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

Posted on May 26, 2020 in Carousel, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Safety, Scroll Images, Uncategorized

BAY AREA, Calif. – Its second nature for people 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 our core competency, 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.”

No Need to Put Off Possible Life-Saving Mammogram Any Longer

Posted on May 19, 2020 in Carousel, Expanding Access, Quality, Safety, Scroll Images, Sutter Medical Foundation, Women's Services

ROSEVILLE, Calif. — Laurie Deuschel of Rocklin received news during the COVID-19 crisis that breast cancer runs in her family, but during the first two months of the pandemic, mammograms were considered elective scans and weren’t being performed. The first week they became available again, Deuschel got an appointment.

“I’m here to have my first mammogram, and I’m a little bit scared,” she said, but she wasn’t scared about catching the novel coronavirus while at the Sutter Imaging center in Roseville Monday, May 18.

Why? “Sutter Imaging knows the cleaning procedures and how to keep me safe,” she said.

Sutter Health is going to great lengths to protect its patients and staff in the COVID-19 era. It has created a “new normal” for its imaging centers, focused on a “safety strategy” that is incorporating guidance from the national Centers for Disease Control, California Department of Public Health and the American College of Radiology. Some of those measures include:

  • Temperature screening of all staff, doctors and patients at the door,
  • Universal masking,
  • Social distancing in waiting rooms (patients can wait in their cars if they prefer),
  • Screening patients at the time of scheduling and arrival for symptoms,
  • Deeper cleaning of equipment after every patient,
  • Regular sanitization of chairs and door handles,
  • Thorough wipe-downs of patient lockers and dressing rooms with a “Cleaned” sign placed for patients and staff to know those areas have been disinfected,
  • Regular audits or “double checks” with staff to ensure that the new procedures are being followed. 

Miyuki Murphy, M.D., the director of breast imaging for Sutter Medical Group, was interviewed for a story on the Sacramento NBC affiliate KCRA, Channel 3. Dr. Murphy explains why not delaying your mammogram is important, and the story includes video of some of the safety measures being taken at Sutter Imaging. Click here for that story on their website.

Dr. Miyuki Murphy on KCRA about the safety of mammograms at Sutter Imaging.

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

Surprise Salute to Our Healthcare Heroes

Posted on Apr 24, 2020 in Carousel, Mills-Peninsula Health Services, People, Scroll Images, Uncategorized, We're Awesome, Year of the Nurse

BURLINGAME, Calif., — On Wednesday April 22nd the staff of Sutter’s Mills-Peninsula Medical Center received a special surprise. 

Uniformed personnel from Central County Fire Department, Burlingame Police, Hillsborough Police, San Mateo County Sheriff’s Department (Millbrae Division), and the San Bruno Police Department had come in the pre-dawn hours, with their vehicles and home-made signs, to honor our healthcare heroes.

Doctors, nurses, respiratory therapists, and others were surprised by the show of support, having had no idea that their daily bravery was going to be recognized by their community’s public safety heroes. The secret was so well kept that reactions ranged from dismay over lack of make-up, to shocked shyness, to touched tears.

Both staff arriving for their 7 a.m. start time, and the overnight crew just ending their shift, received applause and cheers for their professionalism and dedication during the COVID-19 pandemic. 

The event was made even more special by the use of signs made by children who attend the Champions Childcare program – a local daycare that reopened on March 30th with priority enrollment for the children of “essential” workers. Parents in public safety and healthcare professions are relying on Champions to care for their children while they care for the community, and having the kids involved in the surprise salute echoed the strong ties between all essential workers. 

Over 20 vehicles with lights flashing, and over 100 participants with hands clapping, honored healthcare workers in Burlingame and beyond on this uplifting and memorable morning. 

The Digital Doctor Is In: Healthcare Services You Can Access at Home

Posted on Apr 17, 2020 in Carousel, Innovation, Palo Alto Medical Foundation, Scroll Images, Uncategorized, We're Awesome

SACRAMENTO, Calif. – Receiving sound medical advice is more important now than it’s ever been. Albert Chan, M.D., chief of digital patient experience at Sutter Health, shares how you can get advice and take action, all from your living room.

Dr. Chan answers questions from Sutter Health staff in the Q&A below.

Search Your Symptoms

Q: Google has reported a surge in searches related to COVID-19. Are search engines able to give results that can help real people get the counseling and care that they need right now?

Albert Chan, M.D., Sutter Health’s
chief of digital patient experience

A: Many people who develop a fever, shortness of breath, or cough right now may be concerned that they have COVID-19. While Google, WebMD and other online tools are good at providing general guidance, they can’t suggest concrete care options, because they aren’t connected to a group of medical providers.

Sutter Health’s online Symptom Checker is a little different. After entering your brief medical history and current symptoms, you will receive a personalized health assessment and can then enter your location to find nearby care options offered by the Sutter Health network.

Originally launched in February 2019, I see the Symptom Checker as a way to help patients decide whether to engage in self-care or to seek care, if they need an in-person appointment or a video visit, and if they need to be seen now or soon. These distinctions are incredibly apt as we face the COVID-19 outbreak, concurrent with flu and allergy seasons. I’m proud that the Symptom Checker has been updated to recognize a possible COVID-19 infection, and guide patients appropriately.

Turn to the Telephone

Q: Having a trusted source of information and the ability to talk through your symptoms is desperately needed right now — what is available to the public?

A: The public has a few options, one of which is the Sutter Health 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, including self-care at home for those with mild symptoms.

Please note: The COVID-19 Advice Line is intended for people who are ill or caring for someone who is ill. For general information about coronavirus, please refer to the Centers for Disease Control and Prevention (CDC) website. The COVID-19 Advice Line is not for emergency situations. If you think you are experiencing a medical emergency, please call 911 or visit the nearest emergency room.

Seeing is Believing

Q: Some things are hard to diagnose or make decisions about over the phone, what other options are available for patients?

A: Patients can get virtual care from their phone, tablet or computer through Sutter Video Visits. This video gives you a sense of the video visit experience.

We offer a couple of options:

Video visits are expanding to address many primary and specialty care needs. Patients can now call or message their care team via My Health Online to check the availability of video visit appointments with their clinicians.

If you have not yet enrolled in My Health Online, you can now sign up online.

We also offer same-day video visits with our Sutter Walk-In Care clinicians daily from 8 AM to 8 PM for common health issues. Patients can self-schedule a video visit appointment by logging into My Health Online or calling (800) 972-5547 for same-day appointments.

Currently we are conducting virtual assessment of respiratory symptoms daily, which provides both convenient access to care to patients at home and minimizes the risk of spreading illness to others. These video visits can also provide clinicians with the information necessary to decide if a patient ultimately needs to be seen in person at one of our clinics or the hospital.

For more information about COVID-19, please visit Sutter Health’s resources page.

In Need of a Break: Art in Action

Posted on Apr 15, 2020 in Carousel, Palo Alto Medical Foundation, People, Scroll Images, Sutter Maternity and Surgery Center, Santa Cruz, Uncategorized, We're Awesome, Year of the Nurse

SANTA Cruz, CalifTawnya Gilbert, R.N., C.C.R.N. is normally the picture of positivity: upbeat and energetic. But one day in late March, after a shift and a week that all felt especially long and challenging, she felt down. Like all of us Gilbert was concerned about the spread of coronavirus, but unlike most of us, she faced the challenge daily, working as a nurse for Sutter in Santa Cruz County.

“It’s moments like that when I usually go to our staff breakroom and just take a minute to get back in touch with myself, my heart,” said Gilbert, who is also a yoga instructor. “I can usually use the quiet room to recharge and clear my head, but this time was different.”

That’s when she had an idea

“I looked around – at the magazines, the picture window, our little bulletin board – and realized that there wasn’t any art.” Though not an artist herself, Gilbert has always admired the generous amount of art on the walls of Sutter Maternity and Surgery Center. She even helped choose the art in the hospital’s post-anesthesia care unit where she has worked for the past six years.

“I just knew that if we could get some art in the breakroom, and especially if it depicted how healthcare workers are fighting this pandemic, it would inspire staff and lift their spirits.”

The “Surviving COVID” art project began

Gilbert wrote to all the artists she knew, and several she was introduced to, and asked for art that was funny, profound, or uplifting. She encouraged themes of beating coronavirus and thanking healthcare workers, and soon she had 14 original pieces to display in the breakroom at the hospital. The art was an instant hit with staff, and the project has since spread to the Palo Alto Medical Foundation (PAMF) medical buildings in Watsonville and Santa Cruz, the emergency room of neighboring Dominican Hospital and the halls of nearby Watsonville Community Hospital.

Babs Kingsley, M.A., R.N., manager of emergency services at Dominican Hospital said “the staff are incredibly grateful for the donated artwork and sentiment from the community that it represents. The art is providing staff with motivation and strength, and the collaboration between healthcare networks reminds us that we are not fighting this battle alone. Many thanks to Tawnya for helping us turn an uncertain time into one of collaboration and pride.”

Art is an antidote to fear

“Art comforts and connects us; when a doctor, nurse or housekeeper views these images I hope they see an entire community of artists who are supporting them and helping them process emotions that are hard to put into words,” said Gilbert.

Creativity and positivity abound in the works collected to-date. “Glove Conquers All,” for example, is a take on the raised fist, a symbol of solidarity that is used to express unity and strength. In this original work by Andi Mellon, the fist is encased in a glove and surrounded by Gladiolas which symbolize bravery.

Another piece that features gloves is “Creation” by artist Michael Lane. The work imagines an update of the classic “Creation of Adam” for our modern moment. “With all the precautions required for coronavirus, I thought it would be interesting to add a twist on safety to this iconic piece,” said Lane.

“The Brave Nurse” depicts the importance of sheltering-in-place and the bravery of a nurse who protects her community from COVID-19, represented as attacking balls with sharp teeth and angry eyes. Seamlessly blending literal and figurative references, artist Lily K. has been able to include several key elements of the pandemic in one uplifting scene.

Calling all artists

Little more than a week after her idea-inspiring low point, Gilbert feels energized by the entirely volunteer-led and donation-dependent project.

“Today I worked 10 hours, ate dinner, read to my daughter, spoke to two artists about sharing their art and applied for a grant. I’m going to bed, rest well Santa Cruz,” she wrote to friends and family.

Gilbert has been overwhelmed by the response from the community, in the form of art and framing supplies, and she encourages anyone who wants to help to email her at: lokilove28@gmail.com