Posts by Dean

Girl Scout Fieldtrip Inspires Life Devoted to Caring for Seniors

Posted on Aug 30, 2019 in California Pacific Medical Center, Quality, Scroll Images, Transformation, Uncategorized

Dr. Wendy Zachary with 100 year old ACE patient Dorothy Bobbet

SAN FRANCISCO –Years ago, a Girl Scout Brownie troop visited patients in a nursing home in South Carolina. One of those little girls was especially impressed by the setting and enjoyed trying to engage with the patients, many whom likely suffered from dementia. Fast-forward to the present. The little girl who spent an afternoon visiting nursing home patients has dedicated her career to ensuring the special needs of older patients are carefully considered.

Wendy Zachary, M.D., is now a geriatrician and medical director of the Acute Care for the Elderly (ACE) unit at Sutter’s California Pacific Medical Center, Mission Bernal Campus hospital in San Francisco. The need for specialized care for older patients is urgent and growing larger, according to Dr. Zachary. “One of our greatest needs in medicine today is having enough physicians and nurses to care for our aging population,” she says.

Figures from the U.S. Department of Health and Human Services illustrate the size of the problem. In 2016, 49.2 million Americans (1 in 7) were 65 years and older. By 2020, there will be 56.4 million Americans over 65, with the fastest growing population being those aged 85 years and older.

Specialized Care for Older Patients Begins in the ER

The ACE unit at Mission Bernal, one of only six such units in California, was designed with the specific needs of older patients in mind. However, special care to address older patients’ needs actually begins at the point where the majority of ACE unit patients enter CPMC’s Mission Bernal Campus hospital—the emergency department.

The team behind the Geriatric Accreditation. Sara Cohen, MS, RN, AGCNS-BC; Wendy Zachary, M.D., Geriatrician; Ritik Chandra, M.D., Emergency Medicine

Mission Bernal’s emergency department is the first in San Francisco to be geriatric accredited by the American College of Emergency Physicians. This accreditation is awarded to emergency departments that are set up to specifically care for older patients who may have cognitive deficits. Mission Bernal’s emergency department staff are trained to ensure that older patients are directed to the appropriate setting for their specific needs, whether they would benefit most from services provided in an outpatient setting or whether they would be best cared-for in the ACE unit.

Programs Enhance Patient Experience, Reduce Cost of Care

“You wouldn’t want your 8-year-old child to stay on a general medicine floor, you would want them to stay on a pediatrics floor,” said Dr. Zachary. “The same idea applies to older patients who have more chronic medical conditions, sensory deficits, cognitive impairment and may have need for special considerations in regards to medications. This individually-tailored care is what our physicians, staff and Hospital Elder Life Program (HELP) volunteers provide to our ACE unit patients.”

At CPMC’s Mission Bernal hospital, ACE unit patients receive tailored support through the HELP program, a comprehensive patient-centered program aimed at decreasing delirium in older hospitalized adults, thereby preserving mental and physical function. Decreasing delirium is important because it carries the same risk of mortality as a heart attack. Mission Bernal’s ACE unit is the only one in California to fully address all six key risk factors for delirium:  hearing impairment, visual impairment, cognitive impairment, functional impairment, having difficulty sleeping and kidney failure due to dehydration.

The cornerstone of the HELP program is deprescribing, which is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. This starts with normalizing sleep/wake cycles to reduce the risk of delirium in patients. To address sleep/wake cycles, the ACE unit enlists specially trained volunteers to help staff gain insights to motivations that will help mobilize a patient to keep them awake and engaged during the day so that they sleep better at night.  With a better night’s sleep physicians can reduce or eliminate sleep aids and other medications, a step that is shown to lead to fewer complications, fewer falls and a reduced length of stay.

Combined, CPMC Mission Bernal’s HELP program and ACE unit have achieved notable success in the year since the hospital opened in August 2018. So far, length of stay for ACE patients our length of stay is 1.3 days less and our readmission rate is 3% less than standard of care for the older population on non ACE units. With lower length of stay and readmissions, CPMC is safely cutting the cost of care for these fragile patients by over $1 million per year.

By the Numbers

  • The average age of a patient in the ACE unit is 86.
  • Patients age 70 and older can be admitted to the unit for care.
  • The oldest patient to be at the ACE unit was 112 and on the day of discharge this patient walked out of the hospital on their own.
  • More than five percent of patient who are cared for at the ACE unit are 95 year of age or older.

What a Difference a Year Makes

Posted on Aug 29, 2019 in California Pacific Medical Center, Pediatric Care, People, Scroll Images

Baby and Mission Bernal Hospital Share a Birthday

SAN FRANCISCO –One year ago this week, newborn baby Francis Peterson and his mother, were the first patients admitted to the new hospital at Sutter’s California Pacific Medical Center (CPMC), Mission Bernal Campus. Mission Bernal camput hospital opened for service at 7:00 a.m. on August 25, 2018, and shortly thereafter Francis and his mother were wheeled over on a gurney from the old hospital where he was born, to be the first patients through the door.

Now Francis is one year old! For a child, celebrating a first birthday is a major milestone with parties and gifts—whereas a hospital’s first year milestone is acknowledged and quickly moved past in the name of focusing on continuing to provide high quality healthcare.

Opening Mission Bernal hospital’s doors was the beginning of a new chapter in medical care for San Francisco’s southern neighborhoods. With a beautiful new building, and a new name that reflects the neighborhoods in which it’s located. Mission Bernal hospital offers new and expanded services to the community including larger departments for emergency services–with a geriatric accreditation, as well as a larger labor and delivery unit, orthopedic surgeries and the Acute Care for the Elderly (ACE) unit dedicated to the care of patients over the age of 70.

In one year, with 800 babies delivered and over 3,200 surgeries performed, CPMC’s Mission Bernal Campus hospital has become the community hospital of choice in the southern section of San Francisco.

Happy birthday Francis and happy anniversary to Mission Bernal and its dedicated staff and physicians!

 

 

 

29-Year-Old CPMC Heart Transplant Patient Heads Home

Posted on Aug 15, 2019 in California Pacific Medical Center, Cardiac, Quality, Scroll Images

L-R Dr. Michael Pham (Cardiologist), Mitch Peterson, and Dr. Brett Sheridan (Surgeon)

SAN FRANCISCO – At an event on Aug 14, 29-year-old Oakland resident, Mitch Peterson was recognized as CPMC’s 500th heart transplant recipient and celebrated for his speedy recovery. (News story here.) Staff and friends wished Mitch well as he prepared to head home after spending a month in the hospital. Mitch said that he is looking forward to stepping out the doors of the hospital, taking a deep breath and start enjoying the simple things that are often taken for granted. He is also looking forward to a walk around Oakland’s Lake Merritt, which is near his home, and enjoying the active lifestyle he was accustomed to before his illness.

Mitch had a relatively quick recovery after receiving a new heart at Sutter’s California Pacific Medical Center (CPMC) Van Ness Campus hospital just on Aug 2. Mitch’s heart failure had gone undiagnosed and symptoms came on quickly in early July resulting in him seeking care at Sutter Health. (Listen to comments from Mitch before surgery)

Mitch’s Journey

When 29 year old Oakland resident Mitch Peterson began experiencing shortness of breath and fatigue in early July, symptoms that he thought were the flu, he had no idea what was ahead. As his symptoms got worse, Mitch decided to get checked out at the emergency department at Sutter’s Eden Medical Center in Castro Valley. It was at Eden that he learned his condition was much more serious than the flu.

The emergency department doctor at Eden told Mitch that he had heart complications and that he needed to be transferred to Sutter’s Alta Bates Summit Medical Center where an elevated level of cardiac expertise was available to assess the extent of his condition. After spending time at Alta Bates Summit’s Oakland campus, where cardiologists applied medical therapies to stabilize his condition, it was clear that Mitch was suffering heart failure, probably due to damage suffered while undergoing chemotherapy in Wyoming for bone cancer years earlier when he was 13. (It was in Wyoming that he also had a cadaver bone transplant—his first transplant).

The doctors at Alta Bates Summit consulted with cardiologists at Sutter’s California Pacific Medical Center (CPMC). Together, they determined that unfortunately, therapies such as medication would not address the heart failure Mitch was experiencing. The specialists told Mitch that his condition was life-threatening and required advanced treatment, possibly even a heart transplant. Mitch soon found himself at CPMC, on the heart donation waiting list and facing heart transplant surgery.

On the afternoon of Friday, August 2, the call came. A heart had become available. Late that evening, Mitch received a heart transplant at CPMC. During the operation, surgeons successfully connected the new donated heart, allowing Mitch to begin recovery and return to the active lifestyle that he once enjoyed.

Mitch has recovered remarkably quickly and will be going home from the hospital on Wednesday, August 14. It was only two days after surgery that he was out of bed on his own and moving around his room, a feat that he was unable to accomplish the week before surgery.

The integrated system of care at Sutter Health allowed for seamless escalation of Mitch’s care to address his congestive heart failure. This seamless coordination of medical and support services from one caregiver to another reduces complications in care, guarantees the continuum of quality and reduces the overall total cost of care. In Mitch’s case, the integrated care offered at Sutter Health was also life-saving.

At Just 29 Years Old, Two-Time Transplant Recipient is Going Home with a New Heart

Posted on Aug 13, 2019 in California Pacific Medical Center, Cardiac, Scroll Images

Sutter’s CPMC celebrates major milestone: Mitch Peterson becomes 500th heart transplant recipient

Mitch Peterson before surgery

SAN FRANCISCO – 29-year-old Oakland resident, Mitch Peterson, is on the fast track to recovery after receiving a new heart at Sutter’s California Pacific Medical Center (CPMC) Van Ness Campus hospital just 10 days ago. Mitch’s heart failure had gone undiagnosed and symptoms came on quickly in early July resulting in him seeking care at Sutter Health. (Listen to comments from Mitch)

Mitch’s Journey

When 29 year old Oakland resident Mitch Peterson began experiencing shortness of breath and fatigue in early July, symptoms that he thought were the flu, he had no idea what was ahead. As his symptoms got worse, Mitch decided to get checked out at the emergency department at Sutter’s Eden Medical Center in Castro Valley. It was at Eden that he learned his condition was much more serious than the flu.

The emergency department doctor at Eden told Mitch that he had heart complications and that he needed to be transferred to Sutter’s Alta Bates Summit Medical Center where an elevated level of cardiac expertise was available to assess the extent of his condition. After spending time at Alta Bates Summit’s Oakland campus, where cardiologists applied medical therapies to stabilize his condition, it was clear that Mitch was suffering heart failure, probably due to damage suffered while undergoing chemotherapy in Wyoming for bone cancer years earlier when he was 13. (It was in Wyoming that he also had a cadaver bone transplant—his first transplant).

The doctors at Alta Bates Summit consulted with cardiologists at Sutter’s California Pacific Medical Center (CPMC). Together, they determined that unfortunately, therapies such as medication would not address the heart failure Mitch was experiencing. The specialists told Mitch that his condition was life-threatening and required advanced treatment, possibly even a heart transplant. Mitch soon found himself at CPMC, on the heart donation waiting list and facing heart transplant surgery.

On the afternoon of Friday, August 2, the call came. A heart had become available. Late that evening, Mitch received a heart transplant at CPMC. During the operation, surgeons successfully connected the new donated heart, allowing Mitch to begin recovery and return to the active lifestyle that he once enjoyed.

Mitch has recovered remarkably quickly and will be going home from the hospital on Wednesday, August 14. It was only two days after surgery that he was out of bed on his own and moving around his room, a feat that he was unable to accomplish the week before surgery.

The integrated system of care at Sutter Health allowed for seamless escalation of Mitch’s care to address his congestive heart failure. This seamless coordination of medical and support services from one caregiver to another reduces complications in care, guarantees the continuum of quality and reduces the overall total cost of care. In Mitch’s case, the integrated care offered at Sutter Health was also life-saving.

Specially-Designed Hospital Unit Helps Prevent Mental and Physical Decline in Elderly Patients

Posted on Aug 6, 2019 in California Pacific Medical Center, Quality, Scroll Images

SAN FRANCISCO – Hospitalized elderly people are at risk of developing complications like delirium—which carries the same risk of mortality as a heart attack.

Now a specially-designed Acute Care for the Elderly (ACE) unit, combined with a volunteer-powered Hospital Elder Life Program (HELP) at Sutter’s CPMC Mission Bernal Campus hospital, is focused on decreasing incidents of delirium and other complications. ACE unit staff and volunteers are also working to improve these patients’ coordination and mobility, decrease length of hospital stays and reduce readmissions. In addition to better health outcomes, this innovative care helps control costs and fosters affordable, dependable healthcare.

The team behind the Geriatric Accreditation. Sara G Cohen, MS, RN, AGCNS-BC; Wendy Zachary, M.D., Geriatrician; Ritik Chandra, M.D., Emergency Medicine

The hospital, which part of the Sutter’s integrated network of care, recently earned a Geriatric Emergency Department Accreditation (GEDA) from the American College of Emergency Physicians. GEDA was developed by leaders in emergency medicine to ensure that our older patients receive well-coordinated, quality care at the appropriate level at every emergency department encounter. Mission Bernal Campus hospital is the first San Francisco hospital to earn the voluntary designation in 2019 –and it is one of only three Northern California hospitals to do so.

“This accreditation strengthens our goal of providing advanced care for older members of our community who are particularly medically vulnerable,” said Wendy Zachary M.D., a geriatrician and the medical director of the Acute Care for the Elderly (ACE) unit—an inpatient unit at Mission Bernal Campus hospital designed exclusively for people over 70. “Older patients often arrive at the emergency department presenting with multiple chronic conditions and symptoms.”

The decision to voluntarily pursue the emergency department accreditation demonstrates the hospital’s commitment to provide the best quality of emergency care to San Francisco’s older patients—a population that is expected to include 30 percent of residents in San Francisco by 2030 according to San Francisco’s Department of Aging and Adult Services.

Dr. Wendy Zachary with 100 year old ACE patient Dorothy Bobbet

“The Emergency Department is one of the most important access points for older patients seeking medical care,” said Dr. Ritik Chandra, medical director of the CPMC Mission Bernal Emergency Department. “At Sutter CPMC we work to ensure that healthcare is readily available to everyone and we tailor our services to best meet the needs of our diverse community, including the special needs of older patients.”

Mission Bernal Campus hospital’s emergency department features specially-designed exam rooms for older patients, including calming colors, non-slip floors, and measures to reduce falls. Up to 90 percent of the patients in the hospital’s ACE Unit are admitted directly from the hospital’s emergency department. Approximately thirty to thirty-four patients per day are cared for in the ACE unit. ACE unit physicians and staff members undergo training that is specific to the needs of older patients.

The ACE unit is a dedicated floor in the hospital, with 34 private rooms and a physical therapy/rehabilitation room. In addition, there is a large activity room where patients can share meal times and engage in music therapy, guided imagery, and other activities that encourage older patients to continue to socialize and move around during their hospital stay.

With the combination of the geriatric accreditation for the emergency department and the ACE unit, CPMC’s Mission Bernal Campus hospital is focused on providing specialized care to address the needs of San Francisco’s older residents.