med-midwest medical edition-june 2014

JUN

E2

014

Vol. 5 No. 4

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

Hospital ReadmissioN Rates

– What’s Working? BeWaRe of

EHR TimesaversThe Case for

Summer Rosés

CCHs & sd achieve Capitalize on synergy in the New LifeScape

BetterTogether

500-55000-1137 5/14

Short Stay. Smal l Scar.

BIGDIFFERENCE.SINGLE-SITE HYSTERECTOMY ONLY AT SANFORD WOMEN’SThe idea of a hysterectomy can be overwhelming for many patients. Put their minds at ease by referring them to the team of experts at Sanford Obstetrics and Gynecology. • Minimally invasive technique

requires only one small incision.• Results in less scarring, less pain

and less time in the hospital.

THE DIFFERENCE TECHNOLOGY AND EXPERTISE CAN MAKE• Largest team of robotically

trained surgeons in the region.• Nearly 3,300 robotic surgeries

performed. • Recovery time measured

in days instead of weeks.

See the difference in care at Sanford Women’s.

Call (605) 328-7700 to refer a patient, or learn more at womens.sanfordhealth.org.

womens.sanfordhealth.org

VolUmE 5, No. 4 ■ JUNE 2014

ContentsREgUlaR FEaTUREs 2 | from Us to You

5 | med on the Web Exclusive content on midwestmedicalEdition.com

6 | News & Notes New doctors, certifications, clinics, and more

22 | the Nurses’ station Nursing News from around the Region

25 | in Review Bouncebacks! Medical & Legal By michael Weinstock and Kevin Klauer

26 | Wine marketplace Cask & Cork’s CFo makes the Case for summer Rosés

IN THIs IssUE 4 | Patient Safety Improvement in South Dakota

■ By dave Hewett

14 | Single-Site Robotic Gastric Bypass | This new minimally invasive option now available at sanford can lower surgical risks, making the procedure feasible for more patients. surgeon Curtis Peery, mD, explains how it works. ■ By Curtis peery, md

15 | Doctors Partner with Sioux Falls Fitness Club Plan includes new clinic in the greatlIFE Woodlake athletic Club.

17 | Make the Connection: Helpline and avera launch online guide to mental health resources.

18 | Sioux Center Opens the Doors on a New Community Hospital | mED talks to CEo Kathleen lee about the new hospital and the remarkable financial support garnered for the project by this small Iowa community.

20 | Media 101 sharing your health news with the local media . . . What’s it in for you?

23 | Helping Patients Avoid Sarcopenia ■ By Holly swee

On the

COver

page 11

Two longstanding sioux Falls organiza-tions that serve adults and children with

disabilities recently came together to capitalize on what they call the

“synergy” of their two organizations. While the services once offered to

children through Children’s Care

Hospital and school and adults

through south Dakota achieve

will still be of-fered, lifescape

says the union will allow the

new organiza-tion to serve

this population in some brand

new ways.

MidwesT Medical ediTion

Cover photo: only the name has changed. services such a therapy for children with

developmental disabilities, offered for decades by Children’s Care Hospital and school,

will now be offered under the lifescape name. There are no changes in staff planned.

Photo Courtesy LifeScape.

Better Together

JUN

E

2014

Vol. 5 No. 4

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalS

Hospital ReadmissioN Rates

– What’s Working? BeWaRe of

EHR TimesaversThe Case for

Summer Rosés

CCHS & SD Achieve

Capitalize

on Synergy

in the New

LifeScape

BetterTogether

26 Wine Marketplace

9 Streamline or Slipup? Timesaving Features of your EHR system can be risky. Here’s how to use them wisely. ■ By shelly davis

21 Declining Hospital Readmissions in South Dakota ■ By Ryan sailor

By alex strauss

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 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

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

april/may issue march 5

June issue may 5

July/ august issue

June 5

sep/oct issue august 5

November issue october 5

december issue November 5

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

of the publisher. We welcome article proposals, story sug-

gestions and unsolicited articles and will consider all

submissions for publication. Please send your thoughts,

ideas and submissions to [email protected].

magazine feedback and advertising and marketing inquiries,

subscription requests and address changes can be sent to

[email protected].

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 Corbo Design PHoTogRaPHER Kristi Shanks WEB DEsIgN Locable DIgITal mEDIa DIRECToR Jillian Lemons CoPY EDIToR Hannah Steck

CoNTRIBUTINg WRITERs Sally Davis Laurie Drill-Mellum Dave Hewett Curtis Peery Ryan Sailor Holly Swee

sTaFF WRITERs Liz Boyd Caroline Chenault John Knies

AS WE MOVE INTO SuMMER, healthcare is

heating up in our region. In this issue, two long-

time healthcare providers discover that they are

more than the sum of their parts, sioux Center

opens the doors on a long-awaited modern facility, and

sanford announces its planned new breast center. as usual,

our popular News & Notes column is also bursting at the

seams with movers, shakers, and new projects. (If you notice

that something is missing, please send it our way. The MED

website is continually updated with the latest news)

MED is making some improvements of its own. our pub-

lication is now available in a digital format for easy reading

on your apple or android device thanks to the IssUU platform.

Ready to move into the digital age with us? sign up on our

website (www.midwestmedicalEdition.com) to receive noti-

fication via email when the newest MED issue is available

digitally. You can be reading the latest news, features, and

practice management advice up to two weeks earlier with

the digital issue. (If you were reading the digital issue now,

you could click here to sign up!)

our thanks to the physicians and other healthcare experts

who contributed to this issue of MED. as a Northern Plains

healthcare professional, you are invited to send us your own

news, opinions, advice, book reviews, artistic pursuits, or

anything else you want to share with your colleagues through

MED. Reach us at [email protected].

Warmly,

—Alex & Steff

alex strauss

steffanie liston-Holtrop

MED VP steffanie liston-Holtrop

hit the links in the south Dakota

lions Eye and Tissue Bank’s 17th

annual golf Event at minnehaha

Country Club on may 19th.

Pictured with her are (left to

right) stefanie Engebretson,

Butch Hansen, and Randy

Derheim. The event included

golfers from Vance Thompson

Vision, ophthalmology ltd and

sioux Falls Family Vision. In

addition enjoying some beautiful

weather, the golfers helped raise

funds to support the sDlETB.

MED is a sponsor of this event.

midwestmedicaledition.com

http://www.midwestmedicaledition.com/

3June 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 Corbo Design PHoTogRaPHER Kristi Shanks WEB DEsIgN Locable DIgITal mEDIa DIRECToR Jillian Lemons CoPY EDIToR Hannah Steck

CoNTRIBUTINg WRITERs Sally Davis Laurie Drill-Mellum Dave Hewett Curtis Peery Ryan Sailor Holly Swee

sTaFF WRITERs Liz Boyd Caroline Chenault John Knies

One number accesses our pediatric surgical specialists, any problem, anytime.

1.855.850.KIDS (5437)Physicians’ PriOrity Line

your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

ChildrensOmaha.org

Midwest Medical Edition, June, 2014.indd 1 5/1/14 10:09 AM

childrensomaha.org

Midwest Medical Edition 4

By Dave Hewett

Patient Safety Improvement in South Dakota

H OSPITAL READMISSIONS

are down 8% nationally over two-years; early elective deliveries (pre-39

weeks) reduced 65% during that same period and pressure ulcers are down 25%.

Now these are not numbers that the gen-eral public gets that excited about nor does the mainstream media spend much time covering them. But for the physicians and other healthcare professionals working in and around our hospitals, this is the kind of material that can generate two-hour meet-ings and days of comment and analysis.

These numbers are very important. They demonstrate just how much can be achieved when physicians, healthcare professionals and resources are focused on specific targets to improve patient care.

For over two years, 34 mostly rural South Dakota hospitals have been active participants in this project — the Hospital Engagement Network (HEN). It is a grant

program administered by CMS and dedicated to patient safety improvement and it appears to be achieving its goals. Comparable results for South Dakota show readmissions and early elective delivery (EED) rates for the two-year period (2012 and 2013) down by 40% each. South Dakota’s facility acquired pressure ulcer rate was near zero at the beginning of the project and has remained so throughout the course of 2012 and 2013. And again, these results are for rural hospitals in this state.

Certainly, the numbers are important because they represent real savings in healthcare delivery both in terms of lives and dollars. The Centers for Medicare and Medicaid Services (CMS) estimates that these improvements prevented nearly 15,000 deaths in hospitals, saved $4.1 billion in costs, and prevented 560,000 patient harms in 2011 and 2012. Not bad for two-years of work. For South Dakota’s participating hospitals, each EED prevented

saves an average of $15,172. Each readmis-sion prevented saves an average of $9,600 and each hospital acquired pressure ulcer prevented saves an average of $43,180.

South Dakota’s rural hospitals have worked hard to make this happen. Redeploy-ing staff just to complete the reports has been a challenge. In addition, making sure the data is presented in a format that makes it meaningful to physicians and hospital administrators alike is essential.

The HEN is scheduled to conclude its grant funding this year. The challenge going forward will be for hospitals to find the resources necessary to keep the data flowing and interest level high even if the public and mainstream media don’t seem that interested.

dave Hewett is the President and CEo of the

south Dakota association of Healthcare

organizations. ■

www.sdletb.orgREFERRAL HOTLINE

1-800-245-7846 EXT 4

Todd is the newest member of the SDLETB team. He brings with him 23 years of law enforcement experience which gives him a unique outlook on the donation process. As a professional development coordinator for SDLETB, he will be working directly with funeral homes, coroners, and law enforcement/EMS. He will help grow our partnership with our healthcare partners and help them better understand their highly valued role in the donation process. He understands that they play a key role in helping to honorhonor the last wishes of our donors. Todd is grateful for the work that our partners do with SDLETB and the donor families.

Todd DimondProfessional Development Coordinator

www.sdletb.org

5June 2014 midwestmedicalEdition.com

onthe

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!

ONLy ON OuR WeBsite!

midwestmedicaledition.com

find links to these articles and more on the med homepage.

Best practices: How do you handle a difficult family member? How often have you had to deal with the intervention of a difficult family member? How do you handle it? Go online to share your thoughts with colleagues who could benefit. Your ideas could appear in a future issue of MED.

the scales Could tipExperts with the silverstone group have a warning for healthcare professionals on the future of the medical professional liability insurance market. Buying mPl insurance may soon get a lot more complicated.

Blog for med! attract visitors to your own site or start a following as a guest blogger for med. If you are a physician with something to say, contact us at [email protected] to find out how.

◆ 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.

◆ diGital issUe – Read the newest MED on your tablet or smartphone with one click!

◆ BaCk issUes of med – Need to find an article you have seen in MED? Every issue is now available in an easy-to-access digital format. Click the ‘archives’ button on the MED home page.

Go Digital!





http://www.midwestmedicaledition.com/2014/05/28/41875/the-scales-could-tip

http://www.midwestmedicaledition.com/2014/05/27/41874/best-practices-how-do-you-handle-a-difficult-family-member

http://www.midwestmedicaledition.com/calendar

http://www.midwestmedicaledition.com/businesses

http://issuu.com/midwestmedicaledition

www.midwestmedicaledition.com

News & Notessouth Dakota southwest minnesota Northwest Iowa Northeast Nebraska

Happenings around the region

midwest medical Edition 6

Happenings around the region

AverA

By January 1, 2015, the physicians and staff of Avera Medical Group

McHale Institute will become part of Avera Medical

Group Oncology & Hematology at the Avera Cancer Institute in Sioux Falls. Dr. McHale’s practice became part of Avera Medical Group in June 2012. As part of this transition into the Prairie Center, Dr. McHale will expand his focus on outreach services to rural communities. This change will also allow Avera to dedicate more space to the Avera Institute for Human Genetics which currently shares the McHale Institute building.

Rita Blasius, CFO,

Avera St. Benedict Health Center in Parkston was installed as the new President for The South Dakota

health Financial Management Association (SDHMA) for the year June 2014 to May 2015.

Avera Queen of Peace Hospital held a Welcome, Blessing, and Chamber of Commerce Ribbon Cutting on April 22 for its new Avera Brady Vasek “Can Do” Villa.

Tours were offered of the senior living villa, along with the new rehab center, Shirley’s Cinema and Ellen’s “Can Do” Pub.

Jen Poppen has been named the CEO at Avera Creighton Hospital effective

July 1, 2014. Poppen is a native

of Madison, SD and a graduate of The University of South Dakota. She received her Masters of Health Administration from the University of Iowa, Iowa City. Poppen has been serving as the interim CEO at Avera Creighton since early February.

Avera Weskota Memorial Hospital (AWMH) has been recognized as a high-performing hospital by the Health Research & Educational

Trust (HRET), an affiliate of the American Hospital Association (AHA), for attaining a 20 percent reduction in acute care readmissions. AWMH has achieved this goal in the 30 Day All Cause Readmissions category, which includes heart failure, heart attack and pneumonia. AWMH is part of the Hospital Engagement Network (HEN) through the Centers for Medicare and Medicaid Services.

The American College of Health Care Administrators (ACHCA) honored Veronnica Smith, Administrator, Avera Brady

Health and Rehab in Mitchell, South Dakota with a 2014 Eli Pick Facility Leadership Award.

The award was celebrated during the awards luncheon at ACHCA’s 48th Annual Convocation and Exposition in Las Vegas, NV, on April 6, 2014. Smith began her career with Avera at Avera Queen of Peace Hospital in 1992 where she developed the home health and hospice programs and worked with parish nursing prior to moving on to senior services, becoming the Avera Brady Health and Rehab Administrator in March of 2001.

Doug Ekeren, currently the Vice President of Professional and Regional Services

at Avera Sacred Heart Hospital,

has been named interim CEO for the Avera Sacred Heart region effective June 28, 2014. Ekeren has served on the administrative team at Avera Sacred Heart Hospital for the past 21 years. He will be assuming this role when Pamela J. Rezac retires on June 27.

BlAck Hills

The Children’s Miracle Network (CMN) raised $87,284 during the One Call, One Miracle Radiothon broadcast Friday,

May 2. The event took place in Rapid City Regional Hospital’s lobby and aired on Rushmore Media Company Radio Stations. Several local businesses made significant contributions, including the RCRH Auxiliary which presented its largest one-time donation for $51,000. Other major contributors included Coca-Cola, Pool & Spa Center, Dark Canyon Coffee, Soulmate Shoes and Uniform, Headlines Academy and Midcontinent Communications.

Basanta Pathak, MD, was named the Physician of the Quarter for Customer Service Excellence for the first quarter of the year at

Rapid City Regional Hospital.

Dr. Pathak is a board-certified internal medicine physician and has been a member of the RCRH Medical Staff for three years. He was recognized for “continually providing his patients with compassionate, comprehensive and caring medicine”. Colleagues nominated Dr. Pathak for his dedication and commitment in providing compassionate care. All RCRH physicians are eligible for the quarterly award.

stay up-to-date with new medical community

news between issues. Log on!

News & Notes


June 2014 midwestmedicalEdition.com 7

Cardiologist Kelly Airey, MD, FACC, has joined the clinic staff at Regional Heart Doctors in Rapid

City. Dr. Airey completed her medical degree at the University of Toronto. She did a residency in internal medicine and a fellowship in cardiovascular diseases at the University of Nebraska Medical Center in Omaha. She also completed a fellowship in Clinical Cardiac Electrophysiology at the University of Utah in Salt Lake City.

Mark Schulte, FACHE, is the new CEO of Sturgis Regional Hospital where he oversees the hospital and Sturgis Regional

Senior Care. Schulte comes to Regional Health from Avera Creighton Hospital in Nebraska, a 47-bed skilled nursing facility, where he was CEO. Schulte has an MBA from USD and is a certified Emergency Medical Technician (EMT) and firefighter. He was a member of the Creighton Nebraska Rescue Squad and Volunteer Fire Department. Schulte replaces Van Hyde who recently retired after serving 10 years as CEO.

Maureen Henson is the new Regional Health Vice President of Human Resources.

She has previously worked as Vice

President of Human Resources at Mercy Memorial Hospital System in Monroe, Michigan and Vice President of Human Resources at the Henry Ford Health System in Warren, Michigan. Henson is certified as a Senior Professional in Human Resources and is active in many professional societies and associations.

sAnford

Sanford Health will break ground on an integrated breast health building at its Sioux Falls

campus this fall. The Edith Sanford Breast Center will combine research and clinical care and is scheduled for completion in 2017. The three-story, 48,000-square-foot facility will be located on 18th street and connected to the current Sanford Cancer Center and VanDemark Building. Portions of the Sanford Cancer Center and VanDemark Building will also be renovated.

Wellmark Blue Cross and Blue Shield has named Sanford Heart Hospital in Sioux Falls, SD as one of the first hospitals in the nation to receive a Blue Distinction Center Plus (+) designation in the area

of cardiac care. Blue Distinction Centers are hospitals shown to deliver quality specialty care based on objective, transparent measures for patient safety and health outcomes that were developed with input from the medical community. This year, the national program has added a new designation level, Blue Distinction Center Plus (+), to recognize hospitals that deliver both quality and cost-efficient specialty care.

SDSu and Sanford Health have partnered to conduct collaborative research on human nutrition, weight management and other

dietary-related areas. This research will address key objectives of the Sanford Profile, a weight management program that uses customized meal plans and health coaches. SDSU researchers will collaborate with investigators from Sanford Research on topics like metabolism, food choices and consumption, prenatal nutrition, genetics, food manufacturing and nutritional interactions with the human microbiome.


mmicgroup.com


Learn more about PSIC at www.psicinsurance.com.Or call us at 1-800-788-8540.Malpractice insurance is underwritten by Professional Solutions Insurance Company.14001 University Avenue | Clive, Iowa 50325-8258 ©2013 PSIC NFL 9459

A reputation is like trust.

It takes years to grow, but can be ruined in seconds. Make sure

your reputation is protected with medical malpractice

insurance coverage from PSIC.

From

Of

Phone

E-mail

Message We were served

suit papers on

a patient today.

MD_PostIt_Note_Trust_MEDSouthDakota_7x4.6.indd 1 8/8/13 5:36 PM

midwest medical Edition

News & Notes continued

Sanford Health is introducing an innovative new service in North Dakota called O.P.C.

mobileMED. The service will provide healthcare services directly in the oil fields for oil-producing companies (O.P.C.) and their subsidiaries.The plan includes deploying two mobile clinics that can move around to meet the needs of employers and one modular clinic – initially in Watford City. The project will mean an initial investment of $2.7 million along with $4.8 million in annual operating expenses.

Allan Bertram, most recently the head boys’ basketball coach at Chamberlain High School, is the new coordinator of the Sanford POWER

Basketball Academy, a comprehensive player development program. Bertram played basketball at Huron University for one season before finishing his college career at Sinte Gleska University in Mission, South Dakota. He holds an MA in educational administration from the University of South Dakota.

siouxlAnd

The June E. Nylen Cancer Center’s third annual “Cancer Sucks–Comedy Rocks” event held Saturday, April 12 at the Marina Center in Sioux City, Iowa raised more than $16,000 through ticket sales, sponsors, and a silent auction.

The event featured four local comedians and the headliner Pat McGann from Chicago and attracted more than 700 people. Proceeds will allow the Nylen Cancer Center to offer mammograms and colonoscopies to people unable to afford them.

otHer

Horizon Health Care Inc. (Horizon) hired Aberdeen native Katy Goulding, CNP, to serve as the organization’s

Aberdeen Community Health Center in Aberdeen, South

Dakota. A graduate of University of Nebraska Medical Center, Goulding holds a Master’s of Science degree with a specialty in Women’s Health. Among other services, Goulding will offer comprehensive obstetric and gynecologic care, contraception, infertility counseling, menopause and sexual issues, maternal and fetal well-being, high risk pregnancies, and post-partum care.

SAnforD continued

www.psicinsurance.com


DeSpite the many advan-tages of the electronic health record (EHR) for both patients and healthcare facilities, con-

cerns linger regarding the implementation of these systems. For example, while EHR has improved documentation for healthcare providers in many aspects, it has also intro-duced new and complex problems found only in an electronic environment.

Here are a few ways to think about EHR best practices — and help you think before you click.

tempLateS can be a good thing

Well-designed EHR templates offer obvious advantages. However, if used inap-propriately, templates can cause as many problems as they solve. For example, many healthcare providers simply “carry forward” pre-existing information from one template to the next. While much of a patient’s demo-graphic information may remain consistent over time, it is highly unlikely that inci-dent-specific information will, or should, remain the same.

The point here is simple: Templates should not be automatically pre-populated with data. If this is part of your EHR work flow, ensure that any pre-populated data is accurate and try to limit pre-populated fields to demographic information. If it is not, then it is your responsibility to correct the information before signing off on the docu-mentation generated by that template work flow. One mistake in a single template field can lead to patient injury, and to potential malpractice claims. While it might sound time-consuming, this task will take much less time than being involved in a lawsuit. Imagine showing a jury six days of Progress Notes that are identical. This happens, and should not.

By Shelly M. Davis, BSN, JD

cut‑and‑paSte with caRe

The cut-and-paste feature in the EHR can be a great timesaver, but like templates, cut-and-paste is often used inappropriately. Don’t cut-and-paste information that has not been independently obtained or verified. We know patients’ histories and recollec-tions can change depending on many factors, such as who is asking the questions, how questions are asked, a patient’s anxiety or pain level, current medications, and the presence of family members at the time of questioning.

Obtaining complete and accurate patient history is essential. If you simply rely on another provider’s data, there is a risk of over-testing because you have under-listened. Why? Because unfortunately, many physi-cians perceive it to be simpler and quicker to order tests than to listen and think about the big picture.

There have been many documented cases where health information was pasted into an improper location of a patient’s chart, where copied data contradicted the template-gen-erated content, or was lost altogether because it was pasted into the wrong patient’s EHR. So use cut-and-paste with care. Your patient’s safety is more important than the few min-utes this feature can save you.

aLeRt and aLaRm fatigue

For many, alert fatigue has become an EHR nightmare. While these warnings are ostensibly beneficial — by reminding provid-ers of important information — alerts can be so frequent that providers become desen-sitized to them, and hence shut them off with indifference.

But alert fatigue was a concern for years before the advent of the EHR. For example, there have been many cases of monitor and pain pump alarms being shut off without heed, resulting in severe injury for the patient, and sometimes death.

The phenomenon of alarm and alert fatigue needs immediate attention within the healthcare industry. Getting providers to acknowledge the importance of alarm and alert fatigue, and implementing regular reminders about their importance, is only one step toward avoiding adverse outcomes. Another more powerful step is to involve providers in defining the appropriate thresh-olds that trigger the alerts and alarms.

concLuSionKeep in mind that the patient record, no

matter the format, is the prime communica-tion tool used to facilitate reasonable care and treatment. Documentation in the EHR needs to be meaningful, objective and based upon patient presentation. Thus, documen-tation needs the utmost attention. With appropriate use of templates, cutting and pasting, and alerts, the EHR will achieve its original and ultimate goal: improving patient safety. ■

shelly m. davis, BsN, Jd, is a senior Claim

Consultant at mmiC. This article originally

appeared in the summer 2013 issue of Brink,

a quarterly risk solutions magazine published

by mmIC. For more information, visit

mmICgroup.com.

Streamline or Slipup?Timesaving features of your EHR can be risky. use them wisely.


BetterTogether

All photos courtsey LifeScape.

11

Both South Dakota achieve anD chilDren’S care hoSpital anD School have long been recognized for their ability to adapt to the changing medical needs of

Sioux Falls and surrounding communities. Established in 1952 as a school for polio victims, the program originally known as Crippled Children’s Hospital and School trans-formed itself over the years to serve a variety of the most pressing medical and educational needs of children.

South Dakota Achieve has also evolved through different names and service offerings. It was opened in 1958 as the Sioux Chapter Workshop for the Mentally Retarded, and was later known for many years as Sioux Vocational Services. Although it also started out serving children with disabilities, Sioux Voca-tional (and then Achieve) eventually served only adults and older adolescents with support to live independently, commu-nicate, expand their social networks, find work, and stay healthy.

Now, these organizations have proven, once again, their ability and willingness to adapt to changing times by joining forces to form LifeScape. By combining these two demographics, the new non-profit organization, announced in April, has the capacity and expertise to support the varied medical, educational, emotional, mental, and social needs of patients with disabilities at any stage of life, for as long as that support is needed.

originS of lifeScapeBecause they serve so many of the same types of patients

at different stages in their lives, it stands to reason that CCHS and South Dakota Achieve would look for ways to collaborate and they did. LifeScape CEO Anne Rieck McFarland says the conversation started about a year and a half ago.

“It was during those discussions about possible collaborative projects that we realized that there were a lot of synergies here,” says Rieck McFarland who had previously been President and CEO of South Dakota Achieve.

One of the most notable aspects of those discussions was the willingness of both organizations to look beyond their own entrenched and respected community brands, to imagine some-thing bigger. “Even just the fact that two non-profits were able

the new lifeScape offers continuum of Services

for children and adults with Disabilities

By Alex Strauss

specialized therapy and adaptive equipment

services provided to disabled children through

CCHs will now be extended to more adults

through lifescape.

lifescape offers specialized inpatient care for

medically complex children and adults. For

those who live at home, lifescape can provide

highly skilled temporary nursing care to give

their caregivers a break.


to put their egos on the shelf and look at what was going to serve the community best is quite something,” Rieck McFarland notes.

While the birth-to-adulthood LifeScape concept is not unprecedented in the country, it is not common, giving LifeScape few models on which to base their new organiza-tion. As the CCHS and SD Achieve boards explored the possibilities of working together as a single organization, they con-nected with the national Council on Quality

and Leadership, a group that works with human service organizations like LifeScape, which directed them to 5 comparable U.S. programs serving the same demographic.

“We are planning to take advantage of the things these organizations have learned about serving people with disabilities,” says Rieck McFarland. “We also want to pay it forward for other organizations in the future as we come up with the best ways to provide these services.”

new Service areaS

Although the two organizations that combined to form LifeScape will continue to provide the services that have always been associated with them, Rieck McFarland and LifeScape’s Vice President of Medical and Therapy Services, Kristin Tuttle, says LifeScape will be able to serve certain clients in ways that have not previously been possible. Hence, the “Better Together” slogan in LifeScape’s marketing.

One area of service expansion under the LifeScape banner will be mental health, an area with which many service organizations for adults with disabilities struggle. “Like many of these organizations, we have a lot of adults with mental health needs that are unserved or underserved,” says Rieck McFarland. “With the mental health exper-tise we have gained through our association with CCHS, we will be able to better under-stand their needs and help them. We hope to now become more familiar and competent in managing these adults.”

With the goal of helping all people with disabilities reach their full potential,

lifescape provides employment training, preparation, and placement.

How do you take your

? Now available in digital for iPad, iPhone, or Android devices!

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


June 2014 midwestmedicalEdition.com

Respite care to provide a break for the caregivers of adults and children with dis-abilities is another area of planned service expansion. With the expertise to handle even medically complex patients, LifeS-cape will be able to safely provide this much-needed service to more families who need it.

Likewise, adults with significant medi-cal needs, such as those on ventilators, IVs, or feeding tubes who need round-the-clock high level nursing care, can now be served by LifeScape at a level not possible through South Dakota Achieve.

“In the past, Achieve would not have been able to help these people and they might have ended up in a nursing home,” says Rieck McFarland. “No 21-year-old wants to be in a nursing home. That is not the right place for them and now there is an alternative that can help them grow and develop while their medical needs are being taken care of.”

into the futureIn the past year, CCHS and South

Dakota Achieve served an estimated 2,300 children and adults from South Dakota and the surrounding states through pro-grams in Sioux Falls, Rapid City, and many communities and school districts throughout South Dakota. LifeScape will

now continue to serve clients ranging from children with serious birth defects , inju-ries, autism and learning disabilities to mentally disabled adults, those with trau-matic brain injuries, and those with diseases such as Parkinson’s or ALS who may need adaptive equipment.

“Because we have such a wide range of services, we have great intake specialists who help get people where they need to go,” says Tuttle. “Whether they need to be an inpatient or they are looking for rehabilita-tion medical supplies, we can help direct them so that they get what they need.”

Although these services will all con-tinue to be provided through the existing CCHS and South Dakota Achieve facilities in Sioux Falls and Rapid City, Rieck McFar-land says the idea of an eventual new brick and mortar facility is not off the table.

“This is not something that we would do any time soon, but we don’t know what the future will hold,” says Rieck McFar-land of this unique organization. “We will do what we need to do to adequately serve the needs of the community. Because the reality is that we are serving many people who would otherwise not be served at all. Period. If we didn’t serve them, they would be sent to an institution. Our ability to help these people is even greater now that we are together.” ■

“the most important message for medical providers in the area

is that, as LifeScape, we are continuing to

provide all of the same services that Achieve and CCHS provided separately

in the past.”Through lifescape, adults with disabilities can get the assistance they need to live

independently, find employment, maintain their health, and even make social connections.

13

Services provided by the new lifeScape• Inpatient rehabilitation

• Inpatient medically complex medical care

• Residential services

• Outpatient therapy and psychology services

• Supported living

• Special education

• Supported community employment and employment preparedness

• Day services and respite care

• Specialized rehabilitation equipment

• Orthotics and prosthetics

• Community and school-based outreach therapy

kristin tuttle, lifescape’s Vice President of medical

and Therapy services



THE RATE OF obesity has sky-rocketed over the past three decades. A total of $190 bil-lion a year is spent in the

United States treating disease directly cor-related to obesity. Despite this epidemic, our healthcare system poorly addresses the issue of obesity, and medical manage-ment has been shown to be ineffective.

The only treatment proven to resolve obe-sity with lasting results is bariatric surgery. Surgery results in an average excess weight loss of 40 percent to 80 percent and significant improvement or resolution of obesity-related disease. For example, as many as 80 percent of patients with type 2 diabetes will show resolution or improvement after a gastric bypass. At Sanford, 90.9 percent of our patients have a reduction or resolution of at least one health problem after surgery.

Despite the proven results of gastric bypass, many patients and physicians are hesitant to pursue surgery as an option because of the small but real risk of surgical

complications. Surgeons have improved their ability to manage these complications, and the risk of death is now equivalent to that of childbirth. Yet a significant concern is the rate of anastomotic leak (1 percent to 3 per-cent) and stenosis (3 percent to 15 percent). This morbidity cannot be ignored. These patients may have long hospitalizations and large healthcare bills and may miss months of work. As surgeons we strive to make this risk as low as possible.

Robotic surgery has been performed for more than 15 years. In many instances, it has been demonstrated to improve the outcome after surgery. The da Vinci robotic surgical platform enables surgeons to perform com-plex surgery in a minimally invasive fashion similar to laparoscopic techniques. Advan-tages include high-resolution 3D image, scaled movement and reticulated instru-ments. This allows the surgeon to perform intuitive surgical movements similar to open surgery, which is not replicated in laparo-scopic surgery.

Recent peer-reviewed studies have sug-gested a decrease in complications when the gastric bypass is performed robotically. In most laparoscopic gastric bypasses, the gas-trojejunal anastomosis is performed in a stapled fashion. With the robotic technique, the anastomosis is sewn rather than stapled. This is possible due to the improved ergo-nomics, visualization and tremor filtration the da Vinci platform provides. These results cannot be duplicated when sewing is per-formed in laparoscopic cases.

I feel this technology will decrease the number of leak and stenosis complications which occur and the number of subsequent procedures needed to deal with those complications. Every stricture results in an average of one to three endoscopic dilata-tions, which has a leak risk of one percent to two percent. In a study published in Obesity Surgery (Snyder et al., 2010) stric-tures decreased from 2.2 percent to 0.9 percent when performed robotically; leaks similarly decreased from 1.7 percent to zero percent.

At Sanford Surgical Associates, I have been offering the robotic gastric bypass since November 2013. A total of 14 robotic bypasses have been performed with no leaks or stric-tures. The average length of hospital stay is 1.74 days. My early experience has been prom-ising, and the patients are very satisfied with the surgical experience and results.

By providing robotic gastric bypass to our patients, we can further decrease the risk inherent to the surgery. Over time, I am con-fident this will result in our ability to not only show improved safety, but also a substantial decrease in the need for hospitalization and treatment of complications. This will result in saving significant healthcare dollars. ■

dr. Curtis peery is a board-certified general

surgeon with sanford surgical associates in

sioux Falls. He has been performing robotic

surgeries for 10 years.

By Curtis L. Peery, MD
















single-site Robotic gastric BypassNEW, MINIMALLy INVASIVE OPTION LOWERS SuRGICAL RISKS

















single-site Robotic gastric BypassNEW, MINIMALLy INVASIVE OPTION LOWERS SuRGICAL RISKS


www.healthpoint.dsu.edu


DoCtorS PArtner wIth SIoux fAllS fItneSS ClubORTHOPEDIC INSTITuTE in Sioux Falls and the Sioux Falls Specialty Hospital have partnered with GreatLIFE Malaska Golf & Fitness Club, managers of the GreatLIFE Woodlake Athletic Club in Sioux Falls and other area fitness facilities to integrate healthcare services into the mix of benefits available to GreatLIFE members at select locations.

As a GreatLIFE health partner, Orthopedic Institute will open a clinic in the GreatLIFE Woodlake Athletic Club addition scheduled for completion in January of 2015. Members will have convenient access to sports medicine, therapy and education. Sioux Falls Specialty Hospital will also provide clinic services in the new addition at Woodlake and will provide

healthcare services, seasonal clinics and educational seminars for members and guests.

In addition to Woodlake, other area GreatLIFE facilities include Bakker Cross-ing, Willow Run, Central Valley, Hidden Valley, Hiawatha, River Ridge, Luverne Country Club, The Bridges at Beresford,

Emerald Hills and Okoboji View golf courses, EmBe, and McCook Wellness. According to GreatLIFE, the goal of the new healthcare partnerships is to make healthcare services convenient and accessible and to encourage members to integrate regular pre-ventative care and health maintenance into their lives. ■

architect’s rendering of

the planned expansion at

greatlIFE Woodlake

athletic Club in sioux Falls

Log on to see additional images of the planned GreatLIFE Woodlake project.


http://www.midwestmedicaledition.com/2014/05/27/41873/doctors-partner-with-sioux-falls-fitness-club


SANFORD HEART HOSPITALS in Fargo, North Dakota and Sioux Falls, South Dakota have adopted a new FDA-approved minimally invasive medical device to treat patients with severe aortic stenosis who are too ill or frail to have their aortic valves replaced through traditional open-heart surgery.

Approximately one-third of patients who suffer from severe aortic stenosis are not eligible for open-heart surgery because of increased risk. If left untreated, the heart muscle could weaken, leading to heart failure and an increased risk for sudden cardiac death. These patients have a 50 percent risk of death at one year unless they are treated.

The advanced design of the CoreValve System from Medtronic was developed to address the needs of the transcatheter aortic valve replacement (TAVR) patient population, serving a broad spectrum of severe aortic stenosis patients. CoreValve TAVR is performed by a team of interventional cardi-ologists and cardiothoracic surgeons. Most commonly, CoreValve is inserted through a catheter procedure, either via the chest or groin. It is a self-expanding device designed to replace a severely narrowed aortic heart valve.

Sanford Heart has offered minimally inva-sive TAVR procedures since 2012 through the Edwards’ SAPIEN valve. CoreValve will allow Sanford to offer the procedure to patients who may not be candidates for other valve options. ■

a NEW oPTIoN FoR aoRTIC sTENosIs Now available in sioux Falls

hotharleynights.com


regIonAl heAlth PreSIDent & Ceo ChArleS hArt to retIre

WITH A LONG AND DISTINGuISHED CAREER as a physician and healthcare executive, Charles Hart, MD, MS, Regional Health President and CEO, has announced his intention to retire. Hart will continue to lead Regional Health until his successor is in place, with the organizational goal of filling the position by January 2015.

Dr. Hart has been associated with Regional Health and Rapid City Regional Hospital (RCRH) for 31 years with 10 of those as Regional Health’s first President and CEO. Dr. Hart began his career at the organization as an RCRH Emergency Department physician in 1983. He has served in a variety of leadership positions throughout his career including Interim President and co-CEO, Chairman of the Board of Trustees, Chief of the Medical Staff, Vice President of Medical Affairs, Hospital/Medical Liaison Officer, Emergency Department Chairman, and Regional LifeFlight Medical Director.

UNdeR dR. HaRt’s leadeRsHip, ReGioNal HealtH Has aCHieVed: ◆ System integration – Forty-eight facilities throughout western South

Dakota and into northern Wyoming have been unified under the parent corporation of Regional Health.

◆ System growth – the organization has grown to 48 facilities in 2014. There are also about 4,900 system employees today.

◆ Enhanced physician partnership – the number of partner physicians has grown to almost 175 physicians and 95 mid-level healthcare providers.

◆ Creation of a strong foundation for the system’s future – Excellence in healthcare, paired with solid financial performance, has made Regional Health a strong and respected healthcare entity.

◆ Enhanced access to core services – Regional Health has continually added services at its hospitals and clinics. It has also increased the number of clinics to serve people close to home.

◆ Regional Health has maintained an A1 bond rating through Moody’s Investors Service.

Dr. Hart has served as the President-Elect, Vice President, Treasurer and Speaker of the House for the South Dakota State Medical Association and is a past faculty member of the University of South Dakota Sanford School of Medicine. Dr. Hart is a past and active member of multiple state and local organizations including the Rapid City Chamber of Commerce and the Chamber Government Affairs Committee, Black Hills Vision Board, Rapid City Economic Development Board, State Chamber of Commerce Board, and the South Dakota Community Foundation Board.

Dr. Hart has been the recipient of multiple awards including Distinguished Service from the South Dakota Medical Association, the Black Hills Hispanic Community Award, and the Distinguished Leadership in Medicine for Community Service from the University of Notre Dame.

The Regional Health Board has formed a committee to immediately begin the search for the new Regional Health President and CEO. A nationally-recognized search firm, B. E. Smith, has been retained to lead a national search. ■

make the ConnectionHELPLINE AND AVERA LAuNCH ONLINE GuIDE TO MENTAL HEALTH RESOuRCES

sIoUx Falls HElPlINE Center and avera

mcKennan Behavioral Health services have

launched a new online sioux Falls mental

Health Resource guide. The guide consists

of a searchable database of mental health

resources in the sioux Falls area, including

providers, agencies and professionals.

additional resources include a guide for

selecting a mental health practitioner and

a glossary of professional accreditations.

The guide is also available as a download-

able PDF.

“This guide is set up to be an easy-to-use,

one-stop resource for people who are strug-

gling with a mental health issues, or for

people seeking help for a loved one,” says

Helpline Center Executive Director Janet

Kittams-lalley. “This guide empowers people

by breaking down the options into a simple

format that will allow them to make the best

possible choices for their situation.”

“We want to remove as many barriers as

possible as people seek help for various

mental health conditions, whether that’s

depression, anxiety, addiction, substance

abuse disorder, or other illnesses,” says

Thomas otten, Director of Behavioral Health

Inpatient services for avera mcKennan Hos-

pital & University Health Center. “less than

half of children and adults with diagnosable

mental health conditions receive the help

they need. Here in the sioux Falls region, we

hope to change that disturbing statistic.” ■

Log on to find a link to the free Sioux Falls Mental Health Resource Guide.


http://www.midwestmedicaledition.com/2014/05/28/41887/make-the-connection


Photo Co

urtesy Siou

x Center H

ospital

tHe NeW sioUx CeNteR

CommUNitY Hospital aNd

HealtH CeNteR aVeRa,

which welcomed its first patients at the end of May, is a community hospital in the truest sense of the word.

From before the $48.5 million dollar project broke ground in July 2012, the project received more than a quarter of its funding from pledges and donation from the community of just 7,000 people. CEO Kayleen Lee says the outpouring is a testament to the community’s engagement with the project and desire for some new directions in healthcare.

“The community has really embraced this project from the beginning,” says Lee. “Before we even designed the facility, we went to the community with focus groups and asked them what they wanted, what they thought we needed.”

Although fundraising experts told hospital planners

they could gather the informa-tion they needed from three or four focus groups, Lee says the board held a total of four-teen, including more than 200 community members. The consensus on healthcare needs in Sioux Center? More wellness services, more ambulatory care options, and a greater focus on specialty care.

“So that really helped us set our design for the hospital,” says Lee. “We combined that information with statistical analysis on things like popula-tion demographics, frequency of different diagnoses, dispari-ties, etc. That is how we came up with the size, number of rooms, etc.

The new 123,500 sq. ft. facility, which includes a 107,000 square foot hospital and a 16,500 square foot pri-mary/specialty clinic, will replace the current hospital built in 1951 and land-locked on Highway 75. The existing facility is not capable of

expanding the outpatient and specialty services that are changing the landscape of healthcare delivery. Lee says the new, more modern medical campus will serve as the prom-inent healthcare facility for a growing community and aging population.

“Some of the issues we were running into in the old facility had to do with privacy,” she explains “I joke that we are going from an Emergency Room to an Emergency Depart-ment because we literally had a room with two cots before. At the same time, visits to the ED are increasing.” To accom-modate the higher volume, the new hospital has three trauma rooms and 4 exam rooms.

Another national trend mirrored in Sioux Center is the move toward outpatient care. According to Lee, 75% of the hospital’s revenues come from outpatient services. The new facility includes a same-day surgery center with ten

Sioux Center opens the Doors on a new Community hospital

sIoUx CENTER CommUNITY

hoSpitaL factScost: $48.5 million

community funds Raised: $13+ million

hospital size: 107,000 sq. feet

clinic size: 16,500 sq. feet

Rehab space: 3,000 sq. feet

architects: Cannon moss Brygger

The new facility welcomed its first

patients on may 22. It replaces the old

hospital which was built in 1951.’

Kayleen lee


“USF’s MBA program promotes learning from knowledgeable professors and a diverse group of

professionals. For the adult balancing work, school and family commitments, this program is ideal.”

Kelia Smith, M.B.A. Healthcare ManagementSanford Health Project Coordinator, Facilities & Planning

Your MBA. The USF Way.Affordable. Attainable. Achievable.

° Take classes online or on campus.° Earn degree in two years.° $370 per credit, no fees or hidden costs. (Best value in the region!)° Proven success since 1993.° MBA concentrations: •Entrepreneurial Studies •Healthcare Management •General Management •Marketing

usiouxfalls.edu/mba » 605-331-6680 [email protected]

Sioux Center opens the Doors on a new Community hospital

ambulatory care rooms for pre- and post-treatment as well as for same-day surgeries.

The facility includes two spacious LDRs and four post-partum rooms designed for family comfort and safe, low-intervention births. The new hospital campus includes 3,000 square feet for rehabilitation ser-vices, which have been located off site in an old nursing home.

“The great thing about therapy in the new hospital,” says Lee, “is that you don’t have to come in the main entrance. Rehabilitation services have their own separate entrance so patients, many of whom shouldn’t be walking long dis-tances anyway, won’t have to.”

Some of the new technologies on the medical campus are electronic white boards in each room featuring vital information and controlled at the Nurses’

Station, an advanced communi-cations system that utilizes wearable pendants, tracking devices for patients in surgery so families can monitor their progress, kiosks to improve wayfinding, and temperature monitoring devices for refrigera-tion units. The rooms feature various ports to accommodate future technology.

The campus was designed by Cannon Moss Brygger Architects of Sioux City to incorporate themes from the 23rd Psalm, including verdant pastures, still waters, and resto-ration of the soul. It features tall ceilings, large windows throughout that look out on greenery, and a circular ‘Town Center’ that makes it easier for patients to find their way around. Reflective stone on the exterior (from Mankato, Minnesota) helps the building blend

seamlessly with the landscape. Reaction to the new facility

at a donor gala in April and two public open houses in May was overwhelmingly positive and Lee says the project has reignited public and staff enthusiasm about the future of healthcare in Sioux Center.

“When you have staff that provide wonderful care in an old facility, you know that the care

is going to be that much better in an advanced new facility,” says Lee. ■

Phot

o by

Mat

t To

erin

g

The 107,00 sq. foot hospital features

soaring ceilings, natural light, and Kasota

stone in its lobby or ‘Town Center’.

Log on for additional photos of the hospital and the open houses.


usiouxfalls.edu/mba

http://www.midwestmedicaledition.com/2014/05/28/41891/sioux-center-opens-the-doors-on-a-new-community-hospital


NO MATTER WHO yOu are or how great you believe your “pitch” to be, approach-ing a member of the media

(or, in some cases, your own PR depart-ment) with a medical story idea can be intimidating.

For one thing, you risk the very real pos-sibility that the person to whom you are explaining your great idea will not “get it” or find it valuable enough to want to share with the public. There is also the natural aver-sion to making oneself vulnerable to scrutiny or criticism. Most people with potentially valuable information to share – including health professionals – conclude that the risks and hassle are not worth the effort.

But the fact is that the media and the public they serve need what you know – now, more than ever. The advantages of timely, relevant health news for consumers are obvious, but this is about more than public service. By way of encouraging more engagement with your local news providers, here are a few things I believe are “in it” for you, the health professional:

By Alex Strauss

mEDIa 101

1 O’Hanluain, Daithi, “Patients forget about two-thirds of doc-tors’ treatment instructions, says neuropsychologist”, European Society of Cataract and Refractive Surgeons, July 2003

THE FOuR

“ps”pRoVide

Although no news report could ever match the value of personalized, one-to-one human interaction, when you put a health scare into perspective, recommend a healthy course of action, or explain a new treatment option through the media, you are being a provider on a level that is simply not possible within the walls of the office or hospital.

And unlike the words you say during an office visit, which research suggests are often misunderstood or forgotten within minutes of the appointment1, words that are captured in a news article may be broadcast multiple times, repeated, copied, disseminated online, and even referenced again in future stories.

positioNSpeaking through the media gives you the opportunity to position yourself as an author-

ity, bolstering trust and credibility among your own patients, as well as among those who may become patients in the future.

When you demonstrate that you are willing to provide your expertise, the media responds in kind by presenting you as an expert source. Fortunately, even if you have never been asked to speak to the press before, it only takes one good interview (during which you offer clear, concise information) or one newsworthy story idea to put you on their radar.

pRomoteAppearing in a news segment, being quoted in the newspaper or online, or being inter-

viewed on a television or radio show, are ideal ways to help promote your practice and your services, provided that you do not take it too far by being blatantly self-promotional.

In an increasingly competitive healthcare environment, the authority you can establish and the respect you can earn through unpaid media interactions can give you and your practice a competitive edge that simply cannot be achieved through advertising alone.

paRtiCipateBy establishing good relations with your local health news providers, you are opening

what can be an inestimably valuable channel of communication between the medical world and the “real” world. Like doctors, journalists want to uncover truth and serve their audiences.

At a time when the gulf of understanding between patients and providers seems to be widening, in a very real sense, by accepting and working with the media, you can help close it. That is the power of physicians and the press, together. ■

med editor alex strauss is a former television

health reporter and the author of Physicians

and the Press: A Doctor’s Guide to Working

with the Media.

What’s in it for you?

sharing your health news with the media –


HE A L T H -

C A R E prov iders a c r o s s

South Dakota have been creating programs to help reduce avoidable

hospital readmissions. A readmission occurs when a patient who was recently discharged from a hospital needs to be admitted to a hospital again, generally within 30 days. At the national level, read-missions impact nearly 1 in 5 Medicare patients. These readmissions disrupt patient lives and are costly to both the patient and the hospital. Readmission performance is now publicly reported on Medicare’s Hospital Compare website, and the Cen-ters for Medicare & Medicaid Services (CMS) created the Readmission Reduction Program, which financially penalizes hos-pitals with higher rates of readmissions.

REaDmIssIoN RaTE TRENDs – sTaTE aND NaTIoNal For the one-year period ending June 30, 2013, there were 31,967 Medicare inpa-tient hospital discharges in South Dakota and 4,544 people were readmitted to the hospital again within 30 days, for a read-mission rate of 14.2%. For comparison, the national rate of readmission was 18.3% for Medicare patients. Despite the fact that South Dakota already readmits fewer people than the rest of the nation, steady improvement has been made over the last few years, as evidenced by the decline in readmission rates. Because healthcare providers have improved readmission rates, 1,156 fewer Medicare beneficiaries are being readmitted to the hospital each year in South Dakota, as compared to a few years ago.

So the natural question is, what is working so well? With healthcare quality improvement, there are usually multiple factors that drive change. There are many local efforts that have likely contributed to the improvement in readmissions, including:

◆ Healthcare systems and providers are implementing best practices such as post-discharge follow up phone calls to patients, medication reconciliation strategies, home visits when needed, and many other local unique interventions.

◆ South Dakota Foundation for Medical Care (SDFMC) has been bringing hospitals, skilled nursing facilities, home health agencies, physician offices, assisted living facilities, and other community members together in care transitions coalitions across the state. These coalitions have improved provider communication across the healthcare spectrum, identified the cause of local readmissions, and implemented interventions accordingly. In addition, SDFMC shared quarterly data to monitor progress and identify areas for improvement both statewide and locally.

◆ Hospital engagement networks have been providing support, resources, and educational opportunities to hospitals looking to improve.

◆ Sharing lessons learned between communities has enhanced statewide success. ■

Ryan sailor is the Vice President of the

south Dakota Foundation for medical

Care (sDFmC), the medicare Quality

Improvement organization for the state.

Declining Hospital Readmissions in south DakotaBy Ryan Sailor

GREAT STRIDES IN REDuCING READMISSIONS HAVE BEEN MADE IN SOuTH DAKOTA OVER THE LAST FEW yEARS. THIS GRAPH, CALCuLATED FROM MEDI-CARE CLAIMS DATA, DEMONSTRATES THE IMPROVEMENT IN READMISSION RATES:

A look At whAt’S workIng

Log on to view more detailed data on hospital readmissions from the SDFMC.


http://www.midwestmedicaledition.com/2014/05/27/41872/declining-hospital-readmissions-in-south-dakota


at SanfoRd, a geRiatRicS caSe manageR and a caRdioLogy nuRSe aRe the two moSt Recent daiSy RecipientS. lori Jones, a geriatric

nurse at the walk-in Carespan Clinic in sioux

Falls, did what she needed to do to encourage

follow-up in a 76-year-old patient who

described a transient episode of aphasia. The

woman did not want to see her physician since

she was no longer symptomatic. But Jones’

“kindness, sincerity, and empathy” convinced

the woman to seek care.

according to the nomination, “Further test-

ing revealed a positive stress test which led to

an angiogram, the placement of a stent and

medication changes.” The woman is now par-

ticipating in cardiac rehab and expresses her

gratitude to lori for her clinical expertise and

perseverance.

“Jones consistently partners with patients

in the way described above, generating person-

centered care by activating the individual’s

strengths,” wrote CCm arlene Horner in her

nomination of Jones.

DaIsY winner RN Jill Cahill, a cardiology

nurse at sanford, was nominated for the award

by a patient’s husband who described his wife’s

battle with ovarian cancer and Cahill’s respon-

siveness to both the patient and the family.

“she always has a warm smile and shows

genuine compassion,” said the nomination.

“she even remembered that I like my morning

coffee in a large cup. When my wife was

moved to the ICU, Jill took time from her

lunch break to look in on us. In my opinion,

she is the total package.” ■

The Nurses’ stationNursing News from around the Region

Save the DateS!sDNa and INa annual ConventionsThe south Dakota Nurses association will hold its annual convention october 5-6,

2014 in Rapid City. The theme for this year’s convention is “You are Not alone!

Close Encounters of the Nursing Kind”.

The Iowa Nurses association’s Convention will take place october 12 to 14 at

the Isle of Capri in Waterloo, Iowa. more information is available on the sDNa and

INa websites. ■

stephanie Horsley and pam seger are the most recently-awarded winners of Rapid City Regional

Hospital’s DAISY AwArD.

Horsley, a Registered Nurse in the Progressive Care Unit, was nominated for the award by a patient’s family. In their nomination, the family explained that the patient was in a great deal of pain and was agitated and worried, but that Horsley’s kindness helped ease their fear.

“She is a very kind-hearted, calm, compassionate, caring person: everything you would want in somebody who is taking care of you or a loved one,” the nomination stated. “These are not skills a person learns, these are gifts from God.” Horsley has worked at RCRH for two years.

pam seger, an RN in the Emergency Services Department, was nominated for the DAISY award by a patient who had also been in pain. The patient said Seger’s words of encouragement and hand holding made all the difference.“She would tell me over and over that she knew I would be all right because I am a fighter,” the patient said. “She

was the nurse at my bedside everyone wants and needs.” ■

DAISY AwArDSarea Nurses Recognized with DaIsY award for Extraordinary Nursing

lori Jones Jill Cahill


A DEQuATE protein is essential for good nutrition throughout the

lifespan. While there is no single identifiable cause of sarcopenia, a condition associated with a loss of muscle mass and strength in seniors, insufficient protein intake may be a key contributor. Since loss of muscle can decrease stamina, lessen the ability to per-form daily tasks, and increase the risk of falls and bone fractures, the prevention of sarcopenia is becoming an increasingly impor-tant public health issue.

A recent study published in the Journal of the Academy of Nutrition and Dietetics takes a closer look at protein intake among older U.S. adults. Food intake tends to decline with age and current dietary recommenda-tions emphasize a shift to more plant-based diets, which could be cause for concern in regards to adequate protein consumption.

In the newest study, “Charac-terization of Dietary Protein among Older Adults in the United States”, researchers with Califor-nia Polytechnic University used data from the 2005-06 National Health and Nutrition Examination Survey to quantify protein intake

and determine adequacy of protein in the diets of U.S. adults.

Typical protein intakes were considerably lower than if a USDA food pattern was followed. As expected, older adults had lower than average protein intake and a higher incidence of inadequate intake versus younger adults.

Protein intake was also notably lower in women in com-parison to men. Protein from animal sources contributed more than 60% of protein sources, on average, with dairy as the largest contributor, followed by poultry and beef. Specifically, beef provided approximately 14% of total protein intake of all adults (19+ yrs). Using logistic regres-sion analyses, a higher proportion of total protein intake from animal foods predicted a higher likeli-hood of meeting the protein RDA, whereas a higher proportion from plant foods was a negative predictor.

In the current study, the results prompted the authors to suggest that a shift away from animal sources of protein would have a negative impact on overall protein intake, increasing the risk of sarcopenia. To minimize the negative impact of high dietary fat, they recommend greater focus on leaner and lower fat animal protein options. ■

Holly swee is a Registered Dietician

and a licensed Nutritionist with the

south Dakota Beef Council.

Helping Patients avoid sarcopenia

By Holly Swee

stUdY sUGGests moRe leaN pRoteiN maY Be tHe aNsWeR

Log on to find a link to the study on our website.


http://www.midwestmedicaledition.com/2014/05/28/41888/helping-patients-avoid-sarcopenia

www.deadwoodlodge.com

http://www.sdbeef.org/


EARLY LANGUAGE LEARNERS* June 2-5, 8-9 am; Description: Preschoolers develop speech and language skills through play and everyday activities.BREAKFAST CLUB* Tues./Fri., June 3-27, 7:45-8:45 am; Description: A group setting to overcome picky eating and improve oral motor skills.

* Insurance coverage may apply to medical-based camps.

SUMMER CAMPS @ (Formerly

Children’s Care)LifeScape

Call 605.444.9700 for details. 1020 W. 18th St., Sioux Falls, SD 57104

Formerly Children’s Care

LET’S TALK* Aug. 11-14, 9 am-noon; Description: Children will focus on peer interactions while using voice output devices.

HELPING HANDS* Dates & Times TBD; Description: Constraint-induced movement therapy for children with hemiplegia.

POWER MOBILITY* Dates & Times: TBD; Description: Experience the latest technology in power mobility.

cnos.net


E VERy PROVIDER ARRIVING for a shift in the emergency department dreads hearing the question, “Remember that

patient . . . ?” Our heart rate quickens and we get a sinking feeling in our gut as we prepare to hear about a patient whose condition has worsened or even resulted in disaster; about something we missed; or about how we failed in some way to do the right thing by one of our patients.

This is one of the rougher parts of prac-ticing emergency medicine — knowing that some of our patients will “bounce back” — returning to the ED because their condi-tion has persisted or worsened.

Bouncebacks! Medical and Legal is a well-written, well-documented compendium of 10 patient stories, none of which turned out well, recounted from the initial presenta-tion in the ED to a subsequent presentation in the courtroom. In-depth analyses from both clinical and medico-legal perspectives make the book an excellent risk management tool. Any seasoned emergency medicine practitioner will relate to, and learn from, these stories. Any student of primary care or emergency medicine will benefit from these experiences and lessons.

One of my wise attending physicians, Dr. Michelle Biros at the Hennepin County Medical Center Emergency Medicine Pro-gram in Minneapolis, often said, “Our most basic task as emergency medicine docs is to determine who is sick and who is not sick.” That can be surprisingly hard to do. She also continually reminded us that “vital signs are vital.” Overlooking abnormal vital signs is one of the main things that can lead to bouncebacks.

Several valuable lessons can be gleaned from this book and from the review of malpractice claims in general. First, we know that 90 percent of a diagnosis can be made by taking a good history, which requires focused, attentive listening and communicat-ing for understanding.

Second, in emergency medicine, we are trained to rule out the life-threatening causes of symptoms before we hang our hats on more benign explanations for them.

Third, knowing that the majority of significant claims in emergency medicine fall under the category of “delayed or missed diagnosis,” it is best to start with a broad differential and thoroughly document one’s thought process regarding why a certain diag-nosis fits, or does not fit, with the complaint.

Fourth, vital signs are vital: In many of the cases detailed in Bouncebacks! — as well as many cases that end up in litigation — patients were discharged from the ED with abnormal vital signs, or with pertinent lab findings still pending or going altogether unacknowledged.

Finally, giving patients and families clear verbal and written return precautions, as well as a definite and documented plan for follow-up, is paramount at the time of dis-charge. I always say that emergency medicine is a team sport, and that perspective is emphasized in this book. For example, read-ing a triage nurse’s note, then attending to the symptoms and concerns raised in them, is essential. Eliciting and listening to ideas or suggestions from other members of the healthcare team when faced with diagnostic dilemmas or treatment failures is of great value; asking for help from consultants when things aren’t “adding up” is important not

only for patients, but also for you. As Greg Henry, MD, advises in his risk management courses: “Don’t carry the coffin alone.”

In summary, Bouncebacks! makes for a great read. The case review format is one we physicians find useful, and this book is filled with cases that at first seemed benign, but ultimately were not. I’m confident the insights in this book will save untold num-bers of patients from adverse outcomes, and many a physician from having to defend his or her evaluation and care of a patient. Our profession is filled with opportunities to learn, and I highly recommend this book as one of them. ■

laurie C. drill-mellum, md, mpH is Vice

President and Chief medical officer at mmIC.

Her review was originally published in the

Winter 2014 issue of the mmIC publication,

Brink, a quarterly risk solutions magazine

published by mmIC. For more information, visit

mmICgroup.com.

Reviewed by Dr. Laurie Drill-Mellum

Bouncebacks! Medical and Legal by Michael weinstock and kevin klauer

In ReviewWhat You’re Reading, Watching, Hearing



The word rosé is French and refers to a type of wine that in-corporates some of the color from the grape skins, but not enough of the pigment to be classified as a true red wine. Rosé wines are produced via three different methods known as skin contact, saignée, and blending.

In the skin contact method of rosé production, the skin of red wine grapes are allowed to stay in contact with the freshly pressed fruit juice for a few days. Unlike in red wine making, the skins are not allows to stay in contact with the juice throughout the fermenta-tion process.

From the French word for “bleed”, the saignee method of rosé production is the practice of “bleeding off” some of the juice after a limited time in contact with the skins. The remaining wine may still be made into a more concentrated red wine.

As the name implies, “blending” simply involves mixing a white wine with some red wine. With a single varietal wine, the grapes may be from the same yield but fermented from different batches.

what is a rosé anyway?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: You are a big fan of some of the new rosé wines.

why might we want to consider a rosé in the summer?

a: A rosé is a good choice for those wine drinkers out there who shy away from Chardonnay because they find them either too oaky or too buttery. If a Sauvignon Blanc is too acidic, or Riesling too sweet, rosé offers a nice crisp and refreshing profile with the depth that most people don’t expect out of a ‘pink’ wine . . . lol. This is not Grandma’s White Zin!

Q: are there a few good rosés you can recommend?

a: Kokomo Grenache Rosé Pinot Patch Rosé of Pinot Noir and Croze Rosé of Cabernet Sauvignon are all beautifully unique and balanced.

Q: what about pairings? can we bring a rose to a barbeque?

a: Rosé is extremely versatile, it’s perfect with almost any type of meal whether it be a fresh salad or something fresh off of the grill.It has the depth to accompany a complex dish or a simple meat and cheese plate.

Wine to Watch

wine facts the smell of young wine is called an “aroma” while a more mature wine offers a more subtle “bouquet”.

kokomo winery’s 2012 grenache rosé pauline’s vineyard, Dry creek valley

The winery says, “Following a whole berry press, we maintained a cool fermentation in stainless steel which allowed us to retain the fruit’s natural character. Watermelon and strawberry make up the aromatics of this wine. The bright vibrant palate of strawberry juice with hints of minerality leads to a long, lingering finish.”

recommended pairing: Rosé is the most versatile food wine so enjoy with most light summer fair.


http://www.caskncork.com/

27June 2014


Enjoy unique, custom created menus for any budget by two certified

culinary chefs.

Cleaver’s Market provides catering for:

Businesses • Homes • Events

Private wine room and patio are available.We welcome special requests!

Fun Summer Events6-6:30 June 2nd - 10 Minute Meals Demo4-7 June 12th - Whole Hog Roast4-7 June 18th - 4 for Free Wine Tasting4-7 June 26th - Whole Hog Roast

Pork from Hog Roasts - $5.99/lb Take as much as you want!

Cleaver’sCatering

605-271-6328 cleaversmarket.com 5009 S Western Ave.

All Fish are 15% Off June 1 - June 30th, 2014!

605-271-6328 cleaversmarket.com 5009 S Western Ave.

View the full list online at

cleaversmarket.com/seafood

Faroe Island SalmonGrouperHalibut

Manilla ClamsJumbo Scallops

Prince Edward Island Mussels

Never Frozen. Always Fresh.

Shop Cleaver’s Market for truly fresh fish, flown in every

Tuesday and Friday. Our selection includes, but is not limited to:

cleaversmarket.com

cleaversmarket.com

cleaversmarket.com/seafood

mED reaches more than 5000 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 [email protected].

learning opportunities

June 6 pulmonary Symposium 8:00 am – 4:30 pm Location: Prairie Center, Avera McKennan

information: [email protected], 605-322-8950

Registration: www.Avera.org/conferences

June 13 avera Sports medicine Symposium 8:00 am – 4:00 pm information: [email protected], 605-322-8950


June 18 critical care Symposium8:00 am – 4:00 pm Location: Prairie Center, Avera McKennan



June 20 – 21 36th annual Sanford black hills pediatric Symposium7:00 am – 12:30 pm Location: The Lodge at Deadwood

information & Registration: SanfordHealth.org/ClassesandEvents

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

information: Sanfordhealth.org

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

information: 605-328-3851, [email protected]

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



Log on to MED’s calendar to see the

newest upcoming events or add your own.

June – July



200-46350-0886 4/14

Jonathan Bleeker, MD, Paul Bjordahl, MD, Michele Lohr, MD, and Keely Hack, MD

Cancer touches so many lives, from mothers to grandfathers to best friends. Theirs are the faces of cancer. And at Sanford Cancer Center, we are the face of cancer care.

We have brought together a team of experts who combine technology, personalized care and compassion like nowhere else in the region. Our multi-disciplinary team works with patients to develop an individualized care plan to fit their needs throughout their entire cancer journey.

Choose expert care. Choose Sanford.

To refer your patient, call (605) 328-8000.

Implementing the latest technology

and innovative research, we guide patients from their

first treatment to survivorship

and beyond.

The face of expertiseTHE FACE OF CANCER CARE

med-midwest medical edition-june 2014

Documents

new hospital

new clinic

new lifescapebettertogether500

south dakota

new organization

news notes new doctors

brand new ways

childrens care hospital