Sanford Celebrates a Year of Top Level Stroke Care Local Rural Hospitals Win Top Honors
APRIL MAY
Caring for Staff and Family Members: What to Consider
VOL. 13 NO. 3
2022
JOINING FORCES, IMPROVING HEALTH The Center for Neurosciences, Orthopaedics & Spine
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Help your patients understand:
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VO LU M E 13 , N O. 3 ■ A P R I L / M AY 2022
Inside This Issue
CONTENTS PAGE 6 | Area Rural & Community Hospitals Rank Among the Country's Best PAGE 8 | This Month Online Articles you'll find only on the website, upcoming events, a preview of our ND & NE news service, and Ten Facts You May Not Know About MED
On the Cover
PAGE 12 | USD School of Health Sciences Success Spotlight: Aaron Harstein
Joining Forces, Improving Health
PAGE 14 | [SPONSORED] Sanford USD Medical Center Reaches the First Anniversary of Top Stroke Certification
The Center for Neurosciences, Othopaedics & Spine ■
By Alex Strauss
CNOS in Dakota Dunes has a long history of providers joining forces to achieve their mission of improving health in the tri-state region of Iowa, Nebraska, and South Dakota. This year, it happened again. We talked with two providers about what it means for Siouxland. PAGE
10
PAGE 16 | NEWS & NOTES New awards, certifications, providers, and publications PAGE 20 | Program Fights Gestational Diabetes in Rural Areas PAGE 20 | Spencer Gathers Supplies for Medical Teams in Ukraine PAGE 21 | Sioux Falls Surgeon Takes Part in Innovative Weight Loss Procedure Trial PAGE 22 | The Risks of Treating Family Members and Staff By Eric Zacharias, MD
FROM US TO YOU he weather might not reflect it quite yet, but spring has sprung here at MED! In addition to this shiny new issue of MED Magazine, we are celebrating a fresh new website, a new digital newsletter for Nebraska providers, and a blossoming list of subscribers. (If you are not yet among them, sign up for free at MidwestMedicalEdition.com!) Things are also looking bright for the physicians of the CNOS Clinic in Dakota Dunes, this month's featured provider. We spoke with two of their doctors for more on their new location, new physicians, new specialties, new events, and new ways this longstanding independent clinic is serving the Siouxland community. Also in this issue . . . expert advice on navigating the complexities of treating staff or family members, the region's best rural and community hospitals, a new program that is successfully fighting gestational diabetes, and an inside look at Sanford's Comprehensive Stroke Center on its first anniversary. Enjoy!
T
All the Best, —Alex & Steff
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Area Rural & Community Hospitals Rank Among the Country’s Best
S
EVERAL SMALLER HOSPITALS across our region have been recognized for outstanding results on the Chartis Rural Hospital Performance INDEX this year. Compiled by The Chartis Center for Rural Health, this annual recognition program honors outstanding performance among the nation’s rural and critical access hospitals. Areas in which top hospitals particularly distinguish themselves include quality and outcomes, patient satisfaction, costs and charges, market share, and financial stability. “Despite unprecedented adversity, rural providers continue to display resiliency and a steadfast commitment to their communities,” said Michael Topchik, National Leader, The Chartis Center for Rural Health. “Honoring the Top 100 is one of the high points of our year. We are delighted to recognize the exceptional performance and innovation of this year’s recipients, particularly in light of the extraordinary challenges facing America’s rural health safety net.”
THREE OF THIS YEAR'S TOP 20 RURAL & COMMUNITY HOSPITALS ARE IN SOUTH DAKOTA AND TWO ARE IN IOWA. Prairie Lakes Healthcare System in Watertown was recognized as both a Top 100 and a Top 20 Rural & Community Hospital. PLHS has received the Top 100 award every year since
6
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the list was introduced in 2016. This is the fifth year that PLHS has made the Top 20 Rural & Community Hospitals list. This year also marked Spencer Hospital's seventh consecutive place in the Top 100 list. Spencer Hospital is the only mid-sized Iowa hospital to have earned this distinction every year it has been awarded. Spencer Hospital and Lakes Regional Healthcare in Spirit Lake were the only Iowa hospitals to earn this year's Top 20 distinction. Brookings Health System also made it onto the Top 20 list. It is the fifth time in six years that the hospital has made this list, which puts them in the top one percent of rural hospitals. Also on this year's Top 100 Rural & Community Hospitals list from our region were Avera St. Luke's Hospital in Aberdeen, Avera Queen of Peace in Mitchell, Avera St. Mary's in Pierre, and Avera Sacred Heart in Yankton. Avera Sacred Heart also made it onto the Top 20 list. The Top 20 winners will be honored during the NRHA's Annual Rural Health Conference in May. South Dakota hospitals to make the Top 100 Critical Access Hospitals list include Madison Regional Health System, Avera Hand County Memorial in Miller, Faulkton Area Medical Center, Mobridge Regional Hospital, Philip Health Services, Community Memorial Hospital Avera in Redfield, and Sanford Vermillion Medical Center. The Top 20 Critical Access Hospitals will be named in September. ❖
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❱V isit our website for more on the Chartis Rural Hospital Performance INDEX and links to this year's full list of winners.
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APRIL / MAY
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THIS MONTH ONLINE Highlighting content and opportunities available exclusively at MidwestMedicalEdition.com
Three Specialists Join Yankton Medical Clinic Care Team Yankton Medical Clinic, P.C. is pleased to welcome the addition of three new physicians:
Dr. Elizabeth Nicholas , Family Medicine For Dr. Elizabeth Nicholas, the Yankton Medical Clinic is the perfect place to continue her medical career. Upon graduation from the University of South Dakota Sanford School of Medicine and completion of a family medicine residency at the University of New Mexico, Dr. Nicholas has returned to the place where she spent her third and fourth years of medical school.
Yankton Medical Clinic’s newest otolaryngology specialist is no stranger to the clinic or his colleagues. While a third-year medical student, Dr. Robert Nicholas completed rotations with Dr. Micah Likness and Dr. David Abbott, both ENTs at YMC.
Internal medicine specialist Dr. Alan (A.J.) Spanel is now seeing patients at Yankton Medical Clinic, P.C. – Norfolk. Dr. Spanel has joined a healthcare team at the clinic that also includes Dr. Charles Harper and Certified Nurse Practitioner Kelly Jueden.
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2. T he creators of MED launched the region's first medical news magazine in 2000 3. I n addition to this print magazine, MED includes a digital magazine, a comprehensive news website. and three digital newsletters
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5. M ED now curates and shares medical community news and information in South Dakota, North Dakota, and Nebraska 6. M ore than 12,000 subscribers receive MED's digital newsletter every month
7. M ED accepts news and editorial contributions 24/7 from a five-state region 9. B etween them, MED's five-person team owns seven dogs, five cats, and one donkey
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Save the Date:
September 23 8:00 am - 4:00 pm CNOS Orthopaedic Symposium Location: Holiday Inn Express, Dakota Dunes
9
JOINING FORCES, IMPROVING HEALTH
The Center for Neurosciences, Othopaedics & Spine
MidwestMedicalEdition.com
T
HE CENTER FOR NEUROSCIENCES,
but they also want to stay here and support their local
Orthopaedics & Spine (CNOS) has a
healthcare facilities. This group and this model allows us
long history of providers joining forces
to treat people locally with advanced specialty care so
to achieve their mission of improving
they do not have to travel anywhere."
health in the tri-state region of Iowa, Nebraska, and South Dakota.
Fourteen Siouxland-area neurologists, neurosurgeons,
and orthopaedists — specialists that in some regions may
In addition to strengthening and expanding CNOS' orthopaedic offerings, the alignment with Tri-State allows CNOS to expand into two new specialty areas: dermatology and general surgery.
even view each other as competitors — combined their
"This coming together means we can meet more of
practices in 1998 to form the original clinic in Dakota
the needs of the community, not only in orthopaedics but
Dunes, South Dakota.
also in areas we have not been able to offer before," says
In the nearly 24 years since then, the team has expanded to 38 doctors, ten specialties, four clinic locations, 22 outreach sites, and more than 300 employees. Through partnerships with the Dunes Surgical Hospital, Mercy Medical Center and Unity-
CNOS 38 BY THE NUMBERS Physicians
22
309
Outreach locations Employees
9
Specialties
4
Clinic Locations
Point Health–St. Luke's, CNOS providers have contributed to HealthGrades 5-Star ratings in joint
neurosurgeon Hendrik Klopper, MD, who has been with
replacement, total knee replacement, total hip replace-
CNOS since 2017. "This is good for patients in the area and
ment, hip fracture repair, cervical spine and treatment of
good for us as an independent organization."
stroke. Now, CNOS has formed yet another strategic alignment, this time with Tri-State Specialists, an independent multi-specialty practice in Sioux City.
NEW FACES, NEW SPECIALTIES
The group plans to add a gastroenterologist this fall.
INDEPENDENCE AND QUALITY TRACKING Both Althaus and Klopper say the fact that CNOS has remained independent for nearly 24 years, was a big selling point for them.
Tri-State and CNOS combined forces under the CNOS
"I feel like working for an independent organization
umbrella in January adding seven new physicians and
gives me the opportunity to treat patients the way I want
two new specialties. Former Tri-State orthopaedic surgeon
to treat them," says Dr. Althaus. "At CNOS, I have a lot of
Aaron Althaus, MD, a native of Sioux City, is one of them.
control to do what I want to do and to decide how I'm
"It was a very complimentary situation," says Dr.
going to approach each individual case."
Althaus of the merger. "We were able to bring some new
Like Althaus, Klopper is also a native of the Upper
things to the group. And they are a strong practice with
Midwest. Dr. Klopper grew up in Philip, South Dakota and
some advanced expertise and tools like the Mako Robotic
attended the University of South Dakota School of Medi-
System for joint replacement which allows us to offer
cine. He completed his neurosurgical residency at the
state-of-the-art care."
University of Nebraska Medical Center in Omaha and
Althaus, a native of Sioux City and a graduate of the
worked for a larger hospital system in Sioux Falls before
University of Iowa Carver College of Medicine, completed
coming to CNOS. Klopper says the advantages of inde-
his fellowship training at the Insall Scott Kelly Institute
pendence were especially apparent early in the
for Orthopaedics and Sports Medicine at the NYU Hospital
pandemic.
for Joint Diseases in New York City. He has both a broad
"One of the disadvantages in a bigger organization is
knowledge of orthopaedic injuries and conditions and
that there is some bureaucratic inertia and there is not
a deep understanding of the patients he serves.
much physician involvement in the day-to-day decisions,"
"We have a strong agricultural base and a largely blue
he says. "When COVID hit, there was a lot of change from
collar workforce that is loyal to the area," says Althaus.
a regulatory standpoint. We were able to make quick deci-
"People here want and need high quality orthopaedic care,
sions about how we were going to implement things and
Midwest Medical Edition
APRIL / MAY
11
USD School of Health Sciences
Success Spotlight Aaron Harstein Degree: PhD in Health Sciences Current Position: Associate Professor, Division of Physical Therapy, Shenandoah University Physical therapist Aaron Harstein already had a
manage this risk, sometimes within a couple of hours." At the same time, Klopper says he appreciates the organization's commitment to tracking quality measures and continually improving, something he says is less common in independent practices.
faculty position as an Associate Professor of Physical Therapy at Virginia's Shenandoah University when he found the USD School of Health Sciences interprofessional PhD program in Health Sciences. "Because I had been through both a residency and a fellowship program to hone my skill as a PT and had
"We are part of a national registry where every
achieved a level of clinical proficiency, I assumed that it
patient that has spine surgery is followed," explains
would be no problem to teach students in the classroom,"
Klopper. "We look at outcome measures–patient
he says.
reported and objective criteria–and compare these to
But after a few years of teaching, he realized that it
national benchmarks. We work to continue to stay
required a different skillset - one that he had not yet
above the national averages for these quality outcome measures. Not a lot of places outside of major medical centers are doing this."
PAVING THE WAY FOR FUTURE GROWTH CNOS has continued to expand its footprint across the region. In need of more space to accom-
mastered. "I had a lot of depth in my profession, but not a lot of breadth," he says. "I could treat mechanical back pain very well, but I didn't have the breadth to understand things like how healthcare works in a larger organization." Harstein says USD's program was not only flexible enough to meet his needs as an adult learner, but also offered the breadth of curriculum he was looking for.
modate the new physicians, the group opened its
"I was very attracted to the way USD splits credits
fourth clinic location in South Sioux City, Nebraska
between teaching, research, leadership, dissertation and
in March. In addition to the main clinic in Dakota
discipline-specific things," says Harstein, who says being
Dunes, the group also has clinics at Northside and
a part of a cohort of people in different disciplines also
Sunnybrook in Sioux City.
made for a richer experience.
The providers of CNOS now serve patients in 22 outreach locations from Spencer, Iowa in the north and Onawa in the south, west to Norfolk, Nebraska and as far east as Fort Dodge. “We are between two fairly large medical markets and it is our goal to make sure the people in this area have access to the highest quality care, too,” says Dr. Althaus. Althaus says the newest partnership between CNOS and Tri-State not only helps make this possible in the short term, but also paves the way for continued
"I can't say enough good things about the PhD in Health Sciences," he says. "I not only understand what works and what doesn't in the classroom, but I'm also a better clinician now. At the end of the day, we are educating our patients. Early in my career, I overemphasized skill and mechanics. Thanks to this program, I realize that those joints live inside of a person with beliefs, ideas, and experiences and all of that matters."
Congratulations to this USD School of Health Sciences success story!
growth and improvement. “Having this larger, strong team improves our ability to recruit new well-trained specialists to the area," he says. "We also have established doctors who have been around for 30 years who have phenomenal experience. The combination of the two is invaluable.” ❖
12
This SUCCESS SPOTLIGHT brought to you by:
USD.EDU/HEALTH
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Midwest Medical Edition
APRIL / MAY
13
[ S P O NS O R E D ]
SANFORD USD MEDICAL CENTER REACHES THE FIRST ANNIVERSARY OF TOP STROKE CERTIFICATION “Comprehensive Stroke Centers can handle any and all levels of complexity with stroke cases. You really can’t have any better or higher level of care than this,” Dr. Sandhu said. To earn the designation, the Sanford USD Medical Center had to adhere to a long list of eligibility requirements. Comprehensive Stroke Centers must have a dedicated neuro-intensive care unit with specialists able to provide care 24/7 and establish outstanding stroke research and education programs. For surgical stroke care, centers must have a cerebrovascular neurosurgery team able to manage brain vessel pathology of any difficulty with microsurgical and endovascular approaches. Hospitals must prove a commitment to performance improvements and meet strict outcome criteria to keep the designation. They also need to care for a minimum number of patients every year with various treatments, including surgical and pharmaceutical interventions. Patient outcomes and safety must be the number one priority of a Comprehensive Stroke Center. “There have to be redundancies of redundancies of redundancies and fail-safes for fail-safes for fail-safes,” Dr. Sandhu said. “There can be no such thing as a failure of the system.”
O
When applying for the certification, Sanford
ne year ago, the Sanford USD Medical
Health leaders found the hospital was already
Center was named a Comprehensive
meeting many of the stringent eligibility
Stroke Center by The Joint Commission.
standards. One area the leaders increased focus
It remains the only hospital to have
on was specialized education for all staff. The
earned this top certification in South Dakota. Divyajot Sandhu, MD, is an Interventional Neurologist at the Sanford USD Medical Center and has seen firsthand the certification’s impact on
certification requires that anyone who provides any level of care to a stroke patient needs to undergo extensive training. “The training applies to everyone from bedside
the community.
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“This certification isn’t just a plaque hung on the wall. It has real results.” nurses to interventionalists to neurosurgeons —
the most advanced certification has its benefits.
basically everyone a stroke patient comes in contact
“This certification isn’t just a plaque hung on the
with. They all need to know how to care for patients
wall. It has real results,” Dr. Sandhu said. “Numerous
with stroke needs,” Dr. Sandhu said. “That’s part of
studies and patient analyses prove consistently
why we can provide better care than any hospital that
across the board that patients in locations across
isn’t a Comprehensive Stroke Center.”
the world that meet these standards do better. As
Like all other aspects of the designation criteria,
in a several percentage point increase in the number
the education standards
of stroke patients who
were demanding.
survive their stroke or
“It wasn’t just an
the number of people
online test that you could
who were discharged
do at home with a glass of
back home instead of to
wine,” Dr. Sandhu said. “It
a nursing home.”
required a lot of education
The Sanford USD
and testing to be better
Medical Center has seen
prepared for neurovascu-
these results in the last
lar patients.”
year.
Even after a hospital
“Because of the desig-
has met the eligibility
nation and the increase
criteria and completed
in the number of folks
thorough surveys, the
we can help, we have
designation is an ongoing
seen more patients do
process that requires a
better than a year or two
systematic review every
ago. It’s not just volume.
two years. To remain a
We’ve had more people
Comprehensive Stroke
do better,” Dr. Sandhu
Center, hospitals must
said.
prove they have main-
In addition to meeting
tained or improved their
the higher certification
standards and care for
standards, the specialists
stroke patients. “The certification does require quite a bit more work than we had to do before we were a Comprehensive Stroke Center,” said Dr. Sandhu. “But all of that work is worth it.” The Joint Commission offers a range of stroke care designations, including several with less rigorous requirements than the Comprehensive Stroke Center certification. These lower designations are awarded
at the Sanford USD Medical Center are holding themselves to higher standards. “We’ve been keeping a much closer eye on ourselves and are harsher critics of ourselves than before,” Dr. Sandhu said. “And now we’re doing better than we ever were before.” Sanford Health is proud to be the only location in the region to offer stroke care at this caliber.
to hospitals with dedicated stroke programs. However,
“The closest Comprehensive Stroke Center would
they cannot care for certain complex cases, and while
be Sanford Fargo. And then Minneapolis to the east
they have certain specialists on staff, they aren't
and Omaha to the south. For the west, I think you’d
available on-call 24/7.
have to hit Denver,” said Dr. Sandhu. “As far as stroke
For Comprehensive Stroke Centers or international locations that meet similar standards of care, pursuing
Midwest Medical Edition
APRIL / MAY
care is concerned, you can’t go anywhere better than here. There’s no need for a patient to travel.” ❖
15
Happenings around the region
News & Notes
South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska
SANFORD JARED ANTCZAK
MONUMENT Monument Health was selected as the 2021 Collaboration Champion in the Workday Healthcare Innovation Awards. Workday software is used throughout Monument Health for financial management, human capital management (HCM), payroll and supply chain operations. It also helps with inventory and procurement. The goal behind Monument Health's award-winning project was to collaborate with Workday and other Workday users who were planning to implement procurement and inventory. The teams organized monthly discussions to brainstorm solutions to supply chain problems. Since going live, the project has evolved to include optimization, customer networking and discussions in HCM, Finance and Payroll.
AMBER STEINER Amber Steiner, RN, with Rapid City Hospital Oncology, has received the prestigious DAISY Award for extraordinary nursing. She was nominated by a traveling nurse who said Steiner went above and beyond to help her feel welcome and set an excellent example for all of her fellow caregivers to follow.
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Jared Antczak is the new chief digital officer at Sanford Health. Antczak comes to Sanford Health from Highmark Health in Pittsburgh where he served as vice president and head of digital product, leading the digital vision for their enterprise. In his new role, Antczak will lead Sanford Health’s overall digital strategy. His hiring comes at an opportune time, following the launch of Sanford Health’s virtual care initiative. The initiative includes construction of a 60,000 square-foot building scheduled to begin later this year which will expand access for patients and residents by utilizing advanced technologies to provide care closer to home. Antczak holds an MBA from Wake Forest University. Sanford Health is updating its recommendation for when to get a colorectal cancer screening. Those at average risk should start regular screenings at age 45, which is lowered from age 50. According to the CDC, while colorectal cancer rates have decreased for people over 50 years old, they have climbed 51% since 1994 for those under 50. Lowering the recommended age for a screening will help detect an issue early before symptoms begin and when the cancer is most preventable.
Dr. Paola Vermeer, PhD, an associate scientist at Sanford Research, along with neuroscientist colleague Jeff Barr, and other scientists in her lab recently published a study illuminating how intra-tumoral neurons impact cancer. The study was conducted in partnership with the University of Pennsylvania. The study titled "IntraTumoral Nerve-Tracing in a Novel Syngeneic Model of High-Grade Serous Ovarian Carcinoma" appears in the December issue of the journal Cells.
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EARN 2 FREE CMEs Complete the South Dakota CHW Planning and Assessment Toolkit www.chwsd.org/chw-toolkits/
WOR K I N G H AN D I N H A N D : T H E VALU E OF COMMU NITY H E ALTH WORKERS (C HW HWs)
I wish to have a game room Pate, 7
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Refeto receiveg awish. ngin
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Photo credit: Anna Mira Photography
Midwest Medical Edition
APRIL / MAY
Scan to refer a child.
REFER TODAY AT WISH.ORG/MEDICAL-REFERRAL
17
• Happenings around the region
News & Notes
Happenings around the region
Expanding Here Today
COMMITTED TO CARE ALWAYS
CNOS has added a new location to the Riverfront area at 201 E 4th Street, Suite 202, in South Sioux City. Our team looks forward to continuing expanded, comprehensive and patient-centered care.
NEUROLOGY • NEUROSURGERY • ORTHOPAEDICS PODIATRY • RHEUMATOLOGY • SPINE DERMATOLOGY • GENERAL SURGERY
Sanford Health has launched a new brand campaign, “Here for all. Here for good.” which emphasizes the health system’s commitment to providing world-class care for families and communities across the upper Midwest. Central to this campaign is a focus on improving access to care in rural communities – where two-thirds of Sanford Health patients live. The multi-faceted brand campaign includes TV commercials, billboards, social media content and high-impact visuals in hospitals, clinics and landmarks across Sanford Health communities – including grain bins on rural farms across the region. Sanford Health will soon be partnering with Flexwise, a healthcare technology provider based in Nashville, to implement data analytics and artificial intelligence designed to optimize the scheduling of its more than 10,000 nurses. The partnership aligns with Sanford’s goal of improving clinical staffing by scheduling workforce activities through a system-wide application of patient demand forecasting. By working with a hospital’s existing electronic medical record, staff scheduling and time & attendance applications, the Flexwise platform brings all data together in one place to optimize clinical workforce staffing decisions.
AVERA Avera Health marked the second anniversary of the COVID-19 pandemic by sharing some notable statistics. The health system has • Performed over 690,000 COVID-19 tests with over 88,000 positives • Delivered over 247,000 vaccinations • Given 15,700 various treatments for COVID • Hospitalized over 8,300 people • Cared for over 8,400 people in its specialized at-home monitoring program • Facilitated over 220,000 virtual visits between patients and their providers
REFER TO 605-217-2667, OPTION 7.
CNOS.NET
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❱ Intrigued by something you’ve read here? Want to go deeper? Read the full versions of these and other recent news items on our website.
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INDEPENDENTS Yankton Medical Clinic, PC, has expanded its 25-year-old scholarship program this year thanks to a $5,000 donation from Yankton residents Neal and Marie Bowden. The donation will provide an additional five $1,000 scholarships to students enrolled in a nursing program who meet the conditions of the YMC scholarship program for the 2022-23 academic year. In addition to the five nursing scholarships, YMC awards five $1,000 scholarships to area high school students, one $1,000 to a nursing, radiology, medical lab or respiratory therapy student, and a $5,000 scholarship to a medical student at USD.
Midwest Medical Edition
APRIL / MAY
SIOUXLAND CINDY DUNCAN
AMADIN OSAYOMORE Amadin Osayomore, MD, has joined the ER staff at Prairie Lakes Healthcare System. Dr. Osayomore is a board certified family physician. He has served patients in Emergency Medicine for almost 10 years. Dr. Osayomore completed his internal medicine residency at the University of Benin Teaching Hospital in Edo State Nigeria. He joins Dr. Erickson, Dr. Filler, and Dr. Singh in providing for patients with emergent medical needs.
St. Luke’s College Respiratory Care Program Director, Cindy Duncan has been appointed to serve on the Board of Respiratory Care and Polysomnography for the state of Iowa. Duncan applied to serve on the board and was chosen by Governor Reynolds to represent respiratory care professionals in western Iowa. Duncan has been a strong advocate for the Respiratory Care profession and has represented her peers in multiple capacities for the Iowa Society for Respiratory Care. Her three-year appointment will begin in May of 2022. MercyOne says it is strengthening its commitment to helping individuals live their best lives with the launch of a subscription-based wellness platform called Circle+ powered by MercyOne. Members who sign up and complete the initial assessment unlock access to a suite of app-based resources from Circle+ powered by MercyOne partners. The apps include workout videos, recipes, fitness tracking and other resources. Membership is open to anyone, regardless of whether or not they are MercyOne patients.
19
• Happenings around the region
News & Notes
Fighting Gestational Diabetes in Rural Areas
A
VERA WOMEN’S HEALTH profes-
takes funding and reimbursement can take a
sionals knew the problem they faced
long time. “The Health Resources & Services
— gestational diabetes — was tough to
Administration grant got this program started,”
treat in rural settings. But a federal
McKay added. The program now serves patients
grant and a dedicated, patient-centered approach
in Minnesota and soon will reach patients in
has helped “the little program that could” succeed
Iowa and Nebraska, as well.
for moms and babies. “We met with moms-to-be in bathrooms, break rooms and teachers’ lounges,” said Kimberlee
THE THREAT WORTH FACING AND STOPPING Gestational diabetes is often symptomless
McKay, MD, with Avera Medical Group Obstetrics
and if unnoticed, can lead to high blood pressure,
and Gynecology. “We made it convenient for every
preeclampsia and other serious complications. It
patient, and we were able to coach, chart and coax
also doubles the chance the newborn will contract
them, even if they were hours away from us.”
type 2 diabetes later in life.
Teams including registered dietitians and
“We developed a specialized blood sugar
certified diabetes educators used Avera’s virtual
monitor to track numbers,” McKay said. “We also
visit platform to meet with moms in South Dakota.
had to do a lot of talking and teaching. That can
The program began in 2016, and now can show its results, which include: ◆ A decrease in vaginal delivery complications of almost 27% ◆ A decrease in cesarean delivery complications of 17.6% ◆ A reduction in the number of infants born at weights of 4000 grams or more “Our hypothesis was whether or not this sort of coaching and counsel would work – and it does,” says McKay. “The tools can help every patient.” But making them available to every patient
be daunting via telehealth.” Since it began, the program has served more than 450 patients.
CREATIVE COACH FOR PATIENTS IN “FOOD DESERTS” The Avera teams knew the limits of the locations where their patients lived. Advising them to “eat more fresh food” wasn’t always easy. McKay says coaches were able to make it simpler by advising on things like healthier choices at convenience stores or fast food restaurants. “When we can provide an ‘easy’ button, we can help ensure better outcomes,” says McKay. ❖
SPENCER GATHERS SUPPLIES FOR MEDICAL TEAMS IN UKRAINE IN MARCH, SPENCER HOSPITAL’S SUPPLY chain team and plant operations team gathered medical supplies — many items to be used in trauma care as well as orthopedic surgical items — and filled a van which transported the items to Montgomery County Memorial Hospital in Red Oak. Those items, along with donations from several other Iowa hospitals, will be prepared to be shipped the more than 5,000 miles to Ukraine, to support medical teams there. ❖ Pictured, left to right: Joel Wassom, Plant Operations director; Karen Brandt and Brad Smith, Supply Chain leaders.
20
MidwestMedicalEdition.com
SIOUX FALLS SURGEON TAKES PART IN INNOVATIVE WEIGHT LOSS PROCEDURE TRIAL
A
S A BOARD-CERTIFIED general
but the ESG is specifically for a category of
surgeon with Surgical Institute of
patients who fall into a sort of gray area — a
South
Dr.
group of people who often struggle because
Bradley Thaemert has performed
they might be overweight or have diabetes
more than 1,000 bariatric weight
but don’t qualify for weight-loss surgery,”
Dakota
since
1998,
loss procedures, including gastric bypass,
said Dr. Thaemert.
gastric band and gastric balloon proce-
The MERIT study followed 280 patients
dure, as well as the innovative procedure
who had the ESG procedure done. One year
of Endoscopic Sleeve Gastroplasty (ESG).
into the two-year study, participants had 45%
As one of only a handful of surgeons in
more excess weight loss as compared to just
the country who do the ESG procedure, Dr.
making lifestyle diet and exercise changes.
Thaemert recently took part in a
After two years, 91% of patients had
multicenter trial sponsored by the
maintained their weight loss.
Mayo Clinic. The Multi-center ESG
“We are seeing good results
Randomized Intervention Trial, or
and received expected outcomes,”
MERIT, included the participation
Dr. Thaemert said. “We weren’t
of nine medical groups throughout
expecting
the United States.
patients to lose as much weight
the
MERIT
study
“The trial was based on the ESG
with this procedure as patients
procedure, a non-surgical outpa-
with gastric bypass would, and
tient weight loss procedure, done through the mouth, where the stomach
that is exactly what happened. The results fulfilled our expectations.”
volume is reduced by 80%,” Dr. Thaemert
A fellow of the American College of
explained. “There are only a handful of us
Surgeons, Dr. Thaemert graduated from the
that do the procedure and it is not covered
University of Minnesota School of Medicine
by most insurance companies.”
and completed his general surgery residency
Modifying that was one of the study’s
at Gunderson Medical Foundation-Lutheran
primary goals. “We hope the results of this
Hospital in LaCrosse, Wisconsin. His
research helps communicate to insurance
bachelor’s degree is from the University of
companies that the procedure is safe and
Minnesota-Duluth.
effective and should be covered,” Dr. Thaemert said.
Professionally, Dr. Thaemert is an active
Because ESG is a minimally invasive
Association (SDSMA), the American College of Surgeons (ACS), the American Society for
and on an outpatient basis, it is an excellent
Metabolic and Bariatric Surgery (ASMBS),
option for people who are obese but not inter-
the Society of Laparoendoscopic Surgeons
ested in a permanent procedure. Those who
(SLS), the Society of American Gastrointes-
want to lose about 50 pounds; who have a
tinal and Endoscopic Surgeons (SAGES) and
fear of surgery; or who don’t want scars from
the Seventh District Medical Society. He
incisions are good candidates for the proce-
served as the South Dakota chair of the
dure. Patients who opt for the ESG procedure
Committee on Trauma for the American
typically have a body mass index of 30-40.
College of Surgeons and is the medical
not as significant as with gastric bypass,
Midwest Medical Edition
APRIL / MAY
”
member of the South Dakota State Medical
weight loss procedure done endoscopically
“Weight loss with the ESG procedure is
“
WE HOPE THE RESULTS OF THIS RESEARCH HELPS COMMUNICATE TO INSURANCE COMPANIES THAT THE PROCEDURE IS SAFE AND EFFECTIVE AND SHOULD BE COVERED.
director for the Avera McKennan Bariatric Institute. ❖
21
The Risks of Treating Family Members and Staff BY ERIC ZACHARIAS, MD
CASE STUDY 1 An ENT physician schedules his wife for a nasal reconstruction procedure that he will perform. Upon learning this, the surgery facility manager calls the physician to discuss concerns about the appropriateness of him performing this procedure. The physician says he is “the best at this surgery in town” and wants to ensure his wife receives top-notch care.
Analysis
URI might lead to a lymph node biopsy
In the first case, the physician is
normally, you might have waited three
unaware that his actions represent a
months. Personal feelings may com-
concern outlined by the American
promise the objectivity of the clinician
Medical Association’s (AMA) Code of
and make the delivery of sound care
Medical Ethics1 which states “When
a challenge.
the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment.” In the second case, the patient survives but has an expensive and extensive hospital stay. The physician struggles seeing the medical assistant every day and feels guilty. Six months later, the physician feels the medical assistant's performance is poor, but is hesitant to fire her as there may be a risk of litigation.
CASE STUDY 2 A rural family practice physician often treats her staff and their family members for free. She sees her medical assistant’s 12-year-old son for an upper respiratory tract infection. The physician opts for conservative treatment and makes no record of the visit. Three days later, the patient presents to the ER with shaking chills and pneumonia. A prolonged hospitalization follows.
Concerns and Risks Confidentiality — We recognize that in smaller communities, you might truly be the best provider for
see family members or staff, you should complete the same documentation as you would for any patient. When possible, you should treat the person in the office. If there is an emergency situation, then you should communicate any actions taken with the person’s provider. The natural tendency to “curbside” treat and either not or insufficiently document can result in serious diagnostic oversights, medication and prescription errors borne out of informal and quick assessments, and a minimization of serious illness that could possibly lead to preventable harm.
Embarrassing illnesses — Employ-
records might be easy for a coworker
ees/family members might present
to peruse whether electronically or in
with STDs, injuries from abuse, or
a paper form. HIPAA violations might
other ailments that they don't want
occur. If you are treating employees,
others to know about. Would you have
then there should be a strong confiden-
concerns in dealing with this? Will you
tiality policy in place. Your policy
be able to perform the complete phys-
should be consistent and well commu-
ical exam necessary with someone you
nicated to the whole staff.
see every day? More importantly, will
Diagnostic reasoning — We practice best in situations when we have of a sage clinician. Professional relationships with your patients are usually fiduciary in nature. When you
22
Documentation — If you decide to
your staff. But be aware that office
the calm diagnostic decision making
❱F or more background on the stance of the AMA and the American College of Physicians, read the extended version of this article online
because of an affection bias, whereas
you ask the necessary questions to properly diagnose and treat the person? Eric Zacharias, MD, is with the COPIC Department of Patient Safety and Risk Management.
care deeply about someone, this might tilt your clinical acumen one way or the other. A small lymph node after a
1. w ww.ama-assn.org/delivering-care/ethics/ treating-self-or-family 2. N Engl J Med. 1991 Oct 31;325(18):1290-4.
MidwestMedicalEdition.com
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THE ONLY JOINT COMMISSION APPROVED ADVANCED COMPREHENSIVE STROKE CENTER IN SOUTH DAKOTA
For more information, contact the Sanford Neuroendovascular team. For emergent or urgent needs 24/7, call Sanford One Call: (605) 333-4455.
With the highest level of stroke certification, Sanford Health’s advanced stroke care team is certified to treat even the most complex stroke cases. A rapid response from our skilled specialists can make all the difference. The faster you can spot a stroke – the sooner we can stop it. Call 911 at the first sign of stroke to visit the nearest Sanford Health emergency room.
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982-374-302 Rev. 3//22