2013 Call for Nominations
MED Magazine MED Magazine is seeking Nominations for Cover and Feature Article topics for 2013. MED is committed to focusing on pioneering physicians, institutions, programs and technologies that are paving the way for the future of healthcare in our region. No one knows these pioneers better than MED readers. If you know of a person or program that deserves a closer look, tell us about them. (Self-referrals are permitted!) Send us the following information via fax, mail or email.
Med Nomination Form Please include the following information: Name of Nominee_______________________________________________________________________________________________________ Location of Practice______________________________________________________________________________________________________ Reason for Nomination___________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Your Name_____________________________________________________________________________________________________________ Your Contact Information_________________________________________________________________________________________________
Mail / Fax or email this form to: PO Box 90646 Sioux Falls, SD 57109—Fax 605-271-5486—email Alex@MidwestMedicalEdition.com
Contents Midwest Medical Edition
November 2012
Regular Features 2 | From Us to You 4 | News & Notes: Expanded! News from around the region 8 | Meet a MED Advisor – Brad Randall, MD
Medical
Simulation From life-like catastrophes to Code Blue scenarios to responsive mannequins, can simulated healthcare experiences rival the real thing for learning critical clinical skills? A growing number of healthcare educators and health systems, including those in South Dakota, are counting on it. We explore the expanding role of simulation in regional medicine in this issue’s MED cover feature.
20 | Off Hours: The High Trails of Jack Robbins, MD 26 | The Nurses' Station 28 | Grape Expectations: For a Perfect Holiday, Don’t Overthink . . . Just Drink!
| By Heather Taylor Boysen
29 | Learning Opportunities:
Upcoming Symposiums, Conferences, CME Courses
In This Issue 8 | Introducing . . . The MEDDY Awards MED Magazine recognizes two area health professionals for their outstanding content contributions with the first two MEDDYs.
9 | Happy Staff, Happy Patients In a healthcare environment where running an independent physician practice is more challenging than ever, one Sioux Falls clinic has found a way to boost both office efficiency and patient satisfaction. The key is connection. | By Liz Boyd
10 | Telemedicine Helps Community Providers Reap Financial Benefits
| By Tana Phelps
12 | Physicians and the Health Insurance Exchange.
| By Dave Hewett
17 | New Tool May Help to Avoid Diagnostic Surgery Black Hills doctors pioneer a technique for distinguishing malignant thyroid nodules from benign.
18 | Clinical Spotlight South Dakota’s first single-site robotic cholecystectomy and a new heart valve replacement therapy take place in Sioux Falls.
22 | Avera Transplant Institute Performs 1000 th Transplant 24 | Medical Foster Home Project Certified at VA Foster homes aren’t just for children anymore. An innovative national program makes it possible for South Dakota veterans to get the healthcare they need while still living in a home environment.
Cover photo Kristi Shanks Pictured is Andrea Kribell, RN, 2 West Orthopedic Supervisor at Avera McKennan working with an iStan patient simulator in the Avera Simulation Center.
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Cover Feature
From Us to You
Staying in Touch with MED
O
ccasionally, in the course of producing this
regional health community magazine, we run into certain words and concepts over and over again. ‘HIPAA Compliance’ and ‘EMR’ are examples. Lately, the term ‘simulation’ has come up repeatedly, in a variety of different settings. With a fleet of new mobile simulation units in South Dakota, and new sim centers in the medical school and hospitals, it is clear that simulation is playing an increasingly important role in medicine in our region. In this issue’s cover feature, we explore this growing tool to gauge its impact on clinical proficiency, patient safety, outcomes, and communication. Kudos to Kristi Shanks of Kristi Shanks Photography in Sioux Falls for going above and beyond to produce images for this issue’s cover and cover article, taken in the Avera McKennan Simulation Center. As always, we hope that you will consider supporting the people and businesses who help us bring you this publication, (like Kristi Shanks) when you find yourself in need of their services. As we look toward a new year of MED, we welcome your nominations and suggestions for cover and feature articles (the Nomination Form in this issue can get you started). We also welcome reader-contributed articles, news, book reviews, anecdotes, story suggestions, and feedback any time. Because MED is locally owned and operated, we have the flexibility to accommodate our readers, and act on their suggestions, in ways many publications can’t. Finally, in this season of giving thanks, it seems fitting that we at MED should say thank you to some of the contributors who help us fill these pages with timely, relevant, local healthcare news. Be sure to see who won our first two MEDDY Awards (p. 8), and keep an eye out right here for future recipients. With Gratitude, Steff and Alex
Publisher
MED Magazine, LLC Sioux Falls, South Dakota
VP Sales & Marketing Editor in Chief Design/Art Direction Cover Design Photographer Web Design Contributing Editor Copy Editor
Steffanie Liston-Holtrop Alex Strauss Corbo Design Darrel Fickbohm Kristi Shanks 5j Design Darrel Fickbohm Hannah Weise
Contributing Writers
Heather Boysen Dave Hewett Tana Phelps
Steffanie Liston-Holtrop
Staff Writers
Liz Boyd Caroline Chenault John Knies
Contact Information Alex Strauss
Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com
2012 Advertising / Editorial Deadlines Jan/Feb Issue December 5
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©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes Avera Thomas A. Clark, Regional President and CEO, Avera Queen of Peace Region, was
appointed to a three year term on the South Dakota Foundation for Medical Care Board. Clark has served as Regional President and CEO of the Avera Queen of Peace Region since July 2011. He will serve as one of six provider administrators on the Board which helps determine if Medicare services are medically necessary, appropriate, and meet professionally recognized standards of care. The Avera Sacred Heart Hospital Radiology Department has
been awarded a three-year term of accreditation in magnetic resonance imaging (MRI) as the result of a recent review by the American College of Radiology (ACR). Avera Sacred Heart Hospital’s Radiology Department is also ACR accredited in CT, Ultrasound and Mammography.
Clinton L. Seifert, MD, has joined the surgeons at Avera Medical Group Surgery. Dr. Seifert
received his MD from the University of Kansas Medical School in Wichita. He completed a surgical rotation in Zanzibar, Tanzania, during medical school and completed a five-year General Surgery Residency Program at the University of Kansas. Dr. Seifert is Board Eligible in General Surgery and is a member of the American College of Surgeons. Avera Heart Hospital of South Dakota has been named one of the nation’s 50 Top Cardiovascular Hospitals by Truven Health Analytics. The
study examined the performance of more than 1,000 hospitals by analyzing outcomes for patients with heart failure and heart attacks and for those who received coronary bypass surgery and percutaneous coronary interventions such as angioplasties. This is the sixth year that Avera Heart Hospital has been recognized with this honor. Winners were announced in the October 1 issue of Modern Healthcare magazine. Avera McKennan has launched a new website dedicated to helping
patients learn about surgical pain management. Patients and providers can access the site at www.avera.org/pain-management. MRI Technicians Ricardo Santos and Chris Beltz have been instrumental in the accreditation process. The Open Bore Siemens Magnetom Skyra 3T MRI is the most powerful and accurate MRI in the Yankton region.
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Avera McKennan Hospital & University Health Center has again been verified as a Level II Trauma Center by the
Verification Review Committee of the American College of Surgeons (ACS). Avera McKennan has held
this designation since 1992, when it became the first verified Level II Trauma Center in the state of South Dakota. Level II Trauma Centers have 24/7 emergency physician coverage, a trauma surgeon at all trauma team activations, and neurosurgeons and orthopedic surgeons who are continuously and promptly available. Clayton Gropper, Athletic Trainer for Mitchell High School
and an employee of Avera Queen of Peace Hospital, was named the State Athletic Trainer of the Year for 2011-2012 by the South Dakota Athletic Trainers Association. He has an MS in Sports Administration and is a clinical instructor and athletic trainer for Dakota Wesleyan University, and is also a certified instructor for the American Heart Association. Gropper has worked with Mitchell High School athletics through Avera Queen of Peace Hospital for 11 years. John T. Swisher, IV, DO, has joined Avera Medical Group Orthopedics and Sports Medicine.
Dr. Swisher received his DO from Des Moines University Osteopathic Medical School in 2006 and completed a residency in Family Medicine at the University of Iowa/Mercy Medical Center-North Iowa, in Mason City. Dr. Swisher also completed a Primary Care Sports Medicine Fellowship at the University of Minnesota in Minneapolis. He is board certified in Family Medicine and Primary Care Sports Medicine.
Sanford Edith Sanford Breast Health in Sioux Falls recently began using breast tomosynthesis,
also known as 3D mammography, which gives radiologists better visualization of the breast, detects cancer earlier and reduces the need for additional follow-up tests. It uses advanced computer imaging and low-dose X-rays to convert digital breast images into a stack of very thin layers. Breast tomosynthesis is FDA approved and is one of the most advanced technologies available for early detection of breast cancer. Loren Tschetter, MD, Sanford IRB Chairperson, has received the National Cancer Institute’s 2012 Harry Hynes Award, an award that recognizes
excellence in research within the Community Clinical Oncology Program (CCOP) Network. As a founder of the Sioux Community Cancer Consortium in 1983, Dr. Tschetter is responsible for bringing two National Cancer Institute programs to Sanford Health: the Community Clinical Oncology Program, concentrating on clinical trials and the National Cancer Institute’s Community Cancer Centers Program, focusing on developing advanced cancer care programs in community cancer centers.
Midwest Medical Edition
Jesse Dirksen, MD, has joined Sanford Surgical Associates as the region’s newest breast surgeon. A Sioux Falls native, Dr.
Dirksen graduated from USDSM and did his general surgery residency in Pennsylvania. He rotated with the breast surgery department at Memorial SloanKettering Cancer Center in New York and completed a one-year breast surgical oncology fellowship at the University of Iowa. Sanford Health in Sioux Falls is one of the nation’s most innovative users of business technology, according to InformationWeek’s annual “500” list announced last night
at the organization’s yearly conference. It is Sanford’s seventh straight appearance on the list. The list considers technology, strategies, investments and administrative practices of information technology departments of organizations. The popular Indian spice curcumin can suppress prostate cancer cell progression, according to a study led by Meena Jaggi, PhD, recently
published in PLOSONE and featured by UroToday. Dr. Jaggi’s team of four researchers discovered curcumin can maintain the proper level of protein kinase D1 (PKD1) in prostate cancer cells in a mice model. That level is typically low in subjects experiencing prostate cancer. Understanding the molecular basis of prostate cancer progression may allow for earlier diagnosis and the development of treatment strategies, such as curcumin, for the disease.
November 2012
The Sanford Health transplant programs in Fargo and Sioux Falls have earned recognition from the Department of Health and Human Services (HHS) for quality performance in transplant care. The Bronze
A study conducted by Sanford Health’s John Lee, MD, and Etubics Corporation that uses a vaccine to suppress human papilloma virus (HPV) has been published by Cancer Gene Therapy. Dr. Lee and his team used
Award for Transplant Programs, which was based on Sanford’s work with kidney transplants, considered factors to measure quality, including post-transplant survival rates, transplant rates on waitlist patients and pre-transplant mortality rates. The Bronze Medal of Honor for Organ Donations is presented to organizations achieving and sustaining a donation rate of 75 percent or more of eligible donors. Both Fargo and Sioux Falls transplant programs experience a donation rate of nearly 80 percent.
an Etubics drug (Ad5 [E1-, E2b-]) in conjunction with chemotherapy and radiation to successfully improve long-term survival of animals expressing HPV. The study appears in the October issue of the peer-reviewed publication.
Sanford Research has received the largest grant in its history—$13.5 million—
to create a platform to bring together tribal communities and health researchers from multiple disciplines to address health disparities among American Indians in South Dakota, North Dakota and Minnesota. Amy Elliott, PhD, director of the Center for Health Outcomes and Prevention Research at Sanford Research/USD, is the principal investigator for the project, which includes collaboration from the Cheyenne River Sioux Tribe, Oglala Sioux Tribe (Pine Ridge) and Rosebud Sioux Tribe.
The Sanford FIELDHOUSE, an 85 thousand square foot indoor sports facility opened in Sioux Falls in September. Sanford
FIELDHOUSE provides access to athletic performance programs, comprehensive functional, physiological and biomechanical evaluations, and rehabilitation and nutritional consultation services. The facility also features four batting cages, offers indoor adult sporting leagues, and will be available for teams and individuals to rent for practice. Charles Miller, MD, has received his board certification in Neurocritical Care. Dr. Miller joins
Larry Burris, DO, as a board certified neuro-intensivist. Drs. Burris and Miller are the only board certified neuro-intensivists in the Dakotas. Dr. Miller is also boarded in neurological surgery.
MidwestMedicalEdition.com
Greg Shearer, PhD, and Bill Harris, PhD, recently published a study in the Journal of Lipid Research that advances treatment of metabolic syndrome. The study, “Effects of
prescription niacin and omega-3 fatty acids on lipids and vascular function in metabolic syndrome: a randomized controlled trial,” explored the application of a combination of two drugs to treat metabolic syndrome. Dr. Shearer guided a team of five researchers in the clinical trial. The doubleblind study included 60 metabolic syndrome patients in Sioux Falls and lasted 16 weeks.
Sanford Health opened its newest children’s clinic in October. The 9,000 square
foot facility in Klamath Falls, Oregon is designed in a castle theme similar to other Sanford Children’s facilities and will serve a community and broader metropolitan area of 60,000 people, including more than 16,000 children. The new clinic is part of Sanford World Clinic, an initiative outlined in 2007 to increase worldwide access to pediatric care. The next Sanford Children’s Castle of Care, announced in October, is slated for Bismarck, ND.
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South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes Sanford continued David Pearce, PhD, is a 2012 nominee for the RARE Champion of Hope Award for Research & Science.
The Award recognizes an individual who is moving the bar in rare disease research and science. Dr. Pearce serves as vice president of Sanford Research and director of Sanford Children’s Health Research Center. He is one of the world’s leading researchers of Batten disease and also established the Coordination of Rare Diseases at Sanford (CoRDS) program. Jitendra Sharma, MD, has joined Sanford Health as the state’s only interventional neurologist. The addition of
Dr. Sharma adds two important procedures to Sanford’s stroke- and aneurysm-care program: coiling of aneurysms and endovascular mechanical stent removal. Before Dr. Sharma’s arrival, the closest hospitals performing coiling of aneurysms were in Minneapolis or Iowa City. In addition to using drug therapies to dissolve clots, Dr. Sharma utilizes an endovascular mechanical stent to remove clots which can widen the window of therapeutic stroke care from four hours to eight hours.
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Sanford USD Medical Center recently qualified for the American Heart Association’s Mission: Lifeline Gold Performance Achievement Award. The award recognizes
Sanford Health’s commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI patients. Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Gov. Dennis Daugaard has appointed Sanford Health’s Jeffrey Murray, MD, to the nine-member state Board of Medical and Osteopathic Examiners. Dr.
Murray is the Medical Director of the Endoscopy Center and Vice Chairman of the Department of Internal Medicine at the Sanford USD Medical Center. He is also a member of the Sanford Clinic Physician Board of Governors and has served three successive terms as the governor of the American College of Gastroenterology. A grant from the National Institutes of Health (NIH) is allowing Sanford Health researchers to explore the origin of cervical cancer in American Indian women. The
five-year grant totals nearly $1.6 million. Sanford scientist Subhash Chauhan, PhD, is the principal investigator leading a team of seven researchers. Sanford studies have shown American Indian women have a higher incidence of HPV, an early indicator of cervical cancer, than Caucasian women. The study will also look for a link between smoking and cervical cancer. Four times more American Indian women smoke than Caucasian women.
continued
Siouxland The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) has nationally recertified the Cardiac Rehabilitation Program at Mercy Medical Center—
Sioux City. Designed to limit the physiological and psychological effects of heart disease and cardiac illness, Mercy’s 30-year-old cardiac rehabilitation program strives to stabilize or improve the patient’s condition and enhance the patient’s quality of life. Mercy Medical Center is launching year two of a highly successful project that presents relevant and timely health care information to the people of Siouxland. Mercy 101, launched
last October, features free, monthly presentations on health related issues for residents. Mercy 101 is free to the public and will be held on the 4th Tuesday of every month from October through May in the hospital’s Leiter Room off the Fifth Street circle drive. St. Luke’s President and CEO Peter Thoreen has been recognized for excellence in leadership by the Iowa Hospital Association (IHA).
The award is presented annually to an Iowa hospital or health system executive who demonstrates notable achievement in their health system and dynamic involvement in current health affairs. Thoreen has served as President and CEO of St. Luke’s Health System since 2002, leading efforts to build a new surgical services area and a birth center during his tenure. Under his leadership, St. Luke’s same day surgery center was also converted into a successful, hospitalphysician joint venture.
Western South Dakota Speech-language pathologist Lynn Stillwell, MS, CC-SLP has joined the staff of Children’s Care Hospital & School in Rapid City. Stillwell earned
her MS in Speech, Language and Hearing Sciences at the University of Arizona in Tucson. She provides speech therapy services at Children’s Care in Rapid City, and outpatient clinic and outreach services on the Pine Ridge Reservation and specializes in feeding, swallowing and early intervention services. Regional Health is offering free digital mammography screenings in Custer, Rapid City, Spearfish, and Sturgis in November and also in January 2013. The screenings include
a free digital mammogram, a free radiology reading of the mammogram that will be sent to the participant and the participant’s physician, and a $10 gift card. To participate in the free screenings, participants must be at least 40 years old, have a primary care physician, not have had a mammogram in the last 12 months, and have no history of breast cancer or symptoms. Visit www. regionalhealth.com/mammo for screening dates and locations.
Midwest Medical Edition
Happenings around the region
Joe Ferris is the new Chief Financial Officer, David Egermier is the new Emergency Management Director, Michael Collins is the new Human Resources Officer and Carla Bells “C.B.” Alexander is the new Associate Director at the VA
Black Hills Health Care System. Ferris spent 22 years in the military and finished as the CFO for the NATO School in Oberammergau, Germany. Egermier holds an MS in Aeronautical Safety from Embry Riddle Aeronautical University and is a Retired Air Force Senior Master Sergeant, with 24 years of active duty service. Collins is a retired Army Master Sergeant and an RN with 21 years of active duty. Alexander is board certified in healthcare management. VA Black Hills Health Care System’s (BHHCS) Mental Health Service was awarded full accreditation by the Commission on Accreditation for Rehabilitation Facilities (CARF)
for its residential and outpatient programs related to homeless services, employment services, addictions treatment and PTSD programming. The accreditation is for a three-year period, May 20122015. This is the fifth time Mental Health Services has been awarded CARF certification for Residential Programming.
Nephrologist Sujan Pathak, MD, has joined the staff of Regional Medical Clinic in Rapid City. A native of
Nepal, Dr. Pathak completed his residency in Internal Medicine and fellowship in Nephrology at the State University of New York Health Science Center at Brooklyn in Brooklyn, N.Y. Dr. Pathak joins Drs. Frederic Birch, Mazen Nemeh, Ayodele Ogunremi, Bushra Rafeeq, and Louis Raymond in providing Nephrology care to patients in Rapid City. Internist Marci Neilson, MD, has joined the staff of Regional Medical Clinic in Rapid City. A Rapid City native, Dr.
Neilson received her MD from USDSM. She was awarded the Ron Trautman Medical Student Scholarship from Rapid City Regional Hospital in 2007 and 2008. Dr. Neilson completed her residency at the University of Wisconsin Hospital and Clinics in Madison, Wisconsin. Joe Sluka, Executive Vice President and Chief Administrative Officer for Regional Health in Rapid City was elected Chairperson at the Annual Business meeting of the South Dakota Association of Healthcare Organizations (SDAHO). A native of New
Spearfish Regional Hospital (SPRH) recently received the 2012 MAP (Measure, Apply,
and Perform) Performance Improvement in Revenue Cycle Award from the Healthcare Financial Management Association (HFMA). This national award recognizes health care organizations that achieve excellence or demonstrate substantial improvement in revenue cycle performance and serve as models for the health care industry. Rapid City Regional Hospital has been recognized as a Gold-Level Fit-Friendly Company by the
American Heart Association for helping employees eat better and move more. Rapid City Regional Hospital provides a variety of wellness-related opportunities for their employees, including designated walking paths, healthy meal options that are highlighted in the cafeteria, and employee health screenings.
Left to Right: Robin Albers, American Heart Association, Theresa Ferdinand, Cardiac Rehab Coordinator, RCRH and Steve Sylliaasen, Director, Cardiac Services, RCRH.
Jersey, Sluka earned his MBA from the Weatherhead School of Management at Case Western Reserve University. He has been with Regional Health since 2001 and has served on the SDAHO Board of Trustees since 2009. Sluka assumed his leadership role at SDAHO’s 86th Annual Convention in Sioux Falls in September.
November 2012
MidwestMedicalEdition.com
Amy Jacobson, EdD, has been appointed the Executive Director of Medical Education for the Sanford Health Office of Academic Affairs. Dr. Jacobson
has spent the past 9 years in administrative and leadership positions with the Sanford School of Medicine, most recently serving as the Deputy Director of the South Dakota Area Health Education Center (AHEC) and as an Assistant Professor within the Department of Family Medicine. As the Executive Director of Medical Education, Dr. Jacobson will oversee GME, CME, and other health professional education for the enterprise.
Western South Dakota patients now have access to an upgraded and expanded dialysis unit at the VA Black Hills Health Care System Hot Springs Medical Center. The remodeled unit opened
to patients in mid-September and includes amenities such as patient lockers, individual reading lamps, and temperature controls at each station. Dialysis units in western South Dakota have been at, or near, capacity in recent years, making patient placement difficult and presenting difficulties for dialysis patients traveling to the Black Hills. The expansion increases the dialysis unit capacity from 20 patients to 28. The unit averages approximately 2,800 patients per year and is expected to continue to increase.
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A talk with MED Advisor
Brad Randall, MD Pathologist
Q:You have been involved in the last few years in an NIH study that is shedding light on Sudden Unexpected Infant Death. What brought you to this? A: To be honest, this is kind of an orphan child in research circles. The medical examiner community doesn’t really have a big interest in SUID (of which SIDS is a subset) because it’s just an enigma to them. They would rather work with things they understand. But I have had a particular interest in SUID since my fellowship training at the University of North Carolina. Q: What is the PASS network and how are you involved? A: PASS (Prenatal Alcohol and SIDS and Stillbirth) explores the connection between alcohol and infant death with a specific focus on two populations, the Dakota Sioux in our region and the Cape Coloureds (a minority ethnic group) near Capetown, South Africa. The aim of the program is to enroll about 14,000 pregnant women and look very carefully at their background risk factors, including cigarette smoking, drinking, prenatal visits, etc. I am on the pathology committee and my role is to look at the pathology, both from infants that die and from the placentas. Q: And this has led you to some other research projects? A: Yes. SIDS has undergone a tremendous diagnostic shift in recent years. I am working on a classification system for infant deaths. It would be a system that would recognize and incorporate asphyxial risks like tummy sleeping, bed sharing, soft bedding, etc. These risks are much more common than we originally thought. It appears that asphyxia is probably the most common pervasive risk. Q: What do you hope will come of the PASS study? A: A study done some time ago at Harvard found that there are deficiencies in the brain stems of infants who die suddenly and unexpectedly. Because PASS provides much better background information than the Harvard researchers had to work with, I think this will help clarify our understanding of these brain stem defects.
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MED VP of Sales, Steffanie Liston-Holtrop and Dr. Scott Boyens
Introducing the MEDDY Awards
Steffanie Liston-Holtrop and Dr. Gareth Davies
Everyone appreciates being recognized for their contributions. That’s the simple idea behind MED’s newest venture, the MEDDY Awards. MED’s creators have been reporting on medical news for physicians and healthcare professionals in our region for more than 20 years. One thing this experience has taught us is that a publication like MED could not exist without the providers and researchers who regularly help fill these pages with the timely, relevant information our readers have come to expert. The MEDDY Awards are our way of saying ‘Thank You’ to some of those individuals who have gone above and beyond to share their expertise with MED’s writers and editors. Unlike cover story or feature subjects, MEDDY Award winners cannot be nominated or even recommended. MEDDY recipients will be chosen periodically and recognized solely at the discretion of the MED staff and physician advisory board. Each MEDDY Award winner will receive a personalized, framed copy of the MED issue in which their contributions appeared, kudos in the magazine, and our undying gratitude. We would like to congratulate our first MEDDY Award winners, Gareth Davies, PhD, and the Avera Institute for Human Genetics for their contributions to our April/May 2012 Cover Article on Personalized Medicine and genomics, and Sanford Clinic Family Practice Physician, Scott Boyens, MD, for his insights in both our two-part series on the Fate of Primary Care, and his own Off Hours hobby as a referee. We encourage MED readers to thank these physicians for taking the time to share their knowledge with their colleagues for the benefit of the entire medical community. Congratulations and thanks to our first MEDDY Award winners!
Midwest Medical Edition
Happy Staff, Happy Patients By Liz Boyd
USC’s front desk Reception Team-Sara Rokeh, Paula Hoy and Kaye Hammond
In a healthcare environment where running an independent physician practice is more challenging than ever, one Sioux Falls clinic has found a way to boost both office efficiency and patient satisfaction. The key is connection.
A
t Urology Specialists Clinic
and Surgical Center, staff appreciation is serious business. The single-specialty independent clinic includes 7 urologists, 4 physician assistants and a staff that has more than doubled in size in the last two decades. “In the early 1990’s, when we were still on the Avera McKennan campus in Medical Building I, we were probably at 25 full time equivalents,” says Darly Hofer, MD, a Bridgewater native who has been with the practice since 1992. “Now we are over 50.” Although their MB1 office space was getting cramped by the time the group left it in 2009 to build their own free-standing facility on South Minnesota Avenue, the smaller space did have some distinct advantages. “Before we moved, we were always kind of on top of each other,” says Dr. Hofer. “For instance, I used to have to walk by billing every day and I was always aware of what was going on in the lab. You knew what everyone else was doing. So you always knew when one of your colleagues needed help.” But in their modern, spacious new facility, designed for patient comfort and practice efficiency, that kind of connection no longer comes naturally. Instead, it has to be carefully cultivated, with regular planned outings and parties, impromptu staff cookouts, and, most recently, a full week dedicated to staff appreciation and connection. During this year’s first annual ‘USC Week’, each department within the practice – billing, nursing, clerical and providers – enjoyed
November 2012
a full day in the spotlight with posters featuring ‘fun facts’, contests, and incentives to stop by the departments. EMR, which has been up and running for a year at USC, got its own celebration day, with milkshakes for everyone. “This kind of interaction is more than just a fun way to stay connected. It also allows us to deliver the best possible patient care,” says Dr. Hofer. “It is not enough to just do billing well, or do surgery well. When we understand each other’s strengths and weaknesses, and we are working seamlessly together, we can ensure that the patient has an excellent experience, from the time that they get their first CT scan to the time that they receive their bill.” Of course, staff that feels connected to and appreciated by both their employers and their co-workers are also more likely to stay, ensuring continuity for patients and a level of proficiency that only familiarity with an office can bring. Being independent, says Hofer, means the physician owners can “turn on a dime” to create opportunities – like USC Week – that reinforce connection any time of year. “We are well aware that, to succeed as an independent practice, you have to do a very, very good job,” says Dr. Hofer. “And part of doing a very, very good job is having a happy and enthusiastic staff, where people feel understood and supported. Sometimes it’s easier to foster that kind of understanding on the back porch than it is anywhere else. Plus, it’s just fun. And when we are happy in our jobs, everyone – including me – is going to do a better job.” ■
MidwestMedicalEdition.com
Dr. Jack Robbins and Carey Hoekstra, surgery scheduler
Billing Supervisor Jennifer Sikkink
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Telemedicine Helps Community Providers Reap Financial Benefits
I
By Tana Phelps n an era of constant system change, health-care
leaders remain under steep financial pressure, especially in community and rural settings. They have the frequent challenge of providing uncompensated care to individuals with more chronic diseases, less access to care and poorer treatment plan compliance. And these leaders know that as their organizations evolve from fee-for-service work to value-based care, reimbursement will require a higher level of sophisticated, data-driven infrastructure. Enter telemedicine. A perhaps surprising way to improve the patient experience, telemedicine permits two-way, real time interactive communication between a patient and a provider at a distant site. Telemedicine has been shown to reduce costs and improve care coordination by preventing avoidable hospital readmissions and providing regular access to care in remote areas. Consider these known benefits to adding telemedicine services:
Telemedicine is not without its challenges. Consider these: Reimbursement remains a hindrance. About one-third of
states have mandated that payers reimburse telemedicine services, but South Dakota is not one of them. Still, some payers—including Aetna, Cigna, UnitedHealthcare, and BlueCross and BlueShield— are advocating the use of telemedicine as a way to make doctor visits less expensive and more easily available. Staff training and IT are costly. The time and cost associated
with training providers, nurses and aides on the new technology can be extensive, as can be changing workflow to allow for it. In the end, improved outcomes for patients, enhanced time efficiency for physicians and fewer readmissions for hospitals should be included in any telemedicine cost-benefit analysis. ■ Tana Phelps is a marketing specialist at Cassling, a Midwest health-care company that provides local imaging equipment sales and service, and marketing and professional services.
Improved quality outcomes. Telemedicine allows patients to
remain in their local communities, ensuring better continuity of care. It also encourages younger patients—like tech-savvy teenagers—to open up in a familiar environment. School-based telemedicine clinics, for example, can improve outcomes, reduce emergency department visits and help parents avoid work absences—which also saves money. Fewer avoidable readmissions. Health-care organizations need
to manage patients with chronic diseases to curtail repeat hospital admissions. In nursing homes, for example, seniors often call for an ambulance when they have a medical emergency. Through telemedicine, doctors can assess a patient in real-time without an expensive trip to the ED. Plus, telemedicine can be used for routine access to care, reducing the likelihood and frequency of hospitalization. Stronger patient loyalty and market share. For administra-
tors, telemedicine means being able to market additional services, like access to specialists that patients may not get otherwise. In this way, telemedicine can even create a supplemental revenue stream for health-care organizations. According to the American Telemedicine Association, almost 50 different medical subspecialties successfully use telemedicine. Radiology is considered the most successful; other major specialty areas include: mental health, dermatology, ophthalmology, cardiology and pathology.
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Midwest Medical Edition
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“Quite often I take what we’ve learned in class and use it to develop programs and leadership classes at Avera. The assignments are that relevant.” Kathy Maass, M.B.A Director of Process Excellence, Avera McKennan Hospital
November 2012
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Physicians and the Health Insurance Exchange
T
By Dave Hewett
here are two sides to
the Affordable Care Act (ACA) coin – the delivery reform side and the health care coverage side. Faced with innumerable new requirements and deadlines, the providers’ focus has been devoted primarily to delivery reform. You know the list – meaningful use status, reporting patient safety and satisfaction statistics, medical homes, etc… But as providers, it is also important to be cognizant of the other side of the coin – how more people will obtain health insurance coverage under the ACA. After all, that could represent a major shift in how providers are paid in the future for a significant portion of their patient base. By way of background, about 53 million people were uninsured before the ACA was passed. A recent report suggests that number is now about 48 million. It is projected that, when (if) fully implemented, the number of uninsured should slip to about 22 million by early 2015. In South Dakota it is unclear just how many more people will be covered under the ACA. That’s because the State must still determine how much it will increase Medicaid eligibility. But the current 80,000
uninsured could be reduced to 25,000 depending on which options are selected. So how does the country’s uninsured population decrease from 53 million people to about 22 million? The short answer is expanding Medicaid eligibility and requiring individuals to have coverage under the individual mandate. Health insurance exchanges will play an integral albeit not totally defined role in getting both groups covered. The first important point to know about the Health Insurance Exchange is who will be obtaining their health care coverage from this source beginning in 2014. In South Dakota, it will likely be individuals and employees from some smaller businesses (those with 50 employees or less). Also, and this is very important, the Health Insurance Exchange is supposed to determine eligibility for those who are covered by the Medicaid program. That could be as many as 165,000 people depending on what decisions are made by the governor and state legislature. So who will run the exchange for South Dakota? Governor Daugaard has determined that it will be necessary to rely on the Federal government to provide the Health
Insurance Exchange services needed by the state. That makes sense because the fixed costs of starting up and maintaining an insurance exchange are just too high to justify in a state with a low population. The State estimated that it would cost approximately $6 million per year to administer its own Health Insurance Exchange. But it also means that the State could forfeit some of its autonomy on how the exchange will work. It’s unclear at this point just what that will look like. All this is important for physicians for two reasons. As noted above, this represents a big shift in how people get their health insurance coverage and which entities are paying providers. The second is for especially those physicians who are employers as well. This may provide another option for providing coverage to those they employ. Clearly the development of a Health Insurance Exchange in South Dakota remains in its formative stage. But it deserves our continued attention as a major piece of the Affordable Care Act. ■ Dave Hewett is President/CEO of the South Dakota Association of Healthcare Organizations.
The photo at left was taken by Sioux Falls pediatrician Rick Kooima, MD, with Avera Medical Group McGreevy. “It was taken during the partial solar eclipse that occurred earlier this year,” explains Dr. Kooima. “To take the photo, I shortened the shutter speed (about 1/1000th sec.) for the camera and closed the lens aperture (f 22) significantly so that the photo would be underexposed and the eclipse would be visible.” The photo was featured in the Avera McKennan Staff Art Exhibit in the Prairie Center earlier this year.
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Midwest Medical Edition
South Dakota Providers Lead by Linking South Dakota is the third state
in the nationa poised to begin Phase II of its statewide health information exchange. The next phase allows implementation of Point of Care exchange services. According to South Dakota Health Link, the service will make it possible for all providers to share certain healthcare data via a secure platform. Participating healthcare providers can access electronic medical records regardless of where the patient’s regular provider is located. To date, 37 hospitals, 25+ ambulatory practices, and nearly 50 labs and others have agreed to participate in the Point of Care exchange. ■
open. “I’m glad I chose Sioux Falls Specialty Hospital because more time with patients makes for the best possible images and patient experience.” Greg, MRI Technologist, SFSH
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?
Can Mannequins and Mock Events
Really Prepare
Photo by Kristi Shanks
Health Professionals for Clinical Realities
An iSTAN medical simulation mannequin receives care in the Avera Simulation Center.
Medical
Simulation
By Alex Strauss
On the fourth floor of Avera McKennan hospital in a room virtually indistinguishable from every other patient room, a patient goes into cardiac arrest. Pharmacy interns, respiratory therapists and newly graduated nurses rush to his side while experienced health educators look on. Although the ‘patient’ is actually a high-fidelity mannequin – a sophisticated piece of equipment that can replicate hundreds of medical conditions and respond physiologically to interventions – the tension, chaos and adrenaline of this team’s first ‘Code Blue’ are completely real.
Simulation, the Brain and Communication “What we are trying to do in medical simulation is speak to the biology of how the brain works,” explains Hospitalist Jennifer McKay, MD, Medical Information Officer at Avera Health. Brain science suggests that, when forming the experiential memories which will later inform clinical performance, the brain does not make a distinction between a well-orchestrated simulation and the real thing. “If you think about simulation in the way you think about practicing music or rehearsing a play, it makes sense,” says Dr. McKay who has studied patient safety in Northwestern University’s multi-million dollar simulation center. “You
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Photo Courtesy Sanford
Photo by Kristi Shanks Nurses training in the Avera Simulation Center.
One-way mirrors in an adjacent control room in the Sanford Simulation Center allow an operator to control the simulation while recording and assessing the performance of participants.
wouldn’t go on stage without practicing your lines and it’s to life-like high-fidelity mannequins, it includes simpler even more critical when peoples’ lives are on the line.” Student Auscultation Mannequins and advanced birthing Similar practice scenarios are now happening daily in simulators. Task trainers give students the chance to practice skills like lumbar puncture, thoracostomy tube placement, the Sanford Simulation Center, the newly-opened $1.5 milarthocentesis, arterial gas sampling, culturing, umbilical lion dollar Parry Center for Clinical Skills and Simulation catheterization, and ultrasound-guided central venous cathat USD, the region’s nursing schools, and in South Dakota’s fleet of specially-equipped mobile simulation vehicles eterization, thoracentesis and paracentesis. The center also designed to bring high-level simulation to remote locations. makes frequent use of standardized patients to teach historyAlthough simulation can help participants hone or refine taking and patient interaction skills and is a beta-test site their clinical skills, especially in situations they are not likely for Cardionics’ latest simulated stethoscope. to encounter often in practice, there is an even larger goal. The region’s hospital-run simulation centers are similarly “It is really more about working as a team,” says Darcy equipped with mock patient rooms that can be reconfigured to Sherman Justice, RN, Avera’s Director of Nursing Integra“ We don’t need high technology to teach how to start an I.V. tion. “We don’t need high technology to teach someone what each person’s role is, and how to communicate within how to start an I.V. What we an interdisciplinary healthcare team.” are really trying to teach is not only what happens in a code, but what each person’s role is, and how to communicate mimic different environments. Standardized patients, task trainwithin an interdisciplinary healthcare team. In this safe ers, and high-fidelity mannequins which can cough, groan, environment, they can learn from a wrong decision. We perspire, drool, constrict their pupils and emit heart and lung don’t have to wait for this to happen in clinical practice.” sounds, allow for life-like hands-on learning. Time in a simula“The range of teaching possibilities through simulation is tion center is now a must for most new hires at the hospitals. only limited by our imaginations,” says Jeremy Hall, MD, Inside the state’s 5 high-tech SIM-SD (Simulation in Assistant Professor of Emergency Medicine at USDSM and Motion, South Dakota) vehicles, emergency personnel, nurses and others in areas without access to a simulation center have Director of the Parry Simulation Center. Hall says advances in technology, increased emphasis on patient safety, a growing the chance to hone their emergency response skills on highbody of scientific support for simulation, work hour restricfidelity simulators. Made possible by a grant from the Leona tions for residents, and “educational paradigm shifts” are M. and Harry B. Helmsley Foundation and developed by the driving the increased use of simulation in medical training. state health department in partnership with five of the state’s “Experiential learning occurs from deliberate practice and largest healthcare centers, the most advanced mobile units reflective feedback,” says Dr. Hall. “Ultimately, improved include a mock ER, a simulated ambulance interior, and a patient care is the end goal.” central control room. In every simulation center, mobile or otherwise, the capacHigh- and Low-Technology ity to monitor participants with things like one-way mirrors The Parry Center, which opened in September, provides or recording equipment and discuss the results afterward is training for medical students and residents, nursing students, the final – and arguably most critical – element of successful and students in other allied health professions. In addition training.
What we are really trying to teach is . . .
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Photo Courtesy Avera
“The range of teaching possibilities through simulation is only limited by our imaginations.”
organization and communication when stress is high, resources are stretched, and seconds count. These drills may include physicians and hospital personnel at all levels and usually make use of actors trained to portray patients with various acute conditions. Avera employees mobilize personnel during a recent Code Orange disaster drill. “Simulation is so versatile,” says Travis Spier, Director of Simulation at Sanford. “It can address clinical skills and safety issues as well as multidisciplinary communication. There are multiple opportunities for learning within the sim environment.”
Photo Courtesy Regional Health
Simulation and Patient Outcomes
Rapid City Regional Hospital employees Troy Thompson, Paramedic, SIM-SD Simulation Specialist, left, and Darrel Brimm, RN, SIM-SD Nurse Educator, demonstrate how rural providers practice emergency care on human-like computerized mannequins
“The debriefing component takes this way beyond the specific task being done,” says Shaye Krcil, RN, Director of Trauma Services at Rapid City Regional Hospital. “In healthcare, you are busy taking care of patients, moving from one crisis to the next, one task to the next. I don’t think we often take the time to step back and think about what we did well that day and what could have been done better. The opportunity to set aside time after the simulation to discuss how it went is really invaluable.” Not all simulation is high-tech. Many hospitals take part in state-wide and inhouse disaster drills as a way to practice
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Not everyone is ready to embrace simulation. Dr. McKay says her fellow physicians, many of whom are independent-minded and constantly busy dealing with real scenarios, are often the hardest sell. “These are people who are continually answering to crises,” says McKay, who has experienced the power of simulation herself and encourages her colleagues to do the same. “The real challenge is how do we, as physicians, make practice as important as the real crisis right in front of us?” Spier believes one way to get the buy-in of unconvinced physicians and other ‘naysayers’ is to give them the chance to experience the heart-pounding realism of a well-planned simulation event for themselves. “At the beginning they may say things like ‘It’s just a piece of plastic’,” says Spier. “But replicating a realistic experience usually changes their minds. When the mind has a hard time distinguishing what is real from what is not real, it becomes harder not to support it.” “If you ask the participant if it made their heart race, this is the real test,” says Spier. The other test, of course, is whether or not simulation can rival clinical experience in its ability to improve outcomes. Spier says Sanford’s early data suggests that it can. “We
are in the second year of a grant to study this. So far, we have been able to document improvements in outcomes in the neonatal environment, including things like oxygen use and length of stay. We are looking at whether or not simulation training has the ability to also shorten the time these babies spend on the ventilator.” Dr. McKay says Avera saw the value of its regular in-house disaster drills after an anhydrous ammonia leak at the John Morrell meatpacking plant sent dozens of people to the hospital. “One of the biggest things in a disaster scenario is mobilization of personnel,” she says. “A number of people came in in respiratory distress and because of our past experience, we were able to function very efficiently as a team in that scenario.” On a more personal level, evidence also suggests that those who have had simulated experience with a particular medical condition are more likely to recognize the condition and treat it appropriately when they encounter it in practice. The above are all examples of what the Society for Simulation in Healthcare calls the four primary functions of medical simulation: education, assessment, research, and health system integration (which includes disaster drills). With clinical opportunities in shorter supply and patient safety a major priority for hospitals and clinics, training in a way that is safe, accessible, customizable, and provides for detailed feedback makes more sense than ever. “Simulation offers teaching opportunities never before possible,” says Dr. Hall. “The old axiom of ‘See one, do one, teach one’ has now been replaced by ‘Do the pre-reading, simulate the procedure dozens of times until proficient, and then try on a real patient under close supervision’.” “The benefits are already being seen in academics and I anticipate that we will continue to see much more use in hospitals, as well,” says Krcil who has helped run simulations for new graduates as well as experienced pros. “It is a wonderful tool for improving patient safety and patient care.” ■
Midwest Medical Edition
New Tool May Help to Avoid
Diagnostic Surgery Black Hills Doctors Among the First to Offer the Test Physicians have long sought a better method to
distinguish malignant thyroid nodules from benign. For an estimated 15 to 30 percent of patients, the traditional biopsy approach is not conclusive. Statistics show that most of these inconclusive cases wind up in surgery, even though about twothirds of this will not turn out to be malignant. But research conducted at Regional Health Clinical Research (RHCR) in Rapid City has led to the development of the Afirma Gene Expression Classifier (GEC), a diagnostic test that helps physicians reduce the number of avoidable thyroid surgeries by preoperatively reclassifying indeterminate nodules as benign. Thirty local patients were part of this groundbreaking study sponsored by Veracyte, Inc. “Thyroid nodules are common and in order to determine which ones have cancer, a fine needle biopsy is usually performed,” says Endocrinologist Thomas Repas, DO, with Regional Health Physicians. “In the past, most of these nodules with ambiguous results would be surgically removed.” The Afirma GEC assists physicians in determining which indeterminate thyroid nodules present a benign versus suspicious profile by measuring the expression of 167 genes and greatly improves risk assessment of indeterminate thyroid nodules. If the Afirma GEC test shows features consistent with a benign nodule, the risk of cancer is 6% or less and patients can safely be followed by observation. Although this new diagnostic tool will not eliminate every patient with benign thyroid nodules from undergoing surgery, the study estimates that it has the potential to cut the number of unnecessary thyroid surgeries in half. “We are fortunate to be among the first in the country to offer this option to our patients which has been shown to reduce the need for unnecessary surgeries,” Repas said. “We thank our patients who participated in the clinical research trial that helped to make this option possible.” The results of the study were recently published in the New England Journal of Medicine. ■
MED Quotes “Every disease is a physician.” – Irish proverb
November 2012
MidwestMedicalEdition.com
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Clinical Spotlight
Single-Site Robotic Cholecystectomy and Transcatheter Heart Valve Replacement (TAVR), advanced new procedures recently approved by the FDA, are now available to patients in the Sioux Falls area. TAVR is also available at Sanford Health in Fargo.
Dr. Brad Thaemert performs a single-site robotic cholecystectomy at Avera McKennan Hospital & University Health Center.
State’s First Single-Site Robotic Cholecystectomy Performed in Sioux Falls Dr. Brad Thaemert, surgeon with
the Surgical Institute of South Dakota, recently performed the state’s first singlesite robotic gallbladder surgery. The FDA recently approved single-site robotic technology for minimally-invasive cholecystectomy. Currently, it is the only procedure approved for single-site robotic surgery, although the technology is being tested for a range of other procedures. The single-site cholecystectomy was performed at Avera McKennan using the hospital’s da Vinci Si robotic system with an added equipment platform. “Gallbladder surgery has come a long way in the past few decades, from the traditional open procedure, to multi-site laparoscopic surgery, to single-site laparoscopic surgery, to robotic single-site surgery,” says Dr. Thaemert. Thomas Fullerton, MD, general surgeon with Avera Medical Group McGreevy 7th Avenue has also completed training to offer the procedure. He and Dr. Thaemert are
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among only a few hundred surgeons who are specially trained to perform the operation in the US. “With the enhanced visualization and flexible instrumentation that is unique to the robotic platform, the transition from multi-port access to single-port access is much smoother. The robotic single-site technology offers vastly better triangulation of instruments to the operative field, which results in better visualization, tissue handling and ultimately, patient safety,” says Dr. Fullerton. “As instrumentation technology advances, the principles that we use for gallbladder operations will hopefully allow us to expand the surgical applications to other types of intra-abdominal operations and possibly other target anatomy where access space is limited.” One benefit to the patient of a single-site robotic procedure is minimal (if any) scarring. All surgical instruments are inserted through a single port in the navel.
Dr. Thaemert has been performing single-incision laparoscopic surgery since 2008, but only a limited number of thin patients qualify for that procedure, because it’s challenging for surgeons to manipulate all the needed equipment through a single site. “Robotics makes it much easier because the instruments are more flexible and there’s more room to maneuver, so there are virtually no limitations placed on patients who can undergo the single-site procedure,” Dr. Thaemert said. Like laparoscopic procedures, the robotic single-site gallbladder procedure is performed on an outpatient basis. “I am absolutely convinced that multiport robotic-assisted cholecystectomy is superior to standard laparoscopic methods in terms of patient safety and postoperative pain. If the single-site method can take that advantage one step further, that will really be something outstanding to be able to offer to our patients,” Dr. Fullerton added. Dr. Thaemert says his first patients are doing well, and he’s only heard very good feedback from surgeons who have been using the technique for a longer time. “Patients are very excited about it and very satisfied,” he said. ■
Midwest Medical Edition
Clinical Spotlight
The TAVR procedure requires a multidisciplinary team of doctors. It is available at Sanford Heart Hospitals in Sioux Falls and Fargo.
New Heart Valve Replacement Therapy Available in Sioux Falls and Fargo Sanford Health is now offer-
ing a new technology for replacing faulty heart valves. Transcatheter heart valve replacement (TAVR) has been approved by the FDA and is typically used in patients who don’t have other treatment options. The Edwards SAPIEN Transcatheter Heart Valve was approved less than a year ago by the FDA as an option for patients with severe aortic valve stenosis, an abnormal narrowing of the aortic valve in the heart. This procedure places a
November 2012
collapsible aortic heart valve into the body via a catheter in the leg. It is currently a therapy only for adult patients who are not candidates for traditional open-heart surgery. “Research shows that patients with severe aortic stenosis do not survive more than an average of two years after the onset of symptoms if they do not have surgery,” says Dennis Millirons, president of Sanford Fargo Medical Center. “For patients who are not candidates for open heart surgery, this transcatheter
MidwestMedicalEdition.com
valve replacement can be an effective treatment option.” In order to perform transcatheter valve replacement procedures with the Edwards SAPIEN Valve, the members of the Sanford Heart team in Fargo and Sioux Falls participated in a comprehensive training program. The procedure is very complex and requires a multi-disciplinary team approach to help ensure optimal patient outcomes. Regionally, it is available at Sanford Heart Hospitals in Sioux Falls and Fargo. ■
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Off Hours
Passionate Pursuits Outside the Office
Off Road with Off Hours The High Trails of Dr. Robbins
J
ack Robbins, MD, practices medicine
at Urology Specialists in Sioux Falls these days, but his roots are in the mountainous parts of the world and his penchant for wandering high country back trails on foot, bike, or jeep, came about early. He cheerfully admits to being a military brat and having lived in many places but remembers that the desire to hike the countryside and see it firsthand started in Japan when he became a boy scout. Later, he moved to Idaho where he really learned to love the mountains. Normally, medical school is an all-encompassing time demand but Dr. Robbins didn’t stay indoors as he completed his education. He and his college roommate went backpacking twice a year even with deadlines looming. Then, after the death of his father, he took six months sabbatical and went backpacking in Glacier Park and the great Northwest. After that, his roommate and he kept the tradition alive by scheduling a major hike at least once a year. “Nowadays, we usually set aside a time in April or September,” says Dr. Robbins. We get together with friends—anywhere from five to fifteen couples. I started going by myself but my wife went with me once and she loved it so much that now she won’t let me go alone. The trips allow me time to think about things that aren’t work or business-related—just to commune with nature. When I’m out there, I’m just thinking, ‘Can I make it up this next 1000 foot section or not?’ I usually just shut the cell phone off completely.” Aging climbers have more and more limitations and Dr. Robbins points out that getting acclimatized to the altitude is one of the biggest challenges. Coming from the
By Darrel Fickbohm
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I’m out there, I’m just thinking: “ When Can I make it up this next 1000 foot section or not? I usually just shut the cell phone off completely. ”
Plains can be an issue, physically, especially when a climb takes a person up something that’s 3000 feet or more; it’s important to be ready. During the year, he bikes and even does Ragbrai to keep in shape. In the future, Dr. Robbins has a list of goals that stretches across the map. The most tempting for him is to do more of the Pacific Crest Trail which runs a zigzag line on its way from Mexico to Canada through California, Oregon and Washington, passing through high and low desert, forest and alpine country. After that, would be the Continental Divide trail, which crosses five states between Canada and Mexico, running the ridge that separates the eastern states from the western. Next year, he plans to go to New Zealand and hike the famously beautiful south island.
Is there a connection between Dr. Robbin’s off-road adventures and his medical career? “A lot of this is goal setting,” says Dr. Robbins. “Usually when I go out on these things I want to make it to the end. That’s the goal. There are difficulties along the way—things happen. You might run into a flood and have to go around. You might get lost if it’s not well marked. In medicine it’s almost the same: the biggest thing is to reach the end goals with patients and there are things that can sidetrack us along the way.” ■
Dr. Robbins is licensed in SD, MN and IA and sees patients in Sioux Falls, Huron and Luverne, MN. He is Board Certified in Urology. Photo courtesy Dr. Robbins
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Avera Transplant Institute th
Performs 1,000 Transplant Dr. Kelly McCaul
Dr. Tariq Khan
The Avera Transplant Institute
recently performed the 1,000th transplant at Avera McKennan Hospital & University Health Center in Sioux Falls. The total number of transplants includes bone marrow, kidney and pancreas transplants. The area’s first kidney transplant program was established at Avera in 1993 followed by the Dakotas’ only bone marrow transplant program in 1996, which is fully accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) and is offered by three specialty transplant physicians in Sioux Falls. Pancreas transplant was added to the solid organ transplant program in 2003 and remains the only such program in South Dakota. Avera Transplant Institute is among only 21 percent of kidney transplant programs to receive a 2010 governmental award for transplant outcomes, for shorter waitlist times than national norms, and survival on the waitlist and after transplant at national norms. Avera Transplant Institute takes a multidisciplinary approach to managing organ transplant patients. Physicians specializing in transplant surgery, hematology, nephrology and hepatology comprise the medical team managing the patient’s underlying
disease, as well as the transplant course. They are in consultation with pathologists, radiologists, infectious disease specialists, pharmacologists, and others who routinely collaborate with expertise in transplant care. Plaza 3 is the new expanded home of Avera Transplant Institute’s comprehensive services for organ disease, including nephrology, liver disease, transplant and liver surgery, and endocrinology services. Bone marrow transplant is housed in the Prairie Center. “The Avera Transplant Institute provides A-to-Z care in one single center,” said Dr. Tariq Khan, transplant and hepatobiliary surgeon with Avera Medical Group Transplant & Liver Surgery. “Right here in Sioux Falls, we offer an established program and experienced team with outcomes consistent with national standards.”
“Here in Sioux Falls people can get the very same level of care, right next door, or at least nearby home,” said Dr. Kelly McCaul, hematologist with Avera Medical Group Hematology & Bone Marrow Transplant. “We offer the same technology and expertise as bone marrow transplant programs in large metropolitan areas, yet we provide this care closer to home with the compassionate, personalized care that characterizes Avera.” ■
Avera’s Transplant Timeline 1993 – Area’s first Kidney Transplant program established 1996 – Bone Marrow transplant program opens 2003 – Pancreas transplant added 2010 – Transplant Institute receives HRSA award 2012 – 1000th transplant performed
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Midwest Medical Edition
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Daisy and Marvin Seachris are the caregivers and owners of the MFH in the Black Hills.
Medical Foster
Home Project Certified at VA BHHCS
W
hen living at home becomes difficult,
most people would rather remain in a home-like setting than move to an assisted living center. In moments like this, the VA Medical Foster Home (MFH) program, available in South Dakota in Sioux Falls and now the Black Hills, can help. Because some Veterans do not have anyone they can live with when they need a higher level of care, the VA Black Hills Health Care System (BHHCS) now offers them the option of staying in a home setting, while getting the care they need, through the newlycertified MFH program. MFH is part of the VA’s Home Based Primary Care Program (HBPC). “Primary care providers refer patients who are in need of extra attention to help avoid frequent urgent care visits and/or hospitalizations,” says Julie Watts, a Nurse Practitioner with the VA Home Based Primary Care program, who provides care for veterans in the MFH. “Also, we have patients who are referred because of the difficulty they have in physically making the trip in to the clinics to be seen.”
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MFH provides an alternative to nursing home placement for a Veteran who may be chronically or terminally ill with limited social support. The program begins when a private individual or couple decides they want to become Caregivers, and take Veterans into their home. VA ensures the home and Caregivers meet high standards through inspections, background checks, references and CPR and First Aid certifications. The Veteran and family members may also visit the MFH and meet the Caregivers to ensure a good fit. There is currently one approved home in the Black Hills where two Veterans now live. “The advantages that we see are that Veterans who need a higher level of care (who do not always have family available to provide this care) are able to continue to live in a home environment where they are cared for as family,” says Watts. “Another advantage, as the number of homes grows, is that it gives us the opportunity to pair caregivers to Veterans for the best fit.” When a Veteran is placed in a home, they can continue to be assisted through the VA HBPC Program which provides a team of medical professionals who offer primary care in the home setting. The Veteran pays the Caregiver directly and VA continues to provide the medical care and oversight. Watts say the VA will work with the Veterans Benefit Administration to maximize the Veterans’ benefits to help them offset the personal cost of MFH care. The first MFH program was started in 1999 in Little Rock, Arkansas. The program has strong national support and has grown to 441 homes in 102 sites and 43 states, including Sioux Falls, which has been a part of the program since 2008. ■
Midwest Medical Edition
Clinical geneticist Eugene Hoyme, MD, with twins on a previous research trip to South Africa.
Hoyme Advances
International FASD Research Data from a recent trip to South
Africa for Sanford Health’s Gene Hoyme, MD, will be used to develop criteria for more accurate recognition of fetal alcohol spectrum disorders (FASD) in infancy and early childhood. Early recognition of these disorders is critical as it provides children with access to intervention services sooner and improves their health outcomes. Dr. Hoyme, one of the world’s leading researchers on FASD, chief academic officer for Sanford Health and president of Sanford Research, recently returned from the Western Cape Province after examining a group of infants prenatally exposed to large amounts of alcohol. Working with a group of physicians, scientists and medical staff from the University of Stellenbosch School of Medicine in Cape Town, Hoyme and his colleagues examined 250 infants and reviewed data on 400 more. Physical and developmental characteristics were compared to normal control infants of a similar age. “The rural communities of the Western Cape are home to the highest prevalence of FASD in the world; 8 to 10 percent of firstgrade children are affected,” said Hoyme. “Our goal is to eventually eliminate this common cause of a completely preventable set of disabilities.” Hoyme’s work in South Africa—part of an ongoing project funded by the National
Institute of Health (NIH) now spanning 15 years—has established criteria for the diagnosis of FASD worldwide. Further work in South Africa is contingent on a new five-year grant from NIH. That research would involve investigating genetic markers that indicate whether children were exposed to alcohol prenatally and that make certain infants more susceptible to alcohol. Funding would also provide classroom intervention strategies for children with FASD and case management techniques to decrease alcohol abuse among pregnant women. A follow up with earlier
participants in the research would also be included. “We will further investigate some 650 children in the infant cohort through age 7,” Hoyme said. “Accurate diagnosis of FASD at age 7 in this cohort will allow us to look back at our data from infancy to determine which characteristics were most predictive of FASD at school age.” In June, Hoyme received national recognition for his leadership in research by the National Organization on Fetal Alcohol Syndrome (NOFAS) and was awarded their 2012 Excellence Award. ■
Peace, love and litigation support. We protect your peace of mind. And it’s why we’re the right choice for physicians. Medical liability insurance is just the beginning. We protect what matters most, with proven results. It’s a movement, and we’d love to have you join us. Contact your independent agent or broker, or go to PeaceofMindMovement.com to see what MMIC can do for you.
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MMIC has earned the AM Best industry rating of “A” (Excellent) for 20 consecutive years.
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November 2012
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The Nurses’ Station Nursing News from Around the Region
Deborah Christopherson
Carol Linder
Brock Sanderson
Regional’s Newest Daisy
Award Recipients
Brock Sanderson, Carol Linder, and Deborah Christopherson are the latest recipients of Rapid City Regional Hospital’s DAISY Award for Extraordinary
National Study to Assess Simulation in Nursing Ed A national study has
simulation into every core
of simulation as an effective
begun aimed at assessing
clinical course. At the end of
substitute or complement
the value of simulation
each course, students will
to clinical experience, it
in undergraduate nursing
complete
standardized
could help solve the problem
education. The National
knowledge assessment tests
the many schools are having
Simulation Study will include
and surveys about how well
f in din g
nursing students in school
their experiences met their
clinical
across the country and will
learning needs.
their nursing students. In
help determine how effectively
simulation
ap p ro p riate placements
for
Eighty-seven percent
certain settings, hospitals
can
of nursing schools that
may be reticent to welcome
substitute for hands-on clini-
responded to an NSS pole
nursing students because of
cal experience. Unlike other,
last year said they use
the liability. Simulation
more limited studies of simu-
medium- or high-fidelity
would offer a risk-free set-
lation technology, the NSS
simulation in some capacity.
ting for gaining needed
will integrate high fidelity
If the NSS validates the use
experience. ■
Nelson Named a Top COO / Sanford Health Senior Vice President and Chief Operating Officer Becky Nelson is included in this year’s list of “100 Hospital and Health System COOs to Know” by Becker’s Hospital Review. Nelson has advanced health care in the community and region for more than 35 years. She has held various roles at Sanford Health including a staff nurse, nursing supervisor, nursing administrator, vice president of patient services, president of Sanford USD Medical Center and currently as senior vice president and chief operating officer for the entire Sanford Health system. The COOs and presidents and vice presidents of operations included in Becker’s Hospital Review have proven to be adept at leading organizations with various facilities, complex processes and multiple stakeholders in an ever-changing healthcare environment. COOs and presidents and vice presidents of operations were selected for inclusion on this list based on the financial, clinical and operational success of their organizations, nominations and research conducted by the Becker’s Hospital Review editorial team. ■
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Nurses. Sanderson received the award in October, Linder received it in September and Christopherson won in August. Sanderson, an RN in the cardiac interventional unit for a year and a half, was nominated by a patient who claimed his efforts made their hospital stay a pleasant experience. He was also recognized by a physician for doing “an excellent job in caring for his patient, advocating and assisting.” Linder is a Registered Nurse in oncology and has worked at the hospital for six years. A patient recognized her for her outstanding customer service. The patient commented that Linder was “very kind and treated us like we were real people. She was like seeing an old friend every night.” Christopherson is also an RN and works in the Medical Unit. She has been at RCRH for four years. A patient recognized her for her pleasant, caring attitude and respect for the patient and her family that put them at ease about surgery. DAISY is an acronym for “diseases attacking the immune system.” The DAISY Award was established by the DAISY Foundation in California in memory of a patient whose family was grateful for the excellent nursing care he received. The DAISY Award has grown into an ongoing recognition program in partnership with health care organizations, now in seven countries, that celebrates the extraordinary skill and compassion nurses bring to patients and families every day. ■
Midwest Medical Edition
Brun, Blanche Asssume New Positions at Mercy / Lisa Brun has been named Manager of Clinical Services for the Inpatient Rehabilitation Nursing Unit at Mercy Medical Center. Brun has been serving most recently as the Manager for Patient Care Services. She began her nursing career at Mercy in 2006 and has served in various roles including staff nurse and nursing services manager. Brun graduated from Western Iowa Tech with an Associates Degree in Nursing and is now pursuing her BS in Nursing at Briar Cliff University. Prior to her nursing career, Brun worked in customer service at Gateway and 1st Financial Bank USA. Sharon Blanche has been appointed Director of Special Projects. Blanche has worked at Mercy for thirty-seven years and has most recently served as Executive Director of the Mercy Heart Center. In her new role, Blanche will be responsible for working on high level strategic projects including growth, clinical quality and outcomes. She will work closely with Mercy’s Senior Leadership Team implementing and evaluating the impact of strategic initiatives. A native of Canada, Blanche earned her RN from Humber College in Toronto, her BSN from Morningside College. She holds as MS in Administrative Studies from the University of South Dakota. ■
“As physicians, we have so many unknowns coming our way...
One thing I am certain about is my malpractice protection.”
Eddy to Lead Occupational Medicine Program in Mitchell / Mindy Eddy, RN, has accepted the position
of Director of Avera Occupational Medicine at Avera Queen of Peace Hospital in Mitchell, SD. Eddy received her Nursing Degree from Dakota Wesleyan University and has worked as a Customer Service Representative and Clinic Manager for Avera Occupational Medicine for the past seven years. Prior to that, she worked five years as a nurse on Swing Bed at Avera Queen of Peace Hospital and for three years as a long-term care nurse. As director, she is responsible for the service delivery of an occupational medicine clinic, certified case management, multiple employer service, third party administration programs, and collaborative service delivery of occupational health care from numerous health care vendors state-wide. She is responsible for the treatment,
Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control. What we do control as physicians: our choice of a liability partner. I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard. I believe in fair treatment—and I get it.
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Grape Expectations
For a Perfect Holiday . . . Don’t Overthink, Just Drink By Heather Taylor Boysen
G
rowing up in Sioux Falls, I have very fond memories of my childhood, particularly around the holidays. I still remember the year I got my first Barbie Doll. I’m sure one of the reasons I remember it so clearly is because my twin sister didn’t get one. It wasn’t that Santa had forgotten to get her a Barbie; it had actually been caught in one of the branches of the Christmas tree and wasn’t found until we took the tree down after New Year’s! I can only imagine my parents’ confusion. Now that I am a parent, I realize how much work goes into making someone else’s holiday experience as close to perfect as possible. It can be a lot of pressure – particularly when children are involved! It is for this reason that I have learned to take a more reasonable approach when it comes to the adult side of the holidays. Not all meals have to be gourmet and it is OK to ask family members to bring a dish to the feast. Thank goodness everyone likes to hang around in my kitchen because I quickly realized that if you are stuck in the kitchen and don’t get to take part in the fun and laughter then what’s the point? The same thought process applies when considering wine for the holiday season. I read an article r e c e nt ly
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that stated very clearly “don’t over think, just drink!” There are a few tricks one can use to practice this philosophy when serving wine during the holidays. First, don’t pull out a bottle of wine from your cellar complete with history, vintage notes and ratings unless of course your guests have brought their own bottles from their cellars, complete with history, vintage notes and ratings and that is the kind of party you intend to have. Holiday parties at our home are more about a gathering of individuals who want to chat, mingle and just connect with friends or family. I don’t want to focus all of my attention on the wine, but rather on the people who are drinking it. I make sure there are a few cork pulls handy and everyone gets to pitch in and pour. Second, be as flexible and fun with your wine as you would want to be as the host or hostess. The most important trick I have learned over the years is to always have an assortment sure to please every palate. My go-to list always includes Sauvignon Blanc, Pinot Gris (Pinot Grigio), Chardonnay and Riesling for the white wines and Cabernet Sauvignon, Zinfandel, Pinot Noir and my favorite red blend of the moment for the red wine choices. I also always have a Rosé and a sparkling wine on hand. The Rosé is for me while I cook and one should always have a bottle of sparkling on hand! Now I may substitute the Chardonnay with a Marsanne/Rousanne blend and the red blend with a Malbec, but that is the fun and flexible part. All of the wines on my go-to list will please mixed company and will honestly pair with most holiday dishes, appetizers and whatever else you choose to serve.
“Holiday parties at our home are more about a gathering of individuals who want to chat, mingle and just connect with friends or family.” Finally, don’t overspend. As much as I love my friends and family, my priority is seeing my childrens’ faces light up on Christmas morning, it is not about spending my entire Christmas budget on wine. There are many wonderful wines in all sorts of price ranges – just choose the range appropriate for you. Talk with the people at your favorite wine shop and ask them for their suggestions. They may just help you find your new favorite. ■
Midwest Medical Edition
Learning Opportunities November / December 2012 November 2 8:00 am - 5:00 pm
30th Annual North Central Heart Fall Cardiac Symposium Location: Sioux Falls Convention Center Information: www.northcentralheart.com Registration: jhatch@ncheart.com, 605-977-5316
November 9 8:00 am – 5:00 pm
5th Annual SD eHealth IT Summit Location: Ramkota Inn, Sioux Falls Information & Registration: http://healthpoint.dsu.edu/summit2012
November 13 8:00 am – 12:00 pm OR 1:00 pm – 5:00 pm
Advanced Cardiac Life Support Renewal, ACLS Renewal Location: Sanford Health Center for Learning Information: 605-328-6300 Registration: By fax – 605-328-6312, www.sanfordhealth.org
November 16 8:00 am – 4:00 pm
12th Annual Avera Children’s Pediatric Symposium Location: Avera Education Center, Sioux Falls Information & Registration: 322-8950, www.Avera.org/conferences
November 19 – 20 9:00 am – 4:30 pm
Advanced Cardiac Life Support Location: Sanford Health Center for Learning Information: 605-328-6300 Registration: By fax – 605-328-6312, www.sanfordhealth.org
November 27– 28 8:00 am – 3:30 pm
Trauma Nursing Core Course – TNCC Certification Location: Sanford Health Center for Learning Information: 605-328-6300 Registration: By Fax – 605-328-6312, www.sanfordhealth.org
December 3 – 6 8:00 am – 5:00 pm
Sanford Perinatal Nurse Fellowship Location: Sanford USD Medical Center Information & Registration: nikki.terveer@sanfordhealth.org
MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.