In 2006, Spartanburg Pathology Consultants (SPC) in South Carolina was looking for a laboratory medical director with cytopathology and microbiology expertise. Amy Christine Baruch, MD, MHCDS, FCAP, was wrapping up a cytopathology fellowship at the University of Texas MD Anderson Cancer Center in Houston, an educational capstone for her medical degree, master of science in microbiology, and AP/CP residency from the University of Arizona.
SPC had all the qualities of a healthy practice poised for growth. There was a lot going on, too, at Spartanburg Regional Hospital, which would be her primary worksite. Dr. Baruch signed on as a full-time pathologist and microbiology laboratory medical director at Spartanburg Regional Hospital (now a much larger Spartanburg Regional Healthcare System [SRHS]). She proved to be a good fit. A little more than 10 years later, she was elevated to president of the SRHS medical staff (2017–2019) and now chairs the SRHS medical executive committee. These positions proffered not only experience but also more contact with colleagues outside the laboratory, which translated to an insider’s view of the ways nimble leadership can leaven the energies and ease the frustrations that accompany rapid growth. It also grew her understanding of the ways that rapid growth can affect members of the health care team and informed her choices in seeking to right-size laboratories and consolidate microbiology services during inevitable periods of adjustment.
SRHS is now home to a medical staff of 700 physicians who conduct 25,000 surgical procedures, orchestrate 174,000 emergency room visits, and welcome 3,800 babies into the world each year. Maintaining a healthy working environment in an integrated regional system that buzzes with the busyness of 9,000 people is a tall order, but Dr. Baruch likes the pace. As long as the outcomes line up with what is best for patients, she will juggle until the learning curves straighten out.
Forward motion has become the new normal. The laboratory team inaugurated an antimicrobial stewardship committee whose members made more than 12,000 interventions in 2017–2018, including interventions to alert treating physicians when procalcitonin thresholds had dropped sufficiently to allow discontinuation of antibiotics checked all the boxes for value to patient care, efficiency, and bottom line.
The laboratory team got another boost with the December 2019 launch of rapid blood culture ID testing. It’s early yet, Dr. Baruch says, but time to identification of an organism from a positive blood culture dropped by more than 24 hours in the first month. The new system should enable decreased use of broad-spectrum antibiotics, fewer antibiotic days, less antimicrobial resistance, and shorter lengths of stay. In about 90% of cases, PCR-based testing now enables definitive identification of organisms present in blood cultures that are positive after incubation in less than an hour. Rapid blood culture ID can also identify three of the most common antibiotic resistance mechanisms, meaning that patients can be switched from broad spectrum antibiotics to targeted antibiotics up to two days sooner than before and may discontinue antibiotics earlier as well. Reduced antibiotic days, they’re hoping, will reduce Clostridium difficile infections.
Dr. Baruch is a former chair of SRHS Quality Process and Improvement Council, which oversees measures to address things like alarm fatigue, patient falls, and sepsis bundle design. She also has a longstanding interest in the roots and impacts of physician burnout. When Dr. Baruch read about Schwartz Rounds (facilitated forums to help medical personnel talk about the social and emotional issues that arise in the care of patients and their families), she felt certain that they could do something of the kind. The ethics committee chair was immediately on board and her CMO agreed to fund lunch for those who participate in what are known within SRHC as Compassionate Care Rounds.
Mentorship seems to be in the fabric at Spartanburg. It changed Dr. Baruch’s trajectory, and she is always thinking about paying it forward, which may explain her inclination to press for ways to boost efficiency and economy along with morale. It was no surprise that she was invited to join the inaugural class of an SRHS physician leadership course. At their first meeting, she says, when the group brainstormed about possible projects, she shared some of what she had read about hospital rooftop gardens that had given patients, visitors, and staff access to open green space.
As they talked, the rooftop garden idea evolved into a more practical outdoor courtyard, perhaps where earth displaced by unrelated construction sat waiting to be hauled away. Even before the idea took off, Dr. Baruch had pictured what is there today: an outdoor multipurpose space with trees, benches, plants, and tables that offers semiprivate respite from the pace and stress of patient care and is sometimes also a place to celebrate good news. Green space can foster healing. Dr. Baruch knows that. And now, when she walks past, she can almost feel patients and families sensing the care and comfort that gives her colleagues so much satisfaction in their work.