Quality

Car Clinics: The Dual Benefit of Drive-Through Care

Posted on Mar 17, 2020 in Carousel, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Safety, Scroll Images, Uncategorized

Power, data cables and sanitation supplies topped Raymond Fellers long list.

No, Fellers wasn’t preparing to isolate during the COVID-19 outbreak—quite the opposite—he was opening the first ever “car clinic” at the Palo Alto Medical Foundation’s San Carlos Center. One of several across the Sutter network, the car clinic is designed as an in-person option for PAMF patients with serious respiratory symptoms who have already talked to a provider by phone or video visit.

“We’re solving two problems at once,” said Dr. Rob Nordgren, M.D., MBA, MPH and area CEO of PAMF peninsula region. “By keeping potentially contagious people in their car it means that doctors can assess and treat their symptoms, while minimizing exposure to patients who need routine or urgent care inside the medical facility.”

Making use of a covered garage, a procession of patients – each in their personal car – flowed through a series of stations that comprised the clinic. Every station had a laptop connected to Sutter’s electronic health record and the basic medical equipment you’d find in a regular exam room. A portable X-ray machine was even set up outside to help diagnose lung infections.

Arnold Layung, a licensed vocational nurse who usually sterilizes instruments during surgery, brought his sanitation skills to the car clinic.

“The key here, just like in the operating room, is to have one person per job so no steps are missed,” remarked Layung as he disinfected stethoscopes and other equipment after each use. Filling the role of medical technician, Layung was paired with a physician and registered nurse to form a three-person team—each in full gowns, goggles, gloves and masks—who saw patients through their open car window or in a chair just outside their vehicle.

With a background in emergency medicine, Dr. Nathan Bornstein knows the importance of conserving hospital capacity for those with acute illness. “My job out here is to find the people who need to be escalated to a higher level of care, while also helping people manage serious symptoms so they can safely return home,” he said.

Many of the patients who came through the car clinic had existing respiratory conditions, like asthma, which make them prone to serious breathing difficulty if their lungs are put under added strain. For these patients showing symptoms of a virus, Dr. Bornstein ordered a flu test. In accordance with Centers for Disease Control and Prevention guidelines, Dr. Bornstein also collected samples for COVID-19 testing from symptomatic patients in high-risk groups, such as those with certain pre-existing conditions, epidemiologic or social risk factors.

Dr. Bornstein listened to each patient’s lungs, and if indicated, ordered X-ray or CT scans to detect infection. Finally, Dr. Bornstein reviewed current medications to determine if a dosage change or new prescription would help ease a patient’s symptoms enough to keep them out of the hospital.

Every person had their temperature, respiration rate, heart rate and oxygen saturation checked and each left with a personalized plan for what to do if their symptoms worsened.

PAMF’s San Carlos Center is one location within Sutter Health’s integrated network that supports car clinics. This service is not available in all locations, nor is it open to the general public.

Sutter encourages patients who feel ill to schedule a video visit or call their doctor to receive guidance. If one’s symptoms are mild to moderate, they are encouraged to stay home to rest, get well and prevent exposure to others.

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

An Endgame for Epilepsy

Posted on Mar 13, 2020 in California Pacific Medical Center, Innovation, Neuroscience, People, Quality

One man’s struggle with seizures is silenced thanks to a medical device implanted on his brain.

Reno, Nev. — Andy Fiannaca, a college student at the time, first discovered he had epilepsy when he woke up in an ambulance. His head was gouged and bleeding—the result of falling during an intense epileptic seizure. Even with no family history of epilepsy, Fiannaca would soon learn that is exactly what he had.

For years, severe daily seizures affected his quality of life, limiting his activities. He experienced speech problems, such as difficulty finding and forming words, and would often lose the ability to comprehend what people around him were saying, known as aphasia. Everything became a foreign language.

Andy Fiannaca displays his post-surgery scar from where his RNS device was implanted.
Andy Fiannaca’s surgery scar is on full display where his RNS device was implanted.

Fiannaca also suffered from the “Alice in Wonderland” syndrome. During episodes, his visual perception would become drastically distorted. He was either an ant looking up at giants, or a giant looking down at ants. Driving a car was out of the question, and continuing his studies at the University of Nevada, Reno became increasingly difficult.

To control his seizures, Fiannaca tried six different medications and then a surgery in which a series of shallow cuts were made in his brain tissue. The goal was to remove the part of the brain where his seizures originated. Unfortunately, his Reno surgeons found the source was too close to his speech center. His symptoms improved after the surgery, but within two years they returned.

Clearly, Fiannaca required more advanced help. But since he lives in Sparks, Nevada (outside Reno), where this level of advanced neurology is not available, his care team finally referred him to California Pacific Medical Center (CPMC) in San Francisco, part of the Sutter Health not-for-profit network of care.

At CPMC, neurologists David King-Stephens, MD and Peter Weber, MD, recommended the RNS System, an implanted device designed to continuously monitor brain activity, detect abnormal patterns and intervene to stop seizures before clinical symptoms appear. It is the first and only medical device that can monitor and respond to brain activity. This treatment, Fiannaca says, ultimately changed the course of his life.

The Fiannaca Family
The Fiannaca Family.

Since Fiannaca had the RNS device implanted six years ago, his seizures have radically reduced. He hasn’t had a grand mal seizure in two years, and he’s finally able to drive a car again. His wife Sara has been by his side through it all. The couple worried for a long time that epilepsy would prevent them from starting a family, but with his condition now under control, Fiannaca and Sara welcomed their first child 18 months ago.

Epilepsy is a widespread condition characterized by recurrent seizures that often causes a severe impact on a person’s quality of life. It affects as many as one in 26 adults in the U.S., and in 50 percent of epilepsy cases, the cause is unknown.

Epilepsy Awareness Day is March 26, 2020.

Alta Bates Summit Medical Center Cardiac Program Earns Highest Possible Rating for Mitral Valve Surgery from Society of Thoracic Surgeons

Posted on Mar 4, 2020 in Affiliates, Alta Bates Summit Medical Center, Quality, Scroll Images

OAKLAND, Calif.Alta Bates Summit Medical Center earned a distinguished three-star rating, the highest possible, from The Society of Thoracic Surgeons (STS) for excellence in mitral valve replacement and repair (MVRR) surgery. Of the approximately 130 participating hospitals in California, Alta Bates Summit, part of the Sutter Health not-for-profit network of care, is one of only four hospitals in the state to earn this three-star rating for MVRR surgery.

Mitral valve replacement and mitral valve repair surgeries are performed to treat diseases of the mitral valve — the valve located between the left heart chambers.

Junaid Khan, MD
Junaid Khan, MD

“The three-star rating is widely regarded as the gold standard by which cardiac surgery programs are evaluated and it’s the highest honor achievable,” says Junaid Khan, MD, director of Cardiovascular Services for Alta Bates Summit. “We take great pride in the high-quality care we provide that has resulted in long-term positive results. This recognition validates our comprehensive heart program’s excellence.”

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database participant.

Alta Bates Summit also earned a three-star rating from the Society of Thoracic Surgeons (STS) in 2019 for patient care and outcomes in isolated coronary artery bypass grafting (CABG) procedures—the most commonly performed open-heart surgery.

Mitul Kadakia, MD

“Alta Bates Summit provides exceptional care for our valvular heart disease patients under the leadership of Dr. Russell Stanten and Dr. Khan,” says Mitul Kadakia, MD, FACC director, Structural Heart and Valve Disease, Alta Bates Summit. “It is a privilege to be a part of a cardiac program which results in these kind of incredible outcomes for our patients. The 3-Star STS rating for CABG and Mitral surgery is great asset for our patients.”

Russell Stanten, MD

Dr. Khan praised the hospital’s physicians, staff members and departments who were instrumental in making this award possible.

“None of these amazing results would have been possible without our entire team including the expertise of our surgeons, cardiologists, anesthesiologists, nurses, physical and occupational therapists, case management and rehabilitation services,” adds Dr. Khan.

Michael W. Tsang, MD

Michael W. Tsang, M.D. , FACC, director of the Echocardiography Laboratory at Alta Bates Summit says, “While earning a 3 star rating in the recent public report is a great achievement for the medical center and cardiac surgery program, it is the constant and consistent feedback from my patients about their own wonderful and positive surgical experiences that make Alta Bates Summit one of the best mitral valve surgery programs in the state. Under Dr. Khan’s leadership, I have seen steady and significant strides made in our ability to deliver high quality care and to improve patient satisfaction.”

Alta Bates Summit’s three-star rating also drew praise from cardiovascular leaders at other East Bay hospitals.

“The three star rating for CABG and Mitral valve surgery by the nationally recognized Society of Thoracic Surgeons is well earned,” said Marina Tirlesskaya, MD, FACC, Chief of Cardiology, Alameda Health System. “Dr. Khan and his team have been providing outstanding care for our patients with consistently excellent results and unmatched compassion for our community and underserved patient population, supporting our mission at Alameda Health System of caring, healing, teaching and serving all.”

“As a community hospital with no onsite cardiac surgery program, our patients are fortunate to have the ABSMC cardiac surgical team provide superlative, prompt and outstanding care to our patients requiring emergent/urgent bypass surgery and mitral valve repair at Alta Bates Summit,” said Aditya Jain, MD, FACC, Director, Cardiac Catheterization Laboratory, St. Rose Hospital. “Their patient centric team approach has enhanced patient survival and improved overall well-being in the postoperative period.

Big Steps Toward Early Cancer Detection

Posted on Feb 18, 2020 in Affiliates, Expanding Access, Innovation, Quality, Research, Scroll Images

SACRAMENTO, Calif. – Cancer researchers worldwide seek new clues to aid early detection and better treatments for cancer. The future is now, however, as research to support the development of a blood test for the detection of multiple types of the disease is underway at Sutter.

cancer blood test

Last month, Sutter began inviting eligible patients into the PATHFINDER clinical study. Sponsored by GRAIL Inc., the PATHFINDER study will evaluate the diagnostic capabilities of an investigational, multi-cancer early detection blood test. Sutter also helped support the development of GRAIL’s early cancer detection test by participating in the ongoing STRIVE study, which closed to enrollment at Sutter in 2018.

The goal of the PATHFINDER study is to enroll patients across eight sites at Sutter, currently the only health system in California participating in the multicenter PATHFINDER study. Other sites across the U.S. include Intermountain Healthcare, with additional centers launching this year.

While blood tests to detect or monitor cancer progression are not new, existing cancer tests typically screen for one type of cancer (e.g., breast cancer) and must be used with other screening tools . The PATHFINDER study is assessing whether GRAIL’s blood test will help aid early detection for multiple types of cancer with a single blood draw before symptoms present. The study will evaluate the implementation of the investigational test into clinical practice, and marks the first time results will be returned to health care providers and communicated to study participants to help guide diagnosis.

If the investigational test detects a cancer signal, it is designed to identify where in the body the cancer arises from, to inform the appropriate diagnostic next steps confirming if cancer is present.

Charles McDonnell, M.D., FACR

“Insights from the PATHFINDER study may improve how we screen for cancers and expand the types of cancer for which we can screen. Sutter’s participation in this study could help pioneer breakthroughs in early detection that may help save lives around the world,” says Charles McDonnell, M.D., FACR, a Sutter radiologist in Sacramento and lead principal investigator for the study at Sutter.

Dr. McDonnell and Andrew Hudnut, M.D., a family medicine doctor in Elk Grove, saw the potential and importance of the STRIVE study. They were instrumental in securing Sutter as a site for PATHFINDER.

“We anticipate this trial may allow us to personalize cancer screening and may eventually enable earlier, safer care for those patients found to have cancer,” says Dr. Hudnut.

During the PATHFINDER study, blood samples will be collected from eligible Sutter patients who consent to participate in the study. Blood samples will be analyzed for small pieces of the tumor’s DNA (i.e., its genetic “code”). If a study participant is diagnosed with cancer, the participant will be counselled on the results of their blood test and followed during workup to diagnose their cancer. There will be 12 months of follow-up for all participants.

PATHFINDER AT-A-GLANCE:

  • Study participants who are diagnosed with cancer will have their study test results communicated to them by qualified, Sutter clinical research staff and PATHFINDER study physicians. Participants will also receive e-mails and newsletters with information about follow-up appointments and study milestones.
  • The PATHFINDER study is part of Sutter’s coordinated efforts to improve cancer research and treatment outcomes for patients. Sutter also participates in large, phase 1-3 national clinical studies sponsored by the National Cancer Institute (NCI) and collaborates with pharmaceutical companies on cancer research.

Early cancer detection may be part of the “holy grail” for cure. Find out how you can help! Learn more about PATHFINDER by contacting the study team at pathfinderstudy@sutterhealth.org or call 916-746-2161.

Find more clinical trials and research at Sutter.

To Prevent Stroke, Start with the Heart

Posted on Feb 13, 2020 in Affiliates, Cardiac, Carousel, Expanding Access, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, We're Awesome, Women's Services

BURLINGAME, Calif. – Does it sometimes feel like there are butterflies in your chest? Does your heart race or skip a beat? If it’s not your crush making your heart go pitter-pat, it could be a common heart condition called atrial fibrillation or AFib for short. This Valentine’s Day, take heart and consider seeing an expert if you are experiencing these symptoms. After all, AFib dramatically increases the odds of having a life-threatening stroke.

“Stroke occurs when arteries in the brain are either blocked by a blood clot or burst under high pressure,” said Ilana Spokoyny, M.D., neurologist who cares for patients at Sutter’s Mills-Peninsula Medical Center. “So when we talk about stroke prevention, it’s natural that we emphasize how to keep clots from forming or keep blood pressure regulated—and both start with the heart.”

Heart health and stroke prevention were the focus of a recent educational event, hosted by United Airlines, and led by Sutter Health. Attendees toured Northern California’s only Mobile Stroke Unit – a specialized ambulance that has the staff and equipment on-board to start stroke treatment while enroute to a hospital – and heard from the unit’s director, Dr. Spokoyny, about two common heart conditions that increase stroke risk.

Atrial fibrillation

AFib is caused when the upper part of your heart beats out of sync with the lower half. While not usually life-threatening by itself, AFib alters the normal function of the heart which leads to the formation of blood clots in the heart. Eventually these clots are pumped out of the heart and can travel to the brain where they causes a stroke.

According to Dr. Spokoyny, nearly one in every six strokes is the result of AFib, and these strokes are often more serious. “Not only are AFib patients nearly five times more likely to suffer a stroke than those without the condition, AFib-related strokes are nearly twice as fatal and twice as disabling as non-AFib-related strokes.”

“AFib may be asympomatic or symptoms show up intermittently, and because they come and go many people don’t take them seriously,” Dr. Spokoyny explained. “We need to spread the word that you shouldn’t ignore the butterfly feeling in your chest or dismiss the occasional fatigue or shortness of breath you experience.” When diagnosed, AFib is treatable with medication or medical procedures, including surgery, to reduce your risk of stroke.

High blood pressure

High blood pressure increases the strain on blood vessels transporting blood throughout your body. When blood is routinely pumped through arteries at a higher than optimal pressure, the arteries may become weakened or narrowed, creating conditions where they burst or clog more easily.

Dr. Spokoyny reminds patients that high blood pressure is the single most important risk factor for stroke. “About three out of four people who have a stroke for the first time have high blood pressure.” High blood pressure often presents along with atrial fibrillation. The good news is that blood pressure can be managed with lifestyle changes and medications.

Expertise in action

Not-for-profit Sutter Health encourages doctors to work across specialties to ensure that patients receive high quality, coordinated care. Sutter includes sixteen Primary Stroke Centers across its integrated network.

Happy Ending to Librarian’s Story, Thanks to Coordinated Care

Posted on Feb 12, 2020 in Affiliates, Alta Bates Summit Medical Center, Neuroscience, Quality, Scroll Images

BERKELEY, Calif. –When retired UC Berkeley librarian Barbara Kornstein walked into her neighborhood bakery for pastry and coffee on a recent January morning, she never imagined that within moments her fellow patrons would be calling 911 for help after she suffered a stroke and fell from her chair. Fortunately, a dedicated team of first responders, nurses and doctors were close by to coordinate the treatment that would save Kornstein’s life.

Within 30 minutes from the 911 call to the Berkeley Fire Department, Kornstein was evaluated by a doctor with special training in stroke management in the emergency department at Alta Bates Summit Medical Center in Oakland, part of the Sutter Health not-for-profit network of care.

After undergoing a CT scan, Kornstein received clot-dissolving medication and was quickly transferred to the hospital catheterization lab, where a neurologist specially trained in neurointervention removed the blood clot from her brain through a minimally invasive procedure that significantly reduces the risk of stroke-related disability and death.

“Barbara is doing remarkably well thanks to the seamless coordination of care that she received at Alta Bates Summit Medical Center’s Regional Stroke Center,” says Brian Richardson, M.D., medical director of Alta Bates Summit’s stroke program. “Our program is nationally recognized for ensuring stroke patients receive life-saving intervention urgently upon arrival. Barbara’s story is just one example of our commitment to making sure stroke patients receive the very best care possible.”

“I go to the New York International Film Festival every year and I’m so glad that I will be able to attend this year’s festival in September,” says Kornstein. “I’m feeling great and I’m so thankful for all the people that helped saved my life.”

A few days after her stroke, Barbara was resting comfortably in the Alta Bates Summit Acute Inpatient Rehabilitation Unit in Oakland when she received a visit from Chris Barney and Nick Scornaich from the Berkeley Fire Department who were the first to respond to the 911 call. Barney and Scornaich were joined by members of the Alta Bates Summit Emergency Department, Cath Lab, Intensive Care Unit, Regional Acute Inpatient Rehabilitation Center and surgery teams that all played a part in Kornstein’s care.

“It’s wonderful and a bit overwhelming to meet all the people who cared for me,” says Kornstein. “I’m glad that I live so close and have access to such great medical care.”

“It’s quite moving to see everyone that had a touch in Barbara’s care shower her with love and words of encouragement,” says Debra Blanchard, R.N., Stroke Center Coordinator at Alta Bates Summit. “She’s doing great and it’s a testament to our first responders and our stroke team for their ability to provide timely treatment so that people who suffer strokes have the potential to have great outcomes like Barbara.”