LiveWell Magazine, Marshalltown - Winter 2023

PATIENT GRATEFUL AFTER LIFE-SAVING ACTION BY CONRAD CLINIC

WHAT DOES AN OB/GYN OUTREACH CLINIC DO?

SMALL TOWN ER, BIG TIME VOLUME

CITY BOASTS UNUSUALLY BUSY LEVEL IV TRAUMA CENTER

unitypoint.org/marshalltown

For life-threatening (or serious) situations, get to the EMERGENCY DEPARTMENT.

The EMERGENCY DEPARTMENT is equipped to handle things that require rapid or advanced treatment, and we’ll prioritize serious situations over less-serious ones (called “triaging”).

Our UNITYPOINT CLINIC – EXPRESS location sees less-serious issues like cough and cold, sprains, minor lacerations, minor fractures and such.

A Note from Shari

Friends, we’re coming up on a year that we’ve been in our new hospital, and I’m happy to report the fit has been a great one. Indeed, there were growing pains as we adjusted to a more compact floorplan and new processes, but the new facility has proved to be everything we had hoped.

Once we’d moved in, our focus shifted to refining things – the patient experience, communication, efficiencies and more. One of the top boxes we checked off was the accreditation of the hospital by our new quality management system, Det Norske Veritas (DNV), which occurred in October.

Our accreditation by DNV demonstrated that we’re meeting or exceeding patient safety standards set forth by the U.S. Centers for Medicare and Medicaid. It’s a major marker for any hospital, and it was especially important for us as we continued to adjust to our new facility. As required by the accreditation process, DNV will continue to make intermittent visits to our facility, and it’s a process we welcome as we continually reaffirm our commitment to patient safety.

Another point of emphasis for us continues to be educating the community about where to go for their care. These are challenging times in health care. In the wake of the COVID-19 pandemic, the entire industry is continuing to balance the attrition and burnout of healthcare workers with increases in illness and injury.

One of the ways we can all collectively manage this better is to gain a fuller understanding of what kinds of symptoms and injuries are seen by family medicine, urgent care and the emergency room. As you know, each of these performs a different type of service, and it’s in everyone’s best interest if we direct our care to the most appropriate place. It helps patients curb wait times, and it allows our team members to be more responsive.

This is a message we’ve delivered for several years now, and you’ll see more of it in this magazine and other places. Please know you and the rest of the community can help us manage patient volumes by seeking care with the most appropriate clinic or department. Beyond that, enjoy what the rest of this magazine says about our amazing team members. Check out the article on pages 2 and 3 about our busy Level IV trauma center. Also, read the story on pages 4 and 5, which features a life-saving response by our team in the Conrad family medicine clinic.

Finally, allow me to thank both our teams and the community for helping make the past six years so transformational. UnityPoint Health stepped in to take over a bankrupt hospital, and now boasts entirely new facilities and the backing of the state’s strongest health system. It’s been remarkable to watch it all come together.

Please stay safe, everyone, and we’ll be here if you need us.

Sincerely,

Shari King Administrator, UnityPoint Health – Marshalltown

IT’S BEEN REMARKABLE TO WATCH IT ALL COME TOGETHER.

SMALL TOWN ER, BIG TIME VOLUME

When it comes to emergency departments, there’s a perception that smaller towns equal small volumes. Jeff Gilchrist would beg to differ.

Gilchrist, RN, the Trauma Program Supervisor at UnityPoint Health – Marshalltown, says that just isn’t the case in his hospital.

“I think many people consider Marshalltown a ‘small town,’ where very little goes on,” says Gilchrist. “But when I tell them the numbers we see, they’re really surprised. Some here call us ‘Little Big Town’.”

Scott Richard agrees – and would know. As a certified flight paramedic with LifeFlight, he’s been a full-time paramedic for 26 years, having filled that role as a firefighter, with ERs, SWAT teams and more throughout Iowa and Minnesota.

“Marshalltown’s ER is definitely one of the busiest that LifeFlight responds to,” he said. “We get a significant number of patients we fly from there who are very sick and injured – gunshot wounds, car accident victims, agricultural trauma patients, severe infections, heart attacks, strokes, COVID-19 patients and much more.

“I’m continuously impressed with how talented and dedicated the ER staff is there. I actually live in Marshalltown, and I would feel completely confident going to that ER or bringing any of my family members there for medical care.”

The trauma team at UnityPoint Health is especially busy for a community the size of Marshalltown.

NOT EVERY ER IS A TRAUMA FACILITY

To be clear, not all emergency departments are considered trauma facilities, as they must meet stringent requirements to keep their status. A typical ER treats a variety of situations, ranging from non-life-threatening injuries to potential heart attacks and strokes. A trauma center is equipped to handle serious incidents like traumatic brain injuries, gunshot and stab wounds, car accident injuries, blunt trauma and more.

There are four levels for trauma centers in Iowa, and there are only two with Level I status: Iowa Methodist Medical Center and the University of Iowa. For perspective, UnityPoint Health – Blank Children’s Hospital in Des Moines is a Level II, UnityPoint Health – Allen Hospital in Waterloo is a Level III, and Marshalltown’s ER is a Level IV. For local emergencies, Marshalltown’s ER should always be the first call and patients can be transferred to larger trauma centers from there, if necessary. “We may not be a large metro area, but we often times see cases that large metro hospitals see,” Gilchrist says.

THE REASONING BEHIND THE RESULTS

The reasons for the volume can range from geography to demographics. For instance, Tama (including the Meskwaki nation) is one of a handful of counties in the state that doesn’t have its own hospital. As a result, Marshalltown is often the nearest option.

“Marshalltown serves a diverse population in a large geographical area,” explains Sarah Dolash, RN. “We see everything from high-speed car accidents to agricultural injuries. We also have several venues that host large events in the area, which can create a huge challenge in how we manage our resources.”

Sarah points to the motocross weekends Marshalltown hosts. It’s a high-speed, high-risk sport, and an event like that can impact the volumes and wait times in the ER.

“We’re almost guaranteed to get several patients from that event,” Dolash added. “Many of the injuries are minor, but some are major and require quick evaluation and care. We often have to do more with fewer resources than larger trauma centers, and one of these patients can quickly consume our resources.” With its usual numbers, plus a move to a new hospital, 2022 was another busy year for the ER in Marshalltown. It was also a notable one, as the trauma program underwent a reverification process that resulted in zero deficiencies.

“That’s a huge deal,” says Gilchrist. “Not a lot of hospitals can say that they had zero deficits in their reverification.”

TRAUMA CARE IS TEAM EFFORT

Gilchrist attributes the success of the trauma program to the rapid trauma response of the team, which is led by Dr. Sarah HemmingMeyer (pictured left), the medical director of the ER and its trauma program.

“The paramedics and EMTs here are top notch,” Gilchrist says. “They’re the ones who often call the helicopter from the field and get it headed this way. That keeps the ER length of stay shorter and gets the trauma patient to a higher level of care (the Level I and II facilities).

When a trauma alert is called, all ED staff take steps to prepare for a coordinated effort and hand off from the paramedics and EMTs. Team members from laboratory, radiology and respiratory therapy also respond.

“I tell everyone that trauma is a team effort, and that’s why the response here is so good,” Gilchrist says.

“We have so many amazing team members,” Gilchrist says. “All our nurses are TNCC (Trauma Nursing Core Course) trained. This is our foundational trauma nursing course we keep and maintain every four years. Plus, all our physicians, physician assistants and nurse practitioners in the emergency department are required to take ATLS (Advanced Trauma Life Support).”

In January, UnityPoint Health hosted a Rural Trauma Team Development Course in Marshalltown. It’s a world-wide course founded and created by the late Dr. Thomas Foley, a Marshalltown trauma surgeon who helped train many other trauma surgeons currently practicing at Unity Point Health – Methodist.

Patient Grateful After Life-Saving

It was a simple, one-page note delivered with treats, but Rick Eckerman’s short message said it all.

The UnityPoint Health Family Medicine clinic in Conrad saved his life.

It was September, and Rick was at home when he felt chest pain and began sweating profusely. He went to see his primary care provider at the Conrad clinic two blocks away.

Rick typically sees Dr. Steve Scurr. Today, a friend, Tim Cooper, PA-C, was in the office instead. Tim quickly assessed the situation, smiled at Rick and asked gently, “Well, was it in your plans to have a heart attack today?”

The clinic jumped into action. The team took his vitals, performed an EKG and administered nitroglycerin, which helps widen blood vessels to allow blood to get to the heart. The clinic also summoned a UnityPoint Health – Marshalltown ambulance along with BCERTS (local first responders) and the decision was made to get Rick to the cath lab at UnityPoint Health – Allen Hospital in Waterloo. “One of the local first-responders said, ‘You want a chopper?’” Cooper recalls. “I said, ‘Yeah, if it’s possible.’”

Rick Eckerman (second from left) credits provider Tim Cooper, the rest of his Conrad clinic and local first-responders for his life-saving care.

“When the ambulance crew got there, let’s just say they knew exactly what to do, every step of the way,” Rick remembers. “They were very precise in everything they were doing.”

“We took a look at the initial 12 lead (an electrocardiogram) and saw what appeared to be a STEMI (a heart attack involving a completely blocked coronary artery),” said Kyle Enderton, a paramedic with UnityPoint Health in Marshalltown. “We took a second 12 lead, and I found the patient to now be in AFib with the same posterior STEMI being shown. This was a serious sign.”

In a matter of minutes, a helicopter was on the ground near the fire station in Conrad and airlifted Rick to Waterloo.

“Once we were on the ground at Allen, people were all over us,” Rick remembers. “Dr. (Joud) Dib did the angiogram, and they scheduled me for surgery. I ended up having five bypasses.

“I’d forgotten Allen was a teaching hospital, so there wasn’t any lack of attention given to me on the cardiac floor,” he said. “People were coming in all the time to check on things. The staff was very knowledgeable, very informative, very kind, very precise. I haven’t spent a lot of time in hospitals, but I was thoroughly impressed with the level of care and professionalism I received.”

Three days after surgery, Rick was discharged and resumed his recovery with the cardiac rehab program at Grundy County Memorial Hospital, another UnityPoint Health facility.

“I almost look forward to going to rehab, Rick says. “No. 1, I know it’s helping. But No. 2, Brandy (Tripp), Krystle (Primus) and Erika (Leonard) are so nice, professional, attentive, knowledgeable and caring.”

These days, Rick is well on his way to a full recovery, and there are many people he wants to thank.

“My wife, Mary, and I had a charcuterie board put together and delivered it to the clinic with a note,” Rick said. “All the employees came out, and we kind of had a group hug and shared some tears.

“We’re a little more local here. Being smaller town, most everyone knows everyone else and what they do. You probably have more of a personal attachment here than what you might find in bigger cities. Plus, my mother was an RN for all her working career, so I have the utmost respect for the medical community and what they do.”

Rick’s follow-up visit and note was the real treat for the Conrad clinic.

“I’m so proud of this clinic, the quick response from BCERTS (Chris Harris and Mike Purvis) and the ambulance team,” said Clinic Administrator Crystal Anderson. “Things get super stressful, but this is why we do what we do – and what helps keep us going.”

“There are a lot of moving parts in health care,” Cooper summed up, “but I do believe the system saved his life, or at least preserved his heart function.”

HEART DISEASE FACTS

46%

116.4 million (46%) of U.S. adults are estimated to have hypertension.

Someone in the U.S. has a heart attack every 40 seconds.

About 697,000 people die of heart disease in the U.S. every year, that's 1 in every 5 deaths.

45%

#1

Heart disease is the leading cause of death for men and women.

By 2035, more than 45% are projected to have some form of cardiovascular disease.

Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention; 2022. Accessed February 21, 2022.

Why EVERYONE Should Have a Primary Care Provider

Some people question the need for a primary care provider. After all, you don’t need a doctor until you’re sick, right?

Actually, this isn’t a wise way to approach your health. A primary care provider (sometimes called a PCP or family medicine provider), serves as a starting point when exploring health issues. It’s important because this provider develops a long-term relationship with you and keeps tabs on your health history, while providing basic services like routine health screens and immunizations. In a proactive way, this helps keep you healthy, while also keeping an experienced provider on the ready if something goes awry.

Now, can your PCP identify and solve every issue?

No, and that’s when you’re referred to a specialist. Still, the idea is to catch little problems before they become big ones. Or perhaps even stop small issues before they begin.

The statistics “back it up”, and that’s how we know that seeing a PCP regularly leads to better long-term outcomes.

Don’t have a primary care provider? We have a growing list of providers, and most are accepting new patients. Call the clinic that’s most convenient for you.

Nguyen, MD India Chapman, PA-C Jaime Hooley, PA-C Abbie Sharp, ARNP

Amanda Konz, ARNP Sherry Parks, PA-C

Sherri Stebniski, PA-C

Where to Go for Care Guide

IS YOUR ILLNESS OR INJURY LIFE-THREATENING?

YES

EMERGENCY DEPARTMENT

NO

Require rapid/ advanced treatment? The ER sees issues like stroke/heart attack symptoms, head trauma, trouble breathing, severe bleeding and loss of vision. Note: we prioritize serious issues over less-serious ones.

Can your illness or injury wait? Call a family medicine clinic, as it’s often best to see a provider who knows you and keeps tabs on your health.

Care can’t wait? Our Express clinic is open 365 days a year for less-serious issues like cough and cold, sprains, minor lacerations and fractures.

Care is as close as your nearest device. Visit unitypoint. org/clinics/ virtual-care and choose Virtual Urgent Care or SmartExam.

MultiSpecialty Clinic Welcomes OB/GYN Outreach, But What Does that Mean?

As a certified nurse midwife, Josie Rutherford notes that expecting mothers have at least 13 prenatal appointments, and that doesn’t include ultrasounds, labwork or additional testing. That’s why it was important to give Marshalltown residents options for prenatal care close to home, in addition to routine women’s health services.

Thanks to a partnership with UnityPoint Health – Grinnell, obstetric and gynecological appointments are now available on Tuesday mornings in the MultiSpecialty Clinic located inside the new UnityPoint Health hospital in Marshalltown. New and existing patients can make appointments for OB/GYN visits by calling (641) 236-2905 and asking to be scheduled at the Marshalltown clinic.

But what does this mean for women? With this partnership, women’s health and obstetric providers make visits to Marshalltown on a weekly basis. Specifically for expecting mothers, they can have prenatal and postpartum appointments, some ultrasound appointments and OB lab work that includes one- and three-hour glucose screening – all with UnityPoint Health providers close to home. However, deliveries will not occur at the hospital in Marshalltown. Instead, deliveries will be planned for another location – one that the mother will choose.

“Marshalltown and surrounding residents had to travel for prenatal appointments,” says Rutherford. “Now, we’re able to bring our services to patients so they don’t have to worry about transportation costs, taking additional time off work or making arrangements for their other children, in order to travel for appointments leading up to delivery.”

It’s important for expectant mothers to be clear that deliveries will not occur at the hospital in Marshalltown. Instead, a birth plan (including the intended birthing location) will be established as part of the prenatal appointments.

“The OB providers make sure we are all on the same page when it comes to delivering the same great care to each of the patients we see,” says Rutherford. “In the end, we all want the same result, a happy and healthy mom and baby.”

Multi-Specialty Clinic

Multiple

Q&A with SHAYBREE GOSHON

Clinical Manager of Imaging Services

Q Where are you from originally?

A I am from Marshalltown.

Q Why did you get into health care?

A I’ve always loved helping people. A friend of mine was a radiologic technologist and would tell me how much she enjoyed it, so that intrigued me.

Q What qualities best describe the care you and/or your team provide to patients?

A My team is awesome. Based off all the positive patient comments I receive and how I see them interact with their patients, they are truly providing amazing patient care. My team is very compassionate towards their patients and strive to do the best for our patients every time.

Q What does the new hospital mean to you and the care your team provides?

A My team is one of the few teams that were split between the two campuses for the last seven years, so being able to feel like one team again is just great. This building is absolutely beautiful, so being able to practice patient care in such a great space just brings another level for us to be happy about what we do.

Q Are there any fun facts about you or your background?

A I have a goal to have my kids stay in all 50 states, and we’re halfway done.

Q What do you like to do in your free time?

A I love spending time with family and friends, I enjoy traveling any chance I get and watching my kids participate in all their activities.

THE SHAYBREE GOSHON FILE

RESIDES IN: Marshalltown

SCHOOLING: Radiologic Technology at Indian Hills in Ottumwa, Sonography at University of Iowa

OTHER EDUCATION/CERTIFICATIONS: Bachelor of Science Degree

PREVIOUS ROLES/POSITIONS: I started at the hospital in Marshalltown as a limited X-ray tech, then worked as an X-ray tech while I was in ultrasound school. When I graduated from Iowa, they had a sonographer position open, and I accepted it. I was a lead tech for a while, then a supervisor and now I’m a department manager.

FAVORITE QUOTE: “Not in doing what you like, but in liking what you do is the secret of happiness” – J.M. Barrie

We apologize for mailing problems such as duplicate copies. If you have questions or concerns about LiveWell magazine, please email MT_Marshalltown@unitypoint.org.