User:Conradsay/Johns Hopkins Bayview Medical Center

Johns Hopkins Bayview Medical Center (abbreviated JHBMC or Bayview; formerly Francis Scott Key Medical Center and Baltimore City Hospitals) is teaching hospital, level 2 trauma center, and the only burn center in Maryland. Located in East Baltimore, it has been part of the Johns Hopkins Health System since 1984 and is named after its close proximity to the Chesapeake Bay. Since its founding in 1773, it has relocated and undergone internal changes aimed at expanding medical services to patients and the surrounding Baltimore community.

The hospital includes a trauma center, neonatal intensive care unit, geriatrics center, and is home to the Johns Hopkins Burn Center, the only adult burn trauma in Maryland.

History
Founded in 1773, the Johns Hopkins Bayview Medical Center has a long, distinguished history of service and medical excellence, and has been of the longest living and continuous health care institutions on the East Coast. From its inception as the "Baltimore County and Town Almshouse," for the impoverished, it was initially located half a mile west of the city, however, gradual expansion of the city caused a number of relocations. In 1820, the facility was moved to the Calverton mansion, the recently acquired country home of banker Dennis A. Smith. Calverton was used until 1866, when the institution made its final move to its present location east of the city and changed its name to Bay View Asylum because of its close proximity to the Chesapeake Bay where it housed both the impoverished and mentally ill. During the mid-1880s, William H. Welch, the pathologist of Johns Hopkins, "began seeing patients as part of his research," creating the first major connection between the asylum and Johns Hopkins.

The medical center's transition to a hospital began in 1925 where it transitioned to an acute care hospital, a chronic care hospital, and a tuberculosis hospital. Renamed Baltimore City Hospitals, the hospitals continued to accept psychiatric patients until those patients where moved to state institutions in the 1930s. In 1984, the City of Baltimore transferred ownership of the long-established Baltimore City Hospitals to The Johns Hopkins Hospital and The Johns Hopkins University, who renamed it, the "Francis Scott Key Medical Center", which name it carried until 1994 when it was changed to its the Johns Hopkins Bayview Medical Center, in efforts to convey its strong connection with Johns Hopkins Medicine.

Operations
Johns Hopkins Bayview has 420 beds, including 25 neonatal beds, is home to one of Maryland's most comprehensive neonatal intensive care units, a sleep disorders center, a comprehensive neurosurgery center/neurocritical care unit, an area-wide trauma center, the state's only regional burn center equipped with 20 beds, and a wide variety of nationally recognized post-acute care and geriatrics programs. In 2018, Johns Hopkins submitted a proposal to state regulators to allocate $469 million to renovating Bayview to incorporate state-of-the-art operating rooms, expand services in speciality care and providing patients with private rooms to reduce the risks of disease transmissions. Bayview has dedicated its financial resources to updating the emergency and cancer departments, and this new proposal seeks to provide a seven-story inpatient building to modernize the center's services.

Governance
Johns Hopkins Bayview is governed by both a Board of Trustees and Teadership. Bayview is part of the Johns Hopkins Health System Corporation, which includes 5 other hospitals (including the Johns Hopkins Hospital). In 1997, the Johns Hopkins Health System joined their governance structure with the Johns Hopkins University School of Medicine creating Johns Hopkins Medicine.

As of January 2020, Bayview employs 3,416 people, with 2924.01 full-time equivalents.

Community relations
Johns Hopkins Bayview has partnered with non-profit, business, and community organizations to spearhead efforts to engage the surrounding Baltimore community and address access to healthcare services, housing, economic development, and other socioeconomic issues, resulting in the hospitals Healthy Community Partnership. The Community Relations Department manages the organization's relations with local partners and are members of the hospital's Medical Center Community Advisory Board and the Community Health Action Project (CHAP). Services offered to residents of East Baltimore and the surrounding community include Care-A-Van, which is a free, mobile clinic offered to uninsured pregnant women and children. This program offers people immunizations and primary medical care, and grants patients the opportunity to become educated on different medical issues.

Despite the hospital's efforts to engage in the community, the medical center has faced criticism as a result of social and legal issues. In 2008, the Baltimore Sun concluded that Bayview medical center, along with Johns Hopkins Hospital, had filed 14,000 lawsuits against patients from 2003 to 2008 for unpaid medical bills, with the number of new cases steadily rising over the past few years. A majority of the patients, low-income African Americans, expressed discontent over the not-for-profit hospital's concern over unpaid medical bills, as hospitals of this caliber receive federal, state, and local reimbursements each year to continue operations. The average value of medical services is rising each year, particularly for those without health insurance, creating a financial stress for low-income residents.

Controversies
While Bayview medical center has a reputation for its clinical services, the hospital has not always been exempt from medical malpractice and patient safety. In one case, radiologists did not notice a fracture on a CT scan of patient, promoting her to wait months to have the issue resolved. When questioning the hospital over its role in rectifying these types of issues in the future, the hospital acknowledged her concern but did not answer her question. A year after this incident, inspectors resolved that radiologists again had overlooked fatal embolisms on a patients CT scan of their chest. These issues resulted in medical violations filed against the hospital, with the first issue being cited as a concern of patient safety and delay in diagnosis.

Another issue involved research and experimentation, as a 24 year-old women perished after being a test subject in a research experiment at Bayview. The previously healthy women, Ellen Roche, volunteered for a physiological study attempting to induce asthmatic reactions in people without asthma to determine the bronchiolar reflexes react in different people, which was directed by Dr. Alkis Togias, an associate professor and clinical immunologist at the Johns Hopkins Medical Institutions. Despite receiving informed consent prior to the start of the trial, Roche was not made aware of the potential fatal implications of the research study, only being told of the potential side effects of wheezing, chest tightness, and transient dyspnea. In the second phase of the experiment, hexamethonium, a drug blocking lung relaxation caused by deep breathing, was administered to Roche and all test participants. Despite the drug's known adverse effects in the 1950s, the research study used the drug, which is not approved by the Federal Food and Drug Administration (FDA), and ultimately resulted in Roche contracting flu-like symptoms and a 35% reduction in her lung function within 36 hours and her death. Roche's death has raised questions about the ethical treatment of test subjects, and her death was reported to the University's Institutional Review Board and to the Office of Human Research.

Clinical reform
In 2005, the Johns Hopkins Center for Innovative Medicine devised the idea of the Miller-Coulson Academy in an effort to adhere to the pillars of research, education, patient and clinical care, and health systems management associated with academic health centers, and physicians bestowed this honor are supposed to highlight the qualities of academic medicine.

The chairman of the Johns Hopkins Bayview Medical Center established a cohort of "Miller-Coulson Scholars." Physicians granted this title were in charge of recognizing other apt and effective physicians and cultivating a culture dedicated to clinical excellence, the basis for the new academy. This new academy of physicians would be dedicated to provide infrastructure for measuring clinical excellence, identify, recognize, and unite outstanding clinicians and programs demonstrating clinical excellence, and develop new educational curricula to train clinical faculty to reach clinical excellence.

The Miller-Coulson Scholars defined clinical excellence as a culmination of clinical judgement, diagnostic reasoning, use of finite resources, education, and scholarship, with a clinically excellent academic physician displaying professional aptitude in knowledge and technical and communication skills to be employed in scientific discovery. Clinical excellence became measured by a diverse and flexible clinical portfolio to represent the different medical specialties.

The Academy's inaugural class became focused on the Department of Medicine, and invited eight physicians to join, with the stipulation that 20 hours of service annual was required to maintain membership. The clinical portfolios of these physicians were reviewed by a body of medical officials comprised across different prestigious medical institutions.

On May 8, 2009, the Miller-Coulson Academy officially launched at the inaugural "Hopkins Symposium for Excellence in Patient Care." Since the inception of the program, the Academy remains committed to upholding its ideology in recognizing and promoting excellence in patient care. Each year, the Academy hosts three Department of Medicine Grand Rounds, and a panel of three physicians respond to challenging cases by sharing with the audience their different methods in approaching a specified case indicative of their medical knowledge. The Academy is also refining curriculum aimed at helping clinical faculty achieve clinical excellence.

Awards received by Bayview

 * A grade rating for Patient Safety from Leapfrog Hospital Safety Grades (November 2018)
 * Most Wired Designation from CHIME (November 2018)
 * B grade rating for Patient Safety from Leapfrog Hospital Safety Grades (April 2018)
 * Excellence Award for Quality Improvements in Hospitals from Delmarva Foundation for Medical Care (2014)
 * Center of Excellence for Joint Replacements from National Centers of Excellence Network (October 2013)
 * LGBT Healthcare Equity Leader (March 2016)

McCarthy Award
The highest award granted by the Bayview's Board of Trustees, the McCarthy award is named after William McCarthy, a founding trustee of Johns Hopkins Bayview. The McCarthy Award has been awarded annually since 2002, and the most recent (2019) recipient is Dr. Nisha Chandra-Strobos, who currently serves as the chief of cardiology at Bayview and has aided in Bayview offering services in "balloon angioplasty and coronary stenting."