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Sutter Hospitals Honored for High Quality Stroke and Cardiac Care

Posted on Aug 5, 2020 in Carousel, Quality, Scroll Images, Uncategorized

SACRAMENTO, Calif. – Twelve hospitals within Sutter’s not-for-profit network received recognition from the American Stroke Association (ASA) for providing a high level of stroke care and participating in the ASA’s Get With The Guidelines® program. Additionally, 20 hospitals in the Sutter system received recognition from the American Heart Association (AHA) for consistently applying the American College of Cardiology guidelines when treating patients with heart failure, and participating in the AHA’s Get With The Guidelines® program.

Stroke Care

Sutter hospitals including Alta Bates Summit Medical Center in Oakland, California Pacific Medical Center – Van Ness campus in San Francisco, Eden Medical Center in Castro Valley, Memorial Medical Center in Modesto, Mills-Peninsula Medical Center in Burlingame, Sutter Medical Center, Sacramento, Sutter Tracy Community Hospital, Novato Community Hospital, and Sutter Santa Rosa Regional Hospital each earned a Get With The Guidelines®-Stroke Gold-Plus Quality Achievement Award for meeting or exceeded performance-focused quality benchmarks set forth by the American Stroke Association. Memorial Hospital Los Banos and Sutter Roseville Medical Center earned the Silver-Plus Quality Achievement Award and Sutter Solano Medical Center earned Bronze. 

“The care teams in our Brain & Mind service line work closely together, using evidence-based clinical practices, so patients receive high-quality care and exceptional service,” said Bill Isenberg, M.D., chief quality and safety officer for Sutter Health. “Our goal of continuous improvement in the neurosciences helps drive and strengthen our integrated health care network.”

Each of the honored hospitals are designated by The Joint Commission as Primary Stroke Centers and serve as a resource available to patients needing stroke-related services.

Our goal of continuous improvement in the neurosciences helps drive and strengthen our integrated health care network.

Eleven of the Sutter hospitals honored also earned a place in the Stroke Honor Roll —with Sutter Tracy Community Hospital and Sutter Santa Rosa Regional Hospital each receiving Elite Plus Honor Roll status. To qualify for this recognition, these hospitals met quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat acute ischemic stroke.

Furthermore, this year marks the debut of two new Stroke Honor Rolls, and Sutter hospitals earned a place on each. Sutter Medical Center, Sacramento is among only 11 hospitals in California to be listed on the Advanced Therapy Honor Roll which recognizes participating hospitals that met timeliness targets for the removal of blood clots from the brain under image guidance. This procedure, known as endovascular thrombectomy, is not performed at all hospitals. Additionally, eight Sutter hospitals earned a place on the new Type 2 Diabetes Honor Roll, which promotes evidence-based care for patients with this condition.

Cardiology Care

The 2020 Get With The Guidelines® awards also recognizes hospitals that maintain high standards in the treatment of heart failure. Overall, 20 Sutter hospitals demonstrated their commitment to providing the most appropriate cardiac care by following nationally recognized, research-based guidelines to treat heart failure and participating in the Get With The Guidelines® program.

Sutter’s Alta Bates Summit Medical Center (Oakland and Berkeley campuses), California Pacific Medical Center (Davies, Mission Bernal, and Van Ness campuses), Memorial Medical Center, Mills-Peninsula Medical Center, Memorial Hospital Los Banos, Sutter Auburn Faith Hospital, Sutter Coast Hospital in Crescent City, Sutter Davis Hospital, Sutter Delta Medical Center in Antioch, Sutter Lakeside Hospital in Lakeport, Sutter Roseville Medical Center, Sutter Solano Medical Center in Vallejo, Sutter Medical Center, Sacramento, Novato Community Hospital, and Sutter Santa Rosa Regional Hospital each earned a Get With The Guidelines®- Gold Quality Achievement Award for high quality heart failure care. Sutter Tracy Community Hospital earned Silver and Eden Medical Center earned the Bronze Quality Achievement Award for high quality heart failure care. 

Sutter’s Mills-Peninsula Medical Center also earned recognition for the evidence based care of coronary artery disease, and for meeting or exceeding care recommendations for patients presenting with an ST-elevation myocardial infarction (STEMI) – a specific kind of heart attack that can be caused by coronary artery disease.

“The American Heart Association and American Stroke Association are pleased to recognize these Sutter hospitals for their commitment to stroke and cardiac care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines® quality improvement initiative can often see fewer readmissions and lower mortality rates.”

Sutter Health proactively implements programs across its integrated network that continuously improve the quality and value of healthcare for patients. Its integration across regions, clinical settings and data environments is delivering care models with some of the best clinical outcomes in the nation. From heart transplants to valve replacements to cardiac ablations, Sutter’s Cardiovascular Health service line practitioners use innovative procedures and treatments to care for patients with a wide variety of specialized heart and vascular needs.

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!

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 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 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.