Innovation

Sutter’s Electronic ICU Helps Hospitals Handle Influx of Coronavirus Patients

Posted on Sep 9, 2020 in Innovation, Scroll Images

COVID-19 is bringing new relevance to Sutter’s longstanding electronic intensive care units (eICUs) and to telemedicine. The integrated healthcare network’s two eICUs, one in San Francisco and one in Sacramento, enable it to provide hospitalized critical care patients, including COVID-19 patients, in both rural and urban hospitals with the safest, most advanced medical care—as well as expanding the system’s critical care bed surge capacity during the pandemic.

Tom Shaughnessy, M.D. and medical director of Sutter’s Bay Area eICU, says the program’s goal hasn’t changed much since its earliest days: “Making sure the sickest patients across the system’s geographically diverse footprint get access to specially trained nurses and doctors 24-hours a day,” he says.

Sutter’s innovative eICU program began in 2004 and the first of its kind on the West Coast.

Expanding Critical Care during a Pandemic

eICUs allow critical care doctors and nurses to check in on patients remotely using cameras, microphones, alarms and other monitoring tools. This approach not only helps protect on-site physicians, critical care nurses and other professional staff at the patient’s bedside, it also conserves precious personal protective equipment (PPE) and helps provide backup to caregivers who may be stretched thin at both rural and urban ICUs. Electronic ICUs have also helped increase critical care bed capacity in the event of a COVID-19 patient surge.

Read more on CNET.com about how Sutter’s eICU is helping the integrated network handle the influx of patients during the pandemic.

“If you choose to live in a rural community, it doesn’t mean your health should suffer because you don’t have access to the resources that you need,” says Vanessa Walker, D.O., a pulmonary critical care physician and director of the eICU for the Valley area of Sutter Health.

“Sutter’s eICU program has been especially beneficial to nursing staff at our smaller hospitals. [In this pandemic], they’ve had to take a crash course on managing incredibly complicated patients. Our eICU nurses have been there to help, whether it was for a second signature for medications to prevent further exposure or as a practical guide on how to place a patient in a prone position. The teamwork between the eICU and the bedside has been phenomenal,” she says.

“Tell me your life story, I’m listening, I see you.”

Posted on Sep 3, 2020 in California Pacific Medical Center, Community Benefit, Expanding Access, Health Equity, Innovation, Mental Health, People, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento

Faculty and residents in Sutter’s Family Medicine Residency Program

We are a mosaic of our experiences, lifestyle, social and family connections, education, successes and struggles. Apply those factors to our health, and a complex formula arises that clinicians commonly call the patient experience.

Learning the skills to assess these factors and deliver compassionate care to patients is what Sutter’s family medicine resident physicians aim to enhance. The newly enhanced Human Behavior & Mental Health curriculum is helping lead the way.

“We encourage faculty and residents to think about context, systems and dynamics within population health to address social determinants of health,” says Samantha Kettle, Psy.D., a faculty member in Sutter’s Family Medicine Residency Program.

She and colleague, Andy Brothers, M.D., a family medicine physician in Sacramento and faculty member in the residency program, are bringing health equity to the patient experience and training family medicine residents in Sacramento and Davis.

Family medicine faculty and residents at Sutter Medical Center, Sacramento

Seven residents each year learn to screen patients for social determinants of health (such as financial challenges, environmental and physical conditions, transportation needs, access to care and social factors) that may impact patients’ risk of depression and anxiety, substance use disorder and suicide.

This year’s residents may train in addiction medicine, psychotherapy, chronic pain, spirituality in medicine, well-being and the field of medicine that supports those who are incarcerated.

And in a community as diverse as the Sacramento Valley Area, statistics suggest these factors may significantly impact the health of its residents:
• 15.9% of California adults have a mental health challenge(1)
• Nearly 2 million Californians live with a serious mental challenge
• Substance misuse impacts 8.8% of Californians
• The prevalence of mental health challenges varies by economic status and by race/ethnicity: adults living 200% below the federal poverty level are 150% more likely to experience mental health challenges; 20% of Native Americans and Latinos are likely to have mental health struggles, followed by Blacks (19%), Whites (14%) and Asians (10%).

“Taking care of our local population’s health is a moral imperative,” says Dr. Kettle. “Many residents have entered our program to continue their quest in helping people in underserved communities.”

For instance, third-year Sutter family medicine resident Mehwish Farooqi, M.D., is studying ways to screen for post-partum depression using an approach developed through the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program.

“Women are most vulnerable to mental health concerns during the post-partum period: as many as one in seven women experience PPD. ROSE is a group educational intervention to help prevent the diagnosis, delivered during pregnancy. It has been found to reduce PPD in community prenatal settings serving low-income pregnant women,” says Dr. Farooqi.

“Sutter has clearly demonstrated a commitment to health equity and social justice that has propelled our residency program toward a future vision of health care in which all patients are cared for as individuals with unique life stories, struggles and successes,” says Dr. Brothers.

Advancing Social Determinants of Health through Graduate Medical Education at Sutter:
Other family medicine programs across Sutter’s integrated network incorporate health equity into ambulatory training for residents. The family medicine faculty at California Pacific Medical Center include a social worker who teaches residents to address concerns like financial and food insecurity, as well as social isolation. Residents learn how to care for people with depression and anxiety, and lecture series are offered on topics like addiction medicine and chronic pain/narcotic management.

Sutter Santa Rosa Regional Hospital’s Family Medicine Residency Program incorporates social justice through a Community Engagement and a Diversity Action Work Group—a committee comprised of faculty and residents who help tackle issues around inequity and structural racism.

“We are committed to strengthening a relationship between the residency program and the diverse communities we serve, guided with cultural mindfulness and compassion in our pursuit of overall wellness for all,” says Tara Scott, M.D., Program Director of the Family Medicine Residency Program in Santa Rosa.

Learn more about Sutter’s Family Medicine Residency Program.
• Find out how Sutter is advancing health equity.

Reference:

  1. California Department of Health Care Services.

Beyond COVID-19: Making Telehealth More Accessible & Equitable

Posted on Sep 1, 2020 in Innovation, Scroll Images

COVID-19 has provided us with many important lessons, but among the most significant for Sutter Health is how valuable expanded telehealth has been in reaching traditionally underserved communities in new and meaningful ways.

Sutter serves one of the most demographically and geographically diverse regions in the nation. Through our not-for-profit mission we work to ensure every patient gets the care they need, when and where they need it, regardless of their circumstances or ability to pay. We are committed to finding innovative ways to provide all of our patients with high-quality, accessible and affordable healthcare.

Like most U.S. health systems, the policy changes enacted to expand telehealth options to address COVID-19 made it possible for us to significantly expand our telehealth services. In our case, video visits increased by 32,000% – yes thousand – with patient satisfaction ratings right on par with in-person visits. As incredible as they are, what these numbers don’t tell you is how impactful these policy changes have been for vulnerable populations who otherwise may struggle to access the treatment they need.

Read this full article by Sutter Health President and CEO Sarah Krevans on the American Telemedicine blog.

Hungry People Fed through Food Waste Reduction Pilot

Posted on Sep 1, 2020 in Affiliates, Alta Bates Summit Medical Center, Eden Medical Center, Innovation, Memorial Hospital, Los Banos, Memorial Medical Center, Mills-Peninsula Health Services, People, Scroll Images, Sutter Amador Hospital, Sutter Auburn Faith Hospital, Sutter Davis Hospital, Sutter Delta Medical Center, Sutter Medical Center, Sacramento, Sutter Roseville Medical Center, Sutter Solano Medical Center, Sutter Tracy Hospital

35,000 meals donated in first seven months of project

SACRAMENTO, Calif. –In its first seven months, a pilot project involving 14 Sutter hospitals reduced food waste and fed the hungry by donating nearly 35,000 meals to 17 local nonprofits. The effort comes at a critical time as increasing numbers of people experience food insecurity due to the pandemic-induced economic downturn.

Last January, 10 hospitals in Sutter Health’s integrated network launched a collaboration with nonprofit Health Care Without Harm to implement the program, which is partially funded by a grant from the Department of Resources Recycling and Recovery (CalRecycle) through California Climate Investments. Over the summer, an additional four Sutter hospitals joined in Sutter’s efforts.

“From our earliest days, Sutter Health’s network has provided access to high-quality, affordable medical care in our facilities – but we’ve also been deeply invested in the health and wellbeing of our broader communities,” says Chief Medical Officer Stephen H. Lockhart, M.D., Ph.D., executive sponsor of Sutter Health’s Environmental Stewardship program. “The teams behind this project with Copia and Health Care Without Harm are putting our values into action by leveraging innovation to not only reduce our environmental footprint, but also help feed community members in need.”

The work is powered by a technology platform designed by San Francisco-based Copia – a zero waste and hunger technology platform that allows food service employees to measure and prevent food waste while seamlessly donating all unsold or unserved edible excess food. Hospital food services workers measure daily food waste and submit their edible food donations in one streamlined process through Copia’s software application on mobile tablets. Copia’s mobile app then automatically dispatches drivers to pick up and deliver the food to local non-profits feeding food insecure populations.

And local really does mean local in this case – the average distance donated food traveled from the hospitals to someone who needed it was 3.4 miles.

In its first week in the program, Sutter Delta Medical Center recovered nearly 140 pounds of surplus food from the hospital—enough for 116 meals for Love a Child Missions, which serves homeless women and children in Contra Costa County, and Light Ministries Pentecostal Church of God, which serves meals to needy families in Antioch.

“This is an exciting partnership,” says Sutter Delta’s assistant administrator Tim Bouslog. “We’ve always had a vested interest in sustainability at our hospital, and the positive impact on the community during these difficult times makes this a great step forward.”

Another program benefit? The food donations efforts have helped Sutter reduce carbon emissions by 185,000 pounds and saved 15 million gallons of water!

Says Maria Lewis, director of Food and Nutrition Services at Sutter’s Eden Medical Center, “Eden’s first donation provided 45 meals to The Salvation Army in Hayward. This one donation not only consisted of 55 pounds of perfectly edible food, but also saved 241 pounds of CO2 emissions. We are humbled to be able to support our community, as well as help preserve our environment in the same process.”

“Over the first six months of this pilot project, we have gained valuable insight into how to contribute to community health, reduce waste and be good stewards of our own resources,” says Jack Breezee, regional food and nutrition services director for Sutter’s Valley Area. “I can only look forward to what we will learn over the pilot’s remaining year, and how we can build on these successes to serve our patients and communities.”

“Food waste among hospitals is a solvable problem,” says Komal Ahmad, founder of Copia. “If every hospital in the U.S. partnered with Copia, we could provide more than 250 million meals each year to people in need and save hundreds of millions of dollars in purchasing and production of food. Copia is thrilled to partner with Sutter Health to lead the healthcare industry in filling the food insecurity gap and building community resilience, especially during a time when insecurity has never been higher.”

Participating Sutter hospitals are Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Medical Center, Memorial Hospital Los Banos, Memorial Medical Center, Sutter Amador Hospital, Sutter Auburn Faith Hospital, Sutter Center for Psychiatry, Sutter Davis Hospital, Sutter Delta Medical Center, Sutter Medical Center, Sacramento, Sutter Roseville Medical Center, Sutter Solano Medical Center and Sutter Tracy Community Hospital.

An Immune Boost Toward COVID-19 Vaccines

Posted on Aug 18, 2020 in Affiliates, Innovation, Quality, Research, Scroll Images

Microscopy image of the novel coronavirus, COVID-19

As the COVID-19 pandemic continues to persist worldwide, few features of the human body have figured as prominently on center stage as the immune system.

How does the immune system respond to viruses?
One function of the human immune system is to inhibit viruses, and prevent them from causing illness. The body has two types of immune response to accomplish this function: innate immunity, which starts within hours of an infection, and adaptive immunity, which develops over days and weeks.

A virus causes an illness by infecting cells in the body and taking control of their genetic material. The virus then instructs these infected cells to reproduce the virus’s genetic code and replicate more viral “soldiers” that fight against our immune system.

The body’s adaptive immune response consists of two types of white blood cells—called T and B cells—that can detect “signals” specific to the virus and assemble a targeted response to it.

T cells identify and kill cells infected by a virus. B cells make antibodies—a kind of protein that blocks viral material from entering our cells and prevents the virus from reproducing.

In case the body may need to fight the same virus again, the body stores T and B cells that helped eliminate the original infection. These “memory cells” help provide us with long-term immunity. How long is long-term? Antibodies produced in response to a common, seasonal virus last for approximately one year. But the antibodies generated in response to a measles infection, for example, can provide lifelong protection.

Antibodies, a critical component of the human immune system

The human immune system and vaccines
Vaccines provide immunity, or protection against a disease without causing the illness. They are made using killed or weakened versions—called antigens—of the disease-causing virus. For some vaccines, genetic engineering is used to make the antigens included in the vaccine.

If you’re administered a vaccine to prevent viral infection, your immune system responds to the vaccine in the same way it would if exposed to the actual virus, by: recognizing the proteins and other components of the vaccine as foreign; making antibodies to “attack” the vaccine, as if it were the actual virus, and; remembering the foreign invader and how to destroy it. This response means if you are exposed to the disease-causing virus again, your immune system can intervene before you get sick.

The science on COVID-19 vaccines
Worldwide, scientists are studying more than 165 vaccines against COVID-19. Thirty are being tested in clinical trials in humans, and three of those are in Phase 3 studies.(1) Vaccines typically require years of research and testing before reaching the marketplace or clinic, but scientists are attempting to develop a safe and effective COVID-19 vaccine by next year if not sooner.

Each of the COVID-19 vaccines being tested use a different method to “attack” the virus and engage the immune system to fight infection. But to date, there are a few common approaches being studied in clinical trials:(1, 2)

1. Genetic vaccines use one or more of the COVID-19 virus’s genes to provoke an immune response, using genetic material called messenger RNA (mRNA) or DNA to produce viral proteins in the body.
2. Repurposed vaccines rely on vaccines already being used to protect humans against other diseases (e.g., tuberculosis) that may also be effective in protecting against COVID-19.
3. Viral vector vaccines use a virus to deliver COVID-19 genes into cells and provoke an immune response. These vaccines typically use viruses that infect animals such as chimpanzees or monkeys to act as the “carrier” that prompts an immune response against COVID-19 in humans.
4. Whole-virus vaccines use a weakened or inactivated version of COVID-19 to spark an immune response.
5. Protein-based vaccines use a COVID-19 protein or its pieces to invoke an immune response against the virus.

Sutter Health anticipates studying a COVID-19 vaccine being tested in humans through a Phase 3 clinical trial. Stay tuned for more news next month! Curious about other research at Sutter? Learn more.

References:

  1. World Health Organization. Accessed Aug. 11, 2020.
  2. The race for coronavirus vaccines: a graphical guide. Nature news feature, April 2020.

Clearing a Path to Care

Posted on Aug 13, 2020 in Innovation, Scroll Images

When Sutter Health adapted its operations to continue caring for patients while responding to COVID-19, it meant leaning heavily on its integrated network and technology and innovation teams.

During a recent Sacramento Business Journal podcast, Albert Chan, M.D., M.S., Sutter Health’s chief of digital patient experience and Chris Waugh, Sutter Health’s chief innovation officer discussed the rapid expansion of virtual care and telehealth to help support patients and improve their experience.

Albert Chan, M.D.., M.S.

“Our telehealth expansion was originally planned for 2021 and estimated to take 18-24 months. But in response to COVID we rolled out that expansion within six weeks,” said Dr. Chan. “We trained thousands of new physicians on using the technology … and saw a 32,000% increase in telehealth visits in just two months.”

But it’s not just an increase in virtual appointments that drives Sutter’s innovation-focused dynamic duo, it’s the important access that telehealth offers to a wide range of patients who otherwise might not have received the care needed.

Chris Waugh

“We had [patients] who would not have used this technology previously, now willing,” said Waugh.

Dr. Chan shared the story of a patient in rural Northern California who was concerned after finding a lump. Dr. Chan was able to diagnose the lump as a hernia and instruct him on how to recover at home — all through the safety and convenience of a video call.

“Normally, this patient would have had to come in person for an appointment, and he lives a four-hour round-trip from the facility he would need to get to,” Dr. Chan said. “Patient access has been truly transformed … and this is especially important for our remote and rural areas.”

Dr. Chan says the goal is to take a thoughtful approach to implementing technology and look at every step in the patient journey to make it simpler and more efficient. He emphasized that the aim with telehealth is to create better health outcomes at a lower cost.

And better health outcomes are made possible by what Waugh calls the ability of technology to “reduce friction” — or obstacles to accessible care.

“Whenever we can use technology to make the experience more human, not less, therein lies the silver-lining” said Waugh. “We want to create a more human exchange from beginning to end — between the healthcare system and the patients they’re serving — with the goal of creating better relationships and therefore better [health] outcomes.”