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How a Rural Hospital Treated a COVID-19 Patient 120 Miles Away

Posted on Jul 2, 2020 in Expanding Access, Innovation, Memorial Hospital, Los Banos, Quality, Safety, Scroll Images, Uncategorized

When Sutter Health’s Memorial Hospital Los Banos had a critically ill patient test positive for COVID-19, there wasn’t an ICU room for her. The small community hospital’s four ICU beds are located in the same large room separated by curtains, and this patient needed to be isolated.

A private room was made available, but there was a problem: It was not equipped with the Sutter eICU telehealth system that allows 24/7 critical-care physician coverage from a central hub 120 miles north in Sacramento. But, as part of its preparations for a COVID-19 patient surge, Sutter Health had just deployed a new system that allowed its eICUs to more than double its capabilities. The patient in Los Banos was the first to be cared for using the new system.

Sutter, a national pioneer in electronic ICU (eICU), has for years ensured critically ill patients in both large cities and small towns have 24/7 access to an expert team of doctors specially trained in their care. From central hubs in Sacramento and San Francisco, these doctors monitor patients in ICUs many miles away using live interactive video and remote diagnostic tools to instantly assess critical changes in a patient’s condition and provide expert critical-care physician support and supervision for the hospitalists, specialists and nurses who provide the hands-on care.

Sutter Health has more than 300 ICU patient rooms at 18 hospitals, each one outfitted with interactive video cameras, but in a matter of a month, Sutter designed and deployed specialized units that enable the eICU’s critical-care physicians to care for upward of 1,000 coronavirus patients without having to travel from hospital to hospital and using in-demand PPE. As part of its COVID-19 surge planning, each hospital set aside other patient rooms that don’t have the eICU video technology installed, and Sutter’s eICU team created and deployed 82 iPad stands across its network to bring these specialized critical care teams to those patients, too. Including the patient in Los Banos.

“The challenge was to come up with a plan for our eICU to provide care for a surge in patients across Northern California,” said Dr. Tom Shaughnessy, medical director of Sutter Health Bay Area eICU. “We are now able to meet the need of a patient surge by giving the same comprehensive, quality care whether a patient is in one of our ICU beds or a converted room.”

With the assistance of the eICU team through the mobile units, the patient in Los Banos recovered from the novel coronavirus. Now rural hospitals throughout the Sutter network are prepared for patients who need to be isolated and still have 24/7 critical-care physician coverage, and Sutter’s larger hospitals are prepared for a future patient surge of any type that requires all-hours critical-care coverage.

“We have nurses and physicians providing some of the best bedside care in the country, and the eICU allows us to come in and provide advanced specialized support as they care for patients,” said Dr. Vanessa Walker, medical director of the Sutter Health Valley Area eICU. “This is critical in the care for those suffering from compromised lung function due to a virus such as COVID-19. Now with these additional mobile units, we are well prepared to meet a surge of patients from this current crisis or any other that may come in the future.”

Vanessa Walker, D.O., cares for a patient through the eICU system in Sacramento

How to Stay Safe with Rising Heat and COVID-19 Cases

Posted on Jun 26, 2020 in Carousel, Pediatric Care, Quality, Safety, Scroll Images, Sutter Medical Center, Sacramento

Temperatures are rising in Northern California, and so are confirmed cases of COVID-19. How do you keep safe from both? Stay home, says an emergency medicine physician with Sutter Medical Center, Sacramento.

“Our recommendation for the heat is stay inside and exercise intelligently; that’s kind of what we would say about COVID-19. They overlap,” said Arthur Jey, M.D. “Because it’s so hot, we’re not going to want to go out anyway, so it’s a good excuse to stay home with your family.”

With communities opening up and more area residents wanting to take advantage of the great outdoors and other opportunities, Dr. Jey pleads for folks to keep their masks on … or at least handy. Popular activities in the region include walking and hiking, which are great ways to get some fresh air and exercise at the same time. Won’t wearing a mask make you even hotter?

“When you’re outside, walking and hiking, and there’s no one around, you don’t need to wear the mask,” he said. “But you don’t know when you’re going to come close to someone, so keep your mask close by. I am always wearing a mask around my neck or it’s in my pocket. As soon as someone approaches, I put it on. … When there are people around, my mask is on all the time.”

During an interview with the media, Dr. Jey gave some other tips on how to avoid heat-related illnesses, from heat rashes and sunburns to heat exhaustion and heat stroke. Those most susceptible to the heat illnesses include toddlers who can’t communicate that they’re suffering, the very old, and those who have to work in the sun, including farm and construction workers.

What and How Much to Drink

If you are out in the sun, Dr. Jey says the best thing to do is drink a lot of fluids. He recommends good, ol’ plain H2O. Not ice-cold water that can cause cramps, but cooled water. He also recommends sugar-free electrolyte drinks, which are good ways to replenish those essential minerals when working out. Avoid alcoholic beverages along with sodas and sports drinks that contain sugar.

“Make sure you’re smart about what you drink,’ he said. “Alcohol is going to dehydrate you. Really heavy sugared water, like Gatorade, is going to dehydrate you. Electrolyte waters with low or no sugar, fantastic. Water, fantastic.”

He also says it’s not important to count how much fluids to take in, but rather to sip consistently and continually, not a lot at one time. “Everyone asks me how much to drink. Many medical professionals say drink eight to 10 glasses a day. But really, just try to drink well.” He said to take sips at least every half an hour while out in the sun. His counsel: “Don’t wait until you’re thirsty to take a drink.”

He also recommends that those going outside wear light, loose clothing and a hat. “I tend to wear baseball caps a lot, but they aren’t the best choice. The ones that you really want are the wide-brimmed ones, like the fishing hats, that cover the back of your neck. We’ve all been sunburned there before.”

What to Do When You’re Feeling the Heat

“There’s a whole continuum of heat-related diseases,” Dr. Jey says, and they progressively worsen as you’re exposed longer to the hot weather.

1.       Heat rashes, which is a reddening of the skin.

2.       Sunburns, which can be very painful.

3.       Heat exhaustion, when you’re still sweating, but you’re feeling a little woozy or nauseous. Your urine at that point is a darker yellow.

4.       Heat stroke.

“This is when it gets scary,” Dr. Jey says. “You stop sweating and your thinking slows down, and you feel horrible. You look like you’re having a stroke; that’s why it’s called heat stroke. I’ve seen people come in completely confused, acting like they’re almost drunk, that’s when you really get scared. The way you prevent that is that you don’t wait until you’re thirsty to start drinking water.”

He says when heat stroke is happening, the first step is to get out of the heat and let someone know you’re not feeling good. That’s why toddlers who aren’t talking yet are very susceptible to heat illness, because they can’t verbalize how they’re feeling.

Next step: “Get some water in you. Don’t chug it, don’t drink a whole gallon of it. Just sit down in the shade or some air conditioning and sip some water. And, if you don’t get better, then come see us at Sutter.”

Dr. Jey said, even during this pandemic, don’t be afraid to go to the emergency room when you are in a medical emergency, whether it’s heat stroke, a real stroke, or any other kind.

“We get concerned that you push things off too far,” he said. “Our nurses and physicians here work really hard to make sure that we keep you safe. … So if you start feeling problems with temperature, problems with the heat, or for that matter, trouble breathing, come see us. Don’t be scared. We have a separate area for those who we think might have COVID-19. Especially now when we’re starting to have another uprising of it. We’re very cautious of it. But I don’t want that to stop people from coming in when they have other illnesses.”

The Sacramento Bee posted one of Dr. Jey’s interviews on heat illnesses. Click here to watch it, and notice his mask is around his neck for when someone comes close!

A Conversation Guide: COVID-19 Medical Research Terms Defined

Posted on Jun 22, 2020 in Affiliates, Community Benefit, Expanding Access, Innovation, Quality, Research, Safety, Scroll Images

Investigational Treatments
Researchers conduct clinical trials to study investigational or experimental treatments to determine if potential new treatments, such as drugs and medical devices, can safely and effectively prevent or treat disease or other health concerns. Clinical trials of potential new drugs can also provide information on how much of a drug is needed, what benefits and side effects may occur, and how drugs or other interventions impact individuals differently based on age, gender, and race/ethnicity.

Drug and medical device development is most commonly conducted in several phases:
Preclinical tests: Before clinical trials involving humans are conducted, potential treatments are first assessed in preclinical research. Such preclinical research assesses the features of a test or treatment. For example, the research may aim to learn if a device is harmful to humans. Another aim may be to learn more about the chemical composition of a drug. In preclinical studies of vaccines, researchers give the vaccine to animals to see if it produces an immune response.

Phase 0: These studies are the first clinical trials conducted in humans. They aim to learn how a drug is processed in the body and how it affects humans. In these trials, a very small dose of a drug is given to about 10 to 15 people.

Phase 1: These studies assess the safety of a drug or device. This phase of testing, which can take several months to complete, usually includes a small number of healthy study participants (20 to 100 people). Phase 1 studies aim to better understand the effects of the drug or device on humans. For drug studies, this may include how the drug is absorbed, metabolized or excreted in humans, and what side effects may occur as dosing increases. In Phase 1 studies of vaccines, researchers give the vaccine to a small number of people to test safety and dosage, and confirm that it stimulates the immune system.

Phase 2: Phase 2 studies test the effectiveness of a drug or device over several months to two years, and involve up to several hundred patients. Most Phase 2 drug studies are randomized trials where one group of patients receives an experimental drug, while a second “control” group receives a standard treatment or placebo. Often these studies are “blinded,” meaning neither the study participants nor the researchers know who has received the experimental drug or other intervention. With such an approach, comparative information can be generated about the relative safety and effectiveness of the new drug, device or other intervention.

In Phase 2 studies of vaccines, researchers give the proposed vaccine to hundreds of people split into groups to see if the vaccine acts differently among the various groups of study participants. These trials seek to further test the proposed vaccine’s safety and ability to stimulate the immune system.

Phase 3: These studies involve randomized and blind testing in several hundred to several thousand study participants. This large-scale testing, which can last several years, seek to provide the manufacturer of a proposed treatment with a thorough understanding of the effectiveness of the drug or device, as well as the benefits and the possible adverse reactions or side effects. Once Phase 3 is complete, a pharmaceutical company or medical device company may use the data generated and collected from the performance of the Phase 3 study in order to request FDA approval to market the drug or medical device.

In Phase 3 studies of vaccines, researchers give the vaccine to thousands of people and wait to see how many become infected, compared with study volunteers who received a placebo. These trials can determine if the vaccine protects against COVID-19, for example.

Phase 4: These studies, often called Post Marketing Surveillance Trials, are conducted after a drug or device has been approved for consumer use. Pharmaceutical and medical device companies have several objectives at this stage: to compare a treatment with other similar treatments already in the market; monitor the treatment’s long-term effectiveness and impact on a patient’s quality of life, and; to determine the cost-effectiveness of a particular approved treatment relative to other traditional and new therapies.

In Phase 4 studies of vaccines, regulators in each country review the trial results and decide whether or not to approve the vaccine. During a pandemic, a vaccine may receive emergency use authorization before formal approval.

Expanded Access
Sometimes called “compassionate use,” expanded access is a potential route for patients with a serious or life-threatening disease to gain access to an investigational drug or device where there is no comparable, alternative therapy, but the patient’s clinician, in coordination with the pharmaceutical or medical device company, believes that the particular treatment may be beneficial to the patient if applied. Expanded access use of a drug or device is done outside of the clinical trial context, but, as with clinical trials, also involves regulatory and reporting obligations to the FDA.

As of June 2020, expanded access is one pathway advancing the use of convalescent plasma for patients with serious COVID-19, who are not otherwise eligible for or who are unable to participate in clinical trials.

Emergency Use Authorization
An Emergency Use Authorization (EUA) is one way the FDA makes certain medical products (drugs, tests, vaccines) available quickly during a pandemic. The FDA may issue an EUA to provide access to these products when there are no adequate, approved options.

Under an EUA, in an emergency, the FDA provides access to the public based on the best available evidence, without having all the evidence that would normally be needed for full FDA approval. The FDA balances the potential risks and benefits of the medical products based on the data currently available.

EUAs can be revised or revoked by the FDA at any time as the agency continues to evaluate the available data and patient needs during a public health crisis like a pandemic.

“Off-Label” Use of an Approved Drug
After the FDA approves a drug for a certain disease or health condition, doctors may prescribe the drug in clinical care for an use not specifically listed in the approved labeling (i.e., “off-label”) based on the physician’s medical judgment, but recognizing that the FDA has not assessed the safety or effectiveness of such use.

For example, in April 2020 the FDA acknowledged that certain off-label use of the antimalarial drugs hydroxychloroquine and chloroquine had been prescribed by physicians for the treatment of COVID-19. These drugs have been FDA approved for use in treating malaria, but not for widespread use in treating COVID-19 since no formal clinical trials had been previously conducted to examine the efficacy of the drugs for this purpose. The FDA thus did not have data necessary to support an approved use of hydroxychloroquine or chloroquine.

“FDA Approved”
The FDA is the national regulatory agency that among its various duties, approves drugs, medical devices, and vaccines based on clinical data and other information showing that the treatment is safe and effective for its intended use and in compliance with federal quality standards. The “stamp of approval” is provided when the FDA determines that the benefits of a drug, device of other medical product outweigh its risks.

Learn more about clinical research and the phases of clinical trials.

It’s Time to Get the Care You’ve Been Waiting For

Posted on Jun 18, 2020 in Affiliates, Alta Bates Summit Medical Center, Mills-Peninsula Health Services, Quality, Safety, Scroll Images, Uncategorized, Wellness, Women's Services

OAKLAND, CALIF. — California is slowly reopening, but like so many unknowns with COVID-19, it’s unclear how long our return to routine will last.

“A surge in virus spread and infected patients could occur this fall or winter,” says Bill Isenberg, M.D., chief quality and safety officer for Sutter Health. “If this happens, and overlaps with the normal flu season, there could be a significant strain on healthcare services.”

With this in mind, medical experts agree that if you had an appointment postponed or canceled due to COVID-19, now is the time to reschedule it.

Norma Lester-Atwood, RTRM, is a mammographer at the Carol Ann Read Breast Health Center at Alta Bates Summit Medical Center in Oakland, so she’s well-versed in the importance of catching breast cancer early. Lester-Atwood is typically right on schedule for her own mammogram, but this spring, shelter-in-place orders delayed her mammogram by two months. As soon as she could, she had the screening procedure and she’s glad she did, because her mammogram and a subsequent biopsy revealed a Stage 0 (non-invasive) tumor in one of her breasts. After a lumpectomy to remove the tumor, Lester-Atwood feels she is well on her way to recovery.

“As a mammographer, I’ve always told my patients that it’s important to come in every year for a mammogram because I’ve seen patients who developed fast-growing tumors between screenings,” says Lester-Atwood. “And now because of my personal experience, I’ve seen the other side of the coin and I have even more reason to encourage patients to get their regularly scheduled mammograms.”

Timing is Everything
As Lester-Atwood’s experience shows, timing is everything when it comes to staying healthy. Getting cancer screenings at the recommended intervals can help spot early signs of abnormal cell division or tumor growth before it turns into advanced cancer.

Public health department-mandated cancellation of elective procedures and many routine appointments earlier this year caused many screenings to be delayed, which may, unfortunately, have serious repercussions for some people.

Because of the importance of cancer screenings to maintaining good health, Sutter-affiliated clinicians track annual completion of mammograms, says Isenberg. “We estimate that of every 200 mammograms, one patient’s is suspicious for breast cancer and needs further attention. Because so far to date 4,000 – 5,000 people have postponed mammograms, that means approximately 20-25 cancers may have gone undiagnosed.”

The 0.5 percent detection rate for mammograms is roughly the same for colon and cervical cancer screening, says Isenberg, so similar undiagnosed cancers are likely for these diseases. “Mammograms and screenings for other cancers such as skin or prostate cancer, as well as preventative care are all important to keep on top of,” he says. “And although we often think of cancer as a disease that people get at a later stage in life, cancer can strike at any age. In fact, some hormone-sensitive cancers grow more rapidly in younger patients, so having regularly scheduled Pap test or mammograms can be lifesaving.”

“Some women don’t realize that mammograms are needed regardless of your family history, because most women with breast cancer have no family history or other identifiable risk factors,” says Harriet B. Borofsky, M.D., medical director of breast imaging with Mills-Peninsula Medical Center in San Mateo, Calif., part of the Sutter Health not-for-profit integrated network of care.

Screening for colorectal, prostate and lung cancers are also vital. “Simply put, screening saves lives,” says Borofsky. “Delayed screenings can postpone detection of cancer, which may translate into needing more intensive treatment and a more difficult path for patients.”

Taking Steps to Protect Patients and Staff
Catching up on care is one of the most important things you can do to protect your health. All Sutter imaging centers have resumed some level of cancer screening services, or are preparing to resume soon, and each has taken steps to protect patients and staff from exposure to viruses. These steps include:

Mandatory Masking – Staff, patients and visitors must wear masks at all times.
Isolation – Anyone with COVID-19 symptoms is isolated from waiting areas, patient rooms, entrances and spaces the general population uses.
Cleaning – Our teams have increased the frequency of cleaning and disinfecting in all spaces.
Screening – Everyone is screened for signs and symptoms of COVID-19 before entering our care.
Contact-Free Check-In – Skip the front desk and check in from your mobile device at some locations through Hello Patient, a new feature on My Health Online.

These protocols apply to all visits to our outpatient care centers, including scheduled office visits, radiology, lab and walk-ins to Urgent Care.

Resources to Help with Health Insurance Disruption

Health insurance coverage can be disrupted by wage or job loss, but there are options that provide access to important cancer screenings, even if you’ve lost your normal source of coverage.

In California, the Every Woman Counts program covers mammograms and cervical cancer screening for women with no or limited insurance who meet other eligibility criteria. To learn more, patients can call 1(800)-511-2300.

Other options include extending employer-based coverage through COBRA and CalCOBRA, shopping for plans and applying for premium assistance through Covered California, or applying for and qualifying for Medi-Cal. Charity care and financial assistance options may also be available. You can learn more about these options by visiting sutterhealth.org/coverage-options.

PPE Donations: Like Mother, Like Daughter

Posted on Jun 17, 2020 in Affiliates, Alta Bates Summit Medical Center, People, Safety, Scroll Images

Jiaqi Yu

OAKLAND, Calif. –It’s not quite the family business, but 15 year old Jiaqi Yu has definitely learned how to make connections and obtain much-needed PPE like masks and shoe coverings by watching her mom, Minfen Ding, RN.

Minfen Ding, RN

In April, Yu’s mother facilitated donation of 13,000 masks and other PPE to Sutter’s Alta Bates Summit Medical Center in Oakland where she works as an oncology nurse. Now Yu has helped make connections and facilitate the delivery of 20,000 masks to the hospital.

“I am very proud of Jiaqi. She cares about the safety of our staff and is able to advocate for our hospital,” says Ding.

The College Preparatory School ninth grader says she was inspired to facilitate the donation of masks by watching her mom’s efforts to gather PPE to protect her colleagues.

“I believe that every medical worker on the frontlines deserves the best equipment,” says Yu. “They are all working hard to protect us, but they need protection too, and I wanted to do what I can to help them.”

Yu facilitated donation of the masks, which she secured from the Fountain Project Foundation, an East Bay non-profit working to help people with no health insurance obtain medical care.

Feeling Safe Amid Uncertainty

Posted on Jun 16, 2020 in Quality, Scroll Images, Sutter Davis Hospital

Stephanie Myers & Garry Douglas, Sweden 2019

Garry Douglas is one who can appreciate a journey. He made his way from just outside the Saginaw Chippewa Indian Reservation near Mount Pleasant, Michigan, to Northern California in the early 1970s. He explored the majesty and mystery of national forests and grasslands through his job with the U.S. Forest Service. He travels the world with his wife, Stephanie Myers, to visit friends he’s made over the years. But nothing could have prepared Douglas for the journey he endured earlier this year: a diagnosis of COVID-19.

Douglas spent a week in Glasgow, Scotland, visiting a longtime friend before heading to Cambridge, England, for several days and then making the trek to London. He returned home to Winters, a small town in rural Yolo County, on March 16. He started to feel unwell a few days after returning, plagued by headaches and fatigue. After consulting with his physician, Carla Kakutani, M.D., Douglas visited an urgent care clinic where his flu test came back negative. His symptoms took a turn for the worse in the days ahead. The 68 year-old felt disoriented. Shaking with chills one moment, his temperature ratcheting up to 103 degrees the next. On March 30, he came to Sutter Davis Hospital’s emergency department and was eventually admitted.

For Douglas, his recollection of the journey pauses here for a moment. His exhaustion, coupled with the eventual sedation he went under in the intensive care unit, suspends time for him. But Myers picks up the tale – albeit secondhand. She wasn’t allowed to be with Douglas in the hospital because of the visitor limitations in place to limit the spread of coronavirus and protect patients and staff. Conversations with emergency department staff, and Carly Grovhoug, M.D., Myers’ primary care doctor, who works closely with Dr. Kakutani, act like the mile markers toward an unknown destination.

But the path eventually became clearer. The Sutter Davis ICU team was always responsive to her calls any time of the day to check on his status. Social worker Katie Tenerelli was also a “godsend” according to Myers.

“She talked through a lot of things with me, told me what he looked like,” she said.

Myers was eventually able to see him firsthand through the power of video visits with the help of staff as well. Initially, since Douglas was on a ventilator, verbal communication was limited at best.

“He could hear me, but he was out of it. I’d say, ‘Garry, open your eyes,” she said with a laugh.

A visit to Lake Superior, 2019

By the end of the second week, Douglas’ condition improved. He was growing more alert and eventually was removed from the ventilator. He always considered himself relatively healthy and active. But now his activity was limited to “belly band” exercises. Technically known as high-frequency chest wall oscillation, the procedure helps improve lung function. While connected to an airway clearance device, Douglas laid on his back with an elastic band around his abdomen that vibrated 25 minutes at a time. There were also the short-distance field trips—within his room—from the bed to the chair and back again.

“I was a total weakling since I hadn’t moved in two weeks,” he said.

But Douglas was moved by how the thoughtful gestures of Sutter Davis’ ICU staff continued. From the simplest acts of grabbing him coffee to hanging up photos from he and Myers’ wedding or some from their travels made him feel more comfortable, more at home.

Once Douglas was healthy and strong enough to go home, the entire Sutter Davis Hospital team pulled out all the stops. From the second floor on down to the first, through the lobby and even out the hospital’s main entrance, employees lined up for what seemed like miles to applaud his recovery and wish him well.

Douglas was taking his own victory lap to the cheers of adoring fans. It was a salute suited for a hero. And in the eyes of the Sutter Davis team, he was. At this unprecedented time with a lot of unknowns and unpredictability with the virus, he was just as much of a symbol of hope and perseverance to them as they had been for him.

Douglas and Myers are back at home now, adjusting to the new normal. Douglas had a fairly detailed after-care plan that included a home health care nurse and physical therapy visits twice a week coordinated through Sutter Care at Home. Plus, he had a series of other medications and vitamins to take. He is making progress every day and relishes the comforts of home, but reflects back fondly on those he met at Sutter Davis Hospital throughout this uncharted territory of COVID-19.

“It was such a good feeling…to me it just showed how caring they were,” he said.