Access to Care

Respiratory Care Clinics: How Dedicated Exam Spaces Limit the Spread of Viruses

Posted on May 26, 2020 in Access to Care, Scroll Images

BAY AREA, Calif. – Its second nature for people to visit their doctor’s office or an urgent care center when they’re sick — or are worried they might be. In early March doctors across the Sutter Bay Medical Foundation prepared for patient demand at these locations by developing Respiratory Care Clinics (RCCs); an outdoor exam experience that keeps potentially contagious people distanced from those that aren’t, while allowing all who need in-person care to receive it.

“We always knew patients would have concerns that were serious enough to need an in-person exam, but not urgent enough for a trip to the emergency room,” said Kurt Vandevort, M.D., inter-regional medical director for the Palo Alto Foundation Medical Group, part of the Sutter Medical Network. “As community-based providers this middle level of care is what we do best, so it was incumbent on us to find a way to keep providing it, safely.”

By March 16th the Sutter Bay Medical Foundation had established fifteen RCCs in cities across the Bay Area, each seeing patients with COVID-19 concerning symptoms (or who reported a potential exposure to the coronavirus), outside of a nearby medical building that needed to stay open and clean for patients with urgent or medically necessary needs unrelated to COVID.

A month into their operation reporters from The Mercury News and San Francisco Chronicle took notice and wrote about these MASH-like clinics. Now, as Sutter Health resumes more routine patient visits, the RCCs will continue to separate patients with respiratory symptoms from those without, to reduce the risk of exposure to viruses, including the novel coronavirus. Read below to learn more about how the RCCs work and what to expect if you are directed to one.

Call First 

Sutter Health is focused on helping ensure patients have access to the right level of care to match their medical need, but we also understand that sometimes that’s hard for people to gauge. That’s why Sutter Health set up the COVID-19 Advice Line at 1-866-961-2889.

Staffed by a team of nurses from 8 a.m. – 6 p.m., seven days a week, every caller is screened for symptoms linked to coronavirus. Callers are then directed to the most appropriate level of care based on the severity of their symptoms. Patients may be directed to self-monitor at home, to see a provider by video visit or to come to an RCC location where they can receive an in-person exam.

“By linking the RCCs to a pre-screening process (by phone or after a video visit) we can ensure patients coming to RCC do need to be seen in-person, and aren’t ill enough to go straight to the emergency room,” said Dr. Vandevort, who is also the medical director of the RCCs established throughout the Palo Alto Medical Foundation footprint. “When patients arrive at the RCC we also have some information about their chief concerns, thanks to notes entered in our electronic medical record.”

Different, by design 

A physical exam in a parking lot or garage is strange, but the safety that these setting offer is worth the weird-factor. “To protect patients, staff and the community we designed the RCCs to first and fore-most prevent transmission of any virus from a contagious person; that’s why most of them are outdoors and anyone who comes within six feet of the patient is in full personal protective equipment” said Dr. Vandevort. “At the same time we took great pains to try to make the experience similar to what patients are used to when they go to the doctor or urgent care.”

The outdoor RCCs all have a contact-free arrival process, allowing patients to drive-up and call a phone number to “check-in” for their appointment. At every stage of the visit the patient is distanced from others by either staying in their car or in a marked off space within an exam bay.

In addition to an initial temperature check, patients will have their lungs listened to with a stethoscope, have their blood oxygen saturation checked, have their medical history and medications reviewed, and may be tested for coronavirus or the flu if symptoms indicate they should be. Depending on medical need, patients will also receive additional tests and procedures, including imaging scans, blood draws, heart monitoring and more.

The few indoor RCCs are all in buildings, or sections of buildings, that can safely be separated from other areas where patients who don’t have respiratory symptoms are being seen. The indoor RCCs have implemented all the necessary transmission precautions to ensure that spread of a virus from patient to patient or patient to staff is prevented.

Not Just COVID Care

In addition to screening and treating respiratory complaints, the RCCs have filled another important role; addressing non-respiratory related issues reported by patients who have symptoms linked to COVID (fever, cough, shortness of breath). “Just because COVID-19 is here, that doesn’t mean that other illnesses and injuries go away,” said Dr. Vandevort. “One of the best things about the RCCs is that you are being evaluated by a physician who can treat a wide variety of minor illnesses or injuries, prescribe medications or make a dosage change to an existing medication, and otherwise address a whole host of concerns. It’s what we do every day, and in these safe settings, we can keep doing our job even for patients who may have a virus and be contagious.”

In the short time the RCCs have been up and running, doctors staffing them have made unexpectedly important diagnoses and delivered increasingly complex care. “We’ve seen and treated conditions ranging from an appendicitis, to a swallowed fish bone, to an infection requiring IV antibiotics. We’ve done a lot of good.”

Twice the Team 

It’s not easy to run two clinics (one regular and one RCC), simultaneously, just feet apart, but for the safety of our patients and providers that is what we’ve done. “We had to reassign doctors and nurses so we had coverage in both the RCC and the regular urgent care at the same time, some staff now act as a front-door attendants making sure that patients are directed to the right clinic based on their symptoms, and others are runners shuttling supplies between the two spaces.”

All this investment was made for one reason: to prevent the spread of illness. But the RCCs have had several secondary benefits too.

“We’re also helping to preserve hospital capacity by keeping patients from going to the emergency department unnecessarily.” You wouldn’t normally go to the ER for a fever, and the RCCs make sure our smart use of resources stays intact, even during a pandemic.

At the same time, the RCCs have helped refer patients to a higher level of care when that was needed. “Our job is to help stabilize people so they can safely return home, but when their symptoms are serious we help get them to the hospital.”

Sutter Santa Rosa Regional Hospital Family Medicine Residency Program Announces Incoming Class of 2023

Posted on May 26, 2020 in Access to Care, Scroll Images

SANTA ROSA, Calif. (May 26, 2020) – The Sutter Santa Rosa Regional Hospital (SSRRH) Family Medicine Residency Program today announced its incoming class of 2023. The 12 new residents were selected from among 850 applicants representing the nation’s top medical schools. SSRRH’s three-year program, one of 450 family medicine training programs in the United States, has trained hundreds of family physicians since its inception in 1938.

SSRRH’s Family Medicine Residency is a critical strategic asset with which to combat the emerging physician shortage in Sonoma County. The residency has been the largest single source of family physicians to Sonoma County for over 80 years. Residency graduates comprise nearly half of family physicians in Sonoma County, filling openings in private practices, community clinics, and large medical groups such as Sutter Medical Group of the Redwoods, The Permanente Medical Group, local community health centers, Sonoma County Health Services and leadership positions throughout the medical community.

“One of the amazing things about the specialty of Family Medicine is that we continue to adapt our training in order to provide the services that are needed by the particular community and the time in which we serve. After the last three years filled with fires and a SARS-CoV2 pandemic, it is becoming increasingly clear that we need to train doctors who are flexible and can adapt to, and even lead, in disaster,” says Tara Scott, M.D., program director of the residency.

“The Sutter Family Medicine Residency has fortified its position as a key part of the disaster response in the community and we have recruited an amazing class of soon-to-be Family Physicians from all over the country who are attracted to our brand of community-based training and service, says Dr. Scott. “We are thrilled to welcome these 12 amazing young physicians to the county. We know from experience that many will stay here in our community and provide Primary Care for the residents of Sonoma County for years to come.”

The eleven women and one man who will begin the training program in June came from medical schools across the country including: College of Osteopathic Medicine of the Pacific at Western University of Health Science; Frank H. Netter School of Medicine – Quinnipiac University; Edward Via College of Osteopathic Medicine of the Carolinas; George Washington University School of Medicine and Health Sciences; University of California, Davis; University of Kansas School of Medicine; University of Minnesota Medical School; University of Texas Southwestern Medical School; Virginia Commonwealth University School of Medicine; Warren Alpert Medical School – Brown University. They each come with an impressive background of academic achievement and community service.

(Click here for details about each resident.)

The new residents will graduate the program in 2023; they will begin on June 15, 2020.

The Santa Rosa Family Medicine Residency is under the sponsorship of Sutter Santa Rosa Regional Hospital (SSRRH). To provide a broader base of support for the residency and optimize learning experiences for residents, SSRRH engaged Santa Rosa Community Health Centers and Kaiser Permanente in 2006 and continues its affiliations with partners in the community today.

About the Sutter Health Family Medicine Residency Program

With the initiation of formal training in general practice dating back to 1938, Sutter Santa Rosa Regional Hospital (and formerly Sutter Medical Center of Santa Rosa) has an established tradition of excellent training of family physicians with the strong support of community physicians and specialists. In 1969, the program became affiliated with what has since become the Department of Family and Community Medicine at the University of California, San Francisco (UCSF).

About Sutter Santa Rosa Regional Hospital

Sutter Santa Rosa Regional Hospital, part of the not-for-profit, integrated Sutter Health network, has a long, proud history of providing high quality care in Sonoma County and beyond. Because of an unwavering focus on health and healing the hospital is consistently ranked as one of the top hospitals in the region.

Intelligently Ramping Up In-Person Care

Posted on May 20, 2020 in Access to Care, Scroll Images

SANTA ROSA, Calif. – Sutter physicians are moving into the clinical phase of recovery amid COVID-19, with in-person visits resuming with greater frequency.

While fears over contracting the virus persist, Sutter is working hard to communicate to patients the many safety measures in place so they feel comfortable coming in.

“Thanks to residents who continue to practice physical distancing and other responsible public health practices, we are starting to bring back our patients who deferred time-sensitive or preventative care in March and April,” said Gary McLeod, M.D., president of Sutter Medical Group of the Redwoods.

Opening Up, Gradually

California Governor Gavin Newsom said that re-opening the state will not happen all at once.

“There’s no light switch here. It’s more like a dimmer,” he told reporters during an April press conference, where he outlined six indicators, including the ability of hospitals and health systems to handle surges.

Sutter is taking a similar phased approach to reintegrating its operations. According to Bill Isenberg, M.D., Sutter’s Chief Quality and Safety Officer, “We anticipate that full resumption of our operations is likely months away.”

“We are taking a phased approach, not only because we want those patients most in need to be seen first, but also to allow us to continually monitor PPE inventory and testing capability to ensure we can provide care safely and remain prepared for a surge should the number of COVID-19 patients begin to increase again,” Isenberg said.

As patients begin to navigate the new normal of receiving care, it’s important they coordinate closely with their primary care provider to discuss timing and options.

Facilities Going the Extra Mile

Sutter hospitals, outpatient clinics and doctors’ offices are open and have the following safety measures in place:

• Each staff member, patient and visitor are screened for COVID-19 symptoms
• Temperatures are taken for all staff, patient and visitors at every building entrance
• Visitors are limited
• Masks are required and provided for everyone entering any Sutter building
• Lobbies and waiting areas are modified to support social distancing
• Enhanced cleaning of every exam room between visits

“We are continuing to open up and work through measures to ensure safe patient care, which is especially important for our vulnerable patients with complex health issues like heart disease, lung disease, and cancer. These patients really need to see us,” McLeod said.

“At this time, the public can rest assured that medical care is available and safer than ever.”

Program Designed to Attract Docs to Rural Areas Receives Accreditation

Posted on May 15, 2020 in Access to Care, Scroll Images

The Sutter Rural Residency Program received a U.S. grant last year and this week was accredited and is ready to screen applicants. Leaders involved in the program include, from left, Dineen Greer, M.D., program director of the Sutter Family Medicine Residency Program; Sutter Amador Hospital CEO Tom Dickson; HRSA regional administrator Capt. John Moroney, M.D; Jackson Mayor Robert Stimpson; Sutter Valley Area Chief Medical Officer Ash Gokli, M.D.; former Sutter Amador CEO Anne Platt; and Robert Hartmann, M.D., longtime Amador County internal medicine physician and an instructor in the Rural Residency Program.

JACKSON, Calif. – Sutter Amador Hospital’s Rural Residency Program this week received accreditation from ACGME (Accreditation Council for Graduate Medical Education), the organization responsible for accrediting all graduate medical training programs for physicians in the United States. This Sutter Health program is designed to bring more primary-care physicians to rural regions, which have been hampered throughout the country by a shortage of family doctors.

The ACGME accreditation allows the Sutter Health Rural Residency Program to begin screening and selecting residency applicants. Those selected – two each year for six total in the program – will complete core inpatient training in Sacramento during the first year, with their next two years on the campus of Sutter Amador Hospital and in community medical offices.

The goal of the Sutter Health program is to develop a sustainable, accredited rural training track in Amador County and to ultimately expand the area’s rural primary-care workforce. In Amador County, there is a high need for primary-care physicians (PCPs) in the area as the ratio of the population to one PCP is 1,760-to-1; the ratio throughout the state of California is 1,280-to-1, according to the County Health Rankings and Roadmaps website.

“This is welcome news for Amador County, as it will provide an influx of bright, young physicians into our community to care for our families and should give us a steady supply of primary-care physicians for years to come,” said longtime Amador County internal medicine physician Robert Hartmann, M.D., who will be one of the instructors in the Rural Residency Program. “This is a major collaborative accomplishment between Sutter Amador Hospital, Sutter Medical Group physicians and the Sutter Family Medicine Residency Program.”

The Rural Residency Program was made possible through a grant from the U.S. Health Resources and Services Administration (HRSA), which allows not-for-profit Sutter Health to expand its successful Sacramento-based physician residency program to Amador County as part of the federal agency’s efforts to provide better access to quality medical care in rural areas.

Since its inception in 1995, the Sutter Family Medicine Residency Program has graduated 139 physicians, all of whom passed their Board Certification assessments on the first effort. Currently there are 21 residents in the program, and the Amador County program will expand the program to 27 residents.

“We are working to strengthen the physician pipeline throughout our integrated network so our patients receive the same high-quality care no matter where they live,” said Dineen Greer, M.D., program director of the Family Medicine Residency Program. “We have combined a strong, dedicated core faculty, community preceptors, innovative curriculum and access to Sutter hospitals so that our residents develop the skills needed to be outstanding family physicians and leaders in their communities.”

The accreditation was welcome news for the state legislators who serve the Gold Country. State Sen. Andreas Borgeas said: “The physician shortage continues to be a prevalent issue in Amador County and many rural areas of California. I offer my sincere congratulations and gratitude to Sutter Health on the program’s latest achievement, and for its targeted effort to bring much-needed family practice physicians to our community. This is a significant step to help expand access to quality care for our communities in the beautiful, remote areas of our state.”

State Assemblyman Frank Bigelow echoed Sen. Borgeas’ sentiment. “Sutter Health has long supported hospitals in more rural regions of California and they understand how family doctor shortages can have a negative impact on a community’s health,” Bigelow said. “I am so pleased they are pursuing this program and continuing their investment in bringing needed primary care physicians to Amador communities.”

Drs. Greer and Hartmann expect the program to be successful in filling the need for well-trained, community-minded primary-care physicians in Amador County and the greater Mother Lode region.

“The medical students applying for this residency opportunity will enter the program with a strong desire to serve in rural communities,” said Dr. Hartmann, “so their career focus will be the health and well-being of families in our towns and smaller cities. This is great for the future of health care in our community.”

For more on the Sutter Family Medicine Residency Program, go to www.suttermd.com/education/residency/family-medicine

Preventative Services Get Back on Track

Posted on May 12, 2020 in Access to Care, Scroll Images

Providers and patients reconnect for healthcare support during COVID-19

As California begins cautious steps to resume day-to-day life in the state amid the ongoing concerns of COVID-19, essential services like healthcare are signaling changes of their own.

After weeks of planning, the Sutter Health network has begun expanding clinical services for preventative care and those with medically necessary, time-sensitive procedures and appointment needs in the locations supported by local guidance and public health orders.

“The COVID-19 pandemic has taught us a lot and reinforces that our health is precious. We need to do everything we can to protect it,” said Theresa Frei, CEO of Sutter Valley Medical Foundation. “As we begin our phased approach to reopening, we encourage people to take advantage of the summer months to focus on preventative services to promote their best health now.”

Medically necessary, time-sensitive procedures for many people include mammograms, colonoscopies and skin exams. These services complement other ongoing offerings including vaccinations and well-baby visits. Sutter’s expanded clinical services will also help patients with chronic or complex diagnoses like diabetes or high blood-pressure resume needed care that can’t always be managed from afar. Preventative care helps keep chronic health issues from becoming something emergent or acute.

Sutter Health has taken careful steps to make clinics safe and patients feel welcome upon returning to network care centers. Sutter has adopted universal masking for staff and patients, set up temperature check stations for staff, increased frequency of cleanings and moved furniture to promote physical distancing in waiting rooms. Patients with worrisome symptoms are seen in special clinics to where there are added safety measures for staff and patients.

Digital documentation and check-in options are also available for Sutter patients, which helps cut down on wait-times and get patients into exam rooms more quickly. EZ-Arrival lets patients provide and verify check-in information in the safety of their homes. Hello Patient uses GPS to detect when patients have arrived at a Sutter facility. Patients simply tap on the arrival button on their mobile device to indicate they are ready to be seen. Both services are available to patients who are signed up for Sutter’s online patient portal, My Health Online.

“This safety-first approach helps us support patient needs while allowing us to continually monitor personal protective equipment and testing capability to ensure we can provide care safely and remain prepared for a surge should the number of COVID-19 patients begin to increase again,” said Conrad Vial, M.D., chief clinical officer for Sutter Health. “We are confident that we can broaden our clinical services and still maintain surge readiness.”

Video visits remain an option for patients who have routine care needs. Urgent care clinics and hospital emergency departments across Sutter Health’s integrated network also are open and provide care beyond the pandemic. Clinical teams are trained and equipped to care for patients while protecting them along with staff.

“We know that patients who have medical problems that are not well-controlled, such as diabetes or hypertension, are more likely to fare poorly with any other infection including COVID-19. Regular attention to our well-being is one of the best investments we can make in ourselves,” said Lizz Vilardo, M.D., CEO of Sutter Bay Medical Foundation. “We are here to support our communities so they can safely and confidently reengage with their healthcare providers.”

An Unintended Side Effect of Sheltering in Place

Posted on May 8, 2020 in Access to Care, Scroll Images

Fears of the coronavirus are causing some patients to delay or avoid seeking emergency care for a stroke or heart attack. Doctors say every delayed second could put patients at risk for a worse outcome.

If you or someone you know is experiencing an emergency, seek care immediately by calling 911 or going to the nearest emergency department.

OAKLAND, CALIF. – For some people, fear of exposure to COVID-19 outweighs the risk of a heart attack. In “Afraid of going to the hospital,” the San Francisco Chronicle describes how patients like Oakland resident Hany Metwally are delaying critical evaluation and care for fear of the virus. Says Metwally, “I was afraid to have communication with anybody because I am 64 and at high risk for the coronavirus.”

Metwally suffered severe chest pain at home for four days before his son Mohammed Metwally finally convinced him to seek care at Sutter’s Alta Bates Summit Medical Center in Oakland. When he arrived at the Alta Bates Summit emergency department in Oakland, the senior Metwally was impressed with how patients with upper respiratory symptoms are kept separate from those experiencing non-respiratory symptoms like himself.

Ronn Berrol, M.D., medical director of the emergency department at Alta Bates Summit in Oakland, understands why some patients may be concerned but, “We want to reassure people that Sutter hospitals and emergency departments have plenty of capacity to care for them and we are taking every precaution to maintain stringent safety guidelines. So if you or a loved one are experiencing severe pain or illness or have a serious injury, please don’t delay care. We are prepared to care for you and protect you from the virus while you are receiving care.”

Junaid Khan, M.D., director of cardiovascular services at Alta Bates Summit, who performed a successful triple bypass on Metwally, says it’s critical for patients to continue to seek care for serious conditions without delay, despite the virus. “People are correct to be afraid, but their risk of delaying cardiac or stroke care puts them at much greater risk than the risk of acquiring COVID-19.”

Read more about the steps Sutter hospitals and emergency departments have taken to protect patients.