UnityPoint Health St. Luke s Hospital requires physicians

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1 St. Luke s B E A T for physicians Physician simulation testing assures safe, reliable sedation for patients UnityPoint Health St. Luke s Hospital requires physicians who perform moderate and deep sedation to demonstrate their competency during simulation lab testing before being granted sedation privileges. In July, all simulations moved to the state-of-the-art simulation lab at Kirkwood Community College. John Herring, MD, Linn County Anesthesiologists PC & St. Luke s medical director of anesthesiology One million cardiac catheterizations are performed every year in the U.S., according to the Centers for Disease Control. Millions more diagnostic and therapeutic procedures are performed, from colonoscopies to breast biopsies, often under moderate sedation administered by non-anesthesiologists. One result of the increasing amount of these procedures is an increase in complications. In February of this year, St. Luke s changed its credentialing for providers performing moderate and deep sedation in order to meet new, heightened requirements by the Centers for Medicare and Medicaid Services (CMS). St. Luke s new policies closely follow the guidelines published by the American Society of Anesthesiologists (ASA), which were developed to satisfy CMS regulations. The objective is to assure that all practitioners who administer analgesia and/or sedation also demonstrate the necessary skills and judgment to assess, plan, and carry out safe sedation, and that they demonstrate the ability to rescue a patient from a level of sedation that is deeper than intended, said John Herring, MD, Linn County Anesthesiologists PC and St. Luke s medical director of anesthesiology. Our simulation session is designed to be a verification process, not a primary training exercise. St. Luke s provides resources for practitioners, including an ASA video on basic resuscitation and management of moderate sedation and an ASA article about sedation given by non-anesthesia practitioners. Credentialing includes continued In this issue A1 Physician Simulations Assuring reliable sedation for patients A3 Genetic Testing Free cancer and genetic risk assessment services A4 UnityPoint Health St. Luke's Living Centers A6 Two new cardiologists join largest cardiology group A7 Cardiology Care Setting St. Luke's apart P.O. Box 3026 Cedar Rapids, IA / unitypoint.org/medical-staff St. Luke s Hospital A1

2 a knowledge-based test in addition to going through the simulation for skills verification. Providers must re-test every two years. This reflects the need to assure practitioners have the competency to administer medication and resuscitate the patient if necessary, said Sheri Bosch, BSN, RN, CCRN, St. Luke s Heart Care catheterization lab, who coordinates the program with Herring. Simulations for sedation scenarios were initially developed several years ago. However, St. Luke s put simulations on hold while the policies were being revised to develop a more deliberate approach to determine who participated and how they would be accommodated. Simulations restarted in February. In July we took all the simulations out to Kirkwood because they have a better facility for doing simulations, Herring said. Kirkwood s Katz Family Healthcare Simulation Center has nine highfidelity medical simulators, a stateof-the-art audio/visual system and a six-room, seven-bed simulated hospital environment. It is the first fully integrated, multidisciplinary healthcare simulation center in Iowa. Physicians have given positive feedback, with most rating the experience as excellent, and credit the availability of two-way mirrors and the realistic procedural setting with enhancing the experience. Simulations typically look like an intensive care setting or a procedural area, with appropriate monitoring, Herring said. We have the doctor assisted by one nurse who is familiar with that procedure. The doctor may call on a second doctor for an extra pair of hands, if one is available, but the main setting is one doctor, one nurse. The scenario may take 15 to 20 minutes, plus discussion time before and after. Pediatricians, cardiologists, pulmonologists, gastrointestinal endoscopists, emergency physicians, surgeons, interventional radiologists and others request sedation privileges for specific procedures. We offer this simulation training/testing every quarter. This is done in cooperation with Kirkwood and the anesthesiology department, Bosch said. I have trained a group of nurses to assist with the simulations to provide realistic scenarios to enhance the experience for physicians. The overriding goal is to be able to provide a consistent service throughout the spectrum of specialties in the hospital so patients, their families and their referring doctors can all be assured sedation is conducted in the safest manner, Herring said. Simulation has proven to be a very effective teaching strategy, so I believe we will only see an increased use of simulation for on-going education here at St. Luke s, Bosch added. Herring sees value in building an in-depth sedation training course and has received positive feedback from local physicians. For example, oral surgeons have expressed an interest in making sure their office staff is well versed in sedation scenarios so they can do a good job in their offices. It s a best practice approach, Herring said. For additional resources go to St. Luke s intranet, physician tab and scroll down to Sedation Education Resources. A2 St. Luke s Hospital Simulation has proven to be a very effective teaching strategy, so I believe we will only see an increased use of simulation for on-going education here at St. Luke s. Sheri Bosch, BSN, RN, CCRN St. Luke s Heart Care catheterization lab

3 Genetic testing for hereditary cancer syndromes Inherited mutations play a major role in the development of about 5 to 10 percent of all cancers, according to the National Cancer Institute. UnityPoint Health St. Luke s Hospital and the Helen G. Nassif Community Cancer Center offer free Cancer and Genetic Risk Assessment Services to patients. If someone has a hereditary cancer syndrome there are a variety of things we can do with screening and cancer prevention, said Julie Thompson, ARNP-BC, who leads the program. She has nearly 10 years of experience helping cancer patients and their families understand the complicated world of genetics and cancer risk. Patients who receive positive test results for hereditary cancer can work closely with their physician to create a preventive plan, which may include earlier and more frequent screenings or treatments. Though the increased risk for developing breast cancer associated with the BRCA genes is well known, there are other hereditary cancer syndromes that are just as common. Lynch syndrome, for example, greatly increases the risks for developing colon and uterine cancers. Cancer risk assessment and testing Before testing, Thompson performs a cancer risk assessment. This involves taking a thorough family medical history, discussing hereditary cancer syndromes that may have contributed to the cancer diagnosis in the family, the pros and cons of genetic testing and the impact test results may have for both the patient and family. If genetic testing is completed, Thompson discusses options with the patient for surveillance, chemoprevention, and/or surgery per guidelines from the National Comprehensive Cancer Network. A detailed summary letter along with dictation of the visit is sent to the referring provider and the patient receives a copy for their records. Testing is generally covered by insurance. When testing is not required Thompson discusses appropriate cancer screening for the patient and family along with lifestyle changes that help with cancer prevention. Thompson stresses the importance of getting a thorough family medical history from patients that is updated at every visit. It should include both sides of the family; aunts, uncles and cousins, in addition to parents and siblings. Always ask if there have been new cancer diagnoses since the last visit, she said. Cancer risk assessments are free to patients and may be scheduled by a provider or the patient by calling 319/ Making referrals Consider referring patients for Cancer and Genetic Risk Assessment Services after discovering any of the following during a family medical history discussion: A family member was diagnosed with cancer under the age of 50 One family member has two or more primary cancers Two or more close family members have the same type of cancer Several generations of the family have the same or related types of cancer A family member of Ashkenazi Jewish ancestry (Eastern or Central European) who has breast or ovarian cancer Polyposis (ten or more colorectal polyps of any histology) Rare cancers, such as sarcoma or male breast cancer An identified mutation in the family that increases the risk to develop cancer Concern about developing cancer because of family history P.O. Box 3026 Cedar Rapids, IA / unitypoint.org/medical-staff St. Luke s Hospital A3

4 Improving health quickly at UnityPoint Health St. Luke s Living Centers A4 St. Luke s Hospital L iving Centers is helping more patients return home quickly and safely and avoid rehospitalization thanks to the addition of two new nurse practitioners. Getting home safe and staying there is every patient s wish after surgery or illness. In actuality, close to one-fifth of older adults return to the hospital within 30 days, according to a study in The New England Journal of Medicine. A Health Affairs study states hospital readmittance rates increase to nearly 25 percent for Medicare patients requiring additional care at a skilled nursing facility. Living Centers in Cedar Rapids has decreased their rate of hospital readmissions by 73 percent since the arrival of on-site nurse practitioners. In addition, they ve decreased their emergency room (ER) visits by 35 percent. Our primary goal with our skilled patients is to get them back into their homes as quickly as it is safely possible, said Elizabeth Eichhorn, ARNP, Living Centers. The average stay for skilled nursing care at Living Centers is just 22 days. I credit the short length of stay to our staff and the excellent coordination of care. Our therapists do an excellent job of assessing the patient s needs and then putting an appropriate plan of care in place. Our social worker starts working with the patient and family early in their stay to determine the most appropriate discharge plan, Eichhorn said. Almost all of our skilled patients discharge to home with home health, which also helps facilitate a shorter length of stay. Upon discharging from our facility we schedule follow-up appointments with the patient s primary provider within one week to ensure adequate follow-up. This high level of coordination of care is improving the health of our patients. The Living Centers have two UnityPoint Clinic nurse practitioners on site five days a week, which sets the facilities apart from most skilled nursing facilities in the area. Our goal is to keep our patient at the highest level of health possible for them and help to ensure their quality of life is maintained and improved, said Dana Fowler, ARNP, Living Centers. We see our skilled nursing patients every day and review what has occurred. If we need to change anything and/or address acute problems, we can do so in a timely manner. Both nurse practitioners have acute/intensive care backgrounds. We are providing teaching and in-services to our staff on relevant topics and evidence-based practice, such as dementia, IV therapies and tracheotomy management, Fowler said. We also take pride in teaching our staff in the moment and take every opportunity to do so. Fowler and Eichhorn manage and adapt patient care plans set up by the patients physicians and also frequently communicate with the patients specialists. It is our goal to improve communication to the providers caring for patients outside of our facilities, Fowler said. At the completion of their stay with us, We see our skilled nursing patients every day. If we need to change anything we can do so in a timely manner. Dana Fowler, ARNP, Living Centers

5 By offering an on-site presence we have come to know our patients and their families very well, which has led to overall improved care, quicker response times and decreased hospital visits. Elizabeth Eichhorn, ARNP, Living Centers we provide a detailed summary of the events in our facility as well as an accurate medication list. Our on-site presence allows us to detect clinical problems earlier and also allows the nursing staff to discuss non-urgent clinical concerns with us before a new sign or symptom becomes a serious change in medical condition, Eichhorn said. Patients in nursing facilities tend to be frail, sick, and have multiple comorbidities and oftentimes are on many medications. It is only through frequent scheduled presence in the facility that these issues can be addressed. Living Centers connection to St. Luke s means they meet St. Luke s quality and outcome expectations. St. Luke s hospitalists provide physician coverage when the nurse practitioners aren t available. Long-term Living Centers patients also benefit from on-site nurse practitioners. They no longer must leave the facility for provider visits, care coordination and medication reviews. By offering an on-site presence we have come to know our patients and their families very well, which has led to overall improved care, quicker response times and decreased hospital visits. We have also worked hard to educate staff and serve as a resource for them. In the past staff and patients would see a provider on a monthly basis, which allowed very little time for questions from the staff and patients. We will continue to work hard to deliver high-quality, coordinated care, Eichhorn said. To refer a patient, call 319/ Living Center Services Physical therapy Occupational therapy Speech therapy Restorative nursing to improve range of motion Walk-to-Dine program, enabling 85 percent of residents walk to meals Daily living skills practice Social activities and therapeutic recreation unitypoint.org/medical-staff St. Luke s Hospital A5 P.O. Box 3026 Cedar Rapids, IA /

6 UnityPoint Clinic Cardiology welcomes two new cardiologists A6 St. Luke s Hospital In order to continue leading eastern Iowa in comprehensive cardiology care, UnityPoint Clinic Cardiology has hired two new cardiologists to increase the number of board-certified cardiologists on staff to 18. UnityPoint Clinic Cardiology is the largest, most specialized cardiology group in eastern Iowa and works to provide the highest quality care with fewer complications, better outcomes and higher survival rates. Wassef Karrowni, MD, joined UnityPoint Clinic Cardiology on August 1, Karrowni completed his medical degree at American University of Beirut in Beirut, Lebanon. He completed his internal medicine residency, cardiovascular diseases fellowship and interventional cardiology fellowship at University of Iowa Hospitals and Clinics in Iowa City, Iowa. Karrowni is board certified in internal medicine and the following subspecialties: cardiovascular diseases, adult echocardiography, and nuclear cardiology. Laila Payvandi, MD, joins UnityPoint Clinic Cardiology on September 30, Payvandi has worked as a hospitalist with St. Luke s Hospital. She is originally from Cedar Rapids and completed both medical school and her cardiology fellowship training at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. She completed her internal medicine residency and a one-year advanced echocardiography fellowship at Northwestern Memorial Hospital in Chicago, Illinois. She is board certified in internal medicine with a subspecialty in cardiovascular diseases. Her clinical interests include echocardiography, valvular heart disease and women s heart health. The cardiologists at UnityPoint Clinic Cardiology work in partnership with referring physicians to design the best care plan for patients and keep physicians informed of treatments, results and recommendations for ongoing care. To refer a patient, please call 800/ or 319/ Heart care at UnityPoint Clinic Cardiology provides: Same-day appointments. If you have a patient who needs to be seen quickly, you can make a referral for a same-day appointment. Treadmill testing is available with same-day appointments. Routine follow-up visits continue to be scheduled in advance. Greater choice locally. UnityPoint Clinic has the critical size necessary for physicians to develop the skills for advanced, specialized heart and vascular care so patients don t have to travel outside of Cedar Rapids for treatment. Quality care. Physicians at UnityPoint Clinic treat patients exclusively at St. Luke s, which performs the greatest volume of heart and vascular procedures in Cedar Rapids. Medical studies have shown centers with higher volumes and greater experience are associated with significantly improved patient outcomes. St. Luke s has been designated a Top 50 Heart Hospital four times in the last 10 years.

7 Cardiology Care at UnityPoint Health St. Luke s Hospital Comprehensive cardiology care at UnityPoint Health St. Luke s begins the moment a patient arrives at the hospital. St. Luke s is improving heart-attack patients chance of survival by increasing the speed in which patients receive life-saving care. The gold standard for getting a patient from the Emergency Department (ED) to opening a blocked artery (door-toballoon time) is 90 minutes or less. Minutes The average door-to-balloon time at St. Luke s is 60 minutes. St. Luke s fastest reported time in 2012 was 22 minutes. St. Luke s beats the Opening heart blockages faster 78 National benchmark Baseline St. Luke s average time to open blocked arteries. Lower is better national standard opening blocked arteries in the heart in a fraction of that time. Ranked second in Iowa by U.S. News & World Report, St. Luke s was also named one of America s high-performing hospitals for Cardiology & Heart Surgery. St. Luke s has been performing openheart surgery for 35 years, totaling more than 11,900 open-heart surgeries to date. St. Luke s offers the most comprehensive cardiac care available locally and is the only hospital in Cedar Rapids that provides the following procedures: Open-heart surgery EECP (Enhanced External Counter Pulsation) to create a natural bypass around narrowed or blocked arteries Lead extractions for pacemaker or implantable cardioverter defibrillator Structural heart procedures, including closure of atrial septal defects and patent foramen ovale SAVE THE DATE Heart Symposium formerly Cardiologists, L.C. Heart Symposium Saturday, October 12 8 a.m. Noon Cedar Rapids Marriott Hotel 1200 Collins Road NE Cedar Rapids About UnityPoint Clinic Cardiology Heart Symposium Formerly known as Cardiologists, L.C. Heart Symposium, the longest running and most popular cardiology training in the region, this symposium provides a practical approach to common cardiovascular disorders with an emphasis on diagnostic evaluation, treatment modalities and day-to-day management of cardiac disorders. Continuing Education CMEs for physicians and physician assistants and nursing CEUs and CEHs for other attendees will be available. Registration brochures available by calling 319/ For more information, call 319/ or go to cardiology.unitypointclinic.org St. Luke s Hospital A7