Prevention Through Innovation WINTER 2017 Written by Katie Roenigk A Ranger Publication
Making our communities healthier.
Primary Care
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Primary care providers tend to identify medical problems sooner, leading to earlier treatment and a decrease in the likelihood of long-term effects.
here are myriad reasons to establish and maintain a relationship with a primary care provider.
Primary care providers are familiar with their regular patients’ medical and family histories. The physician also knows what medications a person is on, and how that individual may feel about certain treatment options. The intimate knowledge a primary care provider has about a patient allows for more open communication about medical problems, according to Dr. Gentian Scheer, who works as a hospitalist at SageWest.
“The relationship between the doctor and the patient is very important,” she said. “When someone feels comfortable – that they have that established close relationship with a doctor – as soon as they have a problem, they’re much more likely to go see their physician.”
— Dr. Gentian Scheer, hospitalist Dr. Scheer said patients usually feel more comfortable around a physician who already knows their family medical history and preferences – not to mention their personality. “The relationship between the doctor and the patient is very important,” she said. “When someone feels comfortable – that they have that established that close relationship with a doctor – as soon as they have a problem they’re much more likely to go see their physician.” Primary care providers are an “extremely important” factor in preventive care, Dr. Scheer said. In addition to scheduling regular visits with patients as needed, it is the primary care provider who tends to administer vaccinations and facilitate screenings for things like cancer, diabetes, high cholesterol, hypertension and heart disease. Routine screenings lead to earlier diagnoses of problems, sometimes
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before the patient has even experienced symptoms, Dr. Scheer said. Earlier diagnosis means earlier treatment and a decrease in the likelihood of longterm effects. Dr. Scheer has been in other communities where there is no established group of primary care providers. In those places, Dr. Scheer said, people tend to put off seeking care until they are in dire need. “A lot of times it’s through the emergency room, and they’re a lot more sick,” she said. Dr. Scheer sympathizes with people who hesitate to set up an appointment with a physician they don’t know. For one thing, she said, the patient knows he or she will have to update the new physician on their entire medical history – a task that can be difficult for elderly patients in particular. “Things get lost, and it can be something pretty important,” Dr. Scheer said. “The primary care provider is pivotal because they know your entire medical history.” Primary care providers also stay updated when patients have new problems that require specialists or hospital stays, she added. Dr. Scheer, who works with people who are admitted to the hospital, says followup appointments with a primary care provider make it less likely that a patient will experience complications after being released. “We know for sure if we schedule our patients with a follow-up within the next week, the chance of them coming back to the ER with problems is decreased,” she said. “That’s another area (that) really shows the importance of primary care providers. They incorporate it all into the whole care of the patient.” Even people without complex medical problems should visit with a primary care provider at least annually, Dr. Scheer recommends. “It’s variable – some patients need to see their primary care provider more often to monitor whatever treatments they’re having for their medical problems,” she said. “But in general, for younger, healthier people, getting in at least once a year is a good idea.”
2017
Reasons to Have a Primary Care Provider 4 They know YOU 4 They know your medical and family history 4 They know what medications you’re on 4 They are more familiar with how you feel about treatment options and end of life care 4 They administer and keep track of screenings and vaccinations 4 They refer you to specialists and follow up afterward 4 They provide treatment for chronic conditions that require continual monitoring 4 Studies have shown decrease in overall healthcare costs for patients with a primary care provider
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Treating Chest Pain New accreditation ensures every employee at SageWest is aware of best practices for cardiac care
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ageWest Health Care recently became an accredited chest pain center through the Society of Cardiovascular Patient Care.
The accreditation requires that everyone working at the hospital, from physicians and nurses to receptionists and volunteers, has been trained to recognize the symptoms of a heart attack and respond appropriately, no matter where the event takes place. “It’s a multi-disciplinary approach to chest pain,” Dr. Gregory Clifford said. “So even if housekeeping hears someone saying they have chest pain, that can trigger, ‘You need to go to the emergency department.’” Dr. Clifford is the medical director for the emergency department at SageWest Health Care. He has spent the past year working with his team to achieve chest pain accreditation for the hospital. “It was a very major undertaking,” Dr. Clifford said. “All the medical staff had to do some
all of our acute coronary syndrome modules, and I think we benefited from all the training he gave us.” Through the accreditation, though, even the employees at SageWest who already had received training through Dr. Fluture’s initiatives were able to hone their skills and ensure they were aware of best practices for chest pain treatment. “(Now) everyone is on the same page and we’re providing consistent care in a timely fashion,” Dr. Clifford said. “As a patient you can have confidence that the physicians, ancillary staff, pre-hospital EMS crew, flight teams – all of the people that create acute cardiac care for people in Fremont County – will be consistent with the best practice model.” He pointed out that, sometimes, following the best practice means transporting a patient elsewhere for treatment. Local hospital employees have been trained to recognize symptoms that require specialized attention at another institution. To maintain accreditation, SageWest will have to prove ongoing, quality improvement to its chest pain response. Dr. Clifford said the effort that will go into the accreditation process in the long term represents the hospital’s desire to provide the best care possible to the local community. “I’m very proud we followed through with that, and we can present that to our community,” he said. “You should feel comfortable coming here and letting us care for you.”
Common Causes of Chest Pain
Cadiac
training, (and) then of course there was all the paperwork. It was a very intense process. The commitment by everyone to get that done was impressive.” He credited Dr. Adrian Fluture, who oversees cardiac care at SageWest from the Wyoming Medical Center in Casper, for providing the direction over the past five years that made the accreditation achievable. “He deserves initial credit for getting us up to speed,” Dr. Clifford said. “Dr. Fluture initiated
Vascular
• Coronary artery disease • Dissection of the aorta • Aortic valvular disease Neural • Pulmonary hypertension • Herpes zoster • Mitral valve prolapse • Pericarditis Musculoskeletal • Idiopathic hypertrophic • Costochondritis subaortic stenosis • Arthritis • Muscular spasm Pulmonary • Bone tumor • Pulmonary embolism • Pneumonia Gastrointestinal • Pleuritis • Ulcer disease • Pneumothorax • Bowel disease • Hiatel hernia Emotional • Pancreatitis • Anxiety • Cholecystitis • Depression
Am I Having a Heart Attack? It’s important for patients to know the early signs of a heart attack so they can get help as soon as possible. Early symptoms include: • Jaw pain • Pain that travels down one or both sides • Anxiety • Fatigue • Feeling of fullness • Chest pressure • Squeezing or discomfort • Back pain • Nausea Call 911 if any of these symptoms arise or persist. Do not drive. The following are strategies for early heart attack care: First, know the early symptoms of a heart attack in order to prevent the heart attack from ever occurring. Preventing the heart attack prevents heart damage. Second, be responsible for yourself and those around you, who may be experiencing early heart attack symptoms, and obtain immediate treatment. Finally, know the benefits of receiving early treatment and activating emergency medical services. For more information visit scpcp.org.
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Prevention Through Innovation S
New, updated technologies allow SageWest physicians to provide the most effective preventive care
ageWest Health Care has brought new and updated technologies to Fremont County to further assist patients seeking preventive care options locally. The hospital in Riverton recently acquired a new magnetic resonance imaging (MRI) machine and expanded facility. MRIs use magnetic fields and radio waves to create detailed images of organs and tissues, according to the Mayo Clinic. “MRI is a wonderful thing for our community,” said Dr. Gregory Clifford, medical director of emergency services for SageWest Health Care. “You don’t have to travel if you have a local MRI. That’s nice and convenient.”
of stroke and also for the diagnosis of infection of the bone and spinal cord compression – those are the things I really see that are critical.” Riverton also has new colonoscopy tools for the screening and treatment of myriad colon problems.
“It’s a different degree of clarity” — Dr. Gentian Scheer, hospitalist
“It will help out a lot in the Riverton hospital,” said Dr. Gentian Scheer, who works primarily in Lander. “Having the MRI at the hospital for the diagnosis
During a colonoscopy exam, a video camera is attached to a long, flexible tube and inserted into the rectum so the physician can see whether there are abnormalities in the large intestine and rectum or remove polyps or other types of abnormal tissue, according to the Mayo Clinic.
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Dr. Travis Walker, who works as a general surgeon for SageWest Health Care, said the colonoscopy capabilities at SageWest have been updated in the last few months. He added that there also are new gastroscopes, which are used to inspect the interior of the stomach. “They are newer versions with better lens and camera features,” Dr. Walker said of both new tools. “You can see smaller lesions better and the clarity of the image is better.” Computerized tomography scanners have been updated locally. CT scans combine X-ray images taken from various angles to create crosssectional images of bones, blood vessels or soft tissues in the body, according to the Mayo Clinic.
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Cancer Prevention Regular screenings help detect problems early
ore than 1 million people get cancer each year in the United States, according to the American Cancer Society (ACS).
In order to increase the chance of detecting the issue early — when it is most likely to be curable — the group recommends regular screenings for certain kinds of cancer “Hopefully we can catch the problems before they arise,” SageWest Health Care general surgeon Dr. Travis Walker said.
The biopsy involves removing a small piece of core tissue from the lesion and testing the sample for cancer cells. If the biopsy comes back positive, Dr. Walker said most patients undergo a lumpectomy rather than a full mastectomy – removal of the entire breast.
“The days of removing the entire breast have kind of gone by the wayside,” Dr. Walker said, though he noted that he recently performed a mastectomy on a woman whose mass was “very large.” Colonoscopies are another regular screening method, for the early detection of colon cancer. Dr. Walker said the procedure allows doctors to find and remove a polyp or growth all in one sitting, or perform a biopsy if the mass is too large. “That’s the beauty of the colonoscopy – it’s diagnostic and typically therapeutic as well,” he said. “If we see something that’s too big or has worrisome features for cancer we’re just taking a little piece to develop the diagnosis.”
For example, the ACS says breast cancers found during mammograms are more likely to be smaller and isolated to the breast. For women at average risk for breast cancer, the ACS recommends annual mammograms begin around age 40, and definitely by age 45, but Dr. Walker said anyone experiencing symptoms of breast cancer should schedule a mammogram regardless of age. Symptoms include physically feeling a lesion in the breast, he said. Other patients experience dimpling, nipple discharge or changes in the skin overlying the breast. “With those types of things we’d recommend having a diagnostic mammogram,” he said. The mammogram will show whether there are any lesions or masses in the breast. If a lesion is found, a doctor may order an ultrasound, and the lump will most likely be biopsied to determine whether it is cancerous.
Patients usually start getting routine colonoscopies at age 50, Dr. Walker said, with repeat screenings every 10 years. However, Dr. Walker said people who are showing symptoms or who have a family history of colon cancer should be screened every five years, and they may want to start sooner. He said anyone with a “first-degree relative” – a brother, sister, mom or dad – who was diagnosed with colon cancer before age 60 should have a colonoscopy by age 40, or when they are 10 years younger than their relative was when diagnosed. For
instance, if someone’s mother was diagnosed with colon cancer at age 45, the individual should start getting regular colonoscopies at age 35. If the relative was diagnosed at age 55, though, Dr. Walker would recommend starting screening at age 40. Symptoms of colon cancer may include changes in bowel habits or blood in the stool, Dr. Walker said. If symptoms already have presented, though, he said the colonoscopy becomes more diagnostic than preventive.
Cancer Screening Guidelines Cancer
Colorectal
Test Colonoscopy
Usual USPSTF Frequency Level
Age 50-75
Every 10 Years
Breast
Sigmoidoscopy 50-75 (an alternative to colonoscopy) 45-75 for African-Americans (ACG)
Every 5 Years
Fecal occult blood test (an alternative to colonoscopy)
50-75
Annually
Mammogram
40-49 (ACS, ACOG, ACR)
Annually
50-74
Every 1-2 years
RECOMMENDED
Every 3 years if just Pap smear is done
STRONGLY RECOMMEND
Mammogram
Cervical
A STRONGLY RECOMMEND
45-75 for African-Americans (ACG)
Pap smear alone or Pap smear with HPV test
A STRONGLY RECOMMEND
45-75 for African-Americans (ACG)
21-65
A STRONGLY RECOMMEND
C UNCERTAIN
B A
Every 5 years if both Pap smear and HPV test are done
Sources: American College of Gastronenterology, American College of Obstetrics and Gynecology, American College of Radiology, American Cancer Society, U.S. Preventive Services Task Force
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Teaching Compassion & Ethics in Nursing
Long-time local nurse helps educate new graduates to provide the best care possible
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ickie Bessey of SageWest Health Care was nominated this year for the Wyoming Hospital Association’s Norman S. Holt Award for Nursing Excellence. Every hospital in the state is allowed to submit one candidate annually for the award, which was established in 1983. It is presented to one Wyoming nurse each year during the WHA convention, which was held Sept. 7-8 in Cheyenne. SageWest system chief nursing officer Sherrill Sorensen wrote the nomination letter for Vickie, who has worked at the local hospital for 25 years.
nursing as well as her registered nurse license while staying close to home. Her nursing career began in 1991, when she was hired as a unit clerk and nursing assistant locally. Since then, she has moved up the ranks to her current position of assistant chief nursing officer at SageWest Riverton. “She has pursued further education in nursing, focused on providing extraordinary nursing care,” Sherrill wrote. “Vickie constantly looks for ways and means to implement the highest standards of best practice care for our patients.” Vickie expressed pride in her educational achievements. In 2009 she earned a Bachelor of Science in nursing, followed by a Master of Science in nursing in 2015. “The knowledge I have gained through education has influenced the care I give to my patients,” she said, “as well as my ability to lead.” Sherrill said Vickie leads by example, working hands-on to share the lessons she has learned while bringing clarity and resolution to any situation.
“Like many nurses in small community hospitals, she has gained the knowledge to skillfully care for patients across the continuum of care and is versatile with an extensive depth of knowledge,” Sherrill wrote. “Her interaction with staff, providers, patients and their families is heartfelt, compassionate and responsive.” Vickie decided to go back to school to become a nurse at 26 years old. “Historically I had done well academically and was interested in the biological sciences,” she explained.
“She is open and transparent, asking for assistance and sharing information when needed,” Sherrill wrote. “Vickie is a continual learner, and promotes professional development of clinical staff in any role she has had.” Throughout her career, Vickie has worked in infection prevention, as staff educator and case manager. She was the medical-surgical nursing unit director for 14 years, and Sherrill said Vickie made “significant contributions” to the successful transition from paper recording to electronic medical records.
She chose the nursing program with Central Wyoming College, which allowed her to obtain her associate degree in
“Regardless of her role in the organization – Vickie’s focus is being an advocate for patients and nursing,” Sherrill wrote.
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For example, she said, Vickie has “influenced and improved” patient care by assisting in the development of staffing plans, hourly rounding and bedside shift reports, and by educating staff on pain management and proper use of restraints. “Her passion for the work and value of nursing is evident every day in each interaction with staff, families, patients, administration, colleagues and other professionals,” Sherrill wrote. “Her commitment to excellent care and love for the work of nursing influences the quality of their practice and inspires them in their work.” Many current nurses in the organization have been oriented and mentored by Vickie. Most recently, 10 new graduate nurses started working at the hospital, and to support them Vickie developed a new cohort-based, 12-week graduate nurse orientation program to help them transition into practice. The program includes didactic components, group activities, self-study and simulation and utilizes evidence based practices that promote nurse retention, engagement and quality care, Sherrill said. Vickie also has organized training and recruited instructors for American Heart Association cardiopulmonary resuscitation and advanced cardiac life support courses to ensure SageWest offers the best training courses for its staff and community providers, according to Sherrill’s nomination letter. Vickie said she is motivated in her work by her desire to “make things better” for patients, staff members and the hospital overall. “At the end of the day, I want to make a difference and have a positive impact with people I encounter, whether patients or healthcare providers,” she said. “Identifying problems and seeking solutions in healthcare are so important, and I am encouraged when solutions
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to issues make positive changes and are hardwired for consistency and sustainability by all involved.” She noted that such solutions must be developed using an interdisciplinary approach and “diligent team work.” For example, when the hospital facility in Lander flooded in May 2016, necessitating the evacuation of all inpatients – including people in intensive care, the surgical unit, the psychiatric unit and the nursery – Vickie credited her co-workers, volunteers and the incident command team with successfully transporting all of the patients elsewhere.
and reduced the effects of the disaster until things were under control.” After the initial disaster was over, Sherrill said Vickie also supported Lander-based staff in their temporary transition to working in Riverton. “She has created a well-functioning team with these two groups of staff, who are engaged and continue to give excellent patient care despite
disruptions to their work flows, damages from the storm to their own homes, and uncertainty about when they would return to work in Lander,” Sherrill wrote. “Vickie is a valued employee with a long term commitment to her community hospital and community members. She is highly regarded by all for her fair, compassionate leadership, and she exemplifies the ethics, compassion and skill of nursing.”
“She is highly regarded by all for her fair, compassionate leadership, and she exemplifies the ethics, compassion and skill of nursing.”
“As soon as the patients were safe, we worked as a team to prevent further damage to the structure,” she said. “I was proud to be part of a team of dedicated employees who were assisted by the volunteers, public servants and agencies who ensured safety
— Sherrill Sorensen, Chief Nursing Officer
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Surprise ER Visit
A future resident makes a visit to the SageWest emergency room
hen Di Anne Chudzik of River Grove, Illinois, traveled to Riverton this summer, she knew she wanted to take a look at the local health care facilities. The 62-year-old was scouting out the area as a possible retirement destination, and her list of “things to do” included visiting SageWest Health Care at Riverton. She didn’t anticipate actually becoming a patient, though. “That’s me hiking,” Di Anne said, laughing during a phone interview after her trip. She explained that she sprained her knee while she was exploring the town in July. “I was just out walking around,” Di Anne recalled. “I didn’t want to stay inside one moment more than I had to.” At first, Di Anne didn’t think she would need to seek medical attention for the sprain. But by the next day her knee was swollen and sore, so she asked her son, who had joined her on her road trip, to take her to SageWest. She says it was the best experience she has ever had at a hospital.
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“It was just the whole atmosphere,” Di Anne said, “just quick, comfortable and courteous.” She said she was impressed by the professionalism and courteous attentiveness of the nurses and staff, and by the fact that she didn’t have to wait long to be seen. “I was just going to go prop my knee up and hope for the best,” she said, “but I was in and out. They were just totally outstanding. I’m like, ‘I’ve got to come out here.’” She was so moved by what she saw that she wrote a letter to the hospital when she got home.
“They were pitching in, helping the nurses,” Di Anne said. “We were able to talk while they assisted the staff in the ER.” The emergency room got busier while she was there, Di Anne said, “but it was organized and efficient, and everything moved along quickly.” Her knee was X-rayed, and her leg was outfitted with an immobilizer. After that, Di Anne was sent on her way. “After about a week I was home and back to work,” she said. Her knee, which has given her problems before, will require more attention in the future, Di Anne noted, but she will wait to seek additional treatment. Perhaps by then she will be enjoying her retirement in Riverton. “I fell in love with that place,” Di Anne said. “I just can’t picture myself being any place else. I have every desire, upon retirement, to become a permanent resident. I found Riverton and the surrounding area absolutely the perfect place to spend the rest of my life.”
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Healthcare Exchange Walking through the health insurance marketplace
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ere’s some good news: When it comes to health insurance coverage through the Health Insurance Marketplace, millions of Americans benefit from federal financial assistance each year, and you may, too. Since its inception in 2013, the Affordable Care Act has helped approximately 20 million Americans gain affordable health insurance, 12.7 million of whom have enrolled in marketplace plans. Of those 12.7 million, approximately 85% have benefited from federal subsidies and other financial assistance. That means all of those individuals now have improved access to medical care in the form of preventive health screenings, vaccinations, wellness checks and women’s care, among other healthcare services. While this is great news, there are still millions of Americans who do not have healthcare coverage, likely due
Understanding the Health Insurance Marketplace
Marketplace Highlights
For those of you new to the Health Insurance Marketplace, Wyoming’s is run by the federal government and is located online at www.healthcare.gov. Throughout the 2017 open enrollment window, which runs through January 31, 2017, our hope is to educate people about the opportunity to select a quality health insurance plan through the Marketplace that: • satisfies your current healthcare needs, • ensures you have access to the preventive care you need now to remain healthy later, and • is financially manageable. As you compare plans, you should consider whether each plan includes any physicians and providers regularly seen by you and/or any family members who will be covered by the plan. These include primary care physicians, pediatricians, OB/ GYN, ENTs, dermatologists, and other specialty care providers.
to the monthly premiums. This year, to help you explore your options, we’ve developed an online Subsidy Calculator, which you can use to determine if you are eligible for federal financial assistance. To see if you qualify, visit www.GetEnrollmentHelp.com and click on the Subsidy Calculator.
For those who need help identifying a plan to meet your healthcare needs, SageWest Health Care provides onsite Certified Application Counselors (CACs) to support you in the application process. Simply call 1-888- 982-9144. Our CACs are available for phone or personal appointments.
Making our communities healthier. WINTER 2017 SageWest ± Lander 1320 Bishop Randall Drive Lander, WY 82520
SageWest ± Riverton 2100 West Sunset Drive Riverton, WY 82501
SageLife is published as a community service of SageWest Health Care, supported by Ranger publications. It in no way seeks to diagnose or treat illness or to service as a substitute for professional medical care. For individual guidance, consult your physician. For more information about SageWest Health Care or anything in this publication, please call 307-332-4420 or 307-856-4161. A link to this publication can also be found at www.sagewesthealtcare.com.