April May MED Magazine 2023

Eric Fjeldheim, DPT, Pain Specialist

Dot McAreavey, PT, Director of Rehabilitation Services

1.855.850.KIDS (5437) is your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport.

One number is all you need to connect with the very best care for critically ill children.

LIFE IS B ett er WITH A TEAM YOU CAN TRUST

We’re ready to provide your patients with expert orthopedic care you both can count on. Sanford Orthopedics & Sports Medicine has been recognized by the Joint Commission for providing the highest quality of patient-centered, advanced care that goes unmatched in the region.

MEET OUR TEAM

Orthopedics

Podiatrists

Thomas Flesher, MD Orthopedic care

Donella Herman, MD Family practice, sports medicine

Verle Valentine, MD Family practice, sports medicine

Brian Aamlid, MD Orthopedic care

Josefine Combs, PsyD Concussions

Neuropsychologist

Matthew Anderson, MD Hand and wrist

Jared Daniel, MD Pediatrics

Hillary Becker, MD Hand and wrist

Clint Benge, MD Sports medicine

Chad Kurtenbach, MD Sports medicine

Kristofer Kimber, MD Sports medicine

Joshua Johnson, MD Joint replacement / MSK oncology

Harvey Oliver, MD Sports medicine

Hao Li, MD Hand and wrist

Nathan Skelley, MD Sports medicine

Robert Van Demark Jr., MD Hand and wrist

Robert Van Demark III, MD Trauma

Orthopedic surgeons

Darrel Richards, DPM

Adam Nichols, DPM

Mark Graeber, DPM

New surgeons

Elizabeth Helsper, MD Hand and wrist

Alan Yan, MD Foot and ankle

Mark Heidenreich, MD Joint replacement / MSK oncology

Aaron Pemberton, MD Trauma

Patrick Horrigan, MD Trauma

The Pain Science Center at Prairie Lakes Specialty Clinic

A New Approach to an Old Problem

■

By Alex Strauss

Pain science experts in Watertown are taking a new, more holistic approach to managing chronic pain. Pain specialist and DPT Eric Fjeldheim predicts it is the future of pain management.

PAGE 6 | This Month Online Smile, You’re in Sioux Falls, Ten Little-Known Facts About MED, headlines from other states MED serves, and upcoming spring events

PAGE 8 | [SPONSORED]

Physician Bank, An Exceptional Partner for All Financial Needs

■ By Kim Lee

Find out how this local bank helped a Minnesota physician couple springboard their new clinic.

PAGE 13 | Tackling Rural Health Disparities: The AHA's Rural Health Care Outcomes Accelerator

PAGE 14 | [SPONSORED]

Orthopedic Surgeon Q&A: No, the Robot Doesn’t Take Over During Surgery Are your patients confused about the ins and outs of robotic surgery? In this feature, a Sioux Falls orthopedic surgeon weighs in on exactly how to talk about it.

PAGE 16 | NEWS & NOTES

Area hospitals make it onto Top Hospitals lists, new physicians, expansion projects, & exceptional employees

PAGE 21 | USD School of Health Sciences Success Spotlight: Tammy Phipps, OT

PAGE 22 | Informed Refusal: An Underutilized Patient Safety and Risk Management Tool

■ By Eric Zacharias, MD

FROM US TO YOU

Pain is a ubiquitous part of the human experience, but it can also be a frustrating part of the healthcare experience — for both patients and providers. The new Pain Science Center at Prairie Lakes Healthcare System is taking an innovative approach to managing pain that goes far beyond therapy and medication. We spoke with the head of the new program, one of only a handful of fellowship-trained pain science specialists, for this month’s cover feature.

At MED, our sole mission is to bring you the most timely and relevant local news and information in print, online, and in our bi-monthly digital newsletters. If you are not already a MED VIP (a digital newsletter subscriber), please consider claiming your free subscription. It is the simplest way to stay “in-the-know” between issues of this publication. Being a subscriber also gives you digital access to this publication and makes it even easier to send us news and information you’d like to share with your colleagues. It’s a win-win! Join for free at MidwestMedicalEdition.com

All the Best, —Alex and Steff

CONTACT INFORMATION

STEFFANIE LISTON-HOLTROP

2023

ADVERTISING DEADLINES

Publisher / MED MAGAZINE, LLC

Sioux Falls, South Dakota

Vice President Sales & Marketing

STEFFANIE LISTON-HOLTROP

Editor in Chief / ALEX STRAUSS

Staff Writer / KIM LEE

Graphic Design / CORBO DESIGN

Web Design / SAMPSON HOUSE

Digital Media Director / ALYSSA MCGINNIS

VP Sales & Marketing 605-366-1479

Steff@MidwestMedicalEdition.com

ALEX STRAUSS

Editor in Chief 605-759-3295

Alex@ MidwestMedicalEdition.com

WEBSITE MidwestMedicalEdition.com

MAILING ADDRESS

PO Box 90646, Sioux Falls, SD 57109

THIS MONTH ONLINE

Upcoming EVENTS

April 14

Edith Sanford Breast Center Symposium

Location: Fargo

April 18

Sanford ‘Speaking of Health’ Presentation

Author of The Death Gap Location: Sioux Falls

April 19 -21

CNOS Critical Access Hospital Conference

Location: Omaha

April 20 - 22

SD Counseling Association Conference

Location: Sioux Falls

April 25 - 28

Medicare Provider Enrollment Compliance Conference

Location: Phoenix

May 23 - 24

‘Telehealth Everywhere’ Conference

Location: Minneapolis

May 25

USD School of Health Sciences/Association of Schools Advancing Health Professions (ASAHP) Summit Location: Sioux Falls

Click

SMILE You’re in Sioux Falls

Sioux Falls has been named the nation’s 8th ‘Happiest City’ by WalletHub. In light of the fact that 83 percent of Americans report feeling stressed out by the economy, the personal finance website released its new report in March to coincide with the ‘International Day of Happiness’. WalletHub compared more than 180 of the largest U.S. cities across 30 key indicators of happiness. The data set ranges from depression rate to income-growth rate to average leisure time spent per day.

HAPPINESS IN SIOUX FALLS

(1=Happiest, 91=Average)

23rd • Depression Rate

9th • Adequate-Sleep Rate

46th • Sports-Participation Rate

1st • Unemployment Rate

42nd • Separation & Divorce Rate

TEN FACTS

You May Not Know About MED

1. MED has been serving healthcare professionals in the Upper Midwest for 12+ years

2. The creators of MED launched the region’s first medical news magazine in 2000

3. In addition to this print publication, MED includes a digital edition, a comprehensive news website, and three regional newsletters

4. MED is created and produced entirely in the Dakotas

5. MED now curates and shares medical community news and information in South Dakota, North Dakota, and Nebraska

6. More than 12,000 subscribers receive MED’s digital newsletters every month

7. MED accepts news and editorial contributions

24/7 from a five-state region

8. MED is on Twitter, Facebook and LinkedIn (Come find us!)

9. MED, LLC is a women-owned and operated business

10. A subscription to the bi-monthly MED newsletter in your region is FREE

• Essentia Health Advances Heart Disease Research Through ‘All Of Us’ Program

• Sanford Fargo Completes First Allogeneic Bone Marrow Transplants

• New Sanford Cancer Center Opens In Downtown Bismarck

• $25 Million In Grants Offered To Support Rural Emergency Services Across Nebraska

• Nebraska Hospital CEO Receives National Recognition

• Dr. Higgins’ Lifetime Achievement Award Goes On Display At CHI Health St. Francis

Would you like to receive news like this in your Inbox twice a month? Join the VIP List at MidwestMedicalEdition.com and select the region(s) you’re interested in.

PHYSICIAN BANK, AN EXCEPTIONAL PARTNER FOR ALL FINANCIAL NEEDS

BY KIM LEE

STARTING UP A NEW HEALTHCARE CLINIC from scratch, Dr. Megan and Richard Dillman knew they would face some challenges, with a new construction project, new patients, new staff and new processes. One thing they didn’t have to worry about, though, was trusting their financial partner.

Dr. Megan Dillman is a double-boarded physician in internal medicine and pediatrics, while Richard is a phlebotomist and assists with running the on-site moderate complexity lab. The clinic, called MD 2 , is located in Lakeville, Minnesota.

The couple learned of Physician Bank when their home mortgage was transferred there, and soon discovered what other services the bank offers.

“As we planned the opening of our clinic, we encountered hidden expenses we weren’t prepared for and we discovered our needs were greater than we estimated,” Richard explains. “Physician Bank helped us put together the puzzle of our financial needs. We were connected with Scott Ogdahl, portfolio manager, and he helped us with a small business line of credit, increasing our marketing budget and allowing us to get our name and services out to a

Juanita Schmunk

is vice president of private banking for Physician Bank, which is a division of Heritage Bank, NA, an award-winning national bank based in the Midwest. She says that they are partners with the physicians they work with, in both personal and business affairs.

“We assist them at every level and stage of their life and career, from their physician mortgage, partnership buy in, clinic build out, personal and business accounts and more,” she explains. “Knowing we understand and support their goals matters to them. We also believe in having exceptional service, not making our doctors jump through hoops just to talk to someone. We provide direct one-on-one service when they need it, not just during ‘banker’s hours.’ That is putting our customers first.”

Having been open for nearly a year, Richard says Physician Bank has been fantastic to work with in every way. “They keep our finances in order to make sure we stay up and running,” he says. “Thanks to Physician Bank, we were able to continue operating as normal without eliminating essential vendors due to financial constraints.

“I have dealt with many other vendors in the past and it’s always been a tug of war in some way,” he continues. “Physician Bank has been a breath of fresh air to work with. We will always recommend them to other physicians who need help.”

The bank prides itself on personal relationships with its clients. “I enjoy getting to know all the doctors I work with is such a joy and privilege,” said Schmunk. “I enjoy being able to help them when they need it; most importantly, to hear how they are doing, the name of a new baby or updates to their home. I genuinely enjoy talking with them and look forward to our interactions.”

“I will always recommend Physician Bank to other physicians,” says Dillman. “They are quick, fast, comprehensive, friendly and they listen to issues. I wish I would have known about them sooner.” ❖

Physician Bank is Member FDIC and Equal Housing Lender. All loans are subject to credit approval.

THE PAIN SCIENCE CENTER AT PRAIRIE LAKES SPECIALITY CLINIC A New Approach to an Old Problem

therapist Eric Fjeldheim, DPT, one of fewer than 40 fellows in the US to complete the Fellowship in Pain Sciences through Evidence in Motion. Although the Pain Science Center is part of the PLHS rehabilitation department, Fjeldheim says its approach to pain is unlike other therapies.

“People will say ‘I’ve already tried PT and it didn’t work,’” says Fjeldheim. “ Or they’ll say ‘I’ve seen PTs and massage therapists and doctors and chiropractors and none of it helped.’ And it’s frustrating for everyone involved, including medical professionals. But what they have to understand is that this is a much more holistic, multidisciplinary way of looking at pain.”

“It’s very much an individualized care plan,” agrees Dot McAreavey, Director of Rehabilitation Services and Wound Care. “We start with a very thorough evaluation. The pain science comes in when everything checks out and the pain doesn’t make sense from a physiological standpoint. Once we have a better idea what is going on, a big part of our role is guiding patients to the right resources to handle their unique issue.”

BY ALEX STRAUSS

Pain is one of the most common issues driving people to seek medical care.

The CDC estimates that as many as one in four adults suffer from chronic pain. And yet, researchers are still teasing out the complex web of factors that underlie it. Understanding the root causes of pain and developing individualized plans to reduce or eliminate it is the goal of the new Pain Science Center at Prairie Lakes Specialty Clinic in Watertown.

Located within Rehabilitation Services, the new center is the brainchild of pain specialist and physical

The Making of a Pain Scientist

Fjeldheim studied exercise science at the University of Sioux Falls and earned his Doctorate in Physical Therapy from the University of Saint Mary in Leavenworth, Kansas. A native of Watertown, he came back home to practice in 2016.

“As I got into my clinical practice, I found that there was a group of patients whose pain didn’t always make sense from a musculoskeletal standpoint,” says Fjeldheim. “If you have someone who sprains an ankle, the pain is usually isolated to the ankle. But I was seeing people where all their scans would look good and they would still have pain in their ankle or they developed pain in the entire leg.”

And Fjeldheim was not alone. He heard other

Eric Fjeldheim, DPT, is one of fewer than 40 fellows in the US to complete the Fellowship in Pain Sciences through Evidence in Motion.

healthcare providers also express frustration about patients they couldn’t seem to help.

“It’s that 5 to 10 percent of patients with seemingly unexplained pain that kept me up at night,” says Fjeldheim. “There was a gap between what they teach in school and how to really be an awesome therapist. I needed to figure out how to help these people. I needed to think outside the box.”

Fjeldheim completed his Therapeutic Pain Specialist certification in 2018 and went on to complete his 350 hour fellowship program during the pandemic. Although Fjeldheim is the only therapist at PLHS with fellowship training in pain science, McAreavey says all approximately 18 members of the rehabilitation department, including the receptionist, now have some pain training.

“We are all able to speak the same language,” says McAreavey. “That strengthens what Eric is trying to do here because he now has a whole team of people supporting him.”

Three Types of Pain

“Before we really learned more about pain, we believed that we should always be able to find a reason for pain on a scan,” says Fjeldheim.

And they usually can. Tissue-based or nociceptive pain, like that caused by a broken bone, accounts for the majority of pain. When the injury is repaired and the body heals, the pain clears up. Peripheral neuropathic pain, such as with carpal tunnel or sciatica,

involves the peripheral nervous system. Fjeldheim says traditional approaches can work with both of these types.

But the pain that stumps so many medical providers and drives people to places like the Pain Science Center is nociplastic pain. The NIH defines nociplastic plain as “pain that arises from altered nociception” despite no clear evidence of injury or disease.

“Essentially, the central nervous system becomes exquisitely sensitive to information coming from our bodies and from the environment for some reason,” says Fjeldheim. These are the patients whose pain inexplicably worsens when the weather is damp or they’re under stress.

Fjeldheim says nociplastic pain requires an entirely different approach from other types of pain. Patients may be asked about their sleep, their stress, their diet and other lifestyle factors as well as their thoughts, attitudes, and beliefs about their body. They may even undergo sensory processing testing.

“What is tricky is that everyone’s pain is different. You are rarely going to treat two people the same,” says Fjeldheim. “In medicine, we like things to be black and white. But there is a lot of gray in the complex pain world.”

Treating Pain, Saving Lives

“Before Eric came to town, we didn’t have much to offer chronic pain patients other than physical therapy or turning to injection,” says Aaron Shives, MD, a

The Prairie Lakes aquatic therapy pool is designed to reduce pain, improve range of motion, and enhance outcomes. It may be a treatment option for Pain Science Center patients both young and old.

“ We

are all able to speak the same [pain] language.,” says McAreavey. “That strengthens what Eric is trying to do here . . . ”

Now Seeing More Imaging, CT and MRI Patient Referrals

Medical imaging diagnostics can make all the difference in determining the next path for your patient. CNOS is here to help – with new state-of-the-art technology and additional space.

have tried and failed at just about everything else,” says Dr. Shives. But he cautions other referring providers not to be deterred by skeptical patients.

“I explain that this is a special type of physical therapy that is different from other things they’ve tried,” says Dr. Shives. “You are treating the brain as well as the body. A good number of patients see improvement. If you can get a patient’s pain down from a 7 or 8 to a 2 or 3 and help them reduce or get off of medication, that is a big win.”

Fjeldheim says treatment at the Pain Science Center relies on three pillars. The first focuses on educating patients about pain neuroscience, including the role that things like post-traumatic stress and adverse childhood events may play. The second pillar involves finding ways to give patients a more restful sleep. And the third pillar is about getting more movement.

Fjeldheim hopes to eventually assemble a multidisciplinary team to tackle pain from all angles. “As a PT, I’m not doing cardiac catheterizations and saving lives that way,” he says. “But we can save a lot of lives by helping people get off or reduce their pain medications and reclaim pieces of their lives. We can have a massive impact on the wellbeing of society.” ❖

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

A variety of specialists, technologies, therapies, and procedures are available for each unique pain treatment plan.

Tackling Rural Health Disparities

The AHA’s Rural Health Care Outcomes Accelerator

PEOPLE IN RURAL COMMUNITIES LIVE AN AVERAGE OF THREE YEARS FEWER and have a 40% higher likelihood of developing heart disease (14.2%) compared with their counterparts in small metropolitan (11.2%) and urban (9.9%) areas, a gap that has grown over the past decade. Rural communities face the added challenge of a critical shortage of health care professionals, including public health workers, leaving many people vulnerable to increased morbidity and mortality that could be prevented with appropriate identification and treatment.

A three-year initiative by the American Heart Association®, the world’s leading nonprofit organization focused on heart and brain health for all, will work to ensure Americans living in rural areas have the best possible chance of survival and the highest quality of life attainable by promoting consistent, timely, and appropriate evidence-based care.

The Rural Health Care Outcomes Accelerator, launched in 2022, will achieve that aim by providing up to 700 rural hospitals with no-cost access to Get With The Guidelines® quality programs for coronary artery disease, heart failure and stroke. These programs allow hospitals to measure compliance of evidence-based guidelines, benchmark with peers, and improve on quality of patient care, while simultaneously bringing up-to-date information to inform healthcare guidelines.

“The American Heart Association is committed to bringing equitable care to all, regardless of where they live,” said Mindy Cook, national senior director, rural health care quality for the American Heart Association. “This project will address the unique challenges rural patients and health care professionals face, as well as leverage their unique opportunities and strengths.”

Over three years, the Association will convene rural clinical experts and leaders to develop and publish rural quality and outcomes research. Participating hospitals also will have access to professional education, an online rural community network that encourages peer-to-peer connection and provides resources to support model practice sharing, and collaborative innovation.

To maximize impact, rural eligible hospitals will be prioritized based on their potential to impact the largest number of patients in geographic areas with the highest cardiovascular disease mortality. Participating hospitals must be either a federally designated critical access hospital or a short-term acute care facility or rural hospital in Rural Urban Commuting Area Codes indicating rural and isolated geographic locations.

“Innovative approaches like this are key to improving rural health across the country,” said Cook. “The American Heart Association is uniquely positioned to help close the gap between rural and urban hospital care.”

Addressing the unique health needs of people in rural America is critical to achieving the American Heart Association’s 2024 impact goal for equitably increasing healthy life expectancy nationwide. Innovative approaches like this are key to improving rural health across the nation. ❖

ORTHOPEDIC SURGEON Q&A

“No, the Robot Doesn’t Take Over During Surgery”

HOW OFTEN DO ORTHOPEDIC SURGEONS USE 3-D TECHNOLOGY AND ROBOTICS?

Many surgeons only use it on a case-by-case basis.

WHY NOT USE IT?

Robots might have an added benefit for younger and more active patients. However, an older adult with lower physical demands may have just as good an outcome with a traditional joint replacement surgery.

Experts of Avera Orthopedics use the latest technology and procedures to relieve ongoing knee, hip or shoulder pain. Joint replacement surgery is often supported by 3-D software and robotic-arm technology to help plan and perform surgery.

Travis Liddell, MD, orthopedic surgeon and Clinical Vice President of Avera’s Orthopedic Service Line, answers questions about 3-D and robotic technology.

WHY IS 3-D TECHNOLOGY HELPFUL FOR ORTHOPEDIC SURGERY?

The technology builds a 3-D model of the joint, helping us choose the right size of implant and plan the implant’s position within the joint. We virtually plan the surgery and maneuver around any bone deformity or defect before the patient comes in for the actual procedure.

WHAT IS THE PURPOSE OF THE ROBOTIC ARM?

The robotic arm is a precise cutting tool the surgeon manually operates during surgery.

WHAT ARE THE POTENTIAL BENEFITS TO THE PATIENT?

Robotic technology aids in the patient’s journey by personalizing their treatment plan, enhancing the surgery-planning process, cutting smaller and more precise incisions, and reducing recovery times. However, there’s no replacement for a skilled surgeon. A good surgeon supported by the newest technology will potentially lead to the best outcome possible.

WHAT WOULD YOU TELL A PATIENT ABOUT ROBOTIC SURGERY WHO’S A CANDIDATE FOR IT?

The robot is a hyper-precise instrument that makes cuts exactly where we have planned out. It’s a great tool to enhance the outcome of a patient candidate.

DOES THE ROBOT TAKE OVER?

No, the surgeon is still the one doing the surgery. People have a perception that I’m in a back room with a joystick. No, I’m doing the surgery, scrubbed in and in the operating room.

HOW DO YOU APPROACH A PATIENT WHO IS AFRAID?

Facing any surgery can be overwhelming, with or without robots. It’s most important to focus on expertise and experience. Here at Avera Orthopedics — with our incredible team of surgeons, surgical techs and nurses —surgery is what we’re trained to do. ❖

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa

AVERA

Several Avera hospitals are listed among the Top 100 Rural & Community Hospitals and Critical Access Hospitals in the US for 2023 by the Chartis Center for Rural Health. In addition, Avera Queen of Peace Hospital in Mitchell, SD, was named as a Top 20 hospital by the National Rural Health Association.

Avera Facilities named to the Top 100 Rural & Community Hospitals list include:

• Avera Queen of Peace Hospital, Mitchell, SD (also Top 20)

• Avera Sacred Heart Hospital, Yankton, SD

• Avera St. Luke’s Hospital, Aberdeen, SD

• Avera St. Mary’s Hospital, Pierre, SD

• Lakes Regional Healthcare, Spirit Lake, Iowa (an Avera partner)

Avera hospitals named to the Top 100 Critical Access Hospitals list include:

• Avera Hand County Memorial Hospital, Miller, SD

• Community Memorial Hospital Avera, Redfield, SD (an Avera partner)

• Pipestone County Medical Center & Family Clinic Avera (an Avera partner)

• From the Chartis Top 100 lists, the National Rural Health Association recognizes the Top 20 Rural & Community and Critical Access Hospitals.

Architecture

recognized Avera Director of Facility Development Allison Dvorak with the 2023 Young Architect Award. The AIA Young Architect Award honors individuals who have demonstrated exceptional leadership and made significant contributions to the architecture profession early in their careers. Dvorak, who also serves as the AIA South Dakota President for 2022-2023, earned her Master of Architecture from North Dakota State University and has been a leader in dignified and inclusive design in the community. As the Director of Facility Development, Dvorak oversees construction projects throughout the Avera system.

RHEA LANGE

Rhea Lange, RN, is the most recent recipient of Avera’s quarterly DAISY Award. Lange serves as a coordinated care case manager at Avera Medical Group clinics in Creighton, Crofton, Hartington, Niobrara, Pierce and Verdigre, Nebraska. She joined the organization in 2018.

Monument Health has joined Signify Health’s Accountable Care Organization. Monument says the move will help enhance care, manage risk and improve coordination of patient care for traditional Medicare patients. “The additional resources and access to our physicians and providers means more coordinated care and an expanded care team for our patients,” says Kelly Stacy, MD, Executive Medical Director.

Monument Health Spearfish Hospital has been named a Top 100 Rural & Community Hospital by the Chartis Center for Rural Health. This is the 13th year the Chartis Group has published this list. The annual recognition program honors outstanding performance among the nation’s rural hospitals based on the results of the Chartis Rural Hospital Performance INDEX. The INDEX uses publicly available data to conduct its annual assessment of rural hospitals across the nation. The hospital was one of seven healthcare systems listed in South Dakota.

GLEN POLLOCK

Neurosurgeon Glen Pollock, MD, has joined the Monument Health Neuroscience Center. Dr. Pollock earned his medical degree at the University of South Florida. He completed his neurosurgery residency at the McGraw Medical Center of Northwestern University and at the University of South Florida and went on to complete his Endovascular and Cerebrovascular Fellowship at the Cerebrovascular and Stroke Center of New Jersey Capital Health. He is a member of the American Association of Neurological Surgeons and the American College of Surgeons.

JESS OWCZAREK

Jess Owczarek, a Registered Nurse at Rapid City Hospital Labor and Delivery, has received a DAISY Award for extraordinary nursing. She was nominated by a patient who was in the unit for several months and found that Owczarek stood out as a nurse who goes above and beyond, is humble and compassionate.

JENNIFER LABRIE

Jennifer LaBrie, a Scrub Technician at Rapid City Hospital Labor and Delivery, has received the TULIP Award. This award is presented to nursing support caregivers who exemplify Monument Health’s values of trust, respect, compassion, community and excellence. These individuals make a difference in the lives of their patients and patient families, and are a vital part of the nursing care teams.

ALYSIA LESTER

Alysia Lester, DNP, at Rapid City Hospital NICU, has received a Clinical Excellence Award. Recipients of the Clinical Excellence Award exemplify a commitment to the practice of medicine and to Monument Health’s mission, vision, and values. Their knowledge, skill, and professionalism in day-to-day interactions with patients, families, and colleagues reflect their commitment to clinical excellence. She was nominated by a fellow provider.

As part of Sanford Health’s virtual care initiative to meet the needs of patients, regardless of their zip code, patients can now self-schedule a virtual behavioral health appointment through My Sanford Chart with the first appointments becoming available March 27. scheduling an appointment, patients can be connected with a licensed therapist or psychiatrist. Licensed therapists offer counseling, help create interventions or treatment plans and identify mental, behavioral and emotional disorders such as anxiety or depression. Psychiatrists evaluate, diagnose, prescribe medications and treat patients for a variety of mental health disorders like obsessive compulsive disorder, bipolar disorder, severe anxiety, depression or schizophrenia.

HEATHER HERLYN

JOLYNN ROWBOTHAM KAREN TERHARK Sanford

nurses

JoLynn Rowbotham, RN, of Brookings Clinic (top) and Karen Terhark, RN, of Worthington Medical Center were recently recognized with DAISY Awards for extraordinary nursing.

SIOUXLAND

Session & Expo of the American College of Cardiology in New Orleans in early March. The work of Sanford Health Drs. Eric Larson, Marian Petrasko, Scott Pham, Naveen Rajpurohit, Adam Stys and Tom Stys will be presented at this year’s expo in addition to Dr. Catherine Hajek director of population genomics at Sanford Health. Topics of the presentations include genetic testing and polygenic risk scores, major adverse cardiovascular events, acute coronary syndrome and stroke in COVID-19 related submissive pulmonary embolisms. The expo incorporates global health advocacy with the goal to reduce the burden of cardiovascular disease worldwide and is one of the largest and most prestigious cardiology conferences in the world.

Heather Herlyn, MS, RN, CPHQ, Director of Quality and Safety at the Good Samaritan Society has been elected to serve as a member of the American Healthcare Association/ National Center for Assisted Living (AHCA/NCAL) Quality Award Board through 2026. Herlyn oversees all aspects of the Good Samaritan Society’s quality program, including quality measurement, performance improvement, accreditation and infection prevention. She and her team work closely with regional leadership and directly with locations to help prioritize and improve quality metrics and survey outcomes.

New Mexico-based Presbyterian Healthcare Services and Midwest-based health system UnityPoint Health have signed a letter of intent to explore the formation of a new healthcare organization. The proposed healthcare company would act as a parent company to enhance administrative efficiencies while allowing both not-for-profit systems to preserve their trusted brands and continue delivering care locally. The two organizations collectively represent a 40,000-strong workforce including nearly 3,000 physicians and advanced practice clinicians working alongside independent clinicians, educational partners and colleges. Both systems will now pursue a period of greater evaluation and exploration of next steps towards a definitive agreement and regulatory approvals.

St. Luke’s College–UnityPoint Health has opened a new, interactive Simulation Center for students to experience real-life

scenarios in a safe, controlled setting. Located on the campus of St. Luke’s College, the simulation center features high-fidelity adult and pediatric manikins that are managed by instructors through a two-way mirror within the classroom. New equipment and beds were added to the newly renovated space which includes four mock patient rooms. Simulation centers are popular among healthcare colleges and universities as it helps students gain confidence in high-pressure situations without jeopardizing the health and safety of a patient. The simulation center was part of a $100,000 grant awarded by the Missouri River Historical Development (MRHD) to assist in funding the construction.

INDEPENDENTS

For the third consecutive year, Brookings Health System was named to Newsweek’s list of World’s Best Hospitals. This prestigious award is presented by Newsweek and Statista Inc., the world-leading statistics portal and industry ranking provider. Brookings Health ranks 229 of the Best Hospitals 2023 in the United States, up 25 spots from last year’s ranking.

20 Rural & Community Hospital by the National Rural Health Association (NRHA). The health system ranked number one among peer rural and community hospitals across the nation on the winter 2023 Chartis Rural Hospital Performance INDEX, the tool used to recognize the Top 20. This is the sixth time since the award was established in 2016 that the NRHA has named Brookings Health to the elite Top 20 list. The health system will be recognized at an awards ceremony during NRHA’s Rural Hospital Innovation Summit in May.

Center for Family Medicine and the Sioux Falls Family Medicine Residency are celebrating their 50th anniversary as a family medicine clinic and residency program this year. CFM is a non-profit corporation originally formed in 1973 as the “Family Practice Center”. Since 1973, over 400 doctors have graduated from the SFFMR program, many of which continue practice in South Dakota and the immediately adjacent states. Presently, 33 doctors are residents of the program, including six doctors at the Pierre Rural Family Medicine Residency. CFM and SFFMR will celebrate “5 Decades of Giving” with a 50th Anniversary celebration in October 2023.

❱ 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.

THe SFFMR Class of 2023

DAWN JOHNSON

Huron Regional Medical Center recently named information technology (IT) clinical analyst Dawn Johnson, RN, its Exceptional Employee of the Month. Johnson earned her nursing degree at Huron University in 1985 and began work at HRMC as a surgical floor nurse. After two years, she transitioned to the obstetrics and nursery department where she provided nursing care for 34 years before accepting her new role in information technology in 2021. Johnson was nominated by colleagues.

Approximately two blocks of East 11th Street in Spencer, Iowa will be permanently closed to through traffic on May 1st to accommodate the construction of Spencer Hospital’s new emergency department and campus expansion.The new ED will be constructed on East 11th Street between the Medical Arts Building and the hospital. It will feature patient-centered improvements to include additional and larger treatment rooms; two trauma bays; and two rooms specifically designed for the care of behavioral health patients. Patient privacy will be enhanced by using an “on-stage, off-stage” design model through which a center core work area is dedicated for use by healthcare providers to reduce background sound and activity around patients receiving care.

As your premier medical liability insurance carrier, you can trust us to put our expertise and agility to work on your behalf. Our claims support helps you confidently manage unexpected outcomes and preserve patient relationships. We protect and guide you each step of the way. That’s Value Beyond Coverage.

For the eighth consecutive year, Spencer Hospital is being recognized as one of the Top 100 Rural & Community Hospitals in the United States. Spencer Hospital is the only mid-sized Iowa hospital to have earned this distinction every year it has been awarded and just one of 17 mid-sized hospitals nationally, out of approximately 900, to be an eight-time recipient. The nation’s top rural hospitals are recognized annually by the Chartis Center for Rural Health which identifies top performing hospitals by aggregating hospital-specific data for over 50 service and outcome variables across eight pillars of performance, resulting in an overall hospital strength index. The majority of data used in the study is derived from public sources.

LORI HANSEN

Yankton Medical Clinic’s Dr. Lori Hansen has been named dean of Medical Student Affairs at the Sanford School of Medicine. She had been filling that role on an interim basis. Dr. Hansen received her MD from the University of Nebraska College of Medicine, completed an internal medicine residency at the University of South Dakota, and then went on to complete a fellowship in thoracic diseases at the Mayo Graduate School of Medicine. She has been practicing pulmonary medicine at Yankton Medical Clinic, PC and has been a faculty member at the medical school since 1989. In 1994, she became

dean of the Yankton campus, revolutionizing medical education by introducing the Longitudinal Integrated Clerkship model, which has been replicated in many medical schools throughout the country.

Dakota Vascular in Sioux Falls has reached a major milestone since it’s opening last summer. The team performed their 500th procedure in February. Dakota Vascular physicians include Drs. Patrick Kelly, Angelo Santos, Gregory Nissen and Benjamin Jorgensen.

The University of South Dakota School of Health Sciences is one of six locations nationwide that will host a summit with the Association of Schools Advancing Health Professions (ASAHP) to bring together health industry and academic partners to identify emerging interprofessional trends and create alliances.

The ASAHP is partnering with the Interprofessional Health Education Center (IHEC) at the USD School of Health Sciences to co-host the 2023 summit on May 25th at the USD Health Science Center in Sioux Falls. Healthcare professionals, healthcare educators and industry partners who are interested in participating can find a registration link on MED’s website.

Tammy Phipps, OT

Degree: Master of Occupational Therapy

Current Position: President, CEO, Driver Rehabilitation Center of Excellence, LLC

Tammy Phipps is used to being the first. As a member of the National Guard in the mid-1990s, she became the first woman in a combat unit in South Dakota.

After earning her master’s degree in Occupational Therapy at the University of South Dakota School of Health Sciences in 2000, the Condee native started Aberdeen’s first driver rehabilitation program. She later went on to build and develop the only driver rehabilitation program in the entire Defense Department.

Since 2016, she has run her own company which utilizes a first-of-its-kind model combining occupational therapy with vehicle modification for a true ‘one stop shop’ approach to driver rehabilitation.

“Our motto is ‘roll in the front and drive out the back’,” says Phipps. “Driving is a function to occupation but it’s also more than that. It allows you to get to work, run errands, drop off kids. Our services have saved marriages.”

Phipps says the collaborative learning model she experienced at USD played a big role in her success as a therapist and a business woman.

“I’m a really good problem solver and my foundation taught me to collaborate with others,” says Phipps. “USD offered a truly multidisciplinary approach where we worked alongside other OTs, PTs, medical students and PAs. We took a lot of classes together.”

TAYLOR YOUNG

Taylor Youngberg, Doctor of Physical Therapy, is the clinic lead at the newest Prairie Rehabilitation Location now open in East Sioux Falls. Youngberg has been with Prairie Rehabilitation since 2021. She has expertise in treating a variety of conditions including low back pain, cervical pain, vertigo, temporomandibular joint dysfunction, sports-related injuries, and general orthopedic conditions. Youngberg is also certified in functional dry needling treatments, is a certified LSVT BIG clinician specializing in the treatment of walking and balance disorders related to Parkinson’s disease, and has special training in blood flow restriction treatment. The East Sioux Falls Clinic is located at 5150 East 57th Street.

And there were other advantages to USD for Phipps. Being from a small town, she liked the ‘small town feel’ at the school’s Vermillion campus. She liked the fact that South Dakota graduates are desirable to employers. But what she liked even more was the high pass rate on the certification exam for USD’s OT graduates.

“I felt very well prepared to take my exams,” she says. “USD had an amazing program.” USD.EDU/HEALTH

This SUCCESS SPOTLIGHT brought to you by:

Informed Refusal An Underutilized Patient Safety and Risk Management Tool

BY ERIC ZACHARIAS, MD

CASE STUDY

A 58-year-old woman saw her physician on a Friday morning with complaints of worsening, intermittent heartburn occurring over several months. The patient explained the symptoms felt like reflux and were occasionally improved using over-the-counter antacid tablets. She also stated the symptoms worsened whenever she walked up the stairs in her home.

The physician was concerned that the patient might be experiencing unstable angina mimicking gastroesophageal reflux disease and advised her to go to the emergency department immediately for close monitoring and a cardiac workup.

The patient declined this plan, stating she had several items to do over the weekend, but that she would go to the emergency department on Monday if the symptoms failed to resolve with prescription medications for gastroesophageal reflux. While the physician documented this and his concerns, there was no documentation of his recommendation of seeking an immediate emergency department evaluation or the discussion regarding the risks of delay in evaluation.

The patient experienced a cardiac arrest at home over the weekend. She was resuscitated by EMS and transported to the nearest hospital in critical condition, but died two days after admission. The patient’s family sued the physician, alleging the risks of waiting until Monday were not clearly communicated to the patient, and that the patient would have undergone immediate evaluation had the physician made these risks more clear.

How an “Informed Refusal” Form Helps

This case illustrates a situation where the use of an informed refusal form might have protected the physician from allegations of negligent care and prevented a lawsuit. Though the physician was sure he had the conversation regarding risks around a delay in evaluation, including death, the lack of documentation of this discussion in the chart made the care very difficult to defend in front of a jury.

Using an informed refusal form offers the provider an efficient way to document real-time conversations and recommendations. It is particularly important to use when patients decline provider advice which might result in avoidable, severe outcomes.

Using a physical informed refusal form simplifies the process and demonstrates that the patient was aware of the gravity of the provider’s recommendations. While it’s possible to document the refusal in the medical record as “free text” in the assessment or plan area, a form underscores the provider’s concerns of not

following the advised course of action. When a provider requests a patient to sign an informed refusal form, the request and the form may combine as a persuasive “nudge device,” and the patient may reconsider the recommended course of action and change their mind. Anecdotally, patients have stated that they changed their minds based on the physician’s high level of concern over their treatment refusal.

Having a patient complete an informed refusal form is not a guarantee that a patient or their family won’t sue after an unexpected outcome resulting from failing to follow a provider’s advice. However, informed refusal forms are a strong way to refute arguments that the patient wasn’t informed of the serious, adverse outcomes that could occur if advice wasn’t followed. ❖

Eric Zacharias, MD, is with the COPIC Department of Patient Safety and Risk Management

Working

Hand in Hand: The Value of Community Health Workers (CHWs)

A Community Health Worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

– American Public Health Association, 2022

CHW SCOPE OF WORK:

Health system navigation and resource coordination,

Health promotion and coaching,

Health education to teach or promote methods and measures that have been proven effective in avoiding illness and/or lessening its effects

Learn more by visiting www.chwsd.org