Archive for the ‘Articles’ Category

Nebraska Medicine Earns Elite National Quality Award

Excellence Award from Vizient, Inc. for Quality Leadership Performance

Nebraska Medicine is honored to announce its recognition by Vizient, Inc., as a recipient of the 2016 Bernard A. Birnbaum, MD Quality Leadership Award. The award recognizes Nebraska Medicine’s performance among more than 100 academic medical centers participating in Vizient’s Quality and Accountability Study. Thirteen academic medical centers were recognized this year.  Nebraska Medicine is ranked tenth and is the only health system in the region to earn this recognition. The others are:

  • University of Utah Hospitals and Clinics
  • NYU Langone Medical Center
  • Mayo Clinic Hospital-Rochester
  • Froedtert Health-Froedtert Hospital
  • Rush University Medical Center
  • WVU Medicine West Virginia University Hospitals
  • Penn State Milton S. Hershey Medical Center
  • Cedars-Sinai Health System
  • Houston Methodist
  • Nebraska Medicine
  • The Ohio State University Wexner Health System
  • University of Michigan Hospitals and Health Centers
  • University of Vermont Medical Center

“This is truly a special honor for everyone at Nebraska Medicine,” said Dan DeBehnke, MD, MBA, CEO of Nebraska Medicine. “Achieving a Five Star ranking took a tremendous amount of dedication and work from many, many people here.”

This year, more than 100 academic medical centers and 124 community hospitals were included in the study, which reviewed performance data from a variety of sources, including Vizient’s Clinical Data Base, the core measures data base, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

“Nebraska Medicine is dedicated to providing our patients with the highest quality, safest, most efficient and compassionate care available,” said Michael Ash, MD, Chief Transformation Officer, “To achieve a top ten Vizient Quality Leadership rank, among our nation’s elite academic medical centers, is a reflection of our colleagues and their devotion to extraordinary patient care.”

Heart Failure Patient Becomes Mother

Sarah Hawthorne gave birth to her baby at the same hospital that evaluated her heart defect shortly after she was born.

Sarah Hawthorne gave birth to her baby at the same hospital that evaluated her heart defect shortly after she was born.

Sarah Hawthorne Writes About Her Experience with Our Partnership with Children’s Hospital & Medical Center

May 22, 2016, was a day that changed my life forever. I gave birth to a healthy, 7 pound 7 ounce baby boy at the Nebraska Medical Center. Thirty-one years earlier, I had been airlifted to that same hospital because I was born with a congenital heart defect. Little did my family know then, how much the pediatric and adult congenital heart cardiology teams would become a part of our family.

I was born in the small town of Minden in central Nebraska. The physician that delivered me could tell that something wasn’t quite right. He had me transported to a hospital in Kearney where they decided to airlift me to Omaha. It was there that I was diagnosed with transposition of the great arteries (TGA) – a serious but rare heart defect.

I had open-heart surgery eight months later, and now, as a parent, I am only somewhat able to imagine how incredibly hard that must have been for my parents. Thankfully, everything went well, and I was able to live a fairly normal life as an energetic, active child.

When I was 7-years-old, I went into congestive heart failure and was once again sent to Omaha. This time, at Children’s Hospital & Medical Center. I was given a pacemaker and began my journey with cardiologist John Kugler, MD. Since then, I have had two more pacemakers, several heart catheterizations and another open-heart surgery in 2015.

Sarah Hawthorne after her heart surgery when she was 7 years old.

Sarah Hawthorne after her heart surgery when she was 8 months old.

My pregnancy further added to my team. I was under the care of Nebraska Medicine cardiologist Shane Tsai, MD, and the maternal-fetal medicine specialists at the med center. I moved to Omaha for my last month of pregnancy to ensure that the delivery went smoothly.

On May 22, our baby boy was born healthy and without any heart problems that I could have possibly passed on. Since then, I have continued to see Dr. Tsai and the Adult Congenital Heart Disease (ACHD) team.

What the medical facts don’t illustrate, though, are the relationships that have formed over the years with our doctors and nurses at Children’s and Nebraska Medicine. It’s amazing how Dr. Kugler remembered so much about me even when he was only seeing me once a year.

Toward the end of my 20s and early 30s, I developed some arrhythmias that required more frequent appointments. The interest the doctors and nurses took in my life and family was unnecessary, and yet always made me feel loved and cared for.

Dr. Kugler and his nurse, Kris Houston, even drove three hours to attend my wedding, and when we had our baby at the med center, Kris came to the hospital to visit. As I transition to the ACHD team at Nebraska Medicine, I know those relationships will develop into trusting, caring, and loving relationships as well. This, to me, is what sets these two teams apart from everyone else. They are very knowledgeable about my heart condition and take great care of me medically – all while making me feel extremely important to them as a person.

On top of all of this, they helped me achieve something I only dreamt of for many years – becoming a mother.  And for that, I will be eternally grateful to the Pediatric and ACHD teams.

To learn more about the importance of the ACHD clinic at Nebraska Medicine and the unique relationship they have with Children’s, read this blog from Dr. Tsai.

Surgical Robot Less Invasive, Allows Quicker Recovery


Kolby Baber suffered from a rare digestive disorder that made it difficult, and sometimes impossible, for him to swallow. After trying several other treatments, Baber discovered Dmitry Oleynikov, MD. Dr. Oleynikov told Baber about a new surgical robot, the daVinci Xi, which would be the perfect way to fix his problem. The daVinci features two work stations for Dr. Oleynikov and one of his colleagues to work simultaneously on patients instead of one like the previous model. It also allows surgeons to work on a wider range of cases than they could previously.

See how Dr. Oleynikov used the first daVinci Xi in Omaha for the first time to make Baber’s problem disappear in this video.

New Technology Tapped to Teach Sepsis

Clinical Effectiveness Team Utilizes UNMC’s iEXCEL for Interactive Training

It’s an opportunity for our health care team to learn in a new way: utilizing state-of-the art technology. Our clinical educators are taking advantage of UNMC’s iEXCEL advanced visualization, experiential and learning hub to help our nurses learn about the origins of sepsis and its impact on the body’s organs.

The iEXCEL visualization hub inside the Sorrell Center features MultiTaction panels, often referred to as iWall, that generate an interactive display wall that can detect an unlimited number of fingers, hands and infrared pens to incorporate a level of experiential learning. The simulation and virtual reality training will enhance training of current and future health professionals.

Jessica Strickler, clinical educator for MICU and SICU and Sara Hooper, clinical educator for 8 Telemetry are one of the first to partner with Ben Stobbe, executive director for Clinical Simulation, iEXCEL, to use the technology for our staff training on sepsis.

“We met with Ben and three student workers and described what we wanted the education to look like,” says Strickler, who together with Hooper, researched much of the content of the education.

Micah Beachy, DO, Clinical Effectiveness medical director, provided his expertise on sepsis’ impact on the body’s organs. After four more meetings, the interactive training was ready to go.

This 30-60 minute iWall training, called “Sepsis iWall Education,” is encouraged for nurses, but not required. Nurses who complete it will receive one hour of CEU. To register for class time, log into Apollo. Classes are being offered before and after shifts. Review the training schedule here.

iEXCEL is the programmatic component of UNMC’s Global Center for Advanced Interprofessional Learning.

Jessica Strickler, clinical educator for MICU and SICU, is seen demonstrating the new sepsis education.

Jessica Strickler, clinical educator for MICU and SICU, is seen demonstrating the new sepsis education.

Breakthrough Treatment for Peripheral Artery Disease

We’re among the first in the United States to offer a new treatment recently cleared by the U.S. Food and Drug Administration (FDA) to provide relief for patients suffering from the painful symptoms of peripheral artery disease, or PAD – a condition caused by a build-up of plaque that blocks blood flow in the arteries of legs or feet.

The device, Avinger’s Pantheris™ lumivascular atherectomy system, is an innovative image-guided therapy that, for the first time ever, allows physicians to see and remove plaque simultaneously during atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

Because the Pantheris device incorporates real-time optical coherence tomography (OCT) imaging on a therapeutic catheter – like having a small camera on the tip of the device – physicians are able to remove this plaque more precisely than ever before, with less risk of damage to the artery walls which can result in aggressive scarring that greatly increases the risk of restenosis, or re-narrowing of the artery. In the past, physicians have had to rely solely on X-ray as well as touch and feel to guide their tools while they try to treat complicated arterial disease.

For patients, this safe and more-precise treatment may potentially reduce the need for follow-up procedures and stents.

“Peripheral artery disease greatly impacts quality of life, with patients experiencing cramping, numbness, discoloration and pain,” says vascular surgeon David Vogel, MD. “The Pantheris technology is on the front lines. Nebraska Medicine is the only hospital in the region using it. We’re helping lead the way.”

David Vogel, MD, is seen using this new device on a patient during atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

David Vogel, MD, is seen using this new device on a patient during an atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

Clinical results confirm that the technology is safe and effective: a 130-patient study showed a target lesion revascularization rate of just 8 percent, and not a single event of vessel perforation, clinically significant dissection or late aneurysm resulted from Pantheris. In addition, this radiation-free technology may help minimize radiation exposure to clinicians and patients by decreasing use of fluoroscopy.

KMTV recently featured one of our patients who underwent the procedure.

Peripheral artery disease affects nearly 20 million adults in the U.S. and over 200 million people globally. PAD is caused by a build-up of plaque in the arteries that blocks blood flow to the legs and feet. Often dismissed as normal signs of aging, symptoms of PAD include painful cramping, numbness or discoloration in the legs or feet. PAD can become so severe and difficult to address with traditional treatments that patients and physicians often resort to undergoing invasive bypass surgeries, which can result in even higher health risks and lengthy, painful recoveries. In severe cases, patients often face amputation, the worst-case scenario associated with PAD.

Atherectomy is a minimally invasive treatment for PAD in which a catheter-based device is used to remove plaque from a blood vessel. Lumivascular technology utilized in the Pantheris system allows physicians, for the first time ever, to see from inside the artery during a directional atherectomy procedure by using an imaging modality called optical coherence tomography, or OCT. In the past, physicians have had to rely solely on X-ray as well as touch and feel to guide their tools while they try to treat complicated arterial disease. With the lumivascular approach, physicians can more accurately navigate their devices and treat PAD lesions, thanks to the OCT images they see from inside the artery.

Multidisciplinary Breast Cancer Clinic Offers Comprehensive, Convenient and Personal Care


Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment.

Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment.

Today, there are numerous choices available for breast cancer treatment. The new Multidisciplinary Breast Cancer Clinic at Nebraska Medicine – Cancer Center at Village Pointe, provides a very personalized and comprehensive approach to breast cancer care based on a patient’s individual needs and wishes as well as the expertise and careful assessment of a team of breast cancer specialists.

“Patients benefit from getting not just one opinion, but a comprehensive plan developed by a multitude of breast cancer experts using the most recent studies,” says Sarah Thayer, MD, PhD, surgical oncologist at Nebraska Medicine and physician-in-chief of the Fred & Pamela Buffett Cancer Center. “This model allows for enhanced communication between providers and the patient to ensure her goals and individual needs are met.”

Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment. Patients can receive an array of cancer services in one convenient location including:

  • Comprehensive care plan developed by a multidisciplinary team of experts
  • Consultative services or second options from cancer experts in medical oncology, surgical oncology, radiation oncology and plastic and reconstructive surgery
  • Infusion services within private infusion rooms
  • Radiation treatment center
  • Women Imaging Center with state of the art 3D-mammography and MRI capabilities
  • Amenities and supportive services including wig fittings, a free wig bank, prosthetic and bra fittings, yoga, massage therapy, skin care and make-up lessons specifically geared for people with or recovering from cancer

Multidisciplinary, Personalized Care Plan

Sarah Thayer, MD, PhD

Sarah Thayer, MD, PhD

The multidisciplinary team of experts includes medical oncologists, surgical oncologists, radiation oncologists, plastic and reconstructive surgeons, geneticists and social workers. The team helps each patient navigate through the many decisions available in breast cancer treatment including lumpectomy, mastectomy, chemotherapy, radiation therapy, targeted therapies and breast reconstructive surgery in a collaborative approach that is based on a woman’s personal choices.

“When a patient arrives for an appointment, they will see all of the specialists required for that visit in one setting and one appointment,” says Dr. Thayer. “Not only is this saving our patient’s time but it helps eliminate duplication of tests and services.”

Providing 3-D mammography for all patients is another benefit that will be provided at the clinic and is expected to be available by early summer. “Studies have shown that 3-D mammography when used with standard digital mammograms can bump up breast cancer detection rates and reduce callbacks,” says Dr. Thayer.

Patients will also be given the opportunity to participate in breast cancer clinical trials offered through the University of Nebraska Medical Center as part of their treatment program.

Personal Care Needs

A host of amenities and supportive services are also available to help address a patient’s physical, educational, emotional and spiritual needs providing a more complete and holistic approach to care and includes wig fittings, a free wig bank, prosthetic and bra fittings, yoga, massage therapy, skin care and make-up lessons specifically geared for people with or recovering from cancer.

“The Multidisciplinary Breast Cancer Clinic is designed to provide patients the most oncologically-sound plan in an environment that is more personal, private and positive,” notes Dr. Thayer.

What’s Life Like After Lung Transplantation?

Aleem Siddique, MD

Aleem Siddique, MD

Lung transplantation is a life-changing event. Before transplantation, the lung transplant recipient will have been very limited in his/her day-to-day activities because of severe lung disease. They might have required assistance for even the simplest of tasks, such as having a shower or changing clothes. That degree of limitation leads to significant de-conditioning, hence, after recovering from the transplant surgery, the recipient will begin a process of rehabilitation.

Over time, most lung transplant recipients will experience significant improvements in their functionality and correspondingly will describe significantly better quality of life. They will find it easier to breathe and most patients will no longer require oxygen therapy. The impact of this is difficult to describe or quantify, simply put, breathing itself had become an enormous burden and that strain is lifted.

Lung transplantation is not without it’s own burdens. Principal amongst these is the constant need for immuno-suppression medication to prevent rejection of the transplanted lung(s) by the recipient’s immune system. Conversely, the possibility of acquiring an infection goes hand-in-hand with use of immuno-suppression medications. Therefore close monitoring is required to prevent and treat both rejection and infection, this means that the transplant team is always close at hand. For many patients, the transplant team becomes like family.

Despite some difficulties, most lung transplant recipients report being highly satisfied with the transplant outcome, and that, if they had to make the decision again, they would still choose to have a lung transplant.

Hope for Stroke Patients: Recent Treatment Advances Offer Better Chances for Recovery

brain 4

Stroke is a severely debilitating disease that can permanently change the lives of patients and their families. Everyone knows a family member or a friend whose life has been permanently changed by stroke. Stroke is a very common disease around the world. Every year more than 795,000 people in the United States will suffer a stroke and more than 130,000 will die as a consequence of stroke. In Nebraska, stroke is the fourth leading cause of death and more than 36,000 people live with stroke. Despite these frightening numbers there is hope for stroke patients.

Stroke prevention

The best way to prevent a stroke is to take care of  you health. More than 90% of strokes are the result of poorly controlled medical conditions. Avoid tobacco, control your weight, watch your diet, exercise and follow up regularly with your primary care physician. Work closely with your doctor to control your high blood pressure, diabetes, high cholesterol or heart disease. Just by reducing your blood pressure by 10 points you can decrease your chance of having a stroke by one-third. Controlling the other risk factors will decrease your chances even further.

Sudden signs of stroke: remember them easily with “FAST”

Stroke can present in many different ways: confusion, severe headache, dizziness, double vision, facial droop, difficulty swallowing, arm or leg numbness or weakness, sudden loss of balance, inability to speak and slurred speech all are symptoms of stroke. One easy way to remember the sudden signs of stroke is by using the F.A.S.T. acronym. F is for facial droop, A is for arm weakness, S is for speech difficulties and T is for time to call 9-1-1. If you think you or a loved one is having a stroke, the best course of action is to call 9-1-1. Patients who call 9-1-1 arrive faster to the nearest hospital capable of treating stroke and have better chances of receiving treatment.


Stroke types and treatments

There are two major types of strokes: ischemic and hemorrhagic. Ischemic strokes are by far the most common type in the United States and in Nebraska. An ischemic stroke is usually the result of a blockage in a blood vessel, whereas a hemorrhagic stroke is due to a blood vessel rupture. Treatment is different for each type; however rapid treatment is essential in both.

Since 1996, the only FDA approved treatment for acute ischemic stroke has been to administer alteplase. This is a medication that is given to patients with an ischemic stroke who arrive to the Hospital within 4 ½ hours from the onset of symptoms. Patients who receive this drug have a 33% increased chance of being independent or less disabled at three months after their stroke, when compared with people who did not receive the drug. In the last year there have been significant advances in the treatment of acute ischemic stroke. Five new studies show that patients who suffered a large stroke and were treated with new devices called stent retrievers – within 6 hours of onset, in an experienced stroke center – have a 33% to 71% percent chance of regaining independence or experiencing less disability at three months.

New, advanced treatment options available at Nebraska Medicine

Nebraska Medicine has the capacity to offer these novel treatments to stroke patients who qualify. To make these crucial advancements in stroke treatment available to more people in Nebraska and neighboring states we launched the Nebraska Medicine Tele Stroke Network. Tele Stroke brings stroke neurology expertise to the bedside of community hospitals. Working together, the neurologist and emergency department physician collaborate on the most appropriate treatment for the stroke patient. This program provides local and rural emergency rooms with 24- hour access to stroke neurology expertise and the advanced treatment options available at Nebraska Medicine.

Dr. Kalil is lead author on new pneumonia guidelines

By Stephanie Goldina, Infectious Diseases Society of America


Andre Kalil, M.D.

ARLINGTON, Va. — Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) — which account for 20 to 25 percent of hospital-acquired infections — should be treated with shorter courses of antibiotics than they typically are, according to new guidelines released by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) and published in the journal Clinical Infectious Diseases. In addition, the Society of Critical Care Medicine (SCCM), the American College of Chest Physicians (CHEST), and the Society for Healthcare Epidemiology of America (SHEA) endorsed these guidelines.

At a glance

•Seven days of antibiotics are effective for most hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) infections, according to the new guidelines published by the Infectious Diseases Society of America and American Thoracic Society.
•The new guidelines also recommend that each hospital develop an antibiogram to determine which strains are causing infection and ensure the right antibiotics are used for treatment.
•HAP and VAP cause 20 to 25 percent of hospital-acquired infections, and these may be fatal 10 to 15 percent of the time.

The recommendation of seven or fewer days of antibiotics for most of these infections reflects a change from previous guidelines to ensure safe and effective treatment while limiting the development of antibiotic resistance.
Created by a multidisciplinary panel led by infectious diseases, pulmonary and critical care specialists, the new guidelines also recommend that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally as well as which antibiotics effectively treat them.

When possible, the antibiogram should be specific to the hospital’s intensive care unit patients, according to the guidelines. Antibiograms should be updated regularly, and the most appropriate frequency should be determined by the institution, the guidelines note.

“Once clinicians are updated regularly on what bugs are causing VAP and HAP in their hospitals as well as their sensitivities to specific antibiotics, they can choose the most effective treatment,” said Andre Kalil, M.D., lead author of the guidelines, professor of medicine in the Division of Infectious Diseases and director of the Transplant Infectious Diseases Program at UNMC. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”

Published in 2005, the previous guidelines recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection.

The 2016 guidelines recommend seven days or fewer for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy, Dr. Kalil said. In addition, he said this can reduce antibiotic-related side effects, the risk of Clostridium difficile, a serious diarrheal infection, antibiotic resistance and costs. In some cases, such as when a patient doesn’t improve or worsens, longer treatment may be necessary.

Mechanical ventilators help patients breathe. They are used when a patient is having surgery with general anesthesia or for those who suffer from impaired lung function. One of every 10 patients on a ventilator gets VAP, which is fatal about 10 to 15 percent of the time.

VAP also increases: the amount of time patients remain on a ventilator — from 7.6 to 11.5 days on average — and length of hospital stay — from 11.5 to 13.1 days on average.

While HAP typically is a less severe infection than VAP, half of patients have serious complications, including respiratory failure, fluid in the lungs, septic shock and kidney failure.

Life After A Double Lung Transplant

Andrea Mayberry

Andrea Mayberry

I was diagnosed with cystic fibrosis (CF) at birth. I was in and out of hospitals my entire life.

As my disease progressed, doctors said I would not live to be 16-years-old. I was put on the double lung transplant list at Nebraska Medicine – Nebraska Medical Center at the age of 12. I was on the waiting list for over two years.

I received “the call” in July of 1996 — I was almost 15. My mom got the call at 3:00 p.m. on a Friday and I was in surgery by 3:00 a.m. The surgery lasted 12 hours and all went smoothly. I was in the hospital for three weeks after surgery, which was half the time my previous stays were becoming. I was lucky to have lived so close to the med center, as I know many have to travel far for treatment.

Nebraska Medicine became my second home. All the staff including doctors, nurses, respiratory therapists, x-ray technologists and lab techs all knew me by name and were all part of my support system. Many continue to be part of my “family.” After my transplant, I still had appointments with my doctors. Luckily, my transplant coordinator was amazing at keeping things going and keeping everyone on the same page.

Before my transplant, I was on oxygen 24/7 and had multiple breathing and physical therapy treatments throughout the day — just to maintain my rapidly declining health. The way it was going, I would have been lucky to graduate high school, let alone attend college or get married. I am blessed to say that I did graduate high school, I graduated college with a bachelor’s degree in Medical Imaging and am engaged to my fiancé, Merl!

I have worked at Nebraska Medicine as a mammographer for over 11 years now. Life is amazing. I have the med center and its staff to thank, but most importantly, I have my donor and their family. I will forever be grateful to Nebraska Medicine for the care I received then — and continue to receive. They will always be family to me and I’m thankful to live so close to such an extraordinary medical center.