Positive Impact: Nurse-Driven Universal HIV and Hepatitis C Screening in East Bay ERs Prompts Dozens to Receive Treatment

Posted on Apr 30, 2019 in Expanding Access, Innovation, Scroll Images, Uncategorized

Nurses Week (May 6-12) Marks Two-Year Anniversary of First Patient Diagnosed with HIV Infection through Program

OAKLAND, Calif. — In the U.S., one out of seven people living with HIV don’t know it, and the majority of people living with hepatitis C might be undiagnosed. In Alameda County, HIV[1] and hepatitis C[2] infection rates have not declined significantly over the last 10 years, and a disproportionate amount of people of color are affected by both diseases.

Nurses at Alta Bates Summit Medical Center (ABSMC) in the East Bay, part of the Sutter Health not-for-profit, integrated network of care, have found a way to get more people tested and into treatment. A nurse-led, opt-out screening program at ABSMC’s Oakland and Berkeley campus emergency rooms is testing all eligible patients unless they specifically decline.

Alta Bates Summit Medical Center, Oakland campus, 350 Hawthorne Ave.

“We routinely test people who come to our emergency departments for HIV and hepatitis C virus. They have the option to decline, but the majority of people choose not to opt out,” says Kara Vassily, BSN, R.N., nurse champion for the opt-out testing program at the ABSMC Oakland campus.

More than 12,500 patients have been tested for HIV and hepatitis C (HIV:  13,378; HCV: 12,599) since the ground-breaking program began in May 2017. As a result of the screening effort, 36 people were diagnosed with HIV. Thirty-four of them have been linked to medical care, and 33 are receiving lifelong anti-retroviral therapy (ART).[3] The opt-out screening program also diagnosed 342 people with hepatitis C.  Of these, 108 people have been connected with treatment services and many of them have already started or completed medications that can cure them of this chronic liver disease in just two months.

“Nurses are in a unique position to lead universal screening and testing programs for HIV and hepatitis C in the emergency department,” says Vassily. “Because they spend a significant amount of time with patients, collecting sensitive health history information and providing patient education, they are able to talk with them more in depth about their potential risk factors for transmission of HIV and hepatitis C. It is through these open and honest conversations that the stigma around these two diseases is reduced, universal screening is successful and the overall health of the community is improved.”

“Many of those who test positive for HIV would probably not have known their disease status until they got an opportunistic infection like pneumocystis pneumonia or, in the case of hepatitis C, only after they’d suffered severe liver damage,” says Ryan Anson, a nurse practitioner at East Bay Advanced Care (EBAC) and director of the ED-based testing program.

“An important outcome of our opt-out testing program,” says Anson, “is the significant number of very early (acute) HIV infections we’ve diagnosed. We are detecting HIV infection in people within two to six weeks of their initial exposure to the virus, which means we are able to start them on ART at a very early stage in the disease. And we know from research that the earlier we attack the virus with treatment, the better our patients’ outcomes–and the lower their risk of transmitting HIV.”

The emergency departments were chosen as screening sites because they are often where vulnerable people seek primary care.

Patients newly diagnosed with HIV through the universal screening program, many of them people of color, are now starting ART within 24-72 hours of their diagnosis at ABSMC’s East Bay Advanced Care (EBAC). For more than 31 years, EBAC has provided primary care for low-income people with HIV and AIDS. Beginning ART as soon as possible helps patients to live longer, healthier lives and reduces the risk of HIV transmission to others.

“The opt-out screening program in our emergency departments helps us identify not only who has tested positive for HIV or hepatitis C, but also who needs our specialized services at EBAC. Universal testing is helping us to improve the quality of people’s lives, while it also helps reduce the spread of infection in the community,” says Christopher Hall, M.D. co-medical director of EBAC.

In the Bay Area, only Sutter’s Alta Bates Summit Medical Center, Alameda Health System’s Highland Hospital, and UCSF Benioff Children’s Hospital conduct routine emergency department opt-out testing programs for HIV and hepatitis C.

Based at the Oakland campus of Alta Bates Summit, EBAC (formerly known as East Bay AIDS Center) cares for an average of 1,500 HIV-positive and 500 HIV-negative patients each year and is the only full-time, hospital-based HIV primary care center in Alameda County.  Since 1987, EBAC’s mission is to provide highest-quality, confidential, and nonjudgmental professional treatment and support services to all clients regardless of their income status, insurance or ability to pay.

[1] Alameda County Public Health Department: “HIV in Alameda County 2014-2016” http://www.acphd.org/media/493885/hiv-report-2018.pdf

[2] California Department of Public Health: “Alameda County – Chronic Hepatitis C Cases and Rates of Newly Reported Cases, 2011-2015” https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Converted_Alameda_HCV.pdf

[3] Alameda County Public Health Department: “HIV in Alameda County 2014-2016” http://www.acphd.org/media/493885/hiv-report-2018.pdf. In 2016, nearly 5,000 new diagnoses of HIV infection were made in California, 275 in Alameda County.

Accidental Medication Exposure at Home Takes a Toll on Kids

Posted on Apr 24, 2019 in Eden Medical Center, Innovation, Scroll Images

CASTRO VALLEY, Calif. –You’ve heard the warnings: put medicines out of reach of children, read all labels, take only what is prescribed in the manner it is prescribed. Yet every year, nearly 60,000 kids under the age of 5 are accidentally exposed to medications, according to Consumer Reports.

So, what can be done?

Proper Disposal

Proper disposal of unwanted, unused or expired medicines is a great way to safeguard against unintentional exposure. But throwing unwanted medicines into the garbage, down the toilet, or other non-sanctioned means of disposal is not safe and poses both health and environmental hazards.

The safest way to dispose of medicines is to put them in special medication disposal kiosks where they are stored until they can be destroyed. Working with the Alameda County Med-Project, Eden Medical Center, part of the Sutter Health not-for-profit network of care, now offers medication disposal kiosks to the community. The kiosks are conveniently located in the hospital’s lobby, open to the public, and free of charge for anyone to drop off unwanted or expired medications.

Trauma registrar, Susan Choing, demonstrates how to use the new medication take-back kiosk at Eden Medical Center.

Says Eden’s trauma injury prevention specialist, Pam Stoker, “These kiosks are a symbol of our commitment to the safety and care of our community. By providing a location for safe disposal of medications, we are providing a means for people to proactively safeguard against accidental misuse of medications.”

Another option for safe disposal is to bring medications to the Drug Enforcement Administration’s National Prescription Drug Take-Back Day event on Saturday, April 27 at the Castro Valley Library from 10:00 a.m. until 2:00 p.m. DEA officers will be on hand to collect unwanted or expired medicines as well as illegal drugs for safe disposal—no questions asked.

Safe Storage

Safe storage of medicine is key in protecting against unintentional exposure. According to a new research report, Medicine Safety: A Key Part of Child-Proofing Your Home, a disconnect exists between where people “store” their medications and where they “keep” their medications. Medications that are not frequently used are “stored” in a safe location like a medicine cabinet or closet, whereas daily use prescriptions or over the counter medicines are “kept” in more convenient, easy to reach locations like the nightstand or counter top. This disconnect creates a risk for unintentional poisoning. To keep others safe, maintain all medications out of sight away from locations that are easily accessible—no matter how frequently you use them.

Working Together to Prevent Unintentional Exposure

In Alameda County, several agencies have come together to outreach to the community for medication safety education and awareness. Safe Kids Alameda County is a member of Safe Kids Worldwide, a global network of organizations dedicated to preventing unintentional injury. They work to prevent unintentional childhood injury, the number one cause of death for children in the United States. Its members include Alameda County Emergency Medical Services, Alameda Health Systems, Sutter’s Eden Medical Center, UCSF-Benioff Children’s Hospital, Oakland, and many other local agencies. Work is also being done by the Alameda County Meds Coalition, which meets monthly at Supervisor Nate Miley’s office in Castro Valley. The Coalition brings together various agencies to work on topics of medication safety including legislation and ease of safe disposal of medications, safe prescribing, and education/awareness on medication safety.

To learn more about medication safety visit the SafeKids website.

 

 

 

 

 

 

Sutter Outpatient Surgery Centers Win All Five California Women’s Choice Awards

Posted on Apr 24, 2019 in Expanding Access, Quality, Scroll Images, Sutter Medical Foundation, Sutter Pacific Medical Foundation, Uncategorized, We're Awesome, Women's Services

SACRAMENTO, Calif. — The five ambulatory surgery centers (ASCs) to earn a 2019 Women’s Choice Award for Best ASC in California are all Sutter Health ASCs:

  • PAMF Surgery Center, San Carlos
  • Sutter Santa Rosa Surgery & Endoscopy Center
  • Stockton Surgery Center
  • Sutter Medical Foundation Surgery & Endoscopy Center (Yuba City)
  • Sutter Elk Grove Surgery Center

“Considering that women make about 80 percent of all healthcare decisions for themselves and their families, this recognition represents a strong and important achievement,” said Sutter Surgery Center Division CEO Terry Glubka. “Congratulations on a job well done!”

About the Women’s Choice Award

The Women’s Choice Award surveys women across the country to gain insight about their most trusted businesses, brands and services. Women’s Choice Award used the most recently publicly available information from the Centers for Medicare and Medicaid Services, as well as accreditation information, to select America’s Best Ambulatory Surgical Centers. It also distributed surveys to women to determine which patient satisfaction measures are most important to them.

About Sutter Health’s Ambulatory Surgery Centers

Sutter Health’s network of ASCs provide patients throughout California a safe and convenient option for many procedures, including pain and spine surgery, hernia repair, cataract surgery, and arthroscopic surgery on the knee, shoulder, ankle and wrist. For more information, please visit sutterhealth.org/surgery-center-division.

Sutter Health Supports Expanded Access to Telehealth in California Legislature

Posted on Apr 24, 2019 in Expanding Access, Scroll Images

Sutter Lakeside Chief Administrative Officer Dan Peterson was in California’s capitol voicing support for Assembly Bill 744, critical legislation that improves access to care through telehealth.

SACRAMENTO, Calif.–Sutter Lakeside Hospital Chief Administrative Officer Dan Peterson testified in Sacramento yesterday in support of California state Assembly Bill 744, by Assemblymember Aguiar-Curry, which Sutter Health believes is a critical step toward improving access to quality health care across California by ensuring that healthcare providers are adequately reimbursed for telehealth services.

Sutter Health is driven to continually transform health care – focusing on how, when and where consumers want and need health care services.  One way we are meeting patient needs is through the deployment of advanced telemedicine technology. Through the use of telemedicine we can bring high quality, around-the-clock care to patients who would not otherwise have access to specialists and specialty care.  We believe this is especially important for California’s rural communities.

At Sutter Health, we witnessed this firsthand when Lake County was devastated by a massive wild fire which left Sutter Lakeside Hospital – one of the only remaining health care providers in the county – closed for 14 days. Through Sutter’s integrated network we were able to remotely deploy physicians from parts of our network not impacted by the fires to digitally treat patients of the Lake County community – but we did so without knowing  if these providers would be reimbursed for their services.

Although current California law recognizes the practice of telehealth as a legitimate means for an individual to receive health care services, the language is insufficient to ensure that services are actually reimbursed.  As a result, health insurers may deny coverage to patients looking to benefit from telehealth services, patients are not assured that their insurance will provide coverage, and providers are unable to develop a sustainable telehealth program for the entire patient population.  AB 744 removes these barriers and will require health insurers to include coverage and reimbursement for services provided to a patient through telehealth.

Real-Time Research: Using Insights to Help Healthcare Today and Tomorrow

Posted on Apr 20, 2019 in Alta Bates Summit Medical Center, California Pacific Medical Center, Innovation, Mills-Peninsula Health Services, Research, Scroll Images, Transformation

SAN FRANCISCO – New research shows that weight loss during the first 12 weeks of a year-long behavioral lifestyle program can predict which participants will achieve weight loss after completing the program. This revelation, along with several others, were shared by Sutter Health’s Center for Health Systems Research (CHSR) during the recent annual meeting of the Health Care Systems Research Network (HCSRN) in Portland.

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Robotic Germ Zapper Helps Bring Down Infectious Disease

Posted on Apr 18, 2019 in California Pacific Medical Center, Innovation, Quality, Scroll Images, Uncategorized

SAN FRANCISCO –A germ-zapping robot called LightStrike from Xenex is used at California Pacific Medical Center (CPMC) hospitals to help curb the spread of infectious diseases. This mobile robotic device is used in intensive care units, medical surgery units, operating rooms and in rooms where patients suffering from Clostridioides difficile (also known as C. diff), Methicillin-resistant Staphylococcus aureus (MRSA) and other microorganisms, were discharged. CPMC, part of Sutter Health’s integrated network of care in Northern California, now employs this mobile robotic technology at all campus locations—with a total of seven in operation.

The LightStrike robot emits 67 bright pulses of (UV) light per second that bounce into walls, floors, ceilings and hard-to-clean places where manual cleaning might miss. The UV light is absorbed by and fuses the DNA of microorganisms, causing the cell to break apart and dissolve, deactivating pathogens. A patient room can be disinfected in less than 15 minutes using this system.

The LightStrike robot is not a replacement for manual disinfecting and cleaning by staff. It is another tool used in the hospitals to enhance staffs’ efforts to combat infectious diseases and to create a safer, cleaner environment for patients and their families.

Internal data shows a decline in infectious diseases at CPMC due to an overarching effort associated with training, improved hand hygiene, and diligence in disinfecting patient rooms after discharge — which includes the use of the Xenex technology.

Sutter Medical Center, Sacramento and Sutter Roseville Medical Center –CPMC’s sister hospitals in the Valley — also use the Xenex germ-zapping robots to assist in their efforts to disinfect rooms. They have also seen similar declines in rates of infectious diseases.

 

Collaboration Leads to Reduction in Low-Risk, First-Birth C-sections

Posted on Apr 17, 2019 in Alta Bates Summit Medical Center, Quality, Scroll Images, Women's Services

By Katarina Lannér-Cusin, M.D., administrative medical director, Women’s Services, Alta Bates Summit Medical Center

 

BERKELEY, Calif. – One of the advantages that an integrated healthcare delivery network like Sutter Health has is that its clinicians are able to improve quality by studying the experience and practice patterns of fellow clinicians. An example of this is our work to support vaginal delivery by reducing the rate of cesarean sections for low-risk, first-time births.

Katarina Lannér-Cusin, M.D., Administrative Medical Director, Women’s Services, Alta Bates Summit Medical Center

Sutter Health’s low-risk, first-birth C-section rate is among the lowest in California, with nine hospitals receiving recognition in 2017. Sutter’s average rate of 21.2 percent is lower than the state’s Healthy People 2020 target of 23.9 percent and the 2016 California Maternity Quality Care Collaborative target of 22.2 percent.
Sutter’s integrated network enables sharing of best practices and real-time data for continual process and quality improvement, which allows the network to outperform state and national averages in many quality measures and improve outcomes for the communities it serves. Sutter hospitals are leaders in California in lowering C-section rates—notably low-risk, first-birth C-section rates.

Sutter is a member of the California Maternity Quality Care Collaborative (CMQCC), a multi-stakeholder organization committed to ending preventable morbidity, mortality and racial health disparities in California. Partnering with CMQCC and the California Health Care Foundation, Sutter is leading a labor culture campaign to proactively educate first-time mothers about C-sections and encourage them to engage with their care teams to support vaginal birth and avoid C-sections for low-risk pregnancies.

There are several key drivers that have been instrumental to achieve real progress in decreasing C-section rates in the Sutter network of care.

• The first and most important driver is effective communication and teamwork—a joint commitment by the clinical team (nurses, midwife and physician) to create a great supportive environment for patients.

• The second driver is alignment on best practices for labor support, including collaborative labor management and education. Sutter adopted a checklist in labor and delivery that establishes parameters clinicians need to complete before deciding on a C-section. The teams work collaboratively using the checklist to ensure that all best practices for supporting a vaginal birth have been implemented. Additionally, labor support education has been developed for nurses, midwives and physicians.

• The third driver is maternal agency—a birth preference sheet was created to educate new mothers about choices they make that may increase their likelihood of a vaginal delivery and give them the opportunity to talk with their physician or midwife about these choices before birth.

• Finally, a large component of lowering low-risk, first-time birth C-section rates is the open sharing of physician-level rates among peers. This transparency creates the opportunity for dialogue and shared learning among clinicians. Each group is encouraged to discuss these rates internally and come up with a plan to address any issues uncovered by the data.

Sutter Health is working to ensure that every patient receives the highest quality maternity care for herself and for her baby. For more information, please visit Pregnancy and Childbirth Services.