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Vol. 5 No. 5

South Dakota and the upper MiDweSt’S Magazine for phySicianS & healthcare profeSSionalS

CyberseCUrityHow Safe is Your Practice?

Why “Alarm Fatigue” Can be Deadly News & Notes

From around the region

232Siouxland Doctors Look Back

What We LearneD From

Save the Date

7th Annual Upper Midwest Regional Pediatric Conference

Sept. 25 & 26, 2014Marina Inn & Conference Center South Sioux City

A unique conference presenting the spectrum of care for the sick or injured child.

For conference information and updates go to www.UMRPConference.com

Presented by:

Children’s Hospital & Medical Center, Omaha

Mercy Medical Center, Sioux City

Prairie Pediatrics & Adolescent Clinic, P.C., Sioux City

Siouxland Medical Education Foundation, Sioux City

UnityPoint Health - St. Lukes, Sioux City

MED UMRP AD, 2014.indd 1 6/20/14 9:11 AM

VolUme 5, No. 5 ■ JUly / aUgUst 2014

ContentsregUlar FeatUres 2 | From Us to You

5 | MED on the Web exclusive content on midwestmedicaledition.com

19 | In Review Medical Billing Horror Stories by sharon Hollander

24 | The Nurses’ Station Nursing News from around the region

26 | Wine Marketplace Find out how to bring your favorite vacation wine discovery to your local wine shop

29 | Learning Opportunities Upcoming Conferences, events, and Cme opportunities

iN tHis issUe 7 | Avera’s Cancer Rebranding

Emphasize Consistency and Technology

15 | It is Time to Hone Your Business Skills? an avera VP talks about why she decided to pursue a Healthcare mba

16 | Getting Read for ICD-10: How to thrive and not just surviving change ■ By Natalie Bertch

17 | A “New” Funding Source for the Doc Fix? ■ By Dave Hewett

18 | CORRECTION: Curtis Peery, mD, responds to an incorrect headline in the June issue of meD. Why robotic gastric bypass is a multiport procedure.

20 | Area Critical Access Hospitals Named Top Performers

21 | New Radiation Technology Targets Tumors – avera’s new elekta Versa HD linear accelerator will mean new choices for patients with small, inop-erable and/or hard-to-reach tumors.

22 | Human Error: How to make Fewer mistakes in a busy eD ■ By Mike Miller

28 | Make-A-Wish South Dakota Celebrates 30 Years of Granting Wishes

On the

COver

page 10

Midwest Medical edition

JUly

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2014

Vol. 5 No. 5

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalS

CyberseCUrityHow Safe is Your Practice?

Why “Alarm Fatigue”

Can be DeadlyNews & Notes From around the region

232Siouxland Doctors Look Back

What We LearneD

From

8 News & Notes New doctors, certifications, clinics, and more

14 Risks Surrounding Alarm Management in the Healthcare Setting ■ By Jillyan Morano

By Alex Strauss

twenty-five years after the sioux City crash of United airlines Flight 232, CNos Neurosur-geons Quentin Durward and ralph reeder still remember the experi-ence… and the lessons it taught the entire medical community about disaster response.

6 Healthcare Ranks Last in Cybersecurity ■ By Bryan O’Neal

232What We Learned

From

siouxland Doctors look back

midwest medical edition 2 midwest medical edition

From Us to youstaying in touch with meD

CoNtaCt iNFormatioN

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 steff@midwestmedicaledition.com

Alex Strauss, Editor in Chief 605-759-3295 alex@midwestmedicaledition.com

Fax 605-271-5486

MAILING ADDRESS Po box 90646 sioux Falls, sD 57109

WEBSITE midwestmedicaledition.com

Jan/Feb Issue December 5

March Issue February 5

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November Issue October 5

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2014 Advertising / Editorial Deadlines

reproduction or use of the contents of this magazine is prohibited.

©2011 midwest medical edition, llC

Midwest Medical Edition (meD magazine) is committed

to bringing our readership of 5000 south Dakota area

physicians and healthcare professionals the very latest in

regional medical news and information to enhance their

lives and practices. meD is published 8 times a year by meD

magazine, llC and strives to publish only accurate informa-

tion, however midwest medical edition, llC cannot be held

responsible for consequences resulting from errors or omis-

sions. all material in this magazine is the property of meD

magazine, llC and cannot be reproduced without permission

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meD is produced eight times a year by meD magazine, llC which owns the rights to all content.

PUblisHer MED Magazine, LLC Sioux Falls, South Dakota

VP sales & marketiNg Steffanie Liston-Holtrop

eDitor iN CHieF Alex Strauss

DesigN/art DireCtioN Angela Corbo Gier Corbo Design

PHotograPHer Kristi Shanks

Web DesigN Locable

Digital meDia DireCtor Jillian Lemons

CoNtribUtiNg Writers Natalie Bertsch Dave Hewett Mike Miller Jillyan Morano Bryan O’Neal

staFF Writers Liz Boyd Caroline Chenault John Knies

WelCome to tHe sUmmer issUe oF MED

magazine, the area’s only publication devoted

to improving the lives and businesses of

doctors and other healthcare professionals

on the Northern Plains.

in this issue, you’ll find expert advice for boosting your

office’s “cybersecurity”, information on the overlooked

but potentially deadly problem of “alarm fatigue” in the

healthcare setting, and tips for not just surviving but thriv-

ing with iCD-10. on the lighter side, find out how Cask &

Cork can help you get more of that great wine you tasted

on vacation. Plus, as always, meD is your more comprehen-

sive resource for all of the region’s medical community

news. Do you know of something we are missing? Please

drop us a line and let us know.

meD is actively seeking healthcare professionals who

are interested in contributing content for our rapidly grow-

ing website. if you have something to say, let meD help you

say it to a larger audience. Contact us to find out how.

Finally, we at meD realize that physicians have a life

outside the office and we want to know about it. Do you

have an unusual hobby? Do you play music? Have you read

some great books? Do you have an opinion on the current

topic? meD is dedicated to showcasing the ideas and accom-

plishments of area medical professionals – both in and

outside the hospital or clinic. our great interactive website

makes it easy to share your thoughts and ideas with us. let

us hear from you.

With best wishes for a safe and productive summer!

—Alex & Steff

Be sure to stop by our booth at this year’s SDMGMA Fall Conference, August 20 – 22 at the Cedar Shore Resort in Chamberlain!

alex strauss

steffanie liston-Holtrop

3July / August 2014 MidwestMedicalEdition.com

2014 Advertising / Editorial Deadlines

PUblisHer MED Magazine, LLC Sioux Falls, South Dakota

VP sales & marketiNg Steffanie Liston-Holtrop

eDitor iN CHieF Alex Strauss

DesigN/art DireCtioN Angela Corbo Gier Corbo Design

PHotograPHer Kristi Shanks

Web DesigN Locable

Digital meDia DireCtor Jillian Lemons

CoNtribUtiNg Writers Natalie Bertsch Dave Hewett Mike Miller Jillyan Morano Bryan O’Neal

staFF Writers Liz Boyd Caroline Chenault John Knies

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Now More than a Magazine, A Medical Community Hub

Med Magazine is now offered in a convenient digital format for on-the-go reading on your apple or android device. Find the link to the digital issue on the right hand side of the Med home page and sign up to get your next Med right in your inbox!

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Find links to these articles and more on the MED homepage.

◆ INTERACTIVE DIRECTORY – Find and connect with area businesses and add yours to the list. it’s easy and free to put the web to work for your practice with a listing and link in MED’s online directory.

◆ CALENDAR OF EVENTS – Find local events from Cme opportunities to celebrations, open houses, conferences, seminars and fundraisers. add your own event for free and reach thousands of MED readers.

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Do you know how close your salary is to your colleagues nationwide? the medicare Payment advisory Commission finds that rural doctors make slightly more on average than doctors practicing in larger cities. and what about job satisfaction? Find a link to the 2014 Physician Compensation report and see where you fit in.

Better Training in Healthcare InformaticsHealthcare informatics is the practice of using information to improve healthcare. Now, Dakota state University is working to improve its Healthcare informatics program through a new partnership with the Healthcare information and management systems society. Find out what it will mean for DsU’s growing ms in Hi program and the future of your own research.

Blog for MED!attract visitors to your own blog or start a following as a guest blogger for MED. if you are a physician with something to say, contact us at info@midwestmedicaledition.com to find out how.

Midwest Medical Edition 6

“HEALTHCARE RANkS LAST IN CYBERSECURITY.”that’s a tough pill to swallow, isn’t it? However, according to

an analysis published last month by security rankings provider,

bitsight technologies, it’s true. Healthcare and pharmaceuticals

ranks lowest of the four major industries in the United states.

that’s lower than retail, utilities or finance. ouch.

the report measured security performance from april 2013

through may 2014. Healthcare experienced the longest average

event duration, at 5.3 days per security incident. our industry also

saw the largest percentage of security incidents over the one year

time period.

With a host of valuable information, such as patient identities,

credit cards, and insurance information, healthcare it networks

are a prime target for hackers. this isn’t just about compliance

anymore. today, it can be assumed your network is or will be

compromised. While we should still try to prevent this from

happening, it’s now more important to be able to detect and

respond to these threats.

How are businesses in other industries managing their risk?

they start with an assessment of their firewall traffic. in most

cases, the highest percentage of threats to your data pass through

your firewall. starting with a basic assessment will provide you

the insight needed to see the threats you have now. the report

should include the following:

n identify current vulnerabilities

n list high-risk applications and protocols

n Present traffic distribution statistics by geographic

location, Url category and traffic type

n Highlight the top 20 high-risk applications found

n Highlight the top 20 high-bandwidth

applications found

Don’t wait until your practice has become a victim. your

patients, your business and your reputation are at risk. it’s time

for healthcare to improve its cybersecurity standings. ■

Bryan O’Neal is a healthcare technology consultant at golden West

technologies in rapid City. to request a copy of the bitsight analysis,

contact him at bryanoneal@goldenwest.com.

www.sdletb.orgREFERRAL HOTLINE

1-800-245-7846 EXT 4

Talena has been a member of the SDLETB team for seven years. She remains passionate about donation which is demonstrated by her degree of professionalism as recovery team lead. With an eye on the future of SDLETB, Talena continues to expand her knowledge of recovery techniques. In her role as distribution manager, Talena is dedicated to placing corneal tissue with local recipients. She appreciates the opportunity to work closely with SDLETB’s partners to continue and grow and strength the eye bank.

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Healthcare Ranks Last in Cybersecurity

  MeD Quotes “What is to give light must endure burning.” — Viktor E. Frankl

7July / August 2014 MidwestMedicalEdition.com

AVERA HEALTH has announced that it is rebranding its six regional cancer centers and 40 outreach sites as Avera Cancer Institute.

Under the plan, existing cancer centers at Aberdeen, Mitchell, and Yankton will be renamed Avera Cancer Institute. A new $12.95 mil-lion facility is currently under construction in Marshall, which will be named Avera Cancer Institute Marshall. Fundraising is underway for a $13.5 million building project to expand cancer services in Aber-deen. Avera Cancer Institute Sioux Falls was expanded in 2010 with the construction of the Prairie Center.

Avera serves cancer patients in a 250-mile radius and hopes the rebranding will emphasize the con-sistency and quality of its regional cancer care as well as the availability,

through outreach, transportation, and eServices, of top level technology.

An example is the new Versa HD linear accelerator, which provides stereotactic radiosurgery and body radiation therapy for medically inoperable tumors. (See pg.21). Avera says the high cost of the new machine requires that they serve a patient population of at least 1 million, but its presence in Sioux Falls means that the Versa HD is now accessible to all Avera patients who need it.

“At all locations, patients have access to the technical aspects of care, and the human supportive elements of care,” says Dr. Michael E. Peter-son, MD, Radiation Oncologist with Avera Medical Group Radiation Oncology Yankton, one of the leaders of Avera’s cancer service line. ■

avera’s Cancer rebranding emphasizes Consistency and technology

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News & Notes

Happenings around the region

midwest medical edition 8

AverA

Avera Health and the u.S. Attorney’s Office will host a three-day conference August 12-14 engaging law and

government officials, health care providers, mental health experts, and others in a discussion of human trafficking and sexual assault – a form of modern-day slavery. The keynote speaker is Elizabeth Smart. The Avera Victim Witness/Human Trafficking Conference will be held at the Washington Pavilion in Sioux Falls. Among other things, attendees also will learn best practices in dealing with offenders and victims, as well as the public’s responsibility with regard to the issue.

The Cancer Research Department at the Avera Cancer Institute has received one of eight national Clinical Trials Participation Awards from the American Society of Clinical Oncology and Conquer

Cancer Foundation. Avera’s patient enrollment in clinical research trials is currently at 13 percent of all patients seen at the Avera Cancer Institute, compared to the national average of 3 to 5 percent. The Clinical Trials Participation Award (CTPA) was designed to recognize and promote high-quality clinical research sites with intent to increase the awareness of and participation in clinical trials among physicians. The award was presented during the ASCO Annual Meeting in Chicago, on June 1, 2014.

BlAck Hills

Hot Springs Regional Medical Clinic medical providers Lisa Brown, MD, Bruce Eaton, MD, Joleen Falkenburg, MD, and

Heather Preuss, MD, have relocated to the clinic’s new location at 145 North 16th Street in Hot Springs. The new location offers improved convenience and accessibility as well as more staff efficiency and better patient flow. Dr. Preuss has increased her presence at the clinic with additional hours during the week and is accepting new patients.

Rheumatologist Michael Avery, DO, has joined the clinic staff

at Regional Medical Clinic. Dr. Avery received his graduate degree at Des Moines University (Osteopathic Medical Center) and completed his residency in internal medicine at Wright State University in Dayton, Ohio. He completed his fellowship in rheumatology at the University of Nebraska Medical Center in Omaha. He joins Brian Bowers, DO, James Engelbrecht, MD, Jennifer May, MD, Shari Fechner, CNP, and Emily Huntley, MSPAS-C at Regional Medical Clinic – Aspen Centre on Flormann Street.

The Rapid City Regional Hospital Foundation presented its 10th premier wine tasting event, Grape Time, on

Saturday, June 21, at the Golf Club at Red Rock in Rapid City. The event was a benefit for Women’s and Children’s Services at RCRH. Grape Time featured wine tasting stations, cuisine from several local caterers, a silent auction, and local entertainment. A selection of wines from Cask & Cork, Don Sebastiani & Sons, Sean Minor Wines, Kokomo Wines and the Marchetti Company were featured.

Due to an increase in cases of pertussis in the Black Hills, Regional Health implemented new visitation guidelines in

May. No children under 12 or people with coughing, sneezing, runny nose, or fever are allowed to visit hospitalized patients or senior care residents and symptomatic patients must wear masks in Regional Health clinics. South Dakota had 67 cases of pertussis in 2013 but had 29 cases by mid-May of this year. A disproportionate number of cases have been in the Black Hills area.

In May, Rapid City Regional Hospital offered members of the press the opportunity to tour their newly-renovated

cafeteria and kitchen, the last areas of the hospital to be remodeled since 1979. The renovation has been going on since 2012. RCRH says the project, along with the hiring of a new chef, “will bring a healthy new spin on South Dakota comfort food”.

Regional urgent Care and Occupational Medicine has opened a new clinic at 2116 Jackson Boulevard in Rapid

City. This 5,000 square foot space replaces the previous Urgent Care facility and includes six exam rooms, on-site lab and X-ray, ample parking and an open, modern design.

Hospitalist Robert Houser, MD, is the new Vice President of Medical Affairs at Rapid City Regional Hospital.

Dr. Houser moved into his new role with the organization June 1. He will provide physician perspective on the administrative team and serve as a physician advocate promoting effective physician, hospital, and system relationships. He will also serve on the Regional Health Executive Team. He currently serves as the Co-Medical Director of Hospitalist Services and previously served as Chairman of the Internal Medicine Department.

The Jackson Boulevard Clinic joins Regional urgent Care’s existing north Rapid City

location on Knollwood Drive. It is the first of three planned urgent care and occupational medicine clinics for Regional with additional sites to be built on Lacrosse Street and Highway 44.

south Dakota southwest minnesota Northwest iowa Northeast Nebraska

July / august 2014 midwestmedicaledition.com 9

Stay up-to-date with new medical community news between issues. Log on!

The South Dakota Affiliate of Susan G. Komen for the Cure has awarded a grant to the John T. Vucurevich Regional Cancer Care

Institute (CCI) to assist medically underserved women in western South Dakota with challenges during breast cancer treatment. The “Healing Pathways” program will assist the medically underserved breast cancer patients of western South Dakota by providing travel assistance while they are receiving treatment for breast cancer. Funds totaling $22,650 are available through May 1, 2015.

sAnford

Sanford Health has introduced an integrated approach to weight management and is opening its first retail store

front in Brookings. Profile by Sanford was designed using a large body of clinical research to ensure a sustainable means to healthy weight loss. The Profile system utilizes meal-replacement products, nutritionally complete food, and qualified health coaches. In addition to members consuming both Profile-produced and grocery-store food, coaches develop customized plans for their clients and offer advice on nutrition, exercise and behavior. A clinical and scientific advisory board comprised of 10 Sanford physicians and researchers oversaw the development of the Profile system.

Sanford Health was included in Becker’s Hospital Review “100 Hospitals with Great Heart

Programs” list. The Becker’s editorial team selected these hospitals based on recognition for quality care, clinical awards and research contributions to cardiovascular care. Sanford Heart’s new facility, opened in 2011, offers a hybrid operating room, catheterization labs, and space for more than 750 medical personnel.

Sanford Heart Hospital has also received the Get With The Guidelines–Heart Failure Gold

Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association/American College of Cardiology Foundation secondary prevention guidelines for heart failure patients. This marks the third year that Sanford has been recognized with a quality achievement award.

siouxlAnd

Peter Thoreen, President and CEO of unityPoint Health – St. Luke’s, has assumed the additional role of interim CEO for the system’s newest affiliate,

Meriter Health Services, while they conduct a search for a permanent CEO. Lynn Wold, UnityPoint Health – St. Luke’s Chief Operating Officer, will assume the responsibilities of interim President for St. Luke’s.

unityPoint Health–St. Luke’s Foundation will host the 3rd Annual Golf Invitational on Monday, July 28 at the Sioux

City Country Club. Proceeds from the event will benefit local health initiatives developed by UnityPoint Health – St. Luke’s Foundation, St. Luke’s College and St. Luke’s Children’s Miracle Network. The Invitational begins with lunch at 11:00 and a shotgun start at noon. Following 18-holes of golf on the country club’s premier course, there will be a dinner with awards and prizes for each golfer. For more information or to register, call St. Luke’s Foundation (712) 279-3900.

Patricia Rodriguez, Human Resource Manager at Mercy Medical Center, has been awarded the 2014 Diversity Leader of the Year Award by CHE

Trinity Health. Rodriguez was nominated by the Diversity and Inclusion Committee of Mercy Sioux City’s Board of Directors. Rodriguez has held leadership roles with various programs including Mercy’s HOLA Program (Healthcare Opportunities for Latino Advancement).

In June, the June E. Nylen Cancer Center partnered with the Iowa Cancer Consortium to provide sunscreen and educational information to

2,900 children age 4–14 participating in youth baseball and softball this season. The “Be Sun Safe: Cancer Prevention Program” was a grant that provided individual sunscreen to the players and gallon jugs of sunscreen for fans to use along with a banner and educational material.

otHer

May 20, 2014 – The American College of Health Care Administrators

(ACHCA) recently honored Jason Hanssen, administrator at

The Neighborhoods at Brookview, a part of the Brookings Health System, with the ACHCA 2014 Eli Pick Facility Leadership Award. Hanssen was one of 276 administrators nationally to receive the award which honors facility excellence.

midwest medical edition 10

Disaster preparedness is no accident and every hospital, fire department, and emergency management agency

knows it. When lives are on the line, the ability to mobilize quickly, communicate effectively, and triage efficiently are criti-cal. They are the primary goals of every disaster drill and simulation.

But, regardless of how many such drills and simulations they are involved in, most medical professionals also know that the odds are against their ever encountering a mass casualty disaster like the crash of an airliner. That is what neurosurgeons Quenton Durward and Ralph Reeder assumed, too. Until July 19, 1989.

“I had just finished an operation at Marion Health Center (now Mercy Medical Center) in Sioux City. I went out to speak to the patient’s family and heard that there was maybe going to be an airplane crash,” recalls Quentin Durward, MD, who is now with the

CNOS clinic in Dakota Dunes. “So, I wan-dered down to the ER to see what this was all about.”

When he arrived in the Emergency Room, Dr. Durward learned that David Greco, MD, Director of Marion Health’s Emergency Department, had already boarded a helicopter and headed for the airport. Durward listened as Dr. Greco radioed his eyewitness account of the incoming plane to his tense ER colleagues. “He described the plane coming in and said it was moving very fast,” says Dr. Durward. “At first he said it looks like it’s going to make it. But the next thing we heard was yelling in the cockpit and we knew that it had crashed.”

For a variety of reasons that would be exhaustively examined in the months after the accident, the first victim of Flight 232

arrived at the Marion ER a miraculous 16 minutes later.

Dr. Ralph Reeder, Dr. Durward’s colleague at CNOS and the only other neuro-surgeon in Sioux City at the time of the crash, had moved to town just two weeks earlier. “I barely knew where the bathrooms were,” he says. “I knew maybe 7 physicians in town. I hadn’t yet even had an orientation.”

Fortunately, he had had plenty of trauma experience and had been through mul-tiple mass trauma simulations as a resident at Dart-mouth. By sheer

happenstance, hundreds of Sioux City’s medical and emergency response personnel had themselves gone through a simulated airline disaster at the airport just two years prior to the crash. The new relationships that were fostered between key emergency response agencies during that simulation

By Alex Strauss

232232Flight

What We Learned

From

“ i feel like there was a plan for my life and i was supposed to be there.” — dr. ralph reeder

25 years later, two Siouxland Doctors Look Back

July / august 2014 midwestmedicaledition.com

helped ensure that, when the real thing happened, they were ready and able to coordinate a smooth response.

“The other thing that was as critical part of the speed with which they got going was that the guy in the tower rec-ognized before anyone else that there was a potential massive disaster,” says Dr. Durward. “He called an Alert 3 before the plane crashed.”

The Alert triggered the county’s Emer-gency Operation Plan and mobilized an army of fire trucks, ambulances, helicop-ters, and personnel. At Marion, where a shift change was in progress, everyone was asked to stay, trauma surgeons were located and summoned, the ER and ICUs were cleared of non-critical patients, the ER park-ing lot cleared, and personnel assembled drugs, carts, surgical packs and IV setups. Although technically premature because the disaster had not yet occurred, the early Alert 3 proved to be lifesaving.

“If there is one thing we learned it is that, in a trauma situation, minutes count absolutely,” says Dr. Durward. “The fact that we were able to get these precious 30 minutes of forewarning thanks to the dispatcher in the tower who recognized that this was very likely going to be a mass casualty situation made all the difference.”

Dr. Reeder had just finished a carotid endarterectomy in the Marion OR and was closing when he lost his entire surgical team to the commotion in the ER. When the procedure was finished, he too, joined the throngs of medical personnel treating incoming patients.

“It started out very surreal and got very real, very fast,” says Dr. Reeder.

Because there were medical personnel already at the airport when the impact occurred, including the hospital ED direc-tor, injured passengers were immediately triaged. Those with burns or orthopedic

“ in my career, i have never seen anything even remotely like it.” — dr. Quenton durward

25 years later, two Siouxland Doctors Look Back

Timeline United 23215:16 #2 engine explodes

15:26 sioux city airport alert 2

15:34 alert 3

15:52 1st helicopter takes off

16:02 United 232 crashes

16:17 1st patient arrives at marian (mercy)

a total of 156 crash victims were treated in the st. luke’s

and marion ers. of the 296 people on board Flight 232,

a miraculous 184 survived.

responding to the disaster were 39 fire departments, 35

ambulances, 400 gms personnel, 3 helicopters, and 250

iowa National guard members.

United Flight 232, a DC-10, was in route from Denver to Chicago

when a failure in the tail-mounted engine at 37,000 feet caused the

loss of the plane’s hydraulic systems. in a feat of aviation skill that no

simulation has ever been able to replicate, the crew landed the plane

using only the throttles of the two remaining engines for control.

11

12 midwest medical edition

or non-life threating wounds were sent to St. Luke’s Medical Center and those with head, spine or other life-threating injuries to Marion. At Marion, Dr. Mike Wolpert, the hospital’s head of trauma and most experi-enced trauma surgeon, put his skill to work sorting patients, a decision Dr. Durward calls “brilliant”.

“Even though he was the most experi-enced trauma surgeon, he recognized that his talents would be best used this way. This is an important lesson for any mass casualty.”

At first, Drs. Durward and Reeder tag-teamed the serious head and spine cases. When Dr. Durward was called to St. Luke’s to perform emergency surgery on a previ-ously undiagnosed head injury, Dr. Reeder prioritized cranio-spinal traumas on his own.

“I think I quickly screened at least 40 patients,” says Dr. Reeder. “I can’t tell you the number of bedside consults. I was running from place to place.” Fortunately, he had plenty of help. Hundreds of volunteer physi-cians, nurses, and medical techs flocked to the hospitals – many of them with no previous trauma experience.

“We had podiatrists, psychiatrists, family doctors. Everyone was there, doing what they could,” says Dr. Reeder. “The thing that I took away from this is that, when it really mattered, people didn’t’ worry whether or not they were qualified. No one was concerned about

hierarchy or privilege. We all just saw jobs and did what had to be done. Because you knew that if you didn’t do what you could, right then, the person was going to die.”

Both Dr. Reeder and Dr. Durward have vivid memories of patients who did not make it, despite their efforts, and others who made remarkable recoveries. The woman whose unrecognized epidural hematoma Dr. Dur-ward rushed to St. Luke’s to treat recovered well. A child with a head trauma who was in a coma for three weeks, woke up a day after Dr. Reeder had begun to doubt that she would, and grew up to be an honor student.

Of the 296 people on the plane, an amaz-ing 184 survived, thanks to the phenomenal skill of the flight crew in the air and good planning, early warning, and quick thinking on the ground. When they remember the events of July 19, 1989 and the blur of non-stop workdays that followed, both doctors say they are humbled by the experience.

“I really think it was one of the greatest, most heroic moments in flight,” says Dr. Dur-ward. “And the community response spoke very highly of Sioux City. In my career, I have never seen anything even remotely like it.”

“I feel like there was a plan for my life and I was supposed to be there,” says Dr. Reeder. “I wouldn’t want anything like this to happen again, but we’re prepared. To me, it’s just what you do.” ■

◆ disaster drills can be invaluable

◆ the earlier the alert is sounded, the better response

◆ emergency vehicles should be walked to through a debris field to avoid injuring survivors

◆ there is no substitute for medical expertise on the scene early

◆ sometimes the most experienced doctors are most valuable directing triage

◆ minutes matter

◆ communication is crucial

◆ dividing types of injuries between hospitals simplifies triage

◆ cleared routes to the hospital improves response

◆ serendipity plays a role

◆ siouxland residents are willing to help when it counts

“ it started out very surreal and got very real, very fast.” —dr. reeder

Dr ralph reeder mD Dr Quenton Durward mD

What DiD FLight 232 teach US aBoUt

traUma SitUationS?

Forty-eight plane crash victims were admitted to marian Health Center and 17 were admitted to st. luke’s

regional medical Center in the hours after the plane crash. of the 108 patients that came through the

st. luke’s er, 91 were treated and released.

13July / august 2014 midwestmedicaledition.com

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Midwest Medical Edition 14

THE ISSuE OF ALARM FATIGuE and patient safety has become a ‘center stage’ concern for healthcare providers across

the country over the last two decades. In fact, the Emergency Care Research Insti-tute (ECRI) named alarm hazards as the #1 Health Technology Hazard in 2013.

The number of alarm signals in healthcare facilities can surpass several hundred per patient each day – which can translate to thousands of alarms on every unit and tens of thousands throughout the hospital. While alarms are an important part of patient care, they can reach overwhelming quantities. So, it’s no wonder that clinicians can become desensitized, overwhelmed or immune to the sounds, and can suffer from ‘Alarm Fatigue.’

The risks to patient safety are real. Common injuries resulting from alarm hazards can include falls, delays in treat- ment, medication errors, or in the worst case – death. The Joint Commission Sentinel Database reports 98 alarm-related events between January 2009 and June 2012. Of the 98 reported events, 80 resulted in death, 13 in permanent loss of function, and five in unexpected additional care or extended stay. Unfortunately, these occurrences are happening more and more frequently.

In June 2013, the Joint Commission established a new 2014 National Patient Safety Goal (NPSG) to address improving the safety of clinical alarm systems in hospitals. The NPSG requires hospital and critical access hospital leaders to set alarm management as a priority, establish a formal policy and provide staff training around alarm safety.

meDicaL DeviceS With

aLarm capaBiLitieS

Advancements in technology have created an environment in our healthcare system in which most medical devices now have some sort of alarm capability.

Those devices include:

v Physiological monitors

v Ventilators

v Infusion pumps

v Pulse oximeters

v Bed/Chair alarms

v Patient call systems

v Anesthesia

v Infant incubators and radiant warmers

v Hyper and hypothermia systems

aLarmS in the heaLthcare Setting FaLL into one oF FoUr categorieS BaSeD on priority

v Crisis

v Warning

v Advisory

v Message

In order to understand how to solve some of the issues surrounding alarm fatigue, let’s first take a look at some of key pain points:

cLinicianS’ WorkLoaDS From an ethical perspective, clinicians are in the conundrum of needing to monitor patients to the fullest degree possible. We have dual responsibilities of keeping an eye on our patients along with trying to decipher the myriad of noises coming from these devices.

eqUipment compLexity Less than five percent of the alarms coming from any of these devices are considered critical. Further, there is often little integration between the devices.

Lack oF StanDarDization

For aLarm SignaLS

Too often, we see different monitoring systems on different units, leading to haphazard alarm management. When clinicians have to play by a different set of rules for alarm parameters from one unit to another, confusion almost always ensues.

LiaBiLity This is possibly the greatest challenge we face in regards to the alarm fatigue issue. Conventional wisdom in the healthcare community says that a false positive is better than a false negative when it comes to alarms, so clinicians want all the ‘bells and whistles’. False positives and over-whelming alarm fatigue lead to confusion. Certainly, that confusion can cause problems that could bring liability into play, and that’s a great risk. But false negatives in which an alarm fails to sound during an emergency present far greater liability for healthcare providers. ■

Risks Surrounding Alarm Management in the Healthcare SettingBy Jillyan Morano

For Morano’s complete list of strategies for avoiding alarm fatigue,

LOG ON TO THE MED WEBSITE

Jillyan Morano serves as the Director of Clinical engineering for abm Healthcare support services. she participates in several hospital committees including the hospital task force to improve the alarm management process.

15July / August 2014 MidwestMedicalEdition.com

Is it Time to Hone Your Business Skills?a graduate of UsF’s Healthcare management mba Program discusses the rewards and challenges of returning to the classroom

as tHe bUsiNess oF meDiCiNe becomes

increasingly complex, a growing number of

healthcare professionals, from clinicians and

technicians to administrators and marketing

specialists, are going back to school for

practical tools to sharpen their business

acumen. the University of sioux Falls has

been catering to these professionals with

an mba in Healthcare management since

2005. the program has grown steadily,

attracting a wide cross section of profes-

sionals and providers with features designed

to make education “doable” even for busy

professionals.

lindsay meyers, the newly-named Vice

President for Public relations at avera Health,

recently completed the two-and-a-half year

program.

meD: You were already successful in your career in healthcare marketing. Why did you decide to pursue an MBA?

Lm: i was hoping that i would continue to

learn because healthcare is changing so fast.

especially in Pr – you deal with everything

that is going on. i wanted to understand what

was going on in the healthcare field through

people who were working out there. i can

now talk to administrators in a much more

intelligent way than i had been able to do in

the past.

MED: What do you think was the most valuable aspect of the USF program for you?

Lm: there was a depth of experience among

the students in my class that i found tremen-

dously beneficial. the classwork was interesting

but it was really enhanced by the mix of people

who had been in the working world a long time.

in my case, this included a physician who had

30 years of experience, as well as some people

who had just finished their undergraduate train-

ing. i found that i also had a lot to contribute

because of the breadth of my experience.

meD: In your job, you work with physicians and other healthcare profes-sionals on a regular basis. What do you think these types of professionals could gain from a program like this one?

Lm: among other things, this program really

helps with communication skills and problem

solving, particularly where the complexities of

finances are concerned. i heard from physicians

in my class that they had been on many boards

and had often had to make major decisions in

that capacity, but had never felt that they fully

understood the financial side of things. the

program also really helps you understand

the concept of costing in healthcare. you come

away understanding what needs to be

considered when you are looking at making

a major investment in a piece of equipment,

for instance.

meD: You were working full time and your son was a toddler when you started this program. How did you have time?

Lm: UsF really works with you to help you

map it out and see how you can do it. you are

only in a classroom one evening a week, so

that was doable. it does take a lot of discipline

and good time management but you are done

in less than three years. i have not been out

of the program for long, but i have already

referred back to some of the things i learned.

in fact, i now keep a binder of some of my

classroom materials in my office. ■

the UsF Healthcare management mba

includes such courses as managerial

Communications, Financial Planning and

Control, marketing management and legal

and regulatory issues in Healthcare.more

information can be found on the website a

www.usiouxfalls.edu/mba.

lindsay meyers at her recent graduation from

the UsF Healthcare mba program with husband

Jay and son Finn.

Midwest Medical Edition 16

Getting Ready for ICD-10HOW TO THRIVE AND Not JuST SuRVIVE CHANGE

By Natalie Bertsch

IN THE HEALTHCARE INDuSTRY, we get used to dealing with change. To survive in the medical field, professionals need to be able to

adapt to constant instability: new tech-nology, new rules and new systems of organization.

When the Centers for Medicare and Medicaid Services announced this spring that Oct. 1, 2015 was the latest deadline for ICD-10 implementation, some people in healthcare were relieved.

They anticipated delays in reimburse-ment, denials with claims and frustration for everyone involved. Resisting the new

requirement, they saw the pushed back deadline as a reprieve: one more year before everyone has to live through one more chaotic transition.

While change can be difficult to deal with, as an individual or an organization, now is the time to prepare to do more than just survive change.

A growing number of patients expect healthcare providers to be innovative and offer meaningful service. Adapting to this change gives your practice a chance to develop systems that will serve and appeal to patients who are educated, informed and very “plugged in.”

The way you prepare for ICD-10 implementation is similar to the way you would train for a marathon. You don’t wake up one day and plan to run 26 miles. You prepare, practice and pace yourself to be ready for the race day.

Like a marathon runner, successful healthcare organizations must have a focus, a plan and desired outcome. In the months leading up to implementation, providers can prepare for change and their marathon victory. The following tips will help you get ready to race to the ICD-10 finish line:

17July / August 2014 MidwestMedicalEdition.com

COMBINE MEDICARE PARTS

A and B? It’s a proposal that is being discussed in a few Washington circles to reduce

Medicare spending and/or provide a funding source for a “Medicare Doc Fix”. It has also generated analysis from MEDPAC and the Congressional Budget Office (CBO) as a way to reduce the federal deficit.

Obviously the plan(s) to “combine Parts A and B” are just a bit more complicated than this simple phrase. For providers this may appear to be an eligibility issue that doesn’t require your attention. However I disagree. The reforms being discussed would com-pletely redesign the incentives of how and where Medicare beneficiaries receive their care and demand that providers take a new look at how they are organized and the mix of services they offer.

So let’s start with a basic notion. Anyone turning 65 and entering the Medicare pro-gram has to be mystified. Three separate programs. The first one (Part A) covers inpa-tient hospital and skilled nursing facilities services – sort of. If a beneficiary is a hos-pital inpatient from more than 121 days, they are footing the entire bill. They also pay a deductible of approximately $1,200.

Part B is more like a private insurance product with a modest premium and deductible. Beneficiaries also pay 20% of most Part B services with no upper limit on out-of-pocket spending. Some Part B services are provided without any cost to the beneficiary. Because of the unlimited financial exposure in both Parts A and B, many enrollees will purchase supplemental plans on the private market.

Part D, the prescription drug program was passed in 2006 and is likely more familiar to us. Coverage is provided by through private

insurers primarily using the Internet. But it’s still a separate policy.

What a hodge podge! Any resemblance to the private health plans people have experienced through their workplace or the individual market is purely coincidental.

The CBO has advanced a plan that would combine Parts A and B and disallow supple-mental plans to provide to provide first dollar coverage saving approximately $92.5 billion over 10 years. Other plans have been proposed as well and while the specifics may be different, they have common themes such as:

◆ Lower out-of-pocket costs for those with long hospital stays

◆ Increase costs for those seeking more outpatient care.

◆ Eliminate unlimited economic exposure for the beneficiary

◆ Place restrictions on supplemental or Medigap plans.

This is far from a done deal. But it is viewed as potential middle ground between the Republican focused voucher-type approach and Democrats wedded to the traditional program.

As for providers, it is important that we begin to at least start addressing how this would impact our own local delivery systems. In South Dakota, the good news is that provid-ers are better positioned for this approach than most through integrated delivery net-works and the ability to adapt to this changing healthcare delivery environment. But regard-less, whether it involves the provision of care in a clinic, hospital, nursing facility or home health agency setting, it behooves all of us to be a part of this debate. ■Dave Hewett is President and Ceo of the south Dakota association of Healthcare organizations.

a “New” Funding source for the Doc Fix?By Dave Hewett

Now is the time to take a look at what you are doing and explore your options. Before you have a deadline looming, you can research your options and select a team of individuals that specialize in coding, billing and revenue cycle.

Set a timeline of expectations for making the change. Figure out if you will need to make systems modifications and leave yourself enough time to test out your new system before it has to do the job.

Build a communications board to keep everyone updated and engaged. Make a plan about who will provide information and how that message is to be delivered.

Plan out your educational needs for physicians and staff. Assess your staff’s current skills and schedule workshops, seminars and online testing to make sure that everyone is ready to go.

Prepare your organizations for delay in reimbursement and denials. Develop your strategy and have financial plans in place for the months after ICD-10 goes live so you can work through the transition without it harming your bottom-line.

If your organization is already “training” for this coming change, your practice will be ready to serve patients and clients before the deadline is here. Start working now to take the steps to thrive: integrate technology and position yourself to help more people and be more profitable. ■

Natalie Bertsch is co-owner of Dt-trak

Consulting inc., which has been providing

nationwide professional medical claims

management, revenue enhancement,

training, and onsite consulting services

since 2002.

Midwest Medical Edition 18

NOTE: In the June 2014 issue of MED, there was an error in the title of Dr. Curtis Peery’s article on robotic gastric bypass surgery at Sanford. We mistakenly referred to the surgery as a ‘Single-Site’ procedure. Although some other types of robotic procedures, including, recently, hysterectomies, are now being performed through a single incision, the gastric bypass procedure remains a multiport robotic surgery. To clear up any confusion on this point, we asked Dr. Peery to explain why.

meD: First, what is the difference between single site

and multi-port robotic surgery?

cp: The da Vinci robotic surgical platform has 2-3 working arms that accommodate different surgical instruments. In addition there is a Camera arm. Therefore surgery is performed through at least 3 small (less than one inch) incisions. We refer to this as multiport robotic surgery. Over the years, the platform has been updated in different ways, including a single site platform in the Si model. Surgery with this platform is typically performed through an incision at the umbilicus.

meD: Why is the gastric bypass not currently performed

in a single site fashion?

cp: I personally feel the true advantage of the robotic platform is its increased precision. As the single site system doesn’t currently have instruments with a wrist-like action, precision is decreased compared to multiport robotic surgery. Until these issues are addressed with future robotic platforms I feel the single site surgical platform is not appropriate for the gastric bypass or similar complex surgeries. In addition, the current robotic single site platform has to be performed through an incision that is larger than one inch and this has been shown to increase hernia rates.

meD: Are there any other concerns about robotic surgery

as opposed to the laparoscopic or open gastric bypass?

cp: Robotic surgery costs are typically higher than open or lapa-roscopic surgery cost. Which is why it is crucial to show robotic surgery results in better patient outcomes and decrease complications resulting in less cost in the overall care of the patient. A recent study in JAMA suggested that bariatric surgery doesn’t decrease the spending in health care dollars secondary to complications after surgery. If the rate of surgical complications decreased then a savings would have been shown. This is the reason I switched to the robotic gastric bypass, the current studies show decreased complications. Now we have to prove we can also decrease overall health care dollars used in this patient population. ■

Robotic Gastric Bypass at Sanford MULTIPLE PORTS MEANS GREATER PRECISION, BETTER OUTCOMES

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19July / August 2014 MidwestMedicalEdition.com

If you are a healthcare provider,

Sharon Hollander knows what

your nightmares are made of.

The author and consultant has

put together a book of tales that

many will find scarier than the

latest Stephen king novel.

IN HER NEW BOOK, Medical Billing Horror Stories, reimbursement audi-tor Sharon Hollander showcases real case studies ripped from the head-

lines where doctors got into trouble with Medicare, HIPPA, The Office of Inspector General or worse . . . the FBI.

“It occurred to me that there is not a source of cases on medical billing,” says Hollander. “With the changes in healthcare, the increase in Medicare audits and the confusion about what to do, the idea for the book started to spring to life. With the inci-dence of fraud and abuse on the rise it was the perfect time to write this book.”

Hollander’s consulting portfolio has

included large medical groups and hospitals throughout the country. She has travelled to all 50 states in her capacity as a reimburse-ment auditor in hospitals contracted with her employer. Although written to appeal to doctors, Medical Billing Horror Stories has a mass appeal, because everyone is interested in how doctors behave, their chal-lenges and everyone has their own “horror story” to tell.

“The case studies are true stories of medi-cal professionals,” Hollander says. “Some are about providers who were trying to navigate the complex maze of the medical billing process. This guide will help medical professionals recognize the red flags and triggers so you can avoid a Medicare audit.”

Hollander says readers will discover common problems that plague medical practices and learn what professionals have done wrong in Medical Billing Horror Stories. Medical Billing Horror Stories is available online through Amazon and Barnes & Noble or can be purchased at Hollander’s website at sharonhollander.com. ■

Medical Billing Horror Stories

in reviewWhat you’re reading, Watching, Hearing

August 20-22, 2014 Cedar Shore Resort – Oacoma, SD

South Dakota Medical Group Management Association

Fall Conference Nora BurnsHuman Resource Management & Training Professional

Brenda Clark Hamilton Founder of Fresh Coffee Professional Growth Programs

Matt Michels (invited) South Dakota Lieutenant Governor

For the full schedule or to register, visit our website at sdmgma.org Like us on Facebook at www.facebook.com/sdmgma Follow us on Twitter @SDMGMA

Featuring:

medical billing

specialist sharon

Hollander is the

author of Medical

Billing Horror Stories

Author Sharon Hollander

Midwest Medical Edition 20

ORANGE CITY AREA HEALTH SYSTEM in Orange City, Iowa and Avera Holy Family Hospital in Estherville were recently named among the 20 highest-ranked critical access hospitals (CAHs) in the United States by the National Rural Health Association, as determined by iVantage Health Analytics.

The determining factors for the Top 20 CAHs were based on eight indices of strength using the iVantage Hospital Strength INDEX, which focuses on value-based indicators identified by the Centers for Medicare and Medicaid Services, as well as market/competition and financial indicators. It is the only comprehensive rating of U.S. acute care hospitals that includes the country’s 1,300 CAHs.

In addition to the Top 20 Critical Access Hospital recognition, 60 “best practice” designations were given to facilities that have achieved success in one of three key areas of performance: quality, patient satisfaction, and financial stability. Orange City Area Health System was named among the Top 20 in the Patient Satisfaction category.

A CAH is a hospital certified to receive cost-based reimbursement from Medicare. This program is intended to reduce hospital closures in rural areas, promotes a process for improving rural health care, and focuses on community needs. CAHs can have a maxi-mum of 25 acute care inpatient beds. CAHs provide 24-hour emergency services and are located in a rural area.

Some other area hospitals to make it onto the iVantage HEALTHSTRONG Top Critical Access Hospitals list include Custer Regional Hospital, Madison Community Hospital and Huron Regional Medical Center in South Dakota. ■

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21July / August 2014 MidwestMedicalEdition.com

AVERA FLANDREAu HOSPITAL AND

Avera Medical Group Flandreau recently celebrated the grand opening of their new facility, the culmination of a two-year, $7.6 million new construction and renovation project.

Hospital officials say the new facility was designed to maximize patient privacy, enhance space for outpatient care, provide space for new services and technology, and allow for more efficient operations.

New construction on the northwest side of the facility includes a new clinic with 12 exam rooms, two procedure rooms, an out-reach physician clinic, private registration and waiting areas, and a new laboratory. Also newly constructed were administrative and business offices, diagnostic imaging, outpatient services (including CT and bone-density scanners) and a new emergency department with two state-of-the-art trauma rooms and a more accessible entrance.

Renovation of the existing hospital created larger family-friendly rooms, a more “home-like” environment, a new nurse call system, a welcoming nurses station, high-efficiency heating and cooling, new water and electrical services and improved IT systems. The building’s layout is designed to make it easier for patients and visitors to find their way through the building.

A community capital campaign for the project raised more than $445,000 dollars. In addition, this project was made possible through the City of Flandreau’s gifting of the hospital buildings and property to Avera McKennan Hospital & University Health Center in 2011 as well as Avera Flandreau and Avera McKennan savings and financing.

Avera has been a healthcare partner in Flandreau for two decades. ■

NeW RADIATIoN TeCHNoLoGY targets tumorsAVERA CANCER INSTITuTE IS NOW ARMED WITH A POWERFuL NEW TOOL in the

fight against cancer: the elekta Versa HD linear accelerator. it is specifically engineered

for stereotactic radiosurgery and stereotactic body radiation therapy (srs/sbrt), deliv-

ering high dose radiation to very small targets with great precision.

“this technology, used with curative intent, involves hundreds of beams from many

angles that converge on a small tumor and deliver a very high dose of radiation,” says

James simon, mD, radiation oncologist with avera medical group radiation oncology

sioux Falls. “the increased dose is more likely to destroy the tumor. in addition, the

accuracy and precision provide greater sparing of nearby healthy tissue, with fewer side

effects.”

sbrt with the Versa HD is increasingly being used to treat early stage lung tumors for

patients unable to undergo surgery, a group of patients who previously could not be

treated with a curative intent. sbrt can also be used to treat tumors in other areas of the

body such as the spine, liver, pancreas, kidney and prostate.

stereotactic radiosurgery (srs) is used to treat brain tumors – both primary brain

tumors and metastatic tumors that have spread to the brain.

sbrt and srs cause few side effects, are non-invasive, painless, and require no

anesthesia. the Versa HD can decrease the number of daily sbrt or srs treatments

needed to five or less and dramatically reduces treatment delivery time from hours to

minutes. Patients can immediately return to normal activities.

the new unit in sioux Falls is one of the first machines of its kind to be installed in the

nation and was supported through a $4.2 million grant from the leona m. and Harry b.

Helmsley Charitable trust. ■

FlandreauCelebrates New Hospital and Clinic

Midwest Medical Edition 22

SOME OF uS CAN’T seem to pour coffee and read the morn-ing paper at the same time. But emergency department

(ED) medical professionals must juggle a dizzying array of simultaneous tasks and distractions, all while caring for a multi-tude of patients they’ve usually never met. Amid the flurry of activity in the typical ED, critical patient information can easily be lost, clouding the big picture of a patient’s condition.

According to a 2011 Annual Benchmark-ing Report from CRICO Strategies,1 the Emergency Medicine Leadership Council

defined a lack of sharing patient information between MDs and RNs as the major cause of ED malpractice cases. In fact, one out of three ED malpractice cases alleges com-munication failures by the physician, nurse or both.

In the ED, botched communication is often the culprit in premature or delayed diagnosis. Even small amounts of missing or inaccurate information can lead a physi-cian astray when diagnosing a patient. Research shows 47 percent of ED cases allege a failure to diagnose, the majority of which lead to permanent injury or death.1

Take this case of a tragic communication

error between a physician and nurse: A 47-year-old male admitted to the ED com-plained of shortness of breath and a tight chest. The attending physician failed to notice a nurse’s note that detailed the patient’s recent exposure to new cleaning products at work. After discharge, the patient was found dead in his home with a massive bilateral pulmonary embolism with a diagnosis of asthma exacerbation.1

Typically, in ED care, there is no preex-isting physician/patient relationship. Physicians often cannot quickly access a patient’s medical records and they don’t know if he or she will communicate a complete and accurate medical history. It is not surprising, then, that allegations of inadequate assessment are claimed in nearly 85 percent of ED diagnosis-related malprac-tice cases.1

After patient testing begins, ED physi-cians often remain in a precarious position. CRICO’s report states, “In 39 percent of the ED diagnosis-related cases, a judgment error related to ordering a test or an image was noted. A mismanaged consult was a factor in 26 percent of cases.” 1

Failure or delay in ordering the appropriate diagnostic test is responsible for up to 60 percent of cases, depending on the hospital’s patient intake.1 Practitioners sometimes assume a diagnosis based on incomplete information, oftentimes due to frustration with test and imaging access, turnaround times, or results accuracy. This can lead to patient discharge with improper diagnosis and subsequent litigation against the physician.

Finally, discharging patients from the ED is another major area of concern. Although discharging a patient is an

At MMIC, we believe patients get the best care when their doctors feel confi dent and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, physician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.

To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.

Looking for a better wayto manage risk?

Get on board.

Human errorHoW to make FeWer mistakes iN a bUsy eD

By Mike Miller

23July / August 2014 MidwestMedicalEdition.com

acknowledgement that any and all life-threatening conditions have been assessed or ruled out, 41 percent of diagnosis-related ED cases involve inadequate assessment leading to premature discharge.1 Physicians must specify discharge or follow-up instructions, the patient’s understanding of them, and a slew of other concerns — all while tending to new patients.

WHAT IS THe SoLuTIoN?All care team members must be privy to the same infor-mation at all times. Protecting patients’ well-being is the smartest strategy for protecting a busy ED. Education and Communication are two key factors to managing the risk.

eDuCATe Exercise basic ED skills in order to remain proficient at them. CRICO has established the Emergency Medicine Team Training Program, based on actual malpractice case scenarios. Read about it at www.rmfstrategies.com.

CoMMuNICATe Recognize barriers to gathering and transmitting complete information, then implement communication protocols at critical points during each care procedure.

INTeGRATe Stick to a single communication method that works for your team, such as SBAR (Situation, Background, Assessment, Recommendation) or I-PASS. (I-PASS is a medical education curriculum available at www. ipasshandoffstudy.com.)

uPDATeOptimize EHRs for maximum accessibility both in how information is displayed, as well as in the optimal uptime for system availability. Assess security practices in accor-dance with HIPAA regulations to keep information systems working smoothly. ■

Mike Miller is a Communications specialist with mmiC. this

article originally appeared in the Winter 2013 issue of brink, a

quarterly risk solutions magazine published by mmiC. For more

information, visit mmiCgroup.com.

References 1. Hoffman g, yu W. Crico strategies 2011 annual bench-marking report: malpractice risks in emergency medicine. http://bit.ly/1bvbXlP. accessed september 20, 2013.

  MeD Quotes

“Have no fear of perfection - you’ll never reach it.” — Salvador Dali

Midwest Medical Edition 24

ExCEPTIONAL NURSES & NURSE ADVOCATES HONORED AT RAPID CITY REGIONAL HOSPITAL raPiD City regioNal HosPital

recently honored eight outstanding

employees with Nursing star awards

recognizing excellence in nursing. the

star awards, developed by rCrH’s

Nurse shared governance Council,

encourage employees to nominate

their fellow nurses for the awards. ■

DAISY AWARD Ortho/Neuro Acute Care unit nurse Jon Sorensen, RN, with Sanford uSD Medical Center in Sioux Falls was recently recognized with the hospital’s monthly DAISY Award for outstanding nursing. Sorenson was nominated by two different patients. The following are excerpts from those nominations:

“He was so caring, attentive, patient and good natured. Myself and our entire family just wanted to say Thank you to Jon. He was just the kind of nurse I would wish to care for myself or any other member of my family.”

“My husband was in the unit with Nurse Jon a few days before his death . . . Jon showed human compassion and helped him sit for the last time even though this was a very challenging task and required someone to be in the room with him the entire time. He was very compassionate and caring and spent time with my daughter and I listening to our concerns adding a real personal connection to our difficult experience.” ■

Surgical Nurse Earns New Credentials

Barbara hanks, cnp, Whc-Bc, of regional medical

Clinic–Western Hills Professional building in rapid City,

recently received national certification as a Women’s Health

Care Nurse Practitioner–board Certified (WHC-bC). Hanks

joins more than 120,000 health care professionals to earn

the prestigious National Certification Corporation (NCC) credential since 1975.

to become a WHC-bC, a candidate must pass a written examination covering

physical assessment, primary care, gynecology, obstetrics, pharmacology and pro-

fessional issues. NCC certification must be maintained on an ongoing basis every

three years. | Hanks is part of the general surgery team at rmC-WHPb. ■

the Nurses’ stationNursing News from around the region A nurse’s guide

to end-of-life careSecond edition of popular STTI book includes updates and additional supportive phrases for nurses

How do you support and provide the best care for dying patients and their families? In the new book To Comfort Always: A Nurse’s Guide to End-of-Life Care, Second Edition, Linda Norlander MS, BSN, RN, helps nurses navigate end-of-life care and com-munication by serving as a skilled clinician, advocate, and guide.

“All nurses experience death either professionally or personally, so all nurses should have a basic knowledge of how to care for dying patients,” Norlander says.

Published by the Honor Society of Nursing, Sigma Theta Tau International (STTI), this newly revised version provides readers with additional tools and resources along with expanded content on chronic illness, dementia, care planning, clinical manage-ment, ethics, suffering, and grief to empower nurses to serve as advocates for both the patient and family members.

“Our population is aging and experiencing more long-term chronic illnesses, including dementia,” Norlander said. “These will all be eventually fatal, and we need to be able to care for these patients in a compassionate and holistic way.” ■

Pictured left to right: Guiding Star–Mentor Award winner amber Hill, rN, bsN; Gold Star–Service Award winner glenda Norman, rN; Super Star–Expert Award recipient shawn Hodges, rN; and Supportive Star Award winner ann Wands-smith, PCt.

Front row: Shining Star–Community Award winner mavis Jeffery, rN; Blazing Star–Advanced Practice Nurse Award winner katie kraus, CrNa; Luminary Nurse Advocate Award byrona burnette, Social Worker; and Rising Star–Novice Award winner rahne kunzman, rN, bsN.

25July / August 2014 MidwestMedicalEdition.com

Midwest Medical Edition 26

A recent Los Angeles Times article details a trend some say is the future of wine labeling: labels you can draw on. Terravant Wine Company in Buelton, California has just introduced a new label they call “Scratchpad”. All three of the Scratchpad wines (a Chardonnay, a Sauvignon Blanc, and a Pinot Noir) sport a featureless cream colored label designed for doodling.

The wines, which will retail for less than $20 a bottle, are each sold with a charcoal pencil to spark creativity. Wine buyers are invited to share their original Scratchpad designs via social media or the company’s Facebook page. The winery is calling it the industry’s

first interactive label.

interactive Wine Labels

S o m m e l i e r ’ S c or n e r

WineWine marketplacesponsored by cask & cork

one-on-one with caSk & cork cFo,

Brett KooimaQ: suppose someone tastes a wine on vacation this

summer that they just love but can’t find back home.

can they still get ahold of it?

a: Absolutely! If they contact our office and give us the wine name, we can usually track down the vineyard, explain who we are and what we do, and, if it is not a wine that is distributed in our territory, invite them to let us distribute it for them. Then we ask the end user where they typically like to buy their wine locally and we contact the store to let them know they’ll be in to pick it up. We try to make it as easy as possible for people.

Q: What are the advantages for wine users?

a: Besides being pretty easy, the process will probably also save them money. There is no way an individual can ship a case of wine for what it costs us because we are buying it wholesale. So we can pass that savings on.

Q: do you have any success stories that started out this

way but have “caught on” in our area?

a: We brought in a wine a few years ago from Baldacci Family Vineyards in Napa for a dentist in Rapid City. He and his wife had visited the winery and loved it. At that point, the vineyard was not doing any distribution so we convinced them to give us a shot at it. A representative from Baldacci flew out and we did a very successful wine dinner in Rapid City. We are now the only state outside of California that distributes these excellent Baldacci wines.

Wine to Watch

Wine Facts the world’s oldest bottle of wine dates back to a.d. 325 and was found near the town of speyer, Germany, inside one of two roman sarcophaguses.

Baldacci Family Vineyards 2009 iV sons Fraternity

This 91 point red blend includes Cabernet Sauvignon, Cabernet Franc, Merlot and Syrah. Aromas of vine-ripened raspberries, cherries, coffee, tea leaves, white chocolate and caramel entice you and the lingering flavors of plums, wild berry and a dash of mocha are wrapped in delicious vanilla flavors from the vineyard’s 10% new American Oak barrels.

Robert Parker’s Wine Advocate says:“Fresh cut flowers, red berries and mint all come together in this medium-bodied, nicely delineated wine.”

27July / August 2014 MidwestMedicalEdition.com 27June 2014

Midwest Medical Edition 28

2014 MARKS THE 30TH ANNIVERSARY of Make-A-Wish South Dakota – the orga-nization that grants wishes to children with life-threatening medical conditions across the state. Since 1984, more than 1,085 wishes have been granted to kids between the ages of 2 ½ and 18.

The first wish was granted to Krista of Viborg in January 1984. Her wish was to meet folk singer John Denver in Colorado. Five more wishes were granted that year at a cost of around $1,000 a wish. Today, the chapter grants nearly 70 wishes a year at an average cost of nearly $7,000. While wishes to travel have remained the most popular since day one, upcoming wishes include a puppy, a dirt track, an above

ground swimming pool and a play house.Make-A-Wish South Dakota is celebrat-

ing this 30-year milestone throughout 2014 by hosting birthday party events in Rapid City, Watertown, Aberdeen and Sioux Falls. Wish kids and their families, volun-teers and donors will celebrate together.

“We have impacted the lives of so many kids and families over the last three decades,” Paul Krueger, president and CEO said. “As we celebrate 30 years of granting wishes, we give thanks for each child who has received a wish and are grateful to the generous supporters across South Dakota who have helped us make their wishes come true.”

This year’s Make-A-Wish Golf Tournament on July 21 in Sioux Falls will

also celebrate the anniversary by featuring an event at The District in Sioux Falls including a concert by CMA, ACM and CMT-nominated country duo, “Love and Theft”. Tickets are available for the concert and dinner for $75 per person or $30 for the concert only. Golf teams are $2,400, which includes four golfers and eight tickets to the evening events. For more information about tickets, please call 605.335.8000 or email info@southdakota.wish.org. ■

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Sign up now at MidwestMedicalEdition.comGet MED up to two weeks sooner than print.

Make-A-Wish South Dakota Celebrates 30 Years of Granting Wishes

  MeD Quotes

“ Faith consists in believing what reason cannot.” — Voltaire

29July / August 2014 MidwestMedicalEdition.com

meD reaches more than 5,000 doctors and other healthcare professionals across

our region 8 times a year. if you know of an upcoming class, seminar, webinar,

or other educational event in the region in which these clinicians may want to

participate, help us share it in meD. send your submissions for the learning

opportunities calendar to the editor at alex@midwestmedicaledition.com.

learning opportunities

Log on to MED’s calendar to see the newest upcoming events or add your own.

July – october

July 23 avera infection prevention Day of Sharing8:00 am – 4:00 pm information: events.coordinator@avera.org, 605-322-4645

registration: www.Avera.org/conferences

July 28 – 29 Sanford pediatric oncology Symposium7:30 am – 4:30 pm Location: Sanford Research Center, Sioux Falls

information: pam.koepsell@sanfordhealth.org

registration: Sanfordhealth.org or 605-312-3938

august 12 - 14 avera victim Witness/human trafficking conference8:00 am – 5:00 pm Location: Washington Pavilion

information: events.coordinator@avera.org, 605-322-4645

registration: www.Avera.org/conferences

august 20 – 22 SDmgma Fall conference8:00 am – 5:00 pm Location: Cedar Shore Resort, Chamberlain

information & registration: 605-734-6376

September 5 Sanford Diabetes Symposium 8:30 am – 4:30 pm Location: Sanford Center, Sioux Falls

information & registration: Sanfordhealth.org

September 12 Sanford Surgical Symposium 8:00 am – 4:30 pm Location: Sanford Center, Sioux Falls

information: 605-328-3851, Jessica.johnson2@sanfordhealth.org

September 25 avera cancer institute 15th annual oncology Symposium5:00 pm – 9:00 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan

information: 605-322-8987, averaeducationevents@avera.org

registration: www.Avera.org/conferences

September 24 – 26 SDaho 88th annual convention8:00 am – 5:00 pm Location: Rapid City Civic Center

information & registration: SDAHO.org, 605-361-2281

September 25 - 26 7th annual Upper midwest regional pediatric conference8:00 am – 5:00 pm Location: Marina Inn & Conference Center, South Sioux City, NE

information & registration: www.uMRPConference.com

october 3 avera Women’s conference for the primary care provider8:00 am – 4:00 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan

information: averaeducationevents@avera.org, 605-322-8987

registration: www.Avera.org/conferences

The region’s biggest team for your littlest patients.

saNForD CHiLDreNS

500-54300-0469 6/14

Refer your patients to the place

that offers care like no other.

(605) 312-1050

At the Sanford Castle of Care, our team of pediatric physicians offers a variety of care in these specialties:

Our experts partner with you keeping you informed about your patient’s health assessments and care plans. Together we can deliver the highest level of care to your youngest and most vulnerable patients.

500-54300-0469 6/14

•Cardiology•Critical Care•Developmental•Endocrinology•Gastroenterology•Genetics

•Hematology/Oncology•Hospitalist •Infectious Disease•Neonatology•Nephrology•Neurology

•Palliative Care•Pulmonology•Rehabilitative Care•Surgery•Urology

The region’s biggest team for your littlest patients.

saNForD CHiLDreNS

500-54300-0469 6/14

Refer your patients to the place

that offers care like no other.

(605) 312-1050

At the Sanford Castle of Care, our team of pediatric physicians offers a variety of care in these specialties:

Our experts partner with you keeping you informed about your patient’s health assessments and care plans. Together we can deliver the highest level of care to your youngest and most vulnerable patients.

500-54300-0469 6/14

•Cardiology•Critical Care•Developmental•Endocrinology•Gastroenterology•Genetics

•Hematology/Oncology•Hospitalist •Infectious Disease•Neonatology•Nephrology•Neurology

•Palliative Care•Pulmonology•Rehabilitative Care•Surgery•Urology

The region’s biggest team for your littlest patients.

saNForD CHiLDreNS

500-54300-0469 6/14

Refer your patients to the place

that offers care like no other.

(605) 312-1050

At the Sanford Castle of Care, our team of pediatric physicians offers a variety of care in these specialties:

Our experts partner with you keeping you informed about your patient’s health assessments and care plans. Together we can deliver the highest level of care to your youngest and most vulnerable patients.

500-54300-0469 6/14

•Cardiology•Critical Care•Developmental•Endocrinology•Gastroenterology•Genetics

•Hematology/Oncology•Hospitalist •Infectious Disease•Neonatology•Nephrology•Neurology

•Palliative Care•Pulmonology•Rehabilitative Care•Surgery•Urology