital 973 -983 -5569 CEO/Denville Tom Scott Chief Financial Officer 973 -625 -6677 Jan Bednar, MS, BSN, RN, CEN, MN, NEA-BC Chief Nursing Officer 973 -625 -6629 6

Medical Staff Office Personnel Eileen Pagano, CPCS Manager, Medical Staff Office: (973) 625 -6576 Fax: (973) 625 -6457 Eileen. Pagano@Primehealthcare. com Juan Nieto Coordinator Office: (973) 625 -6503 Fax: (973) 625 -6457 Juan. Carlos. Nieto@Primehealthcare. com Miriam Teti Coordinator Office: (973) 625 -6547 Fax: (973) 625 -6678 Eileen Fiengo Coordinator Office: (973) 625 -6596 Fax: (973) 625 -6457 E General email box: Medical. Staff. Office@Primehealthcare. com 7 Return to table of contents

Medical Staff Membership Expectations Provide Excellent Care for Patients • Maintain competence in and adhere to clinical standards in your specialty. • See patients within the time requirements of the Medical Staff Rules and Regulations. • Have adequate coverage arrangements for patients. Show respect for other people • Exhibit appropriate, professional behavior with colleagues, hospital staff, patients, visitors, including during times of disagreement. Be loyal • Support the medical staff. Support the hospital • No complaints from patients. • Compliance with National Patient Safety Goals. • Compliance with regulatory standards. Be fiscally responsible • Be cost effective when providing care for patients in the hospital. • Utilize data to improve and implement quality care. Take emergency/clinic call as assigned • Respond to calls and pages within the timeframe required in the Rules and Regulations. Be a good citizen • Comply with the requirements of the Bylaws, Rules and Regulations and Credentials Manual. • Provide thorough, clear, legible, timely documentation in Medical Records. Maintain high personal standards • Attend CME programs. • Be Board Certified. • Know EMTALA regulations pertaining to physician on- call responsibilities. 8

Medical Staff Calendar http: //schsintranet/Departments/medicalstaff/default. aspx 9

Medical Staff Calendar http: //schsintranet/Departments/medicalstaff/default. aspx 10

Medical Staff Calendar http: //schsintranet/Departments/medicalstaff/default. aspx 11

Clinical Documentation Improvement Importance of Documentation In patient care organizations, proper and accurate clinical documentation has always been important, but in today’s shifting healthcare landscape, it has become even more of a strategic imperative than perhaps ever before. Good documentation shows that good quality care has been done, and provides valuable information among an interdisciplinary team of physicians, nurses, physical therapists, respiratory therapists, etc. It clearly shows the care that has been done, the diagnosis, and what is left to do. Additionally, if there is a particular diagnosis code and a physician documents too quickly, it could be reimbursement for a certain value when in reality, the care that was provided and performed is a different level of care than what was documented. In short, ‘If it hasn’t been documented, it hasn’t been done. ’ CDI is fast becoming an increasingly important focus for healthcare organizations. There are four primary drivers: 1. CDI now is seen as a key step in dramatically improving operational efficiency of the healthcare organization. 2. Failing to address flaws in documentation processes can result in higher incidences of errors, financial losses and diminished patient care. 3. The increased regulatory burden is spiking physicians’ frustration because it can reduce the amount of time they spend with their patients. 4. An industry-wide movement toward increased clinician collaboration and communication needs a strong technology underpinning in order to facilitate a more team-oriented approach to patient evaluation, diagnosis and remediation. CDI is at the heart of many organizations’ efforts to address their challenges associated with improving patient outcomes, smoothing clinical workflows, enhancing financial performance and streamlining compliance. 12

Clinical Documentation Improvement 13

Clinical Documentation Improvement 14

Clinical Documentation Improvement 15

Physician Documentation Requirements The History & Physical Examination is to be dictated within 30 days prior to Inpatient hospitalization or within 24 hours of admission and should include: the patient's chief complaint, details of the present illness, reason for admission, relevant past, social and family history, a review of body systems, a comprehensive physical assessment, conclusions or impressions drawn from the H&P and a plan or course of action. H&P's for Same-Day-Surgery must be completed within 30 days prior to admission or prior to surgery and should include: Brief history of current illness, pertinent past history, current medications and dosages, known allergies, present medical state and mental status and pertinent physical assessment. The history and physical examination, the results of any diagnostic test, as well as the provisional diagnosis, are to be recorded before the operative procedure. NOTE: All H&Ps not completed on the day of admission or an outpatient surgery must be updated by the physician when the patient enters the facility. Operative reports should be dictated immediately but no later than 24 hours after the procedure and should include: a post-operative diagnosis, name of the licensed independent practitioner(s) who performed the procedure and any assistants, name of the procedure performed, a description of the procedure, findings of the procedure, any specimens removed any estimated blood loss. A written operative note must also be written in the progress notes immediately due to transcription delay. The written progress note should be written before the patient is transferred to the next level of care and include the name(s) of the primary surgeon(s) and assistant(s), procedures performed and a description of each procedure finding, estimated blood loss, specimens removed and post-operative diagnosis. 16

Physician Documentation Requirements (continued) Verbal/telephone orders should be signed as soon as possible by the physician or his/her designee, but no later than 30 days. All paper documentation should be legible, signed in ink (preferably black ink for scanning purposes) and dated and timed at the time written. All electronic documentation should be e-signed as soon as possible. A Discharge Summary which should include: a summarization of the reason for hospitalization, significant findings, care, treatment and services provided and procedures performed, patient’s condition on discharge and pertinent instructions and, if applicable, the cause of death. A final progress note as a substitution for a discharge summary is acceptable for newborns with uncomplicated deliveries or for patients hospitalized less than 48 hours with only minor problems and were discharged alive and not transferred to another health care facility. This note must document the patient’s condition at discharge, discharge instructions and required follow-up care. All medical records need to be completed within 30 days of patient discharge. 17

Length of Stay and Observation Reduction/2 Midnight Rule • Length of Stay (LOS) reduction is an organizational wide responsibility • Inpatient reimbursement is by DRG (diagnosis related group) with corresponding GMLOS (geometric length of stay or expected length of stay) • Clinical documentation is critical for DRG assignment and optimization • Average LOS (actual) should be at GMLOS (or expected LOS) or lower to have a positive margin • Goal: Average LOS (actual) reduction needs to be at GMLOS (expected) or lower 18

Patient Status of Care § Three types of Status of Care: Inpatient, Observation and SDS § Maximum reimbursement is Inpatient § Financial difference between Inpatient and observations case is $5000/case § Goal is to decrease observation cases by providing appropriate clinical documentation to meet medical necessity to meet inpatient status 19

CMS requirements for Inpatient stays greater than 2 Midnights Stays that are greater than 2 midnights, including time spent as OP/ OBS are presumed to be inpatient. • Stays less than 2 midnights are presumed to be observation or outpatient unless procedure is approved for inpatient only stay • REQUIREMENTS FOR INPATIENT GREATER THAN 2 MIDNIGHTS • Time the patient is expected to stay in the hospital • Order to “admit to inpatient or ‘refer to observation/outpatient surgery 20

CMS requirements for Inpatient stays greater than 2 Midnights (continued) The documentation and certification of medical necessity to support the inpatient admission Orders must include: * Order for Inpatient admission * Reason for hospitalization, including severity and symptoms, current medical needs * Diagnosis * Estimated time patient will need to remain in hospital • If patient has recovered prior to the 2 midnights, “unexpected recovery” must be documented in the progress notes • Please contact the Case Manager with any questions. 21

Stroke Protocol STROKE CORE MEASURES: STK--‐ 1 --‐VTE prophylaxis by the end of hospital day 2 STK--‐ 2 --‐Antithrombotic therapy at hospital discharge STK--‐ 3 --‐Anticoagulation therapy at hospital discharge for patients with atrial fibrillation/flutter STK--‐ 4 --‐Thrombolytic therapy for eligible patients within 3 hours of time known well STK--‐ 5 --‐Antithrombotic therapy by the end of hospital day 2 STK--‐ 6 --‐Statin medication at discharge STK--‐ 8 --‐Stroke education provided to stroke patients or their caregivers STK--‐ 10 --‐Assessment for rehabilitative services STROKE POLICIES AND PROTOCOLS (Saint Clare’s intranet only): http: //schsintranet/Docs/Policies%20 and%20 Procedures/Forms/All. Items. aspx? Root. Folder=%2 f Docs%2 f. Policies%20 and%20 Procedures%2 f. Stroke&Folder. CTID=&View=%7 b 309389 DC%2 d 83 B 1%2 d 42 DD%2 d 9125%2 d. BA 96 F 4 F 829 E 3%7 d 22

Stroke Protocol 23

NUANCE (Transcription) 24

Saint Clare’s Health Nuance Dictation (cont. ) 25

Inpatient Electronic Medical Record - Cerner The Cerner Advanced Clinicals project enables you to view the following: • Patient's Demographic Information • Results and Vitals • Physician's Documentation (History And Physical, Consultations, Operative Reports, Discharge Summaries) • Medication Administration Record • Nursing and Ancillary Documentation In the Cerner Powerchart application the physician is expected to: • • • Enter electronic orders and renew medication orders Perform electronic medication reconciliation Electronically sign dictations and other deficiencies Electronically document notes Provide electronic discharge instructions Eprescribe discharge medications Connectivity via a physician portal can also be utilized so you are able to access everything remotely. 26

Health Information Exchange Saint Clare’s is part of the Jersey Health Connect network, which allows the exchange of key clinical information about your patient from the different major health systems, laboratory and pharmacies in the Northern New Jersey area. This will allow you to view care provided by other facilities, which will save you time from retrieving key medical information and reduce costs by avoiding unnecessary and duplicative care. Connectivity to the HIE has been enabled directly from the Cerner applications. Saint Clare’s has also partnered with Relay Health to offer direct messaging capabilities which allows the physician’s practice to receive transition of care documents post discharge electronically. 27

Physician support The One. Care Medical Informatics team provides training and assistance on the physician applications. If you need assistance or more information on the different applications please call the Medical Informaticists at 973 -9835548. Office hours are Monday to Friday from 8 am to 4: 30 pm. Outside of office hours please call the IT Help. Desk at 973 -6256566 from outside the hospital or extension 6566 from inside the hospital. If you need assistance with the portal or remote connectivity and resetting portal/network passwords, please call the help desk. The Prime Help Desk is based out of the corporate offices in Ontario, CA and offers 24/7 coverage. By calling 973 -625 -6566, your call will be redirected to the Prime Help Desk, which may also be reached by email at help@primehealthcare. com. Critical issues should always be reported by calling the telephone number. 28

Patient Satisfaction Communication with Doctors HCAHPS Domain The “Communication With Doctors” questions are answered as follows: “AL WAYS” “USUALLY" “SOMETIMES” “NEVER” During this hospital stay… 1. How often did doctors treat you with courtesy and respect? (Q 5) 2. How often did doctors listen carefully to you? (Q 6) 3. How often did doctors explain things in a way you could understand? (Q 7) 29

Patient Satisfaction Best Practices for Physician Inpatient Communication How to convey courtesy and respect to your patients: 30

Patient Satisfaction Best Practices for Physician Inpatient Communication How to ensure your patients feel they are heard: How to explain things in a way your patients will understand: 31

Ethics Committee • The Ethics Consultation Service is available to you from members of the Ethics Committee. • An ethic consultation can help you and the patient and family when faced with difficult ethical decisions. For example, some areas when a consultation might be useful are: v Dealing with end-of-life and life-prolonging decisions v Suggested treatments that may conflict with religious and cultural values v Making decisions for patients who are unable to make decisions for themselves v Issues of appropriate pain management If you need an Ethics Consultation, please contact: Brandy Johnson, MSW, LCSW Oncology Social Worker 973 -625 -6176 or 973 -490 -4328 Jan Bednar, MS, BSN, RN, CEN, MN, NEA-BC Chief Nursing Officer 973 -625 -6629 or 973 -203 -4824 32

POLST “Practitioner Orders for Life-Sustaining Treatment” • Empowers patients to make important decisions when facing a serious illness/end-of-life. • Unlike a traditional advance directive the form is an actual medical order and is valid in all healthcare settings. • Ensures that patient’s wishes are expressed and respected and is only for very sick and dying patients. For more information, you can visit the POLST website at http: //www. polst. org or contact the Physician Enterprise Department at (973) 983 -1521 33

POLST “Practitioner Orders for Life-Sustaining Treatment” Frequently Asked Questions: Question: Should New Jersey honor out-of-state POLST forms? Answer: New Jersey requires that we honor POLST documents from other states that either meet the requirements of NJ law or the requirements of the law of the state in which it was executed. Question: Someone who has POLST indicates that “John Smith” can change the POLST should I not be able to speak for myself. At a critical moment of decision making, a person is present in the emergency department, bedside, home and says I want you to attempt resuscitation despite the POLST stating not to resuscitate. Does the ED MD/RN/APM/EMS request proof that this is the proxy listed on the POLST form? Answer: No, they should honor it in good faith. Question: If the patient has a more current Advance Directive which is in conflict, does it nullify the POLST? Answer: Always honor the most current form. 34

Saint Clare’s Earns Straight A’s Eight Times in a Row Hospital. Safety. Score. org 35

Emergency Codes • Code RED FIRE • Code BLUE ADULT medical emergency • Code WHITE PEDIATRIC medical emergency • Code AMBER Infant/Child ABDUCTION • Code YELLOW BOMB/Bomb Treat • Code GRAY SECURITY Emergency/PATIENT Elopement • Code SILVER HOSTAGE situation • Code ORANGE HAZMAT situation/Decontamination needed • Code TRIAGE DISASTER situation • Code CLEAR The situation has been CLEARED 36

2017 National Patient Safety Goals Improve the accuracy of patient identification Improve the effectiveness of communication among caregivers Improve the safety of using medications Label all medications, medication containers, and other solutions on and other procedural settings Reduce the likelihood of patient harm associated with the use of anticoagulant therapy Reduce the harm associated with clinical alarm systems Implement evidence based practices to prevent health care associated infections due to multi-drug resistant organisms. Implement evidence based practices to prevent central line-associated bloodstream infections. Implement evidence based practices for preventing surgical site infections Identify patients at risk for suicide Conduct a pre-procedure verification process Mark the procedure site Perform a time-out before a procedure Comply the CDC hand hygiene guidelines Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) 37

Saint Clare’s Denville Hospital http: //www. saintclares. com/Our-Locations/Saint-Clares-Hospital-Denville-New-Jersey-. aspx · · · · · Anesthesia/Pain Management Cardiac Catherization (Non Interventional) Cardiology Emergency Angioplasty Emergency Medicine Endocrinology Endovascular Family Practice Gastroenterology General Internal Medicine Hematology Hospitalist Services Infectious Disease Inpatient Dialysis Level 2 Neonatal Care Nephrology Neurosurgery · · · · · Obstetrics and Gynecology Oncology Ophthalmology Orthopedics Otolaryngology Pathology Pediatrics Pediatric Neurology Perinatology Physical Medicine Psychiatry Pulmonology Radiology Surgery (General) Thoracic Surgery Urology Vascular These services are available through 24 hour per day on-call coverage. A. When a patient’s condition indicates, the patient will be admitted to Saint Clare’s Hospital/Denville by an attending physician and will have the care of the appropriate specialist(s); B. When the patient requires emergent surgery, the surgeon on-call, the on-call operating room team and anesthesiologist will be called in and surgery will be performed. 38

Saint Clare’s Dover Hospital http: //www. saintclares. com/Our-Locations/Saint-Clares-Hospital-Dover-New. Jersey-. aspx • Anesthesia/Pain Management Limited Services (partially available) at Saint Clare’s • Cardiology • Complementary Medicine • Emergency Medicine • Family Practice • Gastroenterology • General Internal Medicine • Hematology • Hospitalist Services • Infectious Disease • Inpatient Dialysis • Nephrology • Neurology • Ophthalmology • Orthopedics • Otolaryngology • Pathology • Physical Medicine • Psychiatry • Pulmonology • Radiology • Sleep Center • Surgery (General) • Urology • Vascular Hospital/Dover: • Pediatric surgery (outpatient or same day only) • Peripheral vascular services • Special imaging procedures • Non-invasive cardiology procedures • Neurosurgery (orthopedic spine surgery only) • Vascular surgery When a service is not available, patients requiring care will be managed by the attending physician or emergency department physician as appropriate: When the patient requires urgent consultation by one of these specialists, they will be stabilized and transferred to Saint Clare’s Hospital/Denville or another facility having the appropriate level of care. Transfers will be made in accordance with EMTALA regulations and with the appropriate consent of the patient/family. 39

Saint Clare’s Sussex Community Urgent Care http: //www. saintclares. com/Our-Locations/Saint-Clares-Health-Center-At-Sussex. aspx Available Services at Saint Clare’s Sussex Health Center These services are available through 24 hour per day on-call coverage. · Emergency Department · X-Ray · Women’s Health Center · Diagnostic & Nuclear Testing · Laboratory · Cardiology Services To schedule a CT Scan or Ultrasound, please contact Call One at 888 -808 -1234. When a service is not available (no on-call coverage on a given day), patients requiring such care will be managed by the attending physician or emergency department physician as appropriate: § When the patient requires urgent consultation by a specialist, they will be stabilized and transferred to Saint Clare’s Hospital/Denville or another facility having the appropriate level of care. Transfers will be made in accordance with EMTALA regulations and with the appropriate consent of the patient/family Saint Clare’s Community Clinic remains open and available to all area residents. The clinic provides basic medical care for the poor and underserved. Clinic is staffed by Dr. Pravinbhai Patel. Hours of operation are: Monday 9 am 1 pm To make an appointment, please call 973 -702 -2925 40

Saint Clare’s Behavioral Health 130 Powerville Road Boonton NJ 07005 Inpatient Care Adult Crisis Intervention Services (ACIS) Voluntary inpatient Behavioral Health Unit which provides comprehensive psychiatric interventions to adults 18 and older who are in crisis and require stabilization in a secure environment. Alcohol Chemical Dependency Unit (ACDU) Inpatient unit accommodating patients who require a hospital setting due to acute intoxication or withdrawal. Also available for those whose chemical dependency has progressed to the point where a hospital setting is required to provide the treatment intensity necessary to address the severity of their addiction. Children’s Crisis Intervention Services Inpatient unit for children and adolescents ages 5 through 17 who have been professionally assessed for psychiatric hospitalization. The unit utilizes patient and family education and treatment to develop coping skills and strengthen support system. A comprehensive postdischarge plan is developed to reduce or prevent future hospitalization. Psychiatric Intensive Care Unit (PICU) Designed to help adults 18 and older who suffer from various forms of mental illness and exhibit danger to themselves or others. Outpatient Care Children’s Adolescent Partial Hospitalization (CAPHP) Short term program serving adolescents 12 to 17 years of age in an intensive, highly structured therapy program to help them and their families manage a serious behavioral, emotional or psychiatric crisis. Alcohol Chemical Dependency Services (ACDS) Meeting our client's individual need, to create a customized recovery plan. Care is directed as a team effort between the client and our licensed and clinical staff. We offer ASAM level II. I Intensive Outpatient and ASAM level I Standard Outpatient levels of care, having a specialized co -occurring track for clients with a substance abuse and non-acute mental health diagnosis. Intensive Outpatient Program (IOP) For clients not requiring inpatient care or those who have recently completed an inpatient treatment program. A group based program held three days per week (morning or evening), offering education, coping skills and group therapy. Clients meet weekly for one on one counseling with an individual clinician. For those clients with a mental health diagnosis, we have an APN on staff to provide psychiatric care and assessment. 41

Hospitalists - Vital Medical Forces • • • Provide 24/7/365 coverage for the hospital including emergencies. Provide inpatient care to hospitalized patients coordinating care with PCPs and consultants. Provide consulting services for medical management of surgical patients including preoperative clearances. Provide admission services for those physicians that still prefer to admit and follow their patients. If temporary coverage is requested, please do so with minimum 4 weeks advance notice. If permanent coverage is requested, please feel free to email or call us. Contact: Rina Kapadia, MD Medical Director – rinakapadia@primehealthcare. com Neil Udani, MD – neiludani@primehealthcare. com Arvind Aggarwal, DO Office #: 973. 989. 3085 (Dover) 973. 983. 5211 (Denville) Answering service: 973. 343. 0048 42

Nursing Experienced Nurse Leadership Team led by Jan Bednar, MS, BSN, RN, CEN, MN, NEA-BC, Chief Nursing Officer. More than 150 Registered Nurses who have attained National Nursing Board Certification in a Practice Specialty. Admission and Discharge Registered Nurses to ensure a complete and thorough admission and discharge. RN Case Managers in the Emergency Department to facilitate placement. RN First Assistants in OR. Daily Touch Base Rounds with Patient/Family, RN Case Manager, RN Shift Supervisor, Social Worker and Ancillary Departments. In accordance with the New Jersey Statute, Registered Nurses at Saint Clare’s may determine and pronounce death on patients who have a DNR. Bimonthly Nursing Newsletter entitled, "Careful Nursing News. " ANCC Pathway to Excellence® designation which recognizes hospitals that for positive practice environments where nurses excel. 43

Emergency Services Saint Clare's provides round-the-clock, comprehensive emergency care services at the Denville and Dover hospitals. Each emergency department (ED) is staffed by boardcertified emergency physicians supported by specially trained and certified nurses. Each ED utilizes the latest in medical technology, including CT scans and ultrasounds. Saint Clare's utilizes a “Fast Track" system that moves patients with minor symptoms and injuries through the emergency room quickly. Our Emergency Rooms each offer a designated care area for children. At our Sussex Campus, Saint Clare’s provides full service satellite Emergency Room services 16 hours per day (from 8 am to midnight, 7 days a week), also staffed by Board certified emergency physicians and supported by specially trained and certified nurses. Each ED is supported by state-certified paramedics, emergency medical technicians (EMTs), and mobile intensive care units (MICUs) who respond to locations throughout the region in the case of an emergency. Our paramedics work alongside local first aid squads to provide advanced life support in patient's homes, in the workplace, or on the road. Saint Clare's Health System also provides Emergency Psychiatric care at Saint Clare's Hospital/Denville. The 24 -hour hotline for Psychiatric Emergency Services is 973 -6250280. Our Emergency Departments can be reached at the following phone numbers: Denville: Dover: Sussex: 973 -625 -6063 973 -989 -3200 973 -702 -2714 44

Central Scheduling - Call. One Multiple appointments. Multiple locations. One call. Call. One. SM, the Saint Clare’s Central scheduling service, provides patients with the most convenient way to schedule appointments at our facilities. The service allows patients to schedule multiple testing and procedure appointments, at most Saint Clare’s facilities, by calling toll-free: PATIENTS: 1 -888 -808 -1234 PHYSICIAN USE ONLY: 1 -877 -936 -1234 Use Call. One. SM when scheduling appointments or tests at the following Saint Clare's departments and centers: After scheduling your appointments, our Call. One. SM representatives will forward an itinerary of appointments and specialized preparation instructions, by procedure, for patient use and reference. For more information visit: http: //www. saintclares. org/call-one-3 45

Pharmacy Hours of operation and contact information: Saint Clare's Hospital - Denville Pharmacy - Hours: 24 hours/day - 7 days/week - Phone: 973 -625 -6003 - Fax: 973 -625 -6197 Saint Clare's Hospital - Dover Pharmacy - Hours: 24 hours/day - 7 days/week - Phone: 973 -989 -3107 - Fax: 973 -989 -3474 Saint Clare's Hospital - Sussex Pharmacy - Hours: 7: 30 am to 4: 00 pm – Monday through Friday - Phone: 973 -702 -2743 - Fax: 973 -702 -2894 Saint Clare's Hospital - Boonton Pharmacy - Hours: 8 am to 4: 30 pm – 7 days/week - Phone: 973 -316 -1883 - Fax: 973 -316 -7223 The Pharmacies at Denville and Dover provide coverage for Sussex and Boonton during the hours that the on-site Pharmacy is closed. Find more information from the Pharmacy on the SCHS intranet at: http: //schsintranet/Departments/Pharmacy/default. aspx 46

Radiology scheduling is done through Call. One: Physician Line - 877 -936 -1234 Patients call 888 -808 -1234 Unless specifically indicated with a bullet by campus below DENVILLE HOSPITAL Outpatient 7 am– 10 pm Inpatient/ER 24 hours/7 days Biopsies and 8 am– 4: 30 pm Interventional Radiology Interventional procedures are scheduled at 973 -983 -5261 CT Ultrasound Nuclear Medicine MRI General Diagnostic Bone Density Women’s Health Specials: PICC Insertion, Central Line Placement, Abscess Drainage, Percutaneous Nephrostomy Tube Insertion, Nephrostogram, Nephrostomy Tube Change, Porta Cath, Check, Pleur-X Catheter, Transperineal Prostate Biopsy, Cholangiogram, Biliary Drainage (PTC) DOVER HOSPITAL Outpatient Inpatient/ER 8 am-10 pm 24 hours/day To schedule a PET/CT, please call Carol at 973 -989 -3545 CT Ultrasound Nuclear Medicine PET/CT X-Ray Fluoroscopy Bone Density; Women's Health SUSSEX HEALTH CENTER Outpatient 8 am-3 pm (Walk-ins welcome) ER 8 am -11 pm Contact numbers: Phone: 973 -702 -2725 Fax: 973 -702 -2886 CT Ultrasound Nuclear Medicine X-Ray; Bone Density Women's Health Note: All campuses linked via Mc. Kesson PACS 47

Radiology/Parsippany Commons Contact Numbers: Phone: Fax: 973 -334 -1006 973 -334 -1008 All scheduling is done through Call. One Physician Line: 877 -936 -1234 Call. One (Patients): 888 -808 -1234 Hours CT, Ultrasound, X-ray: Monday - Thursday 8 am to 8 pm Friday 8 am to 5 pm Saturday 8 am to 12 Noon Diagnostic & Screening Mammography/Bone Density: Monday - Thursday 8 am to 4 pm Screening Mammography/ Bone Density: Wednesday 4 pm to 8 pm Saturday 8 am to 12 Noon Departments/Procedures CT: Diagnostic CT Ultrasound: Diagnostic Ultrasounds X-rays Bone Density Women's Health: Digital Mammography Note: All campuses linked via Mc. Kesson PACS 48

Laboratory Denville 973 -625 -6700 Monday – Friday 7 am to 8 pm Saturday 8 am to 12 Noon Dover 973 -989 -3171 Monday – Friday Saturday 7 am to 5 pm 7 am to 1 pm Sussex 973 -702 -2733 Monday - Friday Saturday 8 am to 3: 30 pm 7: 30 am to 12 Noon Testing done as follows: • Glucose Tolerance over 1 hour • Therapeutic Phlebotomy No appointment necessary Monday through Friday Scheduled in ATU Laboratory Outreach (Home Bound Patients ONLY) • 12 mile Radius around Denville • Schedule appointments 973 983 -2384 • Monday thru Friday (except holidays) 49

Cardiology Services Phone Fax Hours: Denville Hospital 973 -625 -6725 973 -625 -6791 Monday to Friday: 7 am - 4: 30 pm Saturday to Sunday: 7 am – 3: 30 pm Phone Fax Hours: Dover Hospital 973 -989 -3125 973 -989 -3127 Monday to Friday: 7: 30 am – 4 pm Cardiac testing Scheduling is done through Call. One Scheduling. Call. One Physician Line: Call. One (Patients): 877 -936 -1234 888 -808 -1234 Services: EKG’s Echocardiography (Adult & Pediatric) Transesophageal Echocardiography Holter Monitoring Cardiac Stress Testing 50

Center for Wound Care and Hyperbaric Medicine Advanced wound care for chronic, non-healing wounds of all etiologies. Treatments include, but are not limited to: • Negative Pressure Wound Therapy • Total Contact Casting • Bioengineered Skin Substitutes • Sharp Debridement • Hyperbaric Oxygen Therapy (HBO) HBO 2 Two hyperbaric chambers are used in treating: • Diabetic Ulcers of Lower Extremities • Chronic Refractory Osteomyelitis • Soft tissue Radionecrosis and Osteoradionecrosis • Compromised Skin Grafts and Flaps • Progressive Necrotizing Infection • Crush Injury/Acute Traumatic Ischemia • Acute Peripheral Arterial Insufficiency • Actinomycosis Medical Director: Edward J. Mc. Manus, MD, FACP, Clinical Nurse Manager: Safety Director: Eileen Noonan, RN, WCC Bryan Kunze, CHT Contact Us: The Center for Wound Care and Hyperbaric Medicine at Saint Clare's Hospital 400 W. Blackwell Street Dover, NJ 07801 Phone: 973 -989 -3725 Fax: 973 989 3166 Hours of Operation: Monday thru Friday, 8: 30 am– 4: 30 pm 51

Center for Sleep Medicine The Center for Sleep Medicine, located at Saint Clare's Hospital/Dover, is northwest New Jersey's leader in the diagnosis and treatment of sleep disorders. The Center is accredited by the American Academy of Sleep Medicine and is staffed by accomplished physicians specializing in the treatment and management of sleep disorders. The Center also offers an advanced sleep study laboratory and insomnia treatment program, while also serving as a sleep medicine resource for the public and healthcare professionals. The Center coordinates all insurance approvals with the patient, referring physician, and health plans. The facility is open Monday - Friday from 9 am to 5 pm 52

Bott Family Surgical Pavilion, Denville The new pavilion offers a modern surgical interventional platform, including: • Seven Operating Rooms, with a dimension of 600 square feet per room. • Total dimensions of 20, 985 square feet, including the Operating Rooms and support space • Operating Rooms designed to include a central clean core and flexible zones to provide increased storage and future flexibility. • Enhanced patient holding area that provides additional privacy. • Overall floor plan and design that contributes to improved operational efficiencies. • State of the art technology. Communication: • Physicians will have direct access to radiology images, displaying these images on any monitor in room during surgery. • Video integration system for real-time, high-definition communication. • Touch screen for multi-purpose communication and functions. Lighting and Environment: • State-of-the-art LED lighting provides superior visualization for the surgeon. • Designed to maximize natural lighting, operating rooms will utilize windows with sunlight from outside. • Our robotic technology, the da Vinci® Si Dual Console Surgical System, with simulation technology allows physicians to practice their skills and new techniques in a non-clinical environment. 53

Surgical Scheduling and Preference Cards Welcome to the Surgical Suite! Meet with the OR manager and your specialty coordinator to discuss your supply and equipment preferences. We would like a copy of your most recent preference cards as soon as possible in order to have them entered into our case cart system. Location 4 th floor of the Urban Building, using D wing elevators OR Locker A locker will be assigned before your first case. Please bring a personal lock. 54

Center for Robotic Surgery As part of our commitment to providing the latest and most technologically advanced treatment options for patients in our community, Saint Clare’s offers robot-assisted, minimally invasive surgery at the Center for Robotic Surgery. Through the use of the state-of -the-art robotic technology of the da Vinci® Si Dual Console Surgical System, our experienced, specially-trained surgeons are now able to offer a minimally invasive option for complex surgical procedures, allowing patients to turn to Saint Clare’s for surgical procedures that help to improve patient outcomes and redefine today’s standard of care. Our services and procedures include: • Urologic • Gynecologic • Urogynecology • Gynecologic oncology • General surgery 55

Outpatient Behavioral Health Services LOCATIONS Saint Clare’s Behavioral Health Center at Parsippany 1 Medical Drive Parsippany, NJ 07054 Phone 973 -298 -8600 Saint Clare’s Behavioral Health Center at Denville 50 Morris Avenue Denville, NJ 07834 Phone: 973 -625 -7009 Wellness and Recovery 4 Pocono Road Denville, NJ 07834 Phone: 973 -625 -0096 Intensive Family Support Services of Sussex County 20 Walnut Street Sussex, NJ 07461 Phone: 201 -317 -6139 Psychiatric Emergency Services (PES) at Denville Hospital 973 -625 -6150 during business hours 973 -625 -0280 24/7 hotline Centralized Evaluation and Referral Service (CER) 1 -888 -626 -2111 Crisis intervention, admissions, level of care assessments, information and referrals, return to school evaluations and letters, for clients ages five years and older. Appointments made 9 am to 5: 00 pm. Monday-Friday. 56

Behavioral Health Emergency, Urgent and Outpatient Services Counseling Services for Adult, Children and Families – Psychiatric evaluation and medication counseling, Wellness and Recovery Action Plans, Group, Individual, Family counseling, Case management and outreach. Supported Employment - for Morris County adults with a psychiatric disability who want to be employed. Supported Education – Learning Enhancement and Resource Network (L. E. A. R. N. ) for adults with a psychiatric disability, residing in Morris, Bergen, Sussex or Passaic Counties, who want to pursue higher education. Intensive Family Support Services - Saint provides support and education members/caretakers of adults diagnosed mental illness, focusing on enhancing the stability of the family system. Clare's IFSS to family with serious strength and Mental Health First Aid – provides education on risk factors and warning signs of mental health issues. Training is provided by certified mental health first aid practitioners in 8 hours, focusing on early detection and prevention. Program for Assertive Community Treatment (PACT) - A community-based program for adults with serious and persistent mental illness who require ongoing, intensive treatment. Services are delivered by a multidisciplinary team that is available 24 hours a day, seven days a week. Supported Housing - In-home support for Morris County adults (18+) with a primary psychiatric disability, toward the goal of obtaining and maintaining independent living in the community. Counselors work with individuals to locate permanent lease-based housing, negotiate leases, and develop positive landlord-tenant relationships. Substance Abuse Outpatient Care: Alcohol and Chemical Dependency Services treatment programs meeting client's individual needs with a customized recovery plan. Intensive Outpatient Program (IOP) is an excellent option for clients who recently completed an inpatient treatment program. A group based program, held three days per week, three hours per session, morning or evening, offering educational information on substance use and coping skills, along with group therapy. Outpatient Program (OP) A “step down” level of care for those who have completed the IOP program. Less intense, meeting once weekly or group therapy and weekly for individual counseling sessions held morning and evening with a co-occurring track of the program meeting twice weekly for group therapy in order to provide more stability for both substance abuse and mental health treatment. Post Partum Wellness Program – offers assessment, diagnosis and care planning by a team of highly skilled professionals; education for women and their families, individual, family and group therapy, according to need, ongoing support groups for women with postpartum distress. Transitions – A step-down from psychiatric inpatient care or an alternative to unnecessary psychiatric hospitalization for Morris County adults with a primary psychiatric disability or a co-occurring psychiatric and substance abuse disorder. The multidisciplinary treatment team includes a psychiatrist, APN, licensed clinicians and counselors. Programming emphasizes wellness and 57 recovery and includes a variety of evidenced-based

EMR – Electronic Medical Record/Cerner One. Care • • • Improves patient safety and clinical outcomes Enhances the patient experience Provides clinicians and staff with necessary tools and information Eliminates duplication and waste Enables evidence-based practices The One. Care initiative is led by clinicians, designed by the people who deliver care and powered by the IT group. The physician implementations were designed by the Physician Clinical IT Steering Committee. 58