Stanford Health Care People - Spring 2015

STANFORD HEALTH CARE

A PUBLICATION PUBLICATIONFOR FOREMPLOYEES EMPLOYEESOFOF STANFORD STANFORD HOSPITAL HEALTH& CARE CLINICS ISSUE ISSUE ISSUE ELEVEN TEN SIX // WINTER SPRING 2015 2014

THE NEW STANFORD CANCER HUMAN CENTER RESOURCES SOUTH BAY EMPLOYEE AWARDS KUDOS OURCONSTRUCTION PATIENTS NOW

from the CEO

PAGE TWO News and Notes From Around SHC...

Dear Colleagues,

As the Stanford Cancer Center South Bay prepares for its first patients, it is a perfect time to take a behind-the-scenes look at the efforts that brought it all together. Designed with our C-I-CARE and Stanford Operating System principles literally from the ground up, the new facility will support patient- and family-centered care in a truly coordinated and comprehensive way.

Also in this issue you will find a spotlight on the Stanford Health Library, which is celebrating its 25th year of providing local and worldwide communities with evidence-based medical and health information. Moreover, you will also learn about the continued amazing work of our Comprehensive

We’re No. 1! In the most recent publicly reported patient satisfaction scores for our six-county region, Stanford Health Care topped the list in the “likelihood to recommend” category. To the question, “Would you recommend Stanford to your friends & family?” 87 percent answered definitely yes. That places SHC close to the 95th percentile in the nation … Join Team Stanford at 2015 Silicon Valley Kidney Walk on Saturday, June 6, at 10 am at Cityview Plaza in San Jose. We’re looking to bring a team of 100 SHC walkers, led by President and CEO Amir Dan Rubin, who is the Corporate Chair of the walk. Go to SHC Connect for more information … A ribbon-cutting and public ceremony is planned for June to officially launch the SHC-ValleyCare partnership, which was announced last fall.

ValleyCare, a leading community health system serving the Tri-Valley region of Pleasanton,

Livermore and Dublin for more than 50 years, will join the SHC family as a subsidiary of Stanford Health Care. Currently, ValleyCare has a total of 242 beds and a medical staff of over 400. Look for more information on SHC Connect in the upcoming weeks …The Yahoo Wellness Center, in partnership with Stanford Health Care, is now up and running at the Yahoo campus in Sunnyvale. The new health care center provides Yahoo employees with easy workday access to a wide variety of essential services, including doctor visits, basic testing and select on-site pharmacy services. Yahoo is SHC’s second corporate health program, joining Qualcomm in San Diego … SHC is opening its newest primary care clinic in the heart of Silicon Valley early this summer at 2518 Mission College Boulevard in Santa Clara. Stanford Primary Care Santa Clara will serve patients of all ages, from pediatrics to geriatrics.

Stroke Center, which was the first in the nation to be certified (and recently re-certified) by The Joint Commission.

As always, thank you all for everything you do to help heal humanity through science and compassion, one patient at a time.

STANFORD HEALTH CARE PEOPLE IS PUBLISHED BY

SHC OFFICE OF COMMUNICATIONS GARY MIGDOL EDITOR, DIRECTOR OF INTERNAL COMMUNICATIONS KATIE LIPOVSKY INTERNAL COMMUNICATIONS MANAGER GRACE HAMMERSTROM MANAGING EDITOR JAMES LARKIN DIRECTOR OF CORPORATE COMMUNICATIONS/PR

Sincerely, AMIR DAN RUBIN PRESIDENT & CEO

SARA WYKES CLINICAL AFFAIRS WRITER NORBERT VON DER GROEBEN PHOTOGRAPHY HIMANI SHARMA INTERN

Send comments and story ideas to communications@stanfordhealthcare.org

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ON THE COVER: (Left to right): Jacque McCoy, Clinical Operations; Patrick Swift, MD, Medical Director; and Tracey Laney, Southbay Oncology Hematology Partners, are just a few of the faces that will become familiar to patients receiving care at the Stanford Cancer Center South Bay.

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PUTTING PATIENTS FIRST

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New Cancer Center South Bay Brings Advanced Care to a Community Setting

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HEN THE NEW STANFORD CANCER CENTER SOUTH BAY OPENS ITS DOORS IN SAN JOSE THIS SUMMER FOR ITS FIRST PATIENTS, TRACEY LANEY, JACQUE

MCCOY AND CATHERINE KELLY WILL BE THERE WAITING. These three represent perfectly the new center’s determined blend of what

THE CANCER CENTER SOUTH BAY WAS DEVELOPED THROUGH THE COLLABORATIVE EFFORTS OF STAFF, PROVIDERS, PATIENTS AND FAMILIES. SHOWN HERE ARE SOME OF THE KEY CONTRIBUTORS TO THE NEW CENTER: KATE SURMAN (TOP LEFT), CATHERINE KELLY (TOP CENTER) AND DANIEL LAPORTE (LOWER LEFT).

could be called innovative familiarity in a partnership that incorporates a community-based cancer care clinic into Stanford Health Care’s traditional academic medicine setting.

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For nearly 20 years, Laney has been one of the first faces patients saw at the Southbay Oncology Hematology Partners clinic in Campbell, the long-time practice now joined with Stanford Health Care to care for people with cancer at the new Stanford Cancer Center South Bay, a 70,000-square-foot building near the intersection of Highway 85 and Los Gatos Boulevard.

“One of the first things our patients have asked us about the new Cancer Center is, ‘Are you going to be there?’”

Laney said. “We’ve developed relationships with patients— and that’s an important thing for them.”

McCoy, part of the new center’s clinical operations team, started work in that field at the Stanford Cancer Center Palo Alto in 2011 and moved into practice management at the Southbay Oncology Hematology Partners last year because she wanted experience with cancer care at a communitybased clinic. Now, she’ll be at the new Stanford Cancer Center South Bay with that expertise in both large and small scale medical clinics.

“Patients have told me they’re nervous about the new building, that they might get lost,” she said. “I want to be there for them to make them as comfortable as possible as we combine two settings into one.”

Before Catherine Kelly arrived to work as a nurse coordinator with the breast oncology group at the

“ We’ll have two ORs and will be able to do procedures like lumpectomies and simple mastectomies.”

Stanford Cancer Center Palo Alto, she came from a rural hospital in Sonora where she had established its oncology outpatient services. Being part of the new Stanford Cancer Center South Bay means she can help patients understand the opportunities this new Stanford cancer center hybrid can offer them.

“There’s research, access to clinical trials, specialized imaging and tumor boards,” she said. “We’ll have two ORs and will be able to do procedures like lumpectomies and simple mastectomies: For breast cancer patients, we’ll be able to provide care from mammography all the way through to survivorship in one location—right in their own community.”

THE faces OF CANCER CENTER SOUTH BAY Nurse Coordinator Sarah Dunlap, RN, is working with University HealthCare Alliance providers to transition hematology and oncology patients to the new facility. She’s looking forward to delivering interdisciplinary care in one location that facilitates collaboration between providers and offers patients a cohesive, convenient treatment plan.

Sarah Dunlap, RN Nurse Coordinator

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“There’s nothing more patientcentered than removing a physical barrier to care. Our patients primarily live in the San Jose area. We recognize that many people want to go to Stanford but are unable to make the long drive from their homes, especially on a regular basis as required for cancer treatment. Having Stanford cancer facilities in Palo Alto, Redwood City and San Jose widens the pool of people who can receive our services.”

Doug Olson Senior Project Manager For the past two and a half years, Doug Olson has facilitated planning, design and documentation for the facility, and continues to oversee its construction. Olson, who’s been involved in health care design for 25 years, says that this project is the most sophisticated one he’s worked on in terms of its patient-centered integration.

“It co a en m ca te a pa ca ex an be ex B th

Taking Stanford’s high-level, comprehensive cancer care beyond its Palo Alto base has been the primary goal of the project, said Sridhar Seshadri, Vice President, Cancer Services. “As the incidence of cancer grows and more and more people are being diagnosed with cancer, Stanford has wanted to take its expertise beyond the main campus. We saw the Southbay Oncology Hematology Group as a perfect marriage: Many of them are Stanford trained, they’ve been in practice for many years and they have a strong reputation. And we wanted to learn from them as we bring our practice to the community.”

The new Stanford Cancer Center South Bay also gave Stanford an important opportunity to apply its philosophy of patient and family centered care—one designed in partnership with patients, frontline staff and physicians.

The new center’s features—operational, physical and cultural—reflect the experiences and ideas of Stanford’s Patient and Family Advisory Council and from the newest chapter of that group based at the new Cancer Center South Bay. All of these features work to reduce the number of steps and stops that patients will make in the course of their visits. Some of them also represent what may one day be part of every Stanford clinic. They include a locating system that will tell staff if patients have been waiting in an exam

“It’s rare to see such a commitment to provide a fully integrated care environment, one which merges advanced clinical care practices and technologies supported by a design that dignifies the patient. The entire patient care pathway, from wellness exams to complex diagnosis and treatment, can all be done in one place. It’s exciting to be part of South Bay because you’re seeing the future of health care.”

room for more than 10 minutes; exam rooms with two doors to allow a patient to come directly from the waiting area and medical teams to come directly from their work area to foster an on-stage/off-stage healing environment; and universal, one-time registration to eliminate repeated check-ins as a patient moves from one location to another in his or her appointment schedule.

The building also reduces the need for patients to move from one floor to another by consolidating certain services on one floor: The fourth floor, for example, was designed to match the patient journey by co-locating services that are frequently visited together and will contain a clinical lab, medical oncology clinic and an infusion treatment center with an internal pharmacy; the third floor will combine exam rooms, procedure rooms and a Health Library; the second floor will house pathology, sterile processing, the ORs and specialized radiology (mammography, ultrasound, x-ray, film library); the first floor will have additional radiology services (MRI, CT, PET-CT), radiation therapy services and a café.

Support services will also be available at the new center.

Patients won’t have to travel elsewhere to attend a support group meeting or to talk with a social worker, a nutritionist or someone from the palliative care team. The most

As part of a core team tasked with the design, planning and implementation of the new Cancer Center South Bay, Blake Herring has been directly involved in equipment selection and the procurement process, and has worked closely with clinic operations leaders to develop new processes and workflows. Come July, he will oversee daily clinical operations in partnership with colleagues throughout the organization.

Blake Herring, BSN, RN Director Clinical Operations

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“The co-location of departments the patient will be visiting is a great example of the forethought that went into the design of this patientcentered space. The medical oncology clinic, clinical lab, infusion treatment center and pharmacy are all located on the fourth floor, so a patient who is receiving chemotherapy will only need to visit one floor for the entire day, rather than travel between several separate locations. A patient can go from diagnosis to survivorship all within the new Cancer Center.”

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unusual and innovative feature at this new center is the role played in the hiring process by its Patient and Family Advisory Council, said Kate Surman, Administrative Director, Stanford Cancer Center South Bay. The center’s more than 200 employees, even those who won’t work directly with patients, will all have been interviewed by a Patient and Family Advisory Council member as part of their hiring process.

“We are making patients and their needs our highest priority,” Surman said, “and we are shaping the culture at this new center so that everyone, even those who are not involved in direct patient care, understands the importance of, and is recognized for, their role in patient care.”

All of these features, and others focused on revised data technologies to reduce duplication of tests and speed care delivery, are aimed at a new form of care that bridges the warmth and familiarity of a community care model with the advanced care usually found only at academic medical centers—and places that care in a convenient local setting. “It’s very forward thinking,” said Patrick Swift, MD, Medical Director, Stanford Cancer Center South Bay, “and it will be a dramatic change for patients.”

Jennifer Friedenbach, RN Clinical RN, OR Nurse

Jennifer Friedenbach brings a unique perspective to her work–that of family caregiver and employee.

A former CPA, she was inspired to become a nurse after managing end-of-life care for three family members. She’s been with Stanford for the past eight years in inpatient oncology/hematology and the surgical intermediate ICU. She is looking forward to bringing her background in education, chemotherapy and surgical recovery to the outpatient setting.

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Q&A

WITH GAY CRAWFORD

GAY CRAWFORD, KNOWN FOR HER INVOLVEMENT IN ADVOCACY FOR CANCER PATIENTS, IS A TWO-TIME CANCER SURVIVOR. A FOUNDER OF CANCER CAREPOINT, HOSPICE OF THE VALLEY, THE AMERICAN CANCER SOCIETY’S COURAGEOUS KIDS DAY AND THE CALIFORNIA CANCER REGISTRY, SHE IS NOW THE FOUNDING CHAIR OF THE CANCER CENTER SOUTH BAY’S PATIENT AND FAMILY ADVISORY COUNCIL.

“I am excited for our patients who will receive top-quality treatment and medical appointments in one familiar location close to home. When facing a cancer diagnosis, families are overwhelmed by all the appointments, information and specialists involved in caring for their loved one. The supportive wrap-around care available through the CCSB will be a valuable asset for patients and their families as they work to balance their busy lives and obligations.”

Daniel Laporte is bringing his expertise in setting up pharmacies at the Stanford Cancer Center and the Redwood City ITA to his new role as Pharmacy Supervisor at Cancer Center South Bay. Laporte is helping to operationalize the pharmacy at the new Cancer Center, which includes two operating rooms requiring anesthesia medications.

Laporte will be onsite in July to oversee daily operations of the pharmacy, including inventory and regulatory requirements, as well as managing, training and coaching technician staff.

Daniel Laporte, CPHT Pharmacy Technician Supervisor

“T al th m w fa pa th ‘on pa

What is your personal experience with cancer? I was diagnosed with breast cancer at age 30. I had a two-year-old and a baby, and the standard treatment at the time was to do a radical mastectomy. I searched for a physician who would do a modified radical and learned early on you have to become your own patient advocate. At age 60 I was diagnosed with Non-Hodgkins Lymphoma.

How did your experience with cancer influence your community involvement? Cancer and advocacy have consumed the larger part of my life.

Where I have seen a need, I have helped found programs to meet those needs. In 1975, I got involved in the American Cancer Society Reach to Recovery program, and since then I have been involved in just about every cancer program in Silicon Valley and at the state and national levels of the American Cancer Society.

Why did you join the Patient Advisory Council? My journey with the building began in 2009, before it was even built. I worked with the landlord, Samaritan Medical Center, to develop a first-class cancer center. CancerCAREpoint held focus groups with over 200 community members.

Those patients’ wishes for a community cancer center became part of my hopes. When Stanford leased the building, I felt the Advisory Council was a great way to share the conclusions from the focus groups.

What is the role of the Patient and Family Advisory Council?

Our goal is to help bring community understanding and resources to the Stanford brand, which includes excellent clinical care, clinical trials, support and programs. Our members have been involved in advocating for patient navigators, universal registration, patient flow, patient locating, parking and drop off, exterior and interior signage, furniture, café seating, telephone tree and artwork. One of the most unique aspects of our role has been to participate in employee interviews. Our role has been to explore the candidate’s understanding of patient-focused care.

What aspects of the new Cancer Center are you most excited about from a patient’s perspective? I am most excited that the Center will bring one-stop, world-class comprehensive patient care, including clinical trials, to our South Bay cancer patients and families.

“The Cancer Center South Bay allows patients who live in the vicinity to get their treatment needs closer to home without having to travel very far. This will greatly increase patient satisfaction. I hope that CCSB will become the ‘one-stop shop’ for all of our patients’ treatment needs.”

Katie Abbott Senior Program Manager, Business Operations Katie Abbott is a member of the Cancer Center South Bay’s Leadership team involved in the building’s physical infrastructure design, operations planning and management, and helping to set the tone for a culture of patient and family centered care. She is also staff advisor for the Center’s Patient and Family Advisory Council, partnering with PFAC members on aspects of the building’s design, operations and patient flow and staffing. When the building opens, her role will shift to day-to-day operations management with oversight for nonclinical areas.

CCSB

BY THE NUMBERS

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OPERATING ROOMS AND PRIVATE INFUSION BAYS

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IMAGING MACHINES, INCLUDING CT, MRI, PET CT, LINAC, X-RAY, MAMMOGRAPHY, ULTRASOUND, C-ARM AND GAMMA CAMERA

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DUAL-ENTRY EXAM ROOMS

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INFUSION STATIONS

~30

COMMUNITY / UHA ONCOLOGISTS AND STANFORD PHYSICIANS

“As someone who has lost a parent to cancer, I am grateful to have the opportunity to impact the way cancer care is delivered in the South Bay for years to come. The partnership between leading edge academic medicine, the South Bay community and its physicians and the patient and family voice is creating something truly different.”

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FOCUS ON Stanford Stroke Center As the Stanford Stroke Center celebrates National Stroke Awareness Month in May, Director Greg Albers, MD, has a message to share—“The outcomes for stroke have never been better.”

Twenty years ago, Stanford revolutionized stroke care by integrating neurology, neurosurgery and interventional neuroradiology—a concept that at the time was unprecedented. Today integrated care is the standard necessary to meet the clinical demands of the most complicated stroke patients.

Stanford was also the first hospital in the nation to receive comprehensive stroke center certification in 2012 and was recertified at this highest level last fall.

At the foundation of the program’s success is the collaboration of its three founders—Albers, Michael Marks, MD, and Gary Steinberg, MD, PhD. Together, they lead a team of neurologists, interventional neuroradiologists and neurosurgeons, who work closely with nursing, rehabilitation, emergency medicine, social work, pharmacy, laboratory and nutrition to provide advanced stroke care to patients.

This teamwork is never more evident than when a stroke code is called at Stanford. Within minutes, a neurologist, ED physician, specialty nurse, lab technician, pharmacist and registrant meet patients in the ED or ambulance bay to quickly assess, register and transfer them to CT. Rapid transfers and fast door-to-treatment 8 / STANFORD HEALTH CARE PEOPLE

WHEN A STROKE PATIENT ARRIVES AT STANFORD, AN INTERDISCIPLINARY TEAM OF PROVIDERS QUICKLY DEPLOYS TO THE ED TO CARRY OUT A FINELY ORCHESTRATED STROKE PROTOCOL—RAPIDLY REGISTERING PATIENTS, ASSESSING THEIR CONDITION AND TRANSFERRING THEM TO CT AS QUICKLY AS POSSIBLE.

“The number one thing we know is that we need to treat the right patients safely and quickly.” times are hallmarks of this program, which uses advanced MRI techniques and CT perfusion imaging to guide treatment decisions.

“We have been working hard to optimize patient care here in the hospital,” says Mary Brethour, RN, Stroke Coordinator. “We’re very proud of the significant improvement in our door-to-CT and our door-to-needle times.”

Both Brethour and fellow Stroke Coordinator Stephanie Casal, RN, CNS, are part of an interdisciplinary team that meets monthly to continuously improve the patient care process. One of its current initiatives is to shorten doorto-treatment times even further. “The number one thing we know is that we need to treat the right patients safely and quickly,” says Casal. “Time is brain. Our first goal is to minimize damage to the brain and then to optimize recovery.”

As a key participant in major stroke clinical trials, the Stanford Stroke Center also helps advance discoveries in stroke prevention, treatment and recovery.

CARM A LIB MAIN THE

FOCUS ON Stanford Health Library For 25 years, Stanford has employed a team of medical sleuths who quietly comb databases, medical journals and books and provide patients and families with evidence-based information about their health and medical conditions.

They are not doctors. They don’t offer diagnoses or medical advice. But the staff of the Stanford Health Library provides a critical role to the patient care team—helping people make informed decisions about their health care.

According to Director Nora Cain, the Stanford Health Library opened at a time when the patients’ rights movement was in its infancy, when the medical community still believed that medical information should reside in

CARMEN HUDDLESTON, A LIBRARIAN AT THE MAIN HOSPITAL FOR THE PAST SEVEN YEARS.

the hands of clinicians. Not only has that thinking changed; the library itself has transformed.

Celebrating its 25-year anniversary this past fall, the program has expanded from its first location at the Stanford Shopping Center to four branches—the Main Hospital, the Cancer Center, Hoover Pavilion and the Ravenswood Community Health Clinic. In July, a fifth branch will open at Cancer Center South Bay. In 2014 alone, Stanford Health Libraries served 15,740 patrons in person, on the phone or through email.

“We really hope our patrons’ interactions with our librarians will facilitate a more productive interaction with their caregivers,” says Cain of the free consumer health resource for patients, families and the general public.

Patients often stop by the library right after learning a diagnosis. Others search the library’s online repository of health and medical information or call one of its professionally trained librarians to conduct more advanced research.

“Because patients today are used to conducting Internet searches for basic medical information, they want more

DIRECTOR NORA CAIN HAS BEEN WITH THE STANFORD HEALTH LIBRARY FOR 23 YEARS.

“Because patients today are used to conducting Internet searches for basic medical information, they want more in-depth information from us than they did in the past.” in-depth information from us than they did in the past,” says Carmen Huddleston, a librarian at the main hospital for the past seven years. “We have subscriptions to databases and access to more information than what’s available for free on the Internet.”

The Stanford Health Library also shares the expertise of clinicians and researchers through its free evening lecture series, which are now available remotely via webcast or on Stanford’s YouTube Channel.

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KUDOS January Service Spotlight Award

DULCE MORENO Dulce Moreno has exemplified SHC’s commitment to providing exceptional care, one patient at a time. During her tenure here, she became a lifeline for a patient battling advanced lung disease who only spoke Spanish. Moreno assisted the patient with appointments, frequent calls of concern and her progressively worsening illness. Moreno made a difference by forming a caring relationship with the patient and her family, and became a friend to this family for life.

February Service Spotlight Award BARBARY GRANT When a nurse asked long-time hospital musician Barbary Grant if she would play at the bedside of a patient whose death was very near, she did not hesitate, even though she had finished her shift and was leaving for the day. The nurse told Grant that the patient’s family was Irish, and Grant began to play Celtic music on her harp. Grant asked the family if she could sing the Lord’s Prayer in Irish Gaelic. They agreed. Grant sang it in its traditional setting, without instrumental accompaniment. The sadness that filled the room was still there, but somehow the music

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transformed it. The emotions surrounding transition seemed to be acknowledged and honored. Grant has shown a consistent willingness to go the extra mile and to be depended on whenever she is needed at Stanford Hospital, regardless of her busy outside schedule. Over the years, she has brought comfort to many patients, visitors and staff.

discernible pulse. Nicholson and Krane began CPR. “Nicholson was simply amazing in her performance in this tragic, gruesome and intense situation,” Krane said. “She was calm, professional, knowledgeable and skilled.

Soon after we started CPR, the interior of the wreckage into which we reached filled with the strong smell of gasoline, and I know we were both worried it might ignite. Yet she stayed and continued rescue efforts.”

February Patient Safety Star Award DIANE DEVITO

March Service Spotlight Award

While admitting a patient for surgery, Diane DeVito noticed that the patient was in an intermittent irregular heart rhythm.

Anesthesiologist Ray Esaki said DeVito may have saved the patient’s life.

“With a careful and excellent clinical acumen, she picked up on a clinical arrhythmia that otherwise would have been hard to realize preoperatively.”

NORBERT VON DER GROEBEN

March Heroes Healing Humanity Award SARA NICHOLSON, RN Sara Nicholson, RN, clinical nurse, E1, was honored this month with the Heroes Healing Humanity Award.

Nicholson was nominated by Elliot Krane, MD, a Stanford professor of anesthesiology, who happened to be in his car at the same Menlo Park intersection as Nicholson when they witnessed a horrific accident. A Caltrain express had slammed at high speed into an automobile stranded on the tracks. Nicholson ran from her car to help the driver trapped in the wreckage. Krane followed seconds later. The driver, a young woman, had no

Norbert von der Groeben, whose very tall and camera-draped figure has been a familiar sight at SHC since 2008, is the recipient of the March Service Spotlight award. In his journeys throughout the hospital, he has taken more than 50,000 photographs, all while practicing the core values of C-I-CARE in the most natural and compassionate style.

With a confident gentleness, he instantly puts others at ease. He even carries C-ICARE badge cards with him to give away if someone is in need. He is a natural ambassador for SHC.

March Safety Star Award JENNIFER MINOR Jennifer Minor, RN, D3, caught a discrepancy between a scanned label on a medication and the actual medication that earned her March’s Safety Star Award. It also prompted an organizationalwide review to determine our current process and what additional initiatives could be utilized to improve upon patient safety.

GOOD WORKS At SHC Discharging Patients Two by 11 Discharging patients by noon remains a key strategic initiative to improve access to care at Stanford. As part of the Patient Flow Value Stream initiative, Team Care Rounds were enhanced on the medicine units B1, B2, B3 and C3 last October and now include full patient care teams huddling daily to review the plan of care and patient progression.

As facilitators for these new Team Care Rounds, the nurse case management team has adopted lean methodologies and redesigned its workflows to support this effort. Every morning, case managers huddle to review meaningful metrics such as daily census and expected discharges.

They also look at operational readiness.

Where are the hot spots? Who’s flex?

Who needs support?

“Huddles provide an avenue for active problem solving and escalation of key issues,” says Carolyn Hronik,

RN, Manager-Care Coordination. Her team is responsible for coordinating discharge planning and progressing patients through the hospital system.

“This coordination is very important to make sure the hospital and nursing staff can meet the discharge by noon target of 40 percent,” she adds.

To further promote earlier discharges, case managers have partnered with nursing to implement the “Two by 11” approach. In daily huddles, nurses identify two patients who can be discharged by 11 the next day. Case managers track these patients to improve patient flow.

Through the introduction of Team Care Rounds, and the coordinated efforts of case managers and nursing staff, the medicine units experienced a high of 38 percent of discharges before noon as of mid-April.

In the Community Singing for Charity What if you could pursue your passion and raise money for charity at the same time? That’s what Whitney Greene has discovered she can do.

The Director of Business Development for Cancer Services, Greene is also an accomplished amateur singer. For the past four years, she’s performed

CAROLYN HRONIK, RN (RIGHT), HOLDS DAILY HUDDLES WITH HER CASE MANAGEMENT TEAM TO FACILITATE EARLIER PATIENT DISCHARGES.

WHITNEY GREENE RAISES FUNDS FOR CHARITY BY SINGING IN THE SING FOR AMERICA CHOIR.

with a nonprofit organization called Sing for America, an all-volunteer choir that raises money through membersupported benefit concerts. Sing for America helps members like Greene raise charitable funds through singing.

Greene grew up in a home dominated by music. Her mother, a professional singer, spent 40 years performing as part of large symphonic choirs in Washington, DC. “From the time I was two, I was brought to the Kennedy Center to see my mom sing,” says Greene. “It kind of got in my blood.”

Those childhood memories, plus a musical gift, have fueled Greene’s love of singing—a passion she is putting to doing good work with Sing for America.

Through her singing, Greene has raised $4,000 for charity.

“So much of my love of music is because of my mom,” says Greene. “I want to be able to give back.”

Each January, Greene joins other members of the Sing for America choir every Monday night for a two-and-ahalf-hour rehearsal, culminating in the benefit concert in April at the Palace of Fine Arts. At this year’s event, Greene and her mom traded places—with Greene onstage while mom watched proudly from the audience.

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OUR PATIENTS NOW

Triathlete back to surfing, biking, kiteboarding and climbing Kirsten Curtis is not the kind of person who complains much about her physical ailments: She describes herself as extremely active— she’s a triathlete who also surfs, mountain-bikes, kiteboards and skis. She has grown accustomed to the aches and pains that occur naturally with that level of physical activity.

When she came home from a 10-day surfing trip in December 2013 and noticed that she was having trouble doing sit-ups, she wasn’t alarmed. “I had done a lot of surfing on that trip—and I figured this is what happens to you when you come to your 30s,” Curtis said.

Near the end of January, however, a new set of symptoms appeared. Her right arm, from her forearm to her hand, swelled up and turned red. By the next morning, “my bicep had swollen to the size of my head,” she said. “I thought maybe a vein was blocked and I knew this could be something serious.”

Her symptoms increased: extreme fatigue, pain and weakness in her arm, and blurred vision.

By the time Curtis came to Stanford vascular surgeon Jason T. Lee, she was concerned she might lose full functionality of her arm. To Lee, Curtis’ symptoms were familiar: He is a nationally recognized expert in the diagnosis and treatment of a condition called thoracic outlet syndrome (TOS).

TOS symptoms and treatment are often delayed.

TOS is often seen in elite athletes, but it also occurs in anyone who overuses his or her arms in a repetitive motion that can lead to the compression of nerves or blood vessels, or both, in the thoracic

outlet—an area bounded by the base of the neck and the first rib, the one closest to the clavicle.

Diagnosis of TOS is not always straightforward, and the treatment options are sometimes even more controversial. “There’s no one blood test or radiographic test or physical exam finding that confirms the diagnosis,” Lee said. “This makes TOS challenging to diagnose and treat.”

Lee told Curtis that he could remove part of her right side’s first rib to relieve the undue pressure it was putting on a nearby vein—and prevent future episodes of clotting in that area that could worsen Curtis’ symptoms. Since her April 2014 surgery, Curtis hasn’t looked back. Three months later, she was kiteboarding.

At five months after surgery, she was surfing again.

Six months out, she summited the 14,505-foot peak of Mount Whitney, the highest mountain in the contiguous United States and the Sierra Nevada. Seven months post-surgery, she had climbed to the 18,000-foot level of Mount Everest Base Camp in Nepal. Now 33, Curtis is training for a half Ironman triathlon.

One thing has changed, she said. “I am more likely to pick up on little signs that tell me, ‘Don’t push it.’ I’ve learned to listen when my body tells me something.”

Find more patient stories at stanfordhealthcare.org/now.