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Archive for May, 2016

Telestroke Program Off the Ground

Serious Medicine

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Kathleen Harnden, RN, clinical program coordinator in Bellevue, demonstrates how the Telestroke unit functions.

A new technology that’s more convenient for doctors and results in faster treatment for patients has debuted in both Nebraska Medicine emergency departments within the past few weeks.

“We can’t train enough neurologists to support the growing needs of our aging population,” says Marco Gonzalez, MD, neurologist and Telestroke champion. “Telestroke is helping us to fill that gap with the aid of technology. We’re bringing the stroke expert to the bedside.”

3-16-Telestroke-1-690x462Kelley Johnson, nurse in the Emergency Department in Bellevue, receives candy for being the first nurse to use the Telestroke unit in Bellevue.

Stroke treatment is protocol driven. Alteplase is the only FDA-approved drug for the treatment of acute ischemic stroke, but it must be given within four and a half hours of stroke symptom onset. As a result, only about 10 percent of eligible patients receive the treatment, Dr. Gonzales says. Even more advanced treatments like a thrombectomy must be done within six hours, so either way, prompt diagnostics and consultations are essential to quality outcomes.

The Telestroke program has been in the works for more than a year, says Denise Gorski, who began laying the foundation for the program as a clinical program coordinator in Neurosciences before stepping into her current role as director of Diagnostics at Nebraska Medicine – Bellevue.

“Strategic planning for Neurosciences identified Telestroke as a solution to improve access to neurology care at the bedside,” Gorski says. “Emergency physicians welcome it, as it helps them make the best treatment decisions and reduce unnecessary transfers.”

Moving forward, interdisciplinary teams across Nebraska Medicine worked to identify the best technology and processes to make the solution a reality.

In a nutshell, here’s how the Telestroke protocol works:
•A patient presents with recent onset of stroke symptoms (or first responders indicate a likely stroke)
•Someone in the Emergency Department pages the neurologist on call for Telestroke
•The neurologist calls and speaks with the attending emergency physician
•The neurologist uses an app on their phone or tablet to connect to the Telestroke unit

3-16-Telestroke-3-179x190The Telestroke unit functions similarly to the common app FaceTime from a neurologist’s perspective. This is what it looks like to patients.

•The nurse brings the Telestroke unit into the patient’s room, introduces the neurologist and helps with the exam
•The neurologist explains the process, conducts the exam and develops a treatment plan with the patient/family/emergency care provider
•Treatment begins

The Telestroke unit looks like a large, controllable camera screen that acts similarly to the common smartphone application FaceTime. Special adaptations to the Telestroke unit have made it much more clinically useful.

“The Telestroke unit has a number of features to make it useful to clinicians,” says Kyle Hall, Telehealth program coordinator. “It has a wide angle lens to view the patient, family and the care team as if in the same room. It can show the patient’s CT scans to the neurologist and patient. It can zoom on a patient’s eyes and has a stethoscope to help with diagnoses.”

Plans to extend Telestroke to other Nebraska hospitals are under development, Hall says. In the meantime, Nebraska Medicine will focus on optimizing the use of Telestroke to intervene more often and help give stroke patients a higher quality of life as they recover.

“Time is brain, so the sooner we treat, the better the outcome,” says Dr. Gonzalez.

OHSCU’s Journey of Improvement

Extraordinary Service

3-22-OHSCU-Patient-Satisfaction-690x498OHSCU nurses Devon Wilhelm-McMullen (left) and Ben Rawalt are seen discussing a patient in their unit. OHSCU is celebrating a 30-point gain in their patient satisfaction scores and continue to work on other metrics, including overall job satisfaction.

As an organization, we strive to be one of the top places to work in Omaha, attracting and retaining talented people. That’s certainly the goal of leaders in the Oncology Hematology Specialty Care Unit (OHSCU) who desire to make their unit the best in the world. Their focused journey of improvement began about two years ago and it’s one that continues today.

It began during their review of their National Database of Nursing Quality Indicators (NDNQI) survey results in the fall of 2014. The NDNQI survey assesses nurses’ job enjoyment, as well as their perception of their practice environment, which includes leadership, support and staffing resources.

“It provided us a better understanding of how we needed to address our culture challenges,” explains Theresa Woodrum, OHSCU manager. “We analyzed the survey scores and reached out to Employee Engagement for help.”

“This survey was taken during a difficult time,” adds OHSCU associate nurse manager Heidi Tonne. “Many of our nurses are newer nurses. When you have a newer staff treating very sick patients, it can be stressful.”

Linda Gloe, senior analyst, Organizational Development, conducted confidential focus groups to get an understanding of the staff’s concerns last spring. Gloe’s questions included: What behaviors would you like to see more or less of? What is your role in supporting change?

“I really appreciated that Linda also empowered the staff to also consider ‘what could I do to make this a better place to work?’” says Tonne.

From that effort, OHSCU renewed its commitment to creating a culture of clinical excellence, engagement, professionalism, accountability and improved staff satisfaction. With that, changes were made. Tonne says she and Woodrum began coming in around 3 or 4 a.m. alternating weeks to provide greater access to the night staff and an opportunity to talk with them. The two also made an effort to increase communication by sending out their availability for the day through a Voalte’ text.

Around the same time, OHSCU’s Unit Based Council (UBC) rolled out action plans for call lights and bed checks. They implemented the “5-foot rule” which means anyone within five feet of a patient’s room needs to address a call light, even by simply saying “I will get your nurse”, says Tonne.

“We really embraced the concept ‘every patient is our patient’,” Tonne says.

The unit adopted a vision statement of “Safe. Accountable. Caring.”

The unit’s Press Ganey scores improved dramatically this past summer. They achieved the 100 percentile mark for the question “please rate the hospital” and jumped more than 30 percentile points for the question “how quickly were you helped to the toilet.”

The unit also increased its score by nearly 30 points for the question that rates the hospital staff and made a 15-point increase in the call light response time.

“We were working really hard,” says Tonne. “Staff was very engaged. We also focused on holding each other accountable.”

Tonne says their newer nurses now have more than two years of experience, which helped tremendously with their confidence to care for patients.

“They have grown tremendously in their oncology knowledge and their ability to care for pediatric, adult and critical care patients,” says Tonne. “Our entire staff has worked extremely hard to ensure our patients are well cared for and part of a family, not just another patient.”

Unit leadership is celebrating their impressive gains in their patient satisfaction scores, and while this fall’s NDNQI scores didn’t improve the way they hoped, Tonne is not discouraged.

“It can be emotionally difficult to work on OHSCU because of the nature of the patients we treat, but it is also very rewarding,” she says. “This fall, we had several long-term patients pass away. It’s hard. We can look at our staff and know everyone is working very hard. Not only have our Press Ganey scores improved, but we’ve seen great improvements in our quality scores, too.”

Lung Transplant Patient Completes Major Milestone

Serious Medicine

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Lung transplant recipient Donna Jacobsen was introduced to the media April 15. Alongside the Winside, Neb. resident is Heather Strah, MD, medical director of the Lung Transplant Program.

Participated in the Donate Life Nebraska 5K Race & Heroes Walk

Shortly before Thanksgiving, 63-year-old Donna Jacobsen of Winside, Neb. became the first patient to be added to our lung transplant waiting list. Two months later, on Jan. 26, Jacobsen became the second patient to undergo a lung transplant procedure with Nebraska Medicine’s reignited program.

“I was very proud and a bit nervous,” admits Jacobsen. “I got the call the morning of Jan. 25 and just said, ‘okay – here we go!’ I was ready to start feeling healthy again.”

In 2012, Jacobsen had a cough that wouldn’t go away. As a registered nurse with more than 40 years experience, Jacobsen knew she needed to see a physician. A lung biopsy revealed a diagnosis of idiopathic pulmonary fibrosis (IPF), a disease that causes scarring of the lungs, often resulting in respiratory failure. There is currently no cure.

“I felt fine until August 2014 – that’s when I started going downhill,” remembers Jacobsen. “It got so bad that I had no choice but to retire from the job I loved.”

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Heather Strah, MD, Medical director of Lung Transplantation Program

“When I first met Donna last spring, she was very sick and getting worse quickly,” explains Heather Strah, MD, medical director of the Lung Transplantation Program. “Her oxygen needs were going up and she wasn’t able to walk very far. We were worried that she wouldn’t be able to wait for our lung transplant program to start, but Donna was determined to be transplanted close to home even though there were other programs that could have transplanted her sooner.”

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Aleem Siddique, MD, surgical director of Lung Transplantation Program

Jacobsen’s single lung transplant started around 1:30 a.m. on Jan. 26 and lasted between four and five hours. Aleem Siddique, MD, surgical director of lung transplantation, performed the operation, assisted by transplant surgeon Michael Moulton, MD. A team of anesthesiologists, surgeons, physician assistants, perfusionists, pharmacists, nursing personnel and other staff members were also in the room.

“The surgery went very well without any particular complications,” says Dr. Siddique. “We’re very excited and hope that Donna can lead a fulfilling life. For me, the improvement in quality of life is just as important as the longevity gained with a transplant.”

Jacobsen spent three weeks at Nebraska Medical Center before being discharged. Because her hometown is more than two hours away, she’s been staying at an Omaha hotel while attending daily pulmonary rehabilitation sessions at the med center.

“Donna has done wonderfully during her recovery and is on track to move back home by the end of the month,” says Dr. Strah. “But, in order to complete pulmonary rehab, we’ve asked her to do something very special – walk one mile in the Donate Life Nebraska 5K Race & Heroes’ Walk.”

4-18-Lung-Transplant-Family-690x341Donna Jacobsen found strength in numbers over the weekend. The Jacobsen family took part in the Donate Life Nebraska 5K Race & Heroes Walk.

On April 16, Jacobsen, her husband Randy, their three children and eight grandkids, took part in the walk with other members of Nebraska Medicine’s transplant program.

Donna Jacobsen’s Journey

Watch lung transplant patient Donna Jacobsen’s video to learn more about her journey.

“It’s very emotional for me,” says Jacobsen. “Especially when I start to think about my donor and their family. I can’t thank them enough for what they’ve done.”

“Nationally, it’s estimated that 18 people die every day while waiting for organ transplants. A single donor may save up to eight lives,” adds Dr. Siddique. “To see Donna and other transplant patients doing so well is exactly the positive reinforcement and gratification that keeps patients and providers going during difficult times.”

Jacobsen will continue to receive checkups every few months for the rest of her life. Patients who survive their first year after transplant are typically expected to live seven or eight years, but Dr. Strah has seen many patients who were transplanted 10, 15, 20 years ago who are still enjoying relatively good health.

Jacobsen says she’s excited to get home, spend time with her family and start doing all the work around her house that she didn’t have the energy to do before. But, she will miss seeing members of her transplant team every day.

“Everyone at Nebraska Medicine is simply phenomenal. From the doctors, to the nurses and therapists, I couldn’t ask for better care – and that’s saying a lot coming from a nurse!” says Jacobsen. “I am so grateful this hospital is here in Nebraska. I was able to stay close to home and receive my transplant. I don’t know why you’d go anywhere else.”

Nebraska Medicine’s Lung Transplant Program offers single lung, double lung and heart-lung transplants. Clinicians hope to evaluate 20-30 patients and transplant 10 patients in the first year. Along with extraordinary patient care, the program will provide lung education, research and innovation.

To register as an organ donor, visit www.donatelife.net or www.nedonation.org. For more information about our Lung Transplant Program, visit www.nebraskamed.com/transplant.

Bariatrics Center Achieves National Re-accreditation

Serious Medicine

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The Bariatrics Center recently received national re-accreditation by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). The MBSAQIP is a combined program of the American College of Surgeons (ACS) and American Society for Metabolic and Bariatric Surgery (ASMBS), which recognizes commitment to providing multidisciplinary, high-quality, patient-centered care.

To achieve accreditation, bariatrics centers must undergo an independent, voluntary, and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. Bariatric surgery accreditation not only promotes uniform standard benchmarks, but also supports continuous quality improvement. All accredited centers report their outcomes to the MBSAQIP database.

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Corrigan McBride, MD, medical director of the Bariatrics Center

Currently, the Bariatrics Center has three surgeons, an endocrinologist and a psychologist, in addition to other providers.

“We set and achieve high standards for patient outcomes (surgical patients),” says Molly Wickert, clinic manager of the Bariatrics Center. “We are evaluated by our peers and have been recognized as having an outstanding program with no deficiencies.”

Bariatric surgical procedures have been shown to reduce obesity, improve mortality, and decrease the health risks from chronic diseases such as cardiomyopathy and diabetes. For these reasons, the MBSAQIP recognizes those facilities that implement defined standards of care, document their outcomes, and participate in regular reviews to evaluate their bariatric surgical programs.

“We are proud to have once again received this designation,” says Wickert. “It is not only a testament to how hard our team works to provide excellent patient care; but also serves as a solid benchmark for patients to utilize when choosing a facility they can trust to provide high-quality bariatric surgical care.”

 

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