MED-Midwest Medical Edition-June 2014

JUNE

2014

Vol. 5 No. 4

Better Together Hospital Readmission Rates

– What’s Working?

Beware

of

EHR Timesavers

CCHS & SD Achieve Capitalize on Synergy in the New

LifeScape The Case for

Summer Rosés

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Midwest Medical Edition

Contents

Better Together

Volume 5, No. 4 ■ June 2014

By Alex Strauss

Regular Features

Two longstanding Sioux Falls organizations that serve adults and children with disabilities recently came together to capitalize on what they call the “synergy” of their two organizations.

While the services once offered to children through Children’s Care Hospital and School and adults through South Dakota Achieve will still be offered, LifeScape says the union will allow the new organization to serve this population in some brand CCHS & SD Achieve new ways.

Capitalize

2 | From Us to You 5 | MED on the Web Exclusive content on MidwestMedicalEdition.com 6 | News & Notes New doctors, certifications, clinics, and more

JUN E

2014

22 | The Nurses’ Station Nursing News from Around the Region

Vol. 5 No. 4

25 | In Review Bouncebacks! Medical & Legal

By Michael Weinstock and Kevin Klauer

26 | Wine Marketplace Cask & Cork’s CFO Makes the Case for Summer Rosés

In This Issue 4 | Patient Safety Improvement in South Dakota ■ By Dave Hewett

14 | Single-Site Robotic Gastric Bypass |

This new minimally invasive option now available at Sanford can lower surgical risks, making the procedure feasible for more patients. Surgeon Curtis Peery, MD, explains how it works. ■ By Curtis Peery, MD

15 | Doctors Partner with Sioux Falls Fitness Club

Plan includes new clinic in the GreatLIFE Woodlake Athletic Club.

Better Together

es dmissioN Rat Hospital Rea g?

orkin – What’s W

BeWaRe

of

ers EHR Timesav

MED talks to CEO Kathleen Lee about the new hospital and the remarkable financial support garnered for the project by this small Iowa community.

20 | Media 101 Sharing your health news with the local media . . .

What’s it in for you?

23 | Helping Patients Avoid Sarcopenia ■ By Holly Swee

Cover Photo: Only the name has changed. Services such a therapy for children with developmental disabilities, offered for decades by Children’s Care Hospital and School, will now be offered under the LifeScape name. There are no changes in staff planned.

Photo Courtesy LifeScape.

Case for

The sés Summer Ro

page

11

26 Wine Marketplace

Helpline and Avera launch online guide to mental health resources.

Hospital |

LifeScape

e S Ma ga zin MiD we St’ th e up per ar e pro feS Sio na lS ko ta and Sou th Da cia nS & he alt hc ySi f or ph

17 | Make the Connection: 18 | Sioux Center Opens the Doors on a New Community

on Synergy in the New

9

Streamline or Slipup?

Timesaving Features of your EHR system can be risky. Here’s how to use them wisely. ■ By Shelly Davis

21 Declining Hospital Readmissions in South Dakota

■ By Ryan Sailor

On the

COver

From Us to You Staying in Touch with MED

A

s we move into summer, healthcare is heating up in our region. In this issue, two longtime healthcare providers discover that they are more than the sum of their parts, Sioux Center opens the doors on a long-awaited modern facility, and Sanford announces its planned new breast center. As usual, our popular News & Notes column is also bursting at the seams with movers, shakers, and new projects. (If you notice that something is missing, please send it our way. The MED website is continually updated with the latest news) MED is making some improvements of its own. Our publication is now available in a digital format for easy reading on your Apple or Android device thanks to the ISSUU platform.

Ready to move into the digital age with us? Sign up on our website (www.MidwestMedicalEdition.com) to receive notification via email when the newest MED issue is available digitally. You can be reading the latest news, features, and practice management advice up to two weeks earlier with the digital issue. (If you were reading the digital issue now, you could click here to sign up!)

Our thanks to the physicians and other healthcare experts who contributed to this issue of MED. As a Northern Plains healthcare professional, you are invited to send us your own news, opinions, advice, book reviews, artistic pursuits, or anything else you want to share with your colleagues through MED. Reach us at info@MidwestMedicalEdition.com.

Warmly, —Alex & Steff

Publisher

MED Magazine, LLC Sioux Falls, South Dakota

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss

Design/Art Direction Corbo Design Photographer Kristi Shanks

Web Design Locable digital media director Jillian Lemons Copy Editor Hannah Steck

Steffanie Liston-Holtrop

Alex Strauss

Contributing Writers

Sally Davis Laurie Drill-Mellum Dave Hewett Curtis Peery Ryan Sailor Holly Swee

Staff Writers

Liz Boyd Caroline Chenault John Knies

Contact Information 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

2014 Advertising / Editorial Deadlines Jan/Feb Issue December 5

June Issue May 5

Sep/Oct Issue August 5

March Issue February 5

July/ August Issue June 5

November Issue October 5

April/May Issue March 5

MED VP Steffanie Liston-Holtrop hit the links in the South Dakota Lions Eye and Tissue Bank’s 17th Annual Golf Event at Minnehaha Country Club on May 19th.

Pictured with her are (left to right) Stefanie Engebretson, Butch Hansen, and Randy Derheim. The event included golfers from Vance Thompson Vision, Ophthalmology Ltd and Sioux Falls Family Vision. In addition enjoying some beautiful weather, the golfers helped raise funds to support the SDLETB. MED is a sponsor of this event.

December Issue November 5

Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 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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3 5/1/14 10:09 AM

Patient Safety Improvement in South Dakota

By Dave Hewett

H

ospital readmissions

are down 8% nationally over two-years; early elective deliveries (pre-39 weeks) reduced 65% during that same period and pressure ulcers are down 25%.

Now these are not numbers that the general public gets that excited about nor does the mainstream media spend much time covering them. But for the physicians and other healthcare professionals working in and around our hospitals, this is the kind of material that can generate two-hour meetings and days of comment and analysis.

These numbers are very important. They demonstrate just how much can be achieved when physicians, healthcare professionals and resources are focused on specific targets to improve patient care.

For over two years, 34 mostly rural South Dakota hospitals have been active participants in this project — the Hospital Engagement Network (HEN). It is a grant

program administered by CMS and dedicated to patient safety improvement and it appears to be achieving its goals.

Comparable results for South Dakota show readmissions and early elective delivery (EED) rates for the two-year period (2012 and 2013) down by 40% each. South Dakota’s facility acquired pressure ulcer rate was near zero at the beginning of the project and has remained so throughout the course of 2012 and 2013. And again, these results are for rural hospitals in this state.

Certainly, the numbers are important because they represent real savings in healthcare delivery both in terms of lives and dollars. The Centers for Medicare and Medicaid Services (CMS) estimates that these improvements prevented nearly 15,000 deaths in hospitals, saved $4.1 billion in costs, and prevented 560,000 patient harms in 2011 and 2012. Not bad for two-years of work. For South Dakota’s participating hospitals, each EED prevented

saves an average of $15,172. Each readmission prevented saves an average of $9,600 and each hospital acquired pressure ulcer prevented saves an average of $43,180.

South Dakota’s rural hospitals have worked hard to make this happen. Redeploying staff just to complete the reports has been a challenge. In addition, making sure the data is presented in a format that makes it meaningful to physicians and hospital administrators alike is essential.

The HEN is scheduled to conclude its grant funding this year. The challenge going forward will be for hospitals to find the resources necessary to keep the data flowing and interest level high even if the public and mainstream media don’t seem that interested.

Dave Hewett is the President and CEO of the South Dakota Association of Healthcare Organizations. ■

Todd is the newest member of the SDLETB team. He brings with him 23 years of law enforcement experience which gives him a unique outlook on the donation process. As a professional development coordinator for SDLETB, he will be working directly with funeral homes, coroners, and law enforcement/EMS. He will help grow our partnership with our healthcare partners and help them better understand their highly valued role in the donation process. He understands that they play a key role in helping to honor the last wishes of our donors. Todd is grateful for the work that our partners do with SDLETB and the donor families.

Todd Dimond Professional Development Coordinator

www.sdletb.org

4

REFERRAL HOTLINE 1-800-245-7846 EXT 4

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The Scales Could Tip Experts with the SilverStone Group have a warning for healthcare professionals on the future of the medical professional liability insurance market. Buying MPL insurance may soon get a lot more complicated.

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Find links to these articles and more on the MED homepage.

June 2014

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5

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

By January 1, 2015, the physicians and staff of Avera Medical Group

McHale Institute will become part of Avera Medical Group Oncology & Hematology at the Avera Cancer Institute in Sioux Falls. Dr. McHale’s practice became part of Avera Medical Group in June 2012. As part of this transition into the Prairie Center, Dr. McHale will expand his focus on outreach services to rural communities. This change will also allow Avera to dedicate more space to the Avera Institute for Human Genetics which currently shares the McHale Institute building.

Rita Blasius, CFO, Avera St. Benedict

Health Center in Parkston was installed as the new President for The South Dakota health Financial Management Association (SDHMA) for the year June 2014 to May 2015.

Avera Queen of Peace Hospital held a Welcome, Blessing, and Chamber of Commerce Ribbon Cutting on April 22 for its new Avera Brady Vasek “Can Do” Villa.

Tours were offered of the senior living villa, along with the new rehab center, Shirley’s Cinema and Ellen’s “Can Do” Pub.

6

Jen Poppen has been named the CEO at Avera Creighton Hospital effective July 1, 2014.

Poppen is a native of Madison, SD and a graduate of The University of South Dakota.

She received her Masters of Health Administration from the University of Iowa, Iowa City.

Poppen has been serving as the interim CEO at Avera Creighton since early February.

Avera Weskota Memorial Hospital (AWMH) has been recognized as a highperforming hospital by the Health Research & Educational Trust (HRET), an affiliate of the

American Hospital Association (AHA), for attaining a 20 percent reduction in acute care readmissions. AWMH has achieved this goal in the 30 Day All Cause Readmissions category, which includes heart failure, heart attack and pneumonia.

AWMH is part of the Hospital Engagement Network (HEN) through the Centers for Medicare and Medicaid Services.

The American College of Health Care Administrators (ACHCA) honored Veronnica Smith, Administrator, Avera Brady Health and Rehab in Mitchell, South Dakota with a 2014 Eli Pick Facility Leadership Award.

The award was celebrated during the awards luncheon at ACHCA’s 48th Annual Convocation and Exposition in Las Vegas, NV, on April 6, 2014. Smith began her career with Avera at Avera Queen of Peace Hospital in 1992 where she developed the home health and hospice programs and worked with parish nursing prior to moving on to senior services, becoming the Avera Brady Health and Rehab Administrator in March of 2001.

Doug Ekeren, currently the Vice President of Professional and Regional Services

at Avera Sacred Heart Hospital, has been named interim CEO for the Avera Sacred Heart region effective June 28, 2014. Ekeren has served on the administrative team at Avera Sacred Heart Hospital for the past 21 years. He will be assuming this role when Pamela J. Rezac retires on June 27.

Black Hills The Children’s Miracle Network (CMN) raised $87,284 during the One Call, One Miracle Radiothon broadcast Friday, May 2. The event took place in

Rapid City Regional Hospital’s lobby and aired on Rushmore Media Company Radio Stations.

Several local businesses made significant contributions, including the RCRH Auxiliary which presented its largest onetime donation for $51,000. Other major contributors included Coca-Cola, Pool & Spa Center, Dark Canyon Coffee, Soulmate Shoes and Uniform, Headlines Academy and Midcontinent Communications.

Basanta Pathak, MD, was named the Physician of the Quarter for Customer Service Excellence for the first quarter of the year at Rapid City Regional Hospital.

Dr. Pathak is a board-certified internal medicine physician and has been a member of the RCRH Medical Staff for three years. He was recognized for “continually providing his patients with compassionate, comprehensive and caring medicine”. Colleagues nominated Dr. Pathak for his dedication and commitment in providing compassionate care.

All RCRH physicians are eligible for the quarterly award.

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Cardiologist Kelly Airey, MD, FACC, has joined the clinic staff at Regional Heart Doctors in Rapid City. Dr. Airey

completed her medical degree at the University of Toronto. She did a residency in internal medicine and a fellowship in cardiovascular diseases at the University of Nebraska Medical Center in Omaha. She also completed a fellowship in Clinical Cardiac Electrophysiology at the University of Utah in Salt Lake City.

Mark Schulte, FACHE, is the new CEO of Sturgis Regional Hospital where he oversees the hospital and Sturgis Regional

Sanford Sanford Health will break ground on an integrated breast health building at its Sioux Falls campus this fall. The Edith

Sanford Breast Center will combine research and clinical care and is scheduled for completion in 2017. The threestory, 48,000-square-foot facility will be located on 18th street and connected to the current Sanford Cancer Center and VanDemark Building. Portions of the Sanford Cancer Center and VanDemark Building will also be renovated.

Wellmark Blue Cross and Blue Shield has named Sanford Heart Hospital in Sioux Falls, SD as one of the first hospitals in the nation to receive a Blue Distinction Center Plus (+) designation in the area of cardiac care. Blue Distinction

Centers are hospitals shown to deliver quality specialty care based on objective, transparent measures for patient safety and health outcomes that were developed with input from the medical community.

This year, the national program has added a new designation level, Blue Distinction Center Plus (+), to recognize hospitals that deliver both quality and cost-efficient specialty care.

Senior Care. Schulte comes to

SDSU and Sanford Health have partnered to conduct collaborative research on human nutrition, weight management and other dietary-related areas. This

research will address key objectives of the Sanford Profile, a weight management program that uses customized meal plans and health coaches. SDSU researchers will collaborate with investigators from Sanford Research on topics like metabolism, food choices and consumption, prenatal nutrition, genetics, food manufacturing and nutritional interactions with the human microbiome.

Regional Health from Avera Creighton Hospital in Nebraska, a 47-bed skilled nursing facility, where he was CEO. Schulte has an MBA from USD and is a certified Emergency Medical Technician (EMT) and firefighter. He was a member of the Creighton Nebraska Rescue Squad and Volunteer Fire Department. Schulte replaces Van Hyde who recently retired after serving 10 years as CEO. Maureen Henson is the new Regional Health Vice President of Human Resources.

She has previously worked as Vice President of Human Resources at Mercy Memorial Hospital System in Monroe, Michigan and Vice President of Human Resources at the Henry Ford Health System in Warren, Michigan. Henson is certified as a Senior Professional in Human Resources and is active in many professional societies and associations.

June 2014

MidwestMedicalEdition.com

7

News & Notes continued Sanford continued

Sanford Health is introducing an innovative new service in North Dakota called O.P.C. mobileMED. The service will

provide healthcare services directly in the oil fields for oil-producing companies (O.P.C.) and their subsidiaries.The plan includes deploying two mobile clinics that can move around to meet the needs of employers and one modular clinic – initially in Watford City. The project will mean an initial investment of $2.7 million along with $4.8 million in annual operating expenses.

Allan Bertram, most recently the head boys’ basketball coach at Chamberlain High School, is the new coordinator of the Sanford POWER Basketball Academy, a

comprehensive player development program. Bertram played basketball at Huron University for one season before finishing his college career at Sinte Gleska University in Mission, South Dakota. He holds an MA in educational administration from the University of South Dakota.

From Of

ved were ser e W n Message ers o suit pap today. a patient

Phone E-mail

Siouxland

Other

The June E. Nylen Cancer Center’s third annual “Cancer Sucks–Comedy Rocks” event held Saturday, April 12 at the Marina Center in Sioux City, Iowa raised more than $16,000 through ticket sales, sponsors, and a silent auction.

Horizon Health Care Inc. (Horizon) hired Aberdeen native Katy Goulding, CNP, to serve as the organization’s Aberdeen Community Health Center in Aberdeen, South Dakota. A graduate of University

The event featured four local comedians and the headliner Pat McGann from Chicago and attracted more than 700 people.

Proceeds will allow the Nylen Cancer Center to offer mammograms and colonoscopies to people unable to afford them.

of Nebraska Medical Center, Goulding holds a Master’s of Science degree with a specialty in Women’s Health. Among other services, Goulding will offer comprehensive obstetric and gynecologic care, contraception, infertility counseling, menopause and sexual issues, maternal and fetal well-being, high risk pregnancies, and post-partum care.

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8/8/13 5:36 PM

Midwest Medical Edition

Streamline or Slipup?

Timesaving features of your EHR can be risky.

Use them wisely.

D

By Shelly M. Davis, BSN, JD

espite the many advantages of the electronic health record (EHR) for both patients and healthcare facilities, concerns linger regarding the implementation of these systems. For example, while EHR has improved documentation for healthcare providers in many aspects, it has also introduced new and complex problems found only in an electronic environment.

Here are a few ways to think about EHR best practices — and help you think before you click.

Templates can

be a good thing

Well‑designed EHR templates offer obvious advantages. However, if used inappropriately, templates can cause as many problems as they solve. For example, many healthcare providers simply “carry forward” pre‑existing information from one template to the next. While much of a patient’s demographic information may remain consistent over time, it is highly unlikely that incident‑specific information will, or should, remain the same.

The point here is simple: Templates should not be automatically pre‑populated with data. If this is part of your EHR work flow, ensure that any pre‑populated data is accurate and try to limit pre‑populated fields to demographic information. If it is not, then it is your responsibility to correct the information before signing off on the documentation generated by that template work flow. One mistake in a single template field can lead to patient injury, and to potential malpractice claims. While it might sound time‑consuming, this task will take much less time than being involved in a lawsuit.

Imagine showing a jury six days of Progress Notes that are identical. This happens, and should not.

June 2014

Cut‑and‑paste

with care The cut‑and‑paste feature in the EHR can be a great timesaver, but like templates, cut‑and‑paste is often used inappropriately.

Don’t cut‑and‑paste information that has not been independently obtained or verified.

We know patients’ histories and recollections can change depending on many factors, such as who is asking the questions, how questions are asked, a patient’s anxiety or pain level, current medications, and the presence of family members at the time of questioning.

Obtaining complete and accurate patient history is essential. If you simply rely on another provider’s data, there is a risk of over‑testing because you have under‑listened.

Why? Because unfortunately, many physicians perceive it to be simpler and quicker to order tests than to listen and think about the big picture.

There have been many documented cases where health information was pasted into an improper location of a patient’s chart, where copied data contradicted the template‑generated content, or was lost altogether because it was pasted into the wrong patient’s EHR. So use cut‑and‑paste with care. Your patient’s safety is more important than the few minutes this feature can save you.

Alert and alarm

fatigue

For many, alert fatigue has become an EHR nightmare. While these warnings are ostensibly beneficial — by reminding providers of important information — alerts can be so frequent that providers become desensitized to them, and hence shut them off with indifference.

MidwestMedicalEdition.com

But alert fatigue was a concern for years before the advent of the EHR. For example, there have been many cases of monitor and pain pump alarms being shut off without heed, resulting in severe injury for the patient, and sometimes death.

The phenomenon of alarm and alert fatigue needs immediate attention within the healthcare industry. Getting providers to acknowledge the importance of alarm and alert fatigue, and implementing regular reminders about their importance, is only one step toward avoiding adverse outcomes.

Another more powerful step is to involve providers in defining the appropriate thresholds that trigger the alerts and alarms.

Conclusion Keep in mind that the patient record, no matter the format, is the prime communication tool used to facilitate reasonable care and treatment. Documentation in the EHR needs to be meaningful, objective and based upon patient presentation. Thus, documentation needs the utmost attention. With appropriate use of templates, cutting and pasting, and alerts, the EHR will achieve its original and ultimate goal: improving patient safety. ■

Shelly M. Davis, BSN, JD, is a Senior Claim Consultant at MMIC. This article originally appeared in the Summer 2013 issue of Brink, a quarterly risk solutions magazine published

by MMIC. For more information, visit MMICgroup.com.

9

Better Together All photos courtsey LifeScape.

By Alex Strauss

The New LifeScape Offers Continuum of Services for Children and Adults with Disabilities

B

oth South Dakota Achieve and Children’s Care Hospital and School have long been recognized for their

ability to adapt to the changing medical needs of Sioux Falls and surrounding communities. Established in 1952 as a school for polio victims, the program originally known as Crippled Children’s Hospital and School transformed itself over the years to serve a variety of the most pressing medical and educational needs of children.

South Dakota Achieve has also evolved through different names and service offerings. It was opened in 1958 as the Sioux Chapter Workshop for the Mentally Retarded, and was later known for many years as Sioux Vocational Services. Although it also started out serving children with disabilities, Sioux Vocational (and then Achieve) eventually served only adults and older adolescents with support to live independently, communicate, expand their social networks, find work, and stay healthy.

Now, these organizations have proven, once again, their ability and willingness to adapt to changing times by joining forces to form LifeScape. By combining these two demographics, the new non-profit organization, announced in April, has the capacity and expertise to support the varied medical, educational, emotional, mental, and social needs of patients with disabilities at any stage of life, for as long as that support is needed.

Specialized therapy and adaptive equipment services provided to disabled children through CCHS will now be extended to more adults through LifeScape.

Origins of LifeScape Because they serve so many of the same types of patients at different stages in their lives, it stands to reason that CCHS and South Dakota Achieve would look for ways to collaborate and they did. LifeScape CEO Anne Rieck McFarland says the conversation started about a year and a half ago.

“It was during those discussions about possible collaborative projects that we realized that there were a lot of synergies here,” says Rieck McFarland who had previously been President and CEO of South Dakota Achieve.

One of the most notable aspects of those discussions was the willingness of both organizations to look beyond their own entrenched and respected community brands, to imagine something bigger. “Even just the fact that two non-profits were able

LifeScape offers specialized inpatient care for medically complex children and adults. For those who live at home, LifeScape can provide highly skilled temporary nursing care to give their caregivers a break.

11

New Service Areas

With the goal of helping all people with disabilities reach their full potential, LifeScape provides employment training, preparation, and placement.

to put their egos on the shelf and look at what was going to serve the community best is quite something,” Rieck McFarland notes.

While the birth-to-adulthood LifeScape concept is not unprecedented in the country, it is not common, giving LifeScape few models on which to base their new organization. As the CCHS and SD Achieve boards explored the possibilities of working together as a single organization, they connected with the national Council on Quality

and Leadership, a group that works with human service organizations like LifeScape, which directed them to 5 comparable U.S. programs serving the same demographic.

“We are planning to take advantage of the things these organizations have learned about serving people with disabilities,” says Rieck McFarland. “We also want to pay it forward for other organizations in the future as we come up with the best ways to provide these services.”

How do you take your

Although the two organizations that combined to form LifeScape will continue to provide the services that have always been associated with them, Rieck McFarland and LifeScape’s Vice President of Medical and Therapy Services, Kristin Tuttle, says LifeScape will be able to serve certain clients in ways that have not previously been possible. Hence, the “Better Together” slogan in LifeScape’s marketing.

One area of service expansion under the LifeScape banner will be mental health, an area with which many service organizations for adults with disabilities struggle. “Like many of these organizations, we have a lot of adults with mental health needs that are unserved or underserved,” says Rieck McFarland. “With the mental health expertise we have gained through our association with CCHS, we will be able to better understand their needs and help them. We hope to now become more familiar and competent in managing these adults.”

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“

The most important message for medical providers in the area is that, as LifeScape,

we are continuing to provide all of the same services that Achieve and CCHS provided separately in the past.

”

Through LifeScape, adults with disabilities can get the assistance they need to live independently, find employment, maintain their health, and even make social connections.

Respite care to provide a break for the caregivers of adults and children with disabilities is another area of planned service expansion. With the expertise to handle even medically complex patients, LifeScape will be able to safely provide this much-needed service to more families who need it.

Likewise, adults with significant medical needs, such as those on ventilators, IVs, or feeding tubes who need round-theclock high level nursing care, can now be served by LifeScape at a level not possible through South Dakota Achieve.

“In the past, Achieve would not have been able to help these people and they might have ended up in a nursing home,” says Rieck McFarland. “No 21-year-old wants to be in a nursing home. That is not the right place for them and now there is an alternative that can help them grow and develop while their medical needs are being taken care of.”

Into the Future In the past year, CCHS and South Dakota Achieve served an estimated 2,300 children and adults from South Dakota and the surrounding states through programs in Sioux Falls, Rapid City, and many communities and school districts throughout South Dakota. LifeScape will

June 2014

now continue to serve clients ranging from children with serious birth defects , injuries, autism and learning disabilities to mentally disabled adults, those with traumatic brain injuries, and those with diseases such as Parkinson’s or ALS who may need adaptive equipment.

“Because we have such a wide range of services, we have great intake specialists who help get people where they need to go,” says Tuttle. “Whether they need to be an inpatient or they are looking for rehabilitation medical supplies, we can help direct them so that they get what they need.”

Although these services will all continue to be provided through the existing CCHS and South Dakota Achieve facilities in Sioux Falls and Rapid City, Rieck McFarland says the idea of an eventual new brick and mortar facility is not off the table.

“This is not something that we would do any time soon, but we don’t know what the future will hold,” says Rieck McFarland of this unique organization. “We will do what we need to do to adequately serve the needs of the community. Because the reality is that we are serving many people who would otherwise not be served at all.

Period. If we didn’t serve them, they would be sent to an institution. Our ability to help these people is even greater now that we are together.” ■

MidwestMedicalEdition.com

Kristin Tuttle, LifeScape’s Vice President of Medical and Therapy Services

Services Provided by the New LifeScape • Inpatient rehabilitation • Inpatient medically complex medical care • Residential services • Outpatient therapy and psychology services • Supported living • Special education • Supported community employment and employment preparedness • Day services and respite care • Specialized rehabilitation equipment • Orthotics and prosthetics • Community and school-based outreach therapy 13

single-site Robotic gastric Bypass single-site Robotic gastric Bypass NEW, MINIMALLy INVASIVE OPTION LOWERS SuRGICAL NEW, MINIMALLy INVASIVE OPTIONRISKS LOWERS SuRGICAL RISKS

By Curtis L. Peery, MD

T

By

By Curtis CurtisL.L.Peery, Peery,MD MD

HEcomplications.

RATE OF has complications. havehave improved theirtheir Recent peer-reviewed studiesstudies have sugTE OF obesity has sky- HE Surgeons have their Surgeons Recent peer-reviewed studies have sug- peer-reviewed RATE OF obesity obesity hasskysky- improved complications.

Surgeons improved Recent have sugability to manage these complications, and gested a decrease in complications when the rocketed over the past three ability to manage these three complications, gested a decrease in complications whenathe ed over the past three rocketed ability and to manage these complications, and gested decrease in complications when the over the past bypassInis performed robotically. In risk of death isgastric now equivalent that of decades. bilistoperformed robotically. the risk A of death now to that of death s. A total of $190 bil- decades. gastric bypass is performed robotically. In risk of is nowbypass equivalent to that ofgastric A total total ofis of$190 $190equivalent bil- thethe childbirth. Yet a significant concern is the most laparoscopic gastric bypasses, the gaslion a year is spent in the childbirth. a significant is the Yetmost laparoscopic gastric thelaparoscopic gasyear is spent in the lion childbirth. a significant concern is bypasses, the most gastric bypasses, the gasa year Yet is spent in theconcern rate of anastomotic leak (1 percent to 3 pertrojejunal anastomosis is performed in a United States treating disease directly corrate of anastomotic leak (1 percent to of 3 pertrojejunal performed in a anastomosis is performed in a ing disease directly rate anastomotic leak (1anastomosis percent to 3 is pertrojejunal UnitedcorStates treating disease directly corstapled fashion. With the robotic technique, cent) and stenosis (3 percent to 15 percent). related to obesity. Despite this epidemic, stapled fashion.toWith the robotic technique, cent) and stenosis percent to 15cent) percent).

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These results of work.

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These of work.

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80 after surgery.

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Advanaverage ofinone endoscopic bypass.

90.9 in percent ourinvasive ovement afterresolution a gastricAt plex surgery a minimally Every stricture results an to three or Sanford, improvement after a ofgastric plexfashion surgery incomplications. a minimally invasive fashion complications.

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Advanaverage of one to threeofendoscopic bypass. percent oftechniques. our percent. least one problem after surgery. movement and which reticulated instruuction or resolution of have athealth include high-resolution 3D image, has a3D leak risk to of two one percent patients atages reduction or resolution of at scaled tages include tions, high-resolution image, tions, whichInhasa astudy leak published risk of oneinpercent Despite the proven results of gastric ments.

This allows the surgeon to perform Obesity Surgery (Snyder et al., 2010) stricto two In ainstrustudy published in oblem after surgery. movement and reticulated instruto two percent.

In a study published in least one healthscaled problem after surgery. scaled movement andpercent. reticulated bypass, many patients and physicians are intuitive surgical movements similar to open tures decreased from 2.2 percent to 0.9 oven results of gastric ments.

Thisresults allowsofthegastric surgeon to perform Obesity et al., 2010) stricDespite the proven ments.

This allows theSurgery surgeon(Snyder to perform Obesity Surgery (Snyder et al., 2010) strichesitant to pursue surgery as an option surgery, which is not replicated in laparopercent when performed robotically; leaks ents and physicians movements to open tures decreased fromto 2.2 0.9 bypass,are many intuitive patientssurgical and physicians aresimilar intuitive surgical movements similar openpercent turesto decreased from 2.2 percent to 0.9 because of the small but real risk of surgical scopic surgery. similarly decreased from 1.7 percent to zero e surgery as hesitant an optionto pursue surgery, which as is not replicated surgery, in laparowhen performed robotically; leaks surgery an option whichpercent is not replicated in laparopercent when performed robotically; leaks percent. ll but real risk of surgical surgery. to zerodecreased from 1.7 percent to zero because of the scopic small but real risk of surgical scopic surgery.similarly decreased from 1.7 percent similarly At Sanford Surgical Associates, I have percent. percent. been offering the robotic gastric bypass since At Sanford Surgical Associates, I 2013. have At Sanford Associates, November A totalSurgical of 14 robotic bypasses I have been offering the robotic gastric bypass since been thewith robotic gastric have been offering performed no leaks or bypass stric- since November 2013. A total of 14 robotic bypasses 2013.

A total of 14 robotic tures.November The average length of hospital stay bypasses is have been performed with no1.74 leaks or strichave been performed with no leaks days. My early experience has been prom-or strictures. The average length of ising, hospital is average tures.

The of hospital andstay the patients arelength very satisfied with stay is experience results. has been prom1.74 days. My early experiencethe hassurgical been prom1.74 days.

My earlyand experience By providing bypass to with ising, and the patients are very satisfied withtherobotic ising, and patientsgastric are very satisfied our patients, we can further decrease the risk the surgical experience and results. the surgical experience and results. inherent to the time, I am conBy providing robotic gastric bypass tosurgery. Over By providing robotic gastric bypass to fident this will result in our ability to not onlythe risk our patients, we can further decrease risk we can further decrease ourthe patients, improved but alsoOver a substantial inherent to the surgery. Over show time,inherent I am contosafety, the surgery. time, I am condecrease in the need for hospitalization and fident this will result in our ability to not this onlywill result in our ability to not only fident treatment of complications. This will result show improved safety, but also a substantial show improved safety, but also a substantial in saving significant healthcare dollars. â–

decrease in the need for hospitalization andin the need for hospitalization and decrease treatment of complications. This treatment will resultof complications. This will result dr. Curtis peery is a board-certified general â– significant healthcare dollars. â– in saving significant healthcare dollars. in saving surgeon with sanford surgical associates in sioux Falls. He has been performing robotic

dr. Curtis peery is a board-certified dr.general Curtis peery is a board-certified general surgeries for 10 years. surgeon with sanford surgical associates inwith sanford surgical associates in surgeon sioux Falls. He has been performingsioux robotic Falls. He has been performing robotic

14

surgeries for 10 years.

surgeries for 10Midwest years. Medical Edition

Doctors Partner with Sioux Falls Fitness Club Orthopedic Institute in Sioux Falls and the Sioux Falls Specialty Hospital have partnered with GreatLIFE Malaska Golf & Fitness Club, managers of the GreatLIFE Woodlake Athletic Club in Sioux Falls and other area fitness facilities to integrate healthcare services into the mix of benefits available to GreatLIFE members at select locations.

As a GreatLIFE health partner, Orthopedic Institute will open a clinic in the GreatLIFE Woodlake Athletic Club addition scheduled for completion in January of 2015. Members will have convenient access to sports medicine, therapy and education. Sioux Falls Specialty Hospital will also provide clinic services in the new addition at Woodlake and will provide

healthcare services, seasonal clinics and educational seminars for members and guests.

In addition to Woodlake, other area GreatLIFE facilities include Bakker Crossing, Willow Run, Central Valley, Hidden Valley, Hiawatha, River Ridge, Luverne Country Club, The Bridges at Beresford,

Architect’s rendering of the planned expansion at GreatLIFE Woodlake Athletic Club in Sioux Falls

Emerald Hills and Okoboji View golf courses, EmBe, and McCook Wellness.

According to GreatLIFE, the goal of the new healthcare partnerships is to make healthcare services convenient and accessible and to encourage members to integrate regular preventative care and health maintenance into their lives. â–

Log on to see additional images of the planned GreatLIFE Woodlake project.

June 2014

MidwestMedicalEdition.com

15

A New Option for

Aortic Stenosis

Now Available in Sioux Falls Sanford Heart Hospitals in Fargo,

North Dakota and Sioux Falls, South Dakota have adopted a new FDA-approved minimally invasive medical device to treat patients with severe aortic stenosis who are too ill or frail to have their aortic valves replaced through traditional open-heart surgery.

Approximately one-third of patients who suffer from severe aortic stenosis are not eligible for open-heart surgery because of increased risk. If left untreated, the heart muscle could weaken, leading to heart failure and an increased risk for sudden cardiac death. These patients have a 50 percent risk of death at one year unless they are treated.

The advanced design of the CoreValve System from Medtronic was developed to address the needs of the transcatheter aortic valve replacement (TAVR) patient population, serving a broad spectrum of severe aortic stenosis patients. CoreValve TAVR is performed by a team of interventional cardiologists and cardiothoracic surgeons. Most commonly, CoreValve is inserted through a catheter procedure, either via the chest or groin. It is a self-expanding device designed to replace a severely narrowed aortic heart valve.

Sanford Heart has offered minimally invasive TAVR procedures since 2012 through the Edwards’ SAPIEN valve. CoreValve will allow Sanford to offer the procedure to patients who may not be candidates for other valve options. â–

16

Midwest Medical Edition

Regional Health President & CEO

Charles Hart to Retire

With a long and distinguished career as a physician and healthcare executive,

Charles Hart, MD, MS, Regional Health President and CEO, has announced his intention to retire. Hart will continue to lead Regional Health until his successor is in place, with the organizational goal of filling the position by January 2015.

Dr. Hart has been associated with Regional Health and Rapid City Regional Hospital (RCRH) for 31 years with 10 of those as Regional Health’s first President and CEO. Dr. Hart began his career at the organization as an RCRH Emergency Department physician in 1983. He has served in a variety of leadership positions throughout his career including Interim President and co-CEO, Chairman of the Board of Trustees, Chief of the Medical Staff, Vice President of Medical Affairs, Hospital/Medical Liaison Officer, Emergency Department Chairman, and Regional LifeFlight Medical Director.

Under Dr. Hart’s leadership, Regional Health has achieved:

◆ System integration – Forty-eight facilities throughout western South Dakota and into northern Wyoming have been unified under the parent corporation of Regional Health.

◆ System growth – the organization has grown to 48 facilities in 2014.

There are also about 4,900 system employees today.

◆ Enhanced physician partnership – the number of partner physicians has grown to almost 175 physicians and 95 mid-level healthcare providers.

◆ Creation of a strong foundation for the system’s future – Excellence in healthcare, paired with solid financial performance, has made Regional Health a strong and respected healthcare entity.

◆ Enhanced access to core services – Regional Health has continually added services at its hospitals and clinics. It has also increased the number of clinics to serve people close to home.

◆ Regional Health has maintained an A1 bond rating through Moody’s Investors Service.

Dr. Hart has served as the President-Elect, Vice President, Treasurer and Speaker of the House for the South Dakota State Medical Association and is a past faculty member of the University of South Dakota Sanford School of Medicine. Dr. Hart is a past and active member of multiple state and local organizations including the Rapid City Chamber of Commerce and the Chamber Government Affairs Committee, Black Hills Vision Board, Rapid City Economic Development Board, State Chamber of Commerce Board, and the South Dakota Community Foundation Board.

Dr. Hart has been the recipient of multiple awards including Distinguished Service from the South Dakota Medical Association, the Black Hills Hispanic Community Award, and the Distinguished Leadership in Medicine for Community Service from the University of Notre Dame.

The Regional Health Board has formed a committee to immediately begin the search for the new Regional Health President and CEO. A nationally-recognized search firm, B. E. Smith, has been retained to lead a national search. ■

June 2014

MidwestMedicalEdition.com

Make the Connection Helpline and Avera Launch Online Guide to Mental Health Resources Sioux Falls Helpline Center and Avera McKennan Behavioral Health Services have launched a new online Sioux Falls Mental Health Resource Guide. The guide consists of a searchable database of mental health resources in the Sioux Falls area, including providers, agencies and professionals.

Additional resources include a guide for selecting a mental health practitioner and a glossary of professional accreditations.

The guide is also available as a downloadable PDF. “This guide is set up to be an easy-to-use, one-stop resource for people who are struggling with a mental health issues, or for people seeking help for a loved one,” says Helpline Center Executive Director Janet Kittams-Lalley. “This guide empowers people by breaking down the options into a simple format that will allow them to make the best possible choices for their situation.”

“We want to remove as many barriers as possible as people seek help for various mental health conditions, whether that’s depression, anxiety, addiction, substance abuse disorder, or other illnesses,” says Thomas Otten, Director of Behavioral Health Inpatient Services for Avera McKennan Hospital & University Health Center. “Less than half of children and adults with diagnosable mental health conditions receive the help they need. Here in the Sioux Falls region, we

hope to change that disturbing statistic.” ■

Log on to find a link to the free Sioux Falls Mental Health Resource Guide.

17

Sioux Center Opens the Doors

on a New Community Hospital

Photo Courtesy Sioux Center Hospital

The new facility welcomed its first patients on May 22. It replaces the old hospital which was built in 1951.’

The

new

Sioux

Center

Community Hospital and Health

Kayleen Lee

Sioux Center Community Hospital Facts Cost: $48.5 million Community Funds Raised: $13+ million Hospital size: 107,000 sq. feet Clinic size: 16,500 sq. feet Rehab space: 3,000 sq. feet Architects: Cannon Moss Brygger

18

Center

Avera,

which welcomed its first patients at the end of May, is a community hospital in the truest sense of the word.

From before the $48.5 million dollar project broke ground in July 2012, the project received more than a quarter of its funding from pledges and donation from the community of just 7,000 people. CEO Kayleen Lee says the outpouring is a testament to the community’s engagement with the project and desire for some new directions in healthcare.

“The community has really embraced this project from the beginning,” says Lee. “Before we even designed the facility, we went to the community with focus groups and asked them what they wanted, what they thought we needed.”

Although fundraising experts told hospital planners

they could gather the information they needed from three or four focus groups, Lee says the board held a total of fourteen, including more than 200 community members.

The consensus on healthcare needs in Sioux Center?

More wellness services, more ambulatory care options, and a greater focus on specialty care.

“So that really helped us set our design for the hospital,” says Lee. “We combined that information with statistical analysis on things like population demographics, frequency of different diagnoses, disparities, etc. That is how we came up with the size, number of rooms, etc.

The new 123,500 sq. ft. facility, which includes a 107,000 square foot hospital and a 16,500 square foot primary/specialty clinic, will replace the current hospital built in 1951 and land-locked on Highway 75. The existing facility is not capable of

expanding the outpatient and specialty services that are changing the landscape of healthcare delivery. Lee says the new, more modern medical campus will serve as the prominent healthcare facility for a growing community and aging population.

“Some of the issues we were running into in the old facility had to do with privacy,” she explains “I joke that we are going from an Emergency Room to an Emergency Department because we literally had a room with two cots before.

At the same time, visits to the ED are increasing.” To accommodate the higher volume, the new hospital has three trauma rooms and 4 exam rooms.

Another national trend mirrored in Sioux Center is the move toward outpatient care. According to Lee, 75% of the hospital’s revenues come from outpatient services. The new facility includes a sameday surgery center with ten

Midwest Medical Edition

ambulatory care rooms for preand post-treatment as well as for same-day surgeries.

The facility includes two spacious LDRs and four postpartum rooms designed for family comfort and safe, lowintervention births. The new hospital campus includes 3,000 square feet for rehabilitation services, which have been located off site in an old nursing home.

“The great thing about therapy in the new hospital,” says Lee, “is that you don’t have to come in the main entrance.

Rehabilitation services have their own separate entrance so patients, many of whom shouldn’t be walking long distances anyway, won’t have to.”

Some of the new technologies on the medical campus are electronic white boards in each room featuring vital information and controlled at the Nurses’

Station, an advanced communications system that utilizes wearable pendants, tracking devices for patients in surgery so families can monitor their progress, kiosks to improve wayfinding, and temperature monitoring devices for refrigeration units. The rooms feature various ports to accommodate future technology.

The campus was designed

by Cannon Moss Brygger Architects of Sioux City to incorporate themes from the 23rd Psalm, including verdant pastures, still waters, and restoration of the soul. It features tall ceilings, large windows throughout that look out on greenery, and a circular ‘Town Center’ that makes it easier for patients to find their way around.

Reflective stone on the exterior (from Mankato, Minnesota) helps the building blend

Photo by Matt Toering

The 107,00 sq. foot hospital features soaring ceilings, natural light, and Kasota stone in its lobby or ‘Town Center’.

seamlessly with the landscape.

Reaction to the new facility at a donor gala in April and two public open houses in May was overwhelmingly positive and Lee says the project has reignited public and staff enthusiasm about the future of healthcare in Sioux Center.

“When you have staff that provide wonderful care in an old facility, you know that the care

is going to be that much better in an advanced new facility,” says Lee. ■

Log on for additional photos of the hospital and the open houses.

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Kelia Smith, M.B.A. Healthcare Management Sanford Health Project Coordinator, Facilities & Planning

June 2014

MidwestMedicalEdition.com

19

Media 101

Sharing your health news with the media –

What’s in it for you?

By Alex Strauss

N

o matter who you are

or how great you believe your “pitch” to be, approaching a member of the media (or, in some cases, your own PR department) with a medical story idea can be intimidating.

For one thing, you risk the very real possibility that the person to whom you are explaining your great idea will not “get it” or find it valuable enough to want to share with the public. There is also the natural aversion to making oneself vulnerable to scrutiny or criticism. Most people with potentially valuable information to share – including health professionals – conclude that the risks and hassle are not worth the effort.

But the fact is that the media and the public they serve need what you know – now, more than ever. The advantages of timely, relevant health news for consumers are obvious, but this is about more than public service. By way of encouraging more engagement with your local news providers, here are a few things I believe are “in it” for you, the health professional:

MED Editor Alex Strauss is a former television health reporter and the author of Physicians and the Press: A Doctor’s Guide to Working with the Media.

1 O’Hanluain, Daithi, “Patients forget about two-thirds of doctors’ treatment instructions, says neuropsychologist”, European Society of Cataract and Refractive Surgeons, July 2003

20

The Four

“Ps”

Provide

Although no news report could ever match the value of personalized, one-to-one human interaction, when you put a health scare into perspective, recommend a healthy course of action, or explain a new treatment option through the media, you are being a provider on a level that is simply not possible within the walls of the office or hospital.

And unlike the words you say during an office visit, which research suggests are often misunderstood or forgotten within minutes of the appointment1, words that are captured in a news article may be broadcast multiple times, repeated, copied, disseminated online, and even referenced again in future stories.

Position Speaking through the media gives you the opportunity to position yourself as an authority, bolstering trust and credibility among your own patients, as well as among those who may become patients in the future.

When you demonstrate that you are willing to provide your expertise, the media responds in kind by presenting you as an expert source. Fortunately, even if you have never been asked to speak to the press before, it only takes one good interview (during which you offer clear, concise information) or one newsworthy story idea to put you on their radar.

Promote Appearing in a news segment, being quoted in the newspaper or online, or being interviewed on a television or radio show, are ideal ways to help promote your practice and your services, provided that you do not take it too far by being blatantly self-promotional.

In an increasingly competitive healthcare environment, the authority you can establish and the respect you can earn through unpaid media interactions can give you and your practice a competitive edge that simply cannot be achieved through advertising alone.

Participate By establishing good relations with your local health news providers, you are opening what can be an inestimably valuable channel of communication between the medical world and the “real” world. Like doctors, journalists want to uncover truth and serve their audiences.

At a time when the gulf of understanding between patients and providers seems to be widening, in a very real sense, by accepting and working with the media, you can help close it. That is the power of physicians and the press, together. ■ Midwest Medical Edition

Declining Hospital Readmissions in South Dakota

By Ryan Sailor

A look

at what’s

working

H

ealth care

p r ov id e r s a c r o s s South Dakota have been creating programs to help reduce avoidable hospital readmissions. A readmission occurs when a patient who was recently discharged from a hospital needs to be admitted to a hospital again, generally within 30 days. At the national level, readmissions impact nearly 1 in 5 Medicare patients. These readmissions disrupt patient lives and are costly to both the patient and the hospital. Readmission performance is now publicly reported on Medicare’s Hospital Compare website, and the Centers for Medicare & Medicaid Services (CMS) created the Readmission Reduction Program, which financially penalizes hospitals with higher rates of readmissions.

◆ Healthcare systems and providers are Readmission Rate Trends – State and National For the one-year period ending June 30, 2013, there were 31,967 Medicare inpatient hospital discharges in South Dakota and 4,544 people were readmitted to the hospital again within 30 days, for a readmission rate of 14.2%. For comparison, the national rate of readmission was 18.3% for Medicare patients. Despite the fact that South Dakota already readmits fewer people than the rest of the nation, steady improvement has been made over the last few years, as evidenced by the decline in readmission rates. Because healthcare providers have improved readmission rates, 1,156 fewer Medicare beneficiaries are being readmitted to the hospital each year in South Dakota, as compared to a few years ago.

So the natural question is, what is working so well? With healthcare quality improvement, there are usually multiple factors that drive change. There are many local efforts that have likely contributed to the improvement in readmissions, including:

Great strides in reducing readmissions have been made in South Dakota over the last few years. This graph, calculated from Medicare claims data, demonstrates the improvement in readmission rates:

implementing best practices such as post-discharge follow up phone calls to patients, medication reconciliation strategies, home visits when needed, and many other local unique interventions.

◆ South Dakota Foundation for Medical

Care (SDFMC) has been bringing hospitals, skilled nursing facilities, home health agencies, physician offices, assisted living facilities, and other community members together in care transitions coalitions across the state. These coalitions have improved provider communication across the healthcare spectrum, identified the cause of local readmissions, and implemented interventions accordingly.

In addition, SDFMC shared quarterly data to monitor progress and identify areas for improvement both statewide and locally.

◆ Hospital engagement networks have been providing support, resources, and educational opportunities to hospitals looking to improve.

◆ Sharing lessons learned between

communities has enhanced statewide success. ■ Ryan Sailor is the Vice President of the South Dakota Foundation for Medical Care (SDFMC), the Medicare Quality Improvement Organization for the state.

Log on to view more detailed data on hospital readmissions from the SDFMC.

June 2014

MidwestMedicalEdition.com

21

The Nurses’ Station Nursing News from Around the Region

Lori Jones

DAISY AwardS Area Nurses Recognized with DAISY Award for Extraordinary Nursing

Stephanie Horsley and Pam Seger are the most recently-awarded winners of Rapid City Regional

Hospital’s DAISY Award.

Horsley, a Registered Nurse in the Progressive Care Unit, was nominated for the award by a patient’s family. In their nomination, the family explained that the patient was in a great deal of pain and was agitated and worried, but that Horsley’s kindness helped ease their fear.

“She is a very kind-hearted, calm, compassionate, caring person: everything you would want in somebody who is taking care of you or a loved one,” the nomination stated. “These are not skills a person learns, these are gifts from God.” Horsley has worked at RCRH for two years.

Pam Seger, an RN in the Emergency Services Department, was nominated for the DAISY award by a patient who had also been in pain. The patient said Seger’s words of encouragement and hand holding made all the difference.“She would tell me over and over that she knew I would be all right because I am a fighter,” the patient said. “She was the nurse at my bedside everyone wants and needs.” ■

Save the Dates!

SDNA and INA Annual Conventions

Jill Cahill

At Sanford, a geriatrics case manager and a cardiology nurse are the two most recent DAISY recipients. Lori Jones, a geriatric nurse at the walk-in CareSpan Clinic in Sioux Falls, did what she needed to do to encourage follow-up in a 76-year-old patient who described a transient episode of aphasia. The woman did not want to see her physician since she was no longer symptomatic. But Jones’ “kindness, sincerity, and empathy” convinced the woman to seek care.

According to the nomination, “Further testing revealed a positive stress test which led to an angiogram, the placement of a stent and medication changes.” The woman is now participating in cardiac rehab and expresses her gratitude to Lori for her clinical expertise and perseverance.

“Jones consistently partners with patients in the way described above, generating personcentered care by activating the individual’s strengths,” wrote CCM Arlene Horner in her nomination of Jones.

DAISY winner RN Jill Cahill, a cardiology nurse at Sanford, was nominated for the award by a patient’s husband who described his wife’s battle with ovarian cancer and Cahill’s responsiveness to both the patient and the family.

“She always has a warm smile and shows genuine compassion,” said the nomination.

The South Dakota Nurses Association will hold its annual convention October 5-6,

“She even remembered that I like my morning

2014 in Rapid City. The theme for this year’s convention is “You Are Not Alone!

coffee in a large cup. When my wife was

Close Encounters of the Nursing Kind”.

moved to the ICU, Jill took time from her

The Iowa Nurses Association’s Convention will take place October 12 to 14 at the Isle of Capri in Waterloo, Iowa. More information is available on the SDNA and

lunch break to look in on us. In my opinion, she is the total package.” ■

INA websites. ■

22

Midwest Medical Edition

Helping Patients Avoid Sarcopenia Study Suggests More Lean Protein May be the Answer

A

By Holly Swee dequate protein

is essential for good nutrition throughout the lifespan. While there is no single identifiable cause of sarcopenia, a condition associated with a loss of muscle mass and strength in seniors, insufficient protein intake may be a key contributor.

Since loss of muscle can decrease stamina, lessen the ability to perform daily tasks, and increase the risk of falls and bone fractures, the prevention of sarcopenia is becoming an increasingly important public health issue.

A recent study published in the Journal of the Academy of Nutrition and Dietetics takes a closer look at protein intake among older U.S. adults. Food intake tends to decline with age and current dietary recommendations emphasize a shift to more plant-based diets, which could be cause for concern in regards to adequate protein consumption.

In the newest study, “Characterization of Dietary Protein among Older Adults in the United States�, researchers with California Polytechnic University used data from the 2005-06 National Health and Nutrition Examination Survey to quantify protein intake Log on to find a link to the study on our website.

and determine adequacy of protein in the diets of U.S. adults.

Typical protein intakes were considerably lower than if a USDA food pattern was followed. As expected, older adults had lower than average protein intake and a higher incidence of inadequate intake versus younger adults.

Protein intake was also notably lower in women in comparison to men. Protein from animal sources contributed more than 60% of protein sources, on average, with dairy as the largest contributor, followed by poultry and beef. Specifically, beef provided approximately 14% of total protein intake of all adults (19+ yrs). Using logistic regression analyses, a higher proportion of total protein intake from animal foods predicted a higher likelihood of meeting the protein RDA, whereas a higher proportion from plant foods was a negative predictor.

In the current study, the results prompted the authors to suggest that a shift away from animal sources of protein would have a negative impact on overall protein intake, increasing the risk of sarcopenia. To minimize the negative impact of high dietary fat, they recommend greater focus on leaner and lower fat animal protein options. â– Holly Swee is a Registered Dietician and a Licensed Nutritionist with the South Dakota Beef Council.

June 2014

MidwestMedicalEdition.com

23

MER CAMPS SUM@ Scape Life

(Formerly Children’s Care)

EARLY LANGUAGE LEARNERS* LET’S TALK* Aug. 11-14, 9 am-noon; June 2-5, 8-9 am; Description: Preschoolers develop speech and language skills through play and everyday activities.

BREAKFAST CLUB* Tues./Fri., June 3-27, 7:45-8:45 am; Description: A group setting to overcome picky eating and improve oral motor skills. * Insurance coverage may apply to medical-based camps.

Call 605.444.9700 for details.

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Description: Children will focus on peer interactions while using voice output devices.

HELPING HANDS* Dates & Times TBD; Description: Constraint-induced movement therapy for children with hemiplegia.

POWER MOBILITY* Dates & Times: TBD; Description: Experience the latest technology in power mobility.

Formerly Children’s Care 1020 W. 18th St., Sioux Falls, SD 57104

Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

By Michael Weinstock and Kevin Klauer

Bouncebacks! Medical and Legal Reviewed by Dr. Laurie Drill-Mellum

E

very provider arriving

for a shift in the emergency department dreads hearing the question, “Remember that patient . . . ?” Our heart rate quickens and we get a sinking feeling in our gut as we prepare to hear about a patient whose condition has worsened or even resulted in disaster; about something we missed; or about how we failed in some way to do the right thing by one of our patients.

This is one of the rougher parts of practicing emergency medicine — knowing that some of our patients will “bounce back” — returning to the ED because their condition has persisted or worsened.

Bouncebacks! Medical and Legal is a well‑written, well‑documented compendium of 10 patient stories, none of which turned out well, recounted from the initial presentation in the ED to a subsequent presentation in the courtroom. In‑depth analyses from both clinical and medico‑legal perspectives make the book an excellent risk management tool. Any seasoned emergency medicine practitioner will relate to, and learn from, these stories. Any student of primary care or emergency medicine will benefit from these experiences and lessons.

One of my wise attending physicians, Dr. Michelle Biros at the Hennepin County Medical Center Emergency Medicine Program in Minneapolis, often said, “Our most basic task as emergency medicine docs is to determine who is sick and who is not sick.” That can be surprisingly hard to do.

She also continually reminded us that “vital signs are vital.” Overlooking abnormal vital signs is one of the main things that can lead to bouncebacks.

June 2014

Several valuable lessons can be gleaned from this book and from the review of malpractice claims in general. First, we know that 90 percent of a diagnosis can be made by taking a good history, which requires focused, attentive listening and communicating for understanding.

Second, in emergency medicine, we are trained to rule out the life‑threatening causes of symptoms before we hang our hats on more benign explanations for them.

Third, knowing that the majority of significant claims in emergency medicine fall under the category of “delayed or missed diagnosis,” it is best to start with a broad differential and thoroughly document one’s thought process regarding why a certain diagnosis fits, or does not fit, with the complaint.

Fourth, vital signs are vital: In many of the cases detailed in Bouncebacks! — as well as many cases that end up in litigation — patients were discharged from the ED with abnormal vital signs, or with pertinent lab findings still pending or going altogether unacknowledged.

Finally, giving patients and families clear verbal and written return precautions, as well as a definite and documented plan for follow‑up, is paramount at the time of discharge. I always say that emergency medicine is a team sport, and that perspective is emphasized in this book. For example, reading a triage nurse’s note, then attending to the symptoms and concerns raised in them, is essential. Eliciting and listening to ideas or suggestions from other members of the healthcare team when faced with diagnostic dilemmas or treatment failures is of great value; asking for help from consultants when things aren’t “adding up” is important not

MidwestMedicalEdition.com

only for patients, but also for you. As Greg Henry, MD, advises in his risk management courses: “Don’t carry the coffin alone.”

In summary, Bouncebacks! makes for a great read. The case review format is one we physicians find useful, and this book is filled with cases that at first seemed benign, but ultimately were not. I’m confident the insights in this book will save untold numbers of patients from adverse outcomes, and many a physician from having to defend his or her evaluation and care of a patient. Our profession is filled with opportunities to learn, and I highly recommend this book as one of them. ■

Laurie C. Drill-Mellum, MD, MPH is Vice President and Chief Medical Officer at MMIC. Her review was originally published in the Winter 2014 issue of the MMIC publication, Brink, a quarterly risk solutions magazine published by MMIC. For more information, visit MMICgroup.com.

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Wine

Wine Marketplace Sponsored by Cask & Cork

Som m elier’s cor n er

What is a Rosé Anyway?

The word rosé is French and refers to a type of wine that incorporates some of the color from the grape skins, but not enough of the pigment to be classified as a true red wine. Rosé wines are produced via three different methods known as skin contact, saignée, and blending.

In the skin contact method of rosé production, the skin of red wine grapes are allowed to stay in contact with the freshly pressed fruit juice for a few days. Unlike in red wine making, the skins are not allows to stay in contact with the juice throughout the fermentation process.

From the French word for “bleed”, the saignee method of rosé production is the practice of “bleeding off” some of the juice after a limited time in contact with the skins. The remaining wine may still be made into a more concentrated red wine.

As the name implies, “blending” simply involves mixing a white wine with some red wine. With a single varietal wine, the grapes may be from the same yield but fermented from different batches.

Wine Facts The smell of young wine is called an “aroma” while a more mature wine offers a more subtle “bouquet”.

One-on-One with Cask & Cork CFO,

Brett Kooima Q: Y ou are a big fan of some of the new rosé wines.

Why might we want to consider a rosé in the summer?

Wine to Watch Kokomo Winery’s 2012 Grenache Rosé Pauline’s Vineyard, Dry Creek Valley The winery says, “Following a whole berry press, we maintained a cool fermentation in stainless steel which allowed us to retain the fruit’s natural character. Watermelon and strawberry make up the aromatics of this wine. The bright vibrant palate of strawberry juice with hints of minerality leads to a long, lingering finish.”

Recommended pairing: Rosé is the most versatile food wine so enjoy with most light summer fair.

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A: A rosé is a good choice for those wine drinkers out there who shy away from Chardonnay because they find them either too oaky or too buttery. If a Sauvignon Blanc is too acidic, or Riesling too sweet, rosé offers a nice crisp and refreshing profile with the depth that most people don’t expect out of a ‘pink’ wine . . . lol.

This is not Grandma’s White Zin! Q: Are there a few good rosés you can recommend?

A: K okomo Grenache Rosé Pinot Patch Rosé of Pinot Noir and Croze Rosé of Cabernet Sauvignon are all beautifully unique and balanced.

Q: What about pairings? Can we bring a rose to a barbeque?

A: R osé is extremely versatile, it’s perfect with almost any type of meal whether it be a fresh salad or something fresh off of the grill.It has the depth to accompany a complex dish or a simple meat and cheese plate.

Midwest Medical Edition

June 2014

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Never Frozen.

Always Fresh.

All Fish are 15% Off June 1 - June 30th, 2014!

Shop Cleaver’s Market for truly fresh fish, flown in every Tuesday and Friday. Our selection includes, but is not limited to: Faroe Island Salmon Grouper Halibut Manilla Clams Jumbo Scallops Prince Edward Island Mussels View the full list online at

cleaversmarket.com/seafood

605-271-6328

cleaversmarket.com

5009 S Western Ave.

Cleaver’s Catering Fun Summer Events

6-6:30 June 2nd - 10 Minute Meals Demo 4-7 June 12th Whole Hog Roast 4-7 June 18th 4 for Free Wine Ta sting 4-7 June 26th Whole Hog Roast Pork from Hog Roasts - $5.99/lb Take as much as you want!

605-271-6328 28

Enjoy unique, custom created menus for any budget by two certified culinary chefs.

Cleaver’s Market provides catering for:

Businesses

• Homes • Events

Private wine room and patio are available.

We welcome special requests!

cleaversmarket.com

5009 S Western Ave.

Midwest Medical Edition

Learning Opportunities

June – July June 6

Pulmonary Symposium

8:00 am – 4:30 pm

Location: Prairie Center, Avera McKennan Information: mckeducation@avera.org, 605-322-8950 Registration: www.Avera.org/conferences

Avera Sports Medicine Symposium 8:00 am – 4:00 pm Information: mckeducation@avera.org, 605-322-8950

June 13

Registration: www.Avera.org/conferences

Critical Care Symposium 8:00 am – 4:00 pm Location: Prairie Center, Avera McKennan

June 18

Information: mckeducation@avera.org, 605-322-8950 Registration: www.Avera.org/conferences June 20 – 21

36th Annual Sanford Black Hills Pediatric Symposium

7:00 am – 12:30 pm

Location: The Lodge at Deadwood Information & Registration: SanfordHealth.org/ClassesandEvents

September 5

Diabetes Symposium

8:30 am – 4:30 pm

Location: Sanford Center, Sioux Falls Information: Sanfordhealth.org September 12

Surgical Symposium

8:00 am – 4:30 pm

Location: Sanford Center, Sioux Falls Information: 605-328-3851, Jessica.johnson2@sanfordhealth.org September 25

Avera Cancer Institute 15th Annual Oncology Symposium

5:00 pm – 9:00 pm

Location: Sr. Colman Room, Prairie Center, Avera McKennan Information: mckeducation@avera.org, 605-322-8950 Registration: www.Avera.org/conferences

Log on to MED’s calendar to see the newest upcoming events or add your own.

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.

Jonathan Bleeker, MD, Paul Bjordahl, MD, Michele Lohr, MD, and Keely Hack, MD

The face of expertise THE FACE OF CANCER CARE Implementing the latest technology and innovative research, we guide patients from their first treatment to survivorship and beyond.

Cancer touches so many lives, from mothers to grandfathers to best friends. Theirs are the faces of cancer. And at Sanford Cancer Center, we are the face of cancer care.

We have brought together a team of experts who combine technology, personalized care and compassion like nowhere else in the region.

Our multi-disciplinary team works with patients to develop an individualized care plan to fit their needs throughout their entire cancer journey.

Choose expert care. Choose Sanford.

To refer your patient, call (605) 328-8000.

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