The Mediterranean DietStephanie Perruzza, MS, RD, CDN

It’s been touted as one of the healthiest diets around the world; however, the Mediterranean ‘diet’ isn’t considered just one diet, rather a lifestyle. If you remember your geography, the Mediterranean Sea borders about 21 different countries and regions, each with their own version.

Mediterranean-style Grilled Salmoncourtesy of mayoclinic.orgServes 4

Ingredients:4 Tbsp chopped fresh basil1 Tbsp chopped fresh parsley1 Tbsp minced garlic2 Tbsp lemon juice4 salmon fillets, each 5 ouncesCracked black pepper, to taste4 green olives, chopped4 thin slices lemon

Directions:1) Lightly coat grill rack with

cooking spray. Position the cooking rack 4 to 6 inches from the heat source. Heat grill on high.

2) In a small bowl, combine the basil, parsley, minced garlic and lemon juice.

3) Spray the fish with cooking spray. Sprinkle with black pepper. Top each fillet with equal amounts of the basil-garlic mixture.

4) Place the fish herb-side down on the grill. Grill over high heat.When the edges turn white, after about 3 to 4 minutes, turn the fish over and place on aluminum foil. Move the fish to a cooler part of the grill or reduce the heat. Grill until opaque throughout and 145ºF (test with the tip of a knife and an instant-read thermometer inserted into the thickest part of the fish – about 4 minutes longer).

5) Remove the salmon and place on warmed plates. 6) Garnish with green olives and lemon slices.

Nutrition Facts: Serves 6 (about 1/2 cup)Calories: 304Protein: 8.5gTotal fat: 8.1gSaturated fat: 1.1gCarbohydrates: 48.6gFiber: 11.7gSodium: 35mgCholesterol: 0mg

Nutrition Facts: Serves 4 (1 fillet)Calories: 183Protein: 28gTotal fat: 9gSaturated fat: 1.5gMonounsaturated fat: 3gCarbohydrates: 2gFiber: traceSodium: 105mgCholesterol: 78mg

For more delicious recipes visit www.nwhc.net

Mediterranean Tabbouleh Saladcourtesy of eatingwell.comServes 4

Ingredients:1 cup of bulgur wheat3 cups fresh mint or parsley, chopped½ medium onion1 medium tomato, chopped3 Tbsp Extra Virgin Olive Oil (EVOO)1 Tbsp fresh lemon juice or white wine2 cloves of garlic, pressed or chopped1 cup sliced celery

Directions:1) Place 1 cup of bulgur wheat into a bowl.2) Pour 2 cups of boiling water or broth over the

bulgur and stir once.3) Let sit for 15-20 minutes until liquid is absorbed.4) Combine all ingredients and mix well.5) For added flavor, add more olive oil and lemon juice.

Research suggests that those who follow a Mediterranean style of eating may decrease their risk of chronic diseases such as type 2 diabetes and cancer because of the diet’s anti-inflammatory properties. A study published in the New England Journal of Medicine, revealed that eating a calorie-controlled Mediterranean style diet reduced stroke and heart attack risk by 30 percent in individuals who were at high risk. The Mediterranean style is lower in saturated fat and higher in heart-healthy monounsaturated fats and dietary fiber. It’s also a diet rich in vitamins C and E, polyphenols, beta-carotene and other essential minerals.

Be aware, certain foods on this diet are higher in sodium, specifically olives, salt-cured cheeses and capers, so be sure to watch your portions. This lifestyle is also more than just healthy and delicious food; it incorporates exercise, dining with family and friends and of course, a glass of red wine.

The key components of this diet:• Plant-based foods, such as fruits and vegetables, whole grains,

legumes, unsalted nuts and seeds• Unsaturated heart-healthy fats, such as olive oil instead of butter• Herb and spice flavorings instead of salt• Low to moderate consumption of low-fat dairy such as yogurt

and cheese• Limited intake of sweets, sugary drinks and processed or red meat • Red wine in moderation, with meals • Healthier cooking methods such as grilling, sautéing and baking

Tips to help you move towards the Mediterranean style:• Prepare meals in lighter sauces such as low-sodium broth or olive oil• Add fruits to your breakfast oatmeal, on top of a salad or for dessert• Choose fresh seasonal ingredients such as herbs and spices• Make half your grains whole when eating pasta, bread, rice

and other grains• Swap out red meat for skinless chicken and turkey, fish, lentils or beans• Spend time enjoying your meal with family and friends

and savoring each bite!

Women: Don’t Put Up With Pain!

Inside:FALL 20 14

• Immunizations & Kids

• Better Breast Cancer Screening

• Donors Make a Difference

• How Safe is Your Hospital?

• Concussions

• Childhood Asthma

• Preventing Knee Injuries

• Mediterranean Diet

As a woman, there’s a good chance you’ve experienced one of the three most common gynecologic conditions – fibroids, ovarian cysts and endometriosis. But although these conditions can be painful, many women experiencing symptoms or who have received a diagnosis don’t seek treatment, notes Dr. Navid Mootabar, Chief of Obstetrics and Gynecology at Northern Westchester Hospital, and a Director of the Institute for Robotic and Minimally Invasive Surgery.

An ovarian cyst is a fluid-filled or solid growth on an ovary. The solid type is more prone to being cancerous. When female hormones produce a large cyst, it causes pain due to its size or by rupturing. Hormone therapy can shrink a cyst. However, if it’s very big, causes too much pain, or bleeds excessively when it ruptures, surgery may be necessary. In this case, counsels Dr. Mootabar, “The most advanced surgical treatment is single-incision robotic surgery (SILS) for the fastest possible recovery.”

Endometriosis involves cells (“implants”) from the lining of the uterus abnormally scattered about the pelvic area. A woman may suffer pelvic or abdominal pain, mild to severe pain with periods, pain with intercourse, and painful ovarian cysts. By managing the triggering hormones, birth control pills can reduce symptoms. Surgery removes the implants and cysts through either minimally invasive laparoscopy, traditional robotic surgery, or advanced one-incision SILS. “Robotic surgery has revolutionized the treatment of endometriosis,” says Dr. Mootabar. “The greatly improved fine motor control and visualization let us better identify the implants and more safely separate them from the attached organs. SILS offers all these benefits plus even less pain, a faster return to your life, and essentially scar-free surgery.”

Watch Dr. Mootabar discuss single-incision gynecologic surgery at www.nwhroboticsurgery.org/DrMootabar

Navid Mootabar, MDChief, Obstetrics & Gynecology Director, Institute for Robotics & Minimally Invasive SurgeryNorthern Westchester Hospital

“Many women live with unpleasant or painful symptoms because they aren’t aware of the treatment options available for these disorders – especially the exciting new surgical options,” says Dr. Mootabar. Many patients express concern about the side effects of traditional hormonal medications, such as weight gain, moodiness or nausea, not knowing about alternatives. Atthe same time, many women believe they can’t take time out for surgery, not realizing that new surgical approaches make recovery dramatically faster. “My patients tell me, ‘I don’t have time for surgery – I have to take care of everyone else.’” Prepare to be surprised, says Dr. Mootabar!

“What I want women to know,” he says, “is that they have excellent treatment options for all three gynecological conditions, including the most advanced form of robot-assisted surgery, called single-incision laparoscopic surgery (SILS).” This leading-edge technique, which is offered at Northern Westchester Hospital, is performed through a single incision in the belly-button, compared with the four incisions of the original style of robotic surgery, and offers women the fastest, most comfortable recovery ever, with virtually no scar.

Women need to seek treatment for these conditions, cautions Dr. Mootabar, because, besides being painful, they can lead to additional serious medical problems. Some of these can deeply affect your quality of life. Fibroids, for example, can lead to anemia, whose symptoms include fatigue, chest pain and cognitive problems.

Endometriosis, if untreated, can lead to infertility; while surgical intervention can often promote fertility.

It’s time to learn about these common conditions, to recognize their symptoms, and to understand the breadth of today’s treatment options.

Uterine fibroids are benign tumors on the muscular wall of the uterus, their growth fed by female hormones. Symptoms include pain, especially when large fibroids push against organs, heavy and/or painful periods, urinary problems, infertility, miscarriage, and anemia. Hormonal medications, often coupled

with pain medication, can diminish pain and bleeding. Surgical options for fibroid removal or, in extreme cases, hysterectomy, range from open surgery to minimally invasive, robot-assisted and state-of-the-art SILS.

Well Visits and Immunizations for Kids: Don’t Miss Them!

If you’re a parent of school-age kids, you may have already taken them for their

annual well visit. You may have even learned from your pediatrician about the

recent change in required immunizations: Going forward, children will have to be

vaccinated twice against varicella – chicken pox – whereas the second dose used to be

optional. If giving your child all these shots has you feeling leery, you’re not alone.

But there’s absolutely no reason to worry, assures Peter Richel, MD, Chief of

Pediatrics at Northern Westchester Hospital.

Northern Westchester Hospital is celebrating the arrival of a new Hologic

3-D Mammography unit, which produces a clearer image of the breast. We

are excited to be able to offer this new imaging technique to our patients.

NWHealth is published by Northern Westchester Hospital to provide community members with useful and relevant health information and news about the Hospital.

Northern Westchester Hospital400 East Main StreetMount Kisco, NY 10549

Info:NWH Main Number: 914.666.1200Physician Referral: 877.4.NWH.DOC (877.469.4362)Volunteer Services: 914.666.1925NWH Foundation: 914.242.8352www.nwhc.net/jobswww.nwhc.net

You Can Make Excellence PossibleNWH is successful largely because of the

community’s continued generosity.

Tribute GiftsHonor a loved one, friend, or special occasion. 1916 SocietyBequests have a profound and lasting impact.

You can make an impact, learn how 914.242.8392 or www.nwhconnect.org

Peter Richel, MDChief, PediatricsNorthern Westchester Hospital

health. Your doctor may find an illness or an issue that is not obvious to you. If so, the best intervention is early intervention,” he says.

The well visit is also when your child can get up to date on vaccinations, which is vital given the return of potentially deadly diseases like whooping cough and measles, explains Dr. Richel. “There have been recent outbreaks,” he adds. Thanks to the responsiveness of vaccine makers and increased flexibility in scheduling immunizations, parents can keep their children current on vaccinations and keep them safe from potential complications. The best place to learn more about vaccine safety is at your pediatrician’s office.

Ease Your ConcernsA few questions to ask your doctor

1. Would you follow this protocol if this were your child?2. What are the potential adverse side effects – if any?3. Does the vaccine contain thimerasol? 4. Can I separate the vaccinations instead of getting several at once? (The answer should be “yes” provided you agree to have your child get all the shots.)

“If you have fears about vaccinations, the first thing to do is get off the Internet,” advises Dr. Richel. “There’s a lot of misinformation about vaccines, including the soundly discredited belief that they’re linked to autism.” As Dr. Richel points out, the study that supposedly found a link was withdrawn by the journal that published it, The Lancet, and erased from its records.

A preservative in vaccines was another concern – some people believed it was related to autism risk. The suspect was thimerasol, which contains traces of mercury; a few studies suggest that high levels of mercury can interfere with a child’s development. However, vaccines never contained more than miniscule amounts. “Today, children receive single-dose, preservative-free vaccines,” according to Dr. Richel.

Fear of vaccinations has led some parents to skip well visits for their children. That’s a grave mistake, warns Dr. Richel. “During the annual visit, pediatricians monitor a child'sphysical, emotional, and developmental

Bonnie Litvack, MD, FACRDirector, Women’s ImagingNorthern Westchester Hospital

Improved Cancer Detection Bonnie Litvack, MD, FACR

This innovative screening and diagnostic mammography tool is called Digital Breast Tomosynthesis (DBT) and it produces images at the same time and with the same machine as the two-dimensional (2-D) mammogram. For the 3-D portion of the exam the x-ray machine arm sweeps in an arc over the breast, taking multiple thin section images of the breast. No additional compression is required and the 3-D acquisition only takes a few seconds longer for each view. The thin-section 3-D images allow the radiologist to view the breast tissue layer by layer, minimizing breast tissue overlap, enabling the radiologist to provide a more confident assessment.

2-D digital mammography remains the standard of care for breast cancer screening. However, Digital Breast Tomosynthesis is now an FDA-approved option for both screening and diagnostic mammography. The medical literature has shown that Digital Breast Tomosynthesis has a higher

cancer detection rate than 2-D digital mammography alone and that Digital Breast Tomosynthesis decreases the number of patients who need to be called back for additional images, which reduces patient stress. Digital Breast Tomosynthesis can be beneficial for all women. However, it is most helpful for women with dense breasts, those at high risk for breast cancer and women with a personal history of breast cancer.

The Women’s Imaging Center at Northern Westchester Hospital strives to provide the women of our community with the highest level of care. Digital Breast Tomosynthesis (3-D Mammography) is a new tool to help us fulfill our mission.

Schedule your annual mammo today. Call 914.666.1445.

“The services I received saved my life!” shares a Mt. Kisco woman of the care provided to her through the Breast Health Initiative. “The program is excellent, the medical staff is very friendly, and I’m honestly not sure what my alternative would have been had this program not been available to me.”

Breaking BarriersDonors Make a Difference

Northern Westchester Hospital’s Breast Health Initiative (BHI) has made a significant impact in eliminating healthcare disparities for underserved women and increasing their access to high-quality breast healthcare services. Indeed, the initiative, generously supported by the Avon Foundation, has helped thousands of women in its eight years of existence. The Breast Health Initiative primarily serves a low-income Latina population age 40 and up as well as those deemed high-risk in the hospital’s vicinity.

Supporting Northern Westchester Hospital and helping to fund the Breast Health Initiative is all part of Avon’s larger mission to reduce racial disparity in breast cancer mortality. According to Dr. Marc Hulbert, Executive Director of the Avon Breast Cancer Crusade, BHI’s continuum of free, accessible, comprehensive and timely breast health services and multidisciplinary approaches – from education and screening to diagnosis, state-of-the-art treatment, and follow up – is meant to help a population that normally would not have access to care.

Ninety percent of patients served by this program live at or below the poverty line and 90 percent are without insurance. Many are undocumented immigrants. “An important part of the Hospital’s responsibility is to be the safety net for the economically vulnerable among us,” said Keeva Young-Wright, President of NorthernWestchester Hospital’s Foundation. “I find it commendable that in 2013, as a non-profit institution, we were able to meet the medical and surgical needs of over 99 percent of the patients who sought care, but were unable to pay. The fact that some of this is achieved through philanthropy is quite admirable.”

“What’s remarkable about BHI is that every patient who comes through our doors receives the same high-quality care regardless of their ability to pay,” says Clinical Coordinator Mary Greco, RN, FNP-C. That includes being cared for by the best breast surgeons, expert plastic surgeons, skilled breast cancer specialists, leading oncologists and so on – as well as being guided through the entire process with one-to-one support from a bilingual patient advocate.”

“Never before have I seen such compassion and caring in a hospital. I was guided one step at a time; no questions were left unanswered” said another patient of whose experience included numerous biopsies, two surgeries, 30 radiation treatments, acupuncture, Reiki, and “tons of support.”

“There really is no limitation to the resources a Breast Health Initiative patient has,” adds Dr. Ranjana Chaterji, former Breast Fellow, who performed 17 surgeries this past year ranging from partial mastectomy with seed localization to nipple-sparing mastectomies with reconstruction. “It's a fabulous program for women who otherwise would have no access to any formal medical care.”

Ms. Greco is quick to point out that most women who come through BHI do not have breast cancer. Statistics on those diagnosed with breast cancer fall in line with the national average, putting the numbers at one in eight women; though Latina women are often diagnosed at later stages and have larger tumors at diagnosis. The program’s main focus is to screen patients, increase awareness, and educate women so that they’ll come back year after year.

Ms. Greco often speaks in the community, along with Patient Navigator Josefa Martinez, providing education on various topics. Through the program’s outreach efforts, the BHI team has a strong presence at more than 50 health events a year and is active in educational breast health seminars. In addition to the monthly onsite BHI clinic, the team partners with various community organizations such as Open Door Family Medical Centers and Neighbors Link, which also serve Latina women.

“It’s critical to understand,” explains Ms. Martinez, “that many of these women are afraid to come forward and be absorbed into a system they aren’t familiar with. Many of them are undocumented and 90 percent of them don’t speak English.”

This program was specifically designed with the patients’ needs in mind. If a woman finds out she has a lump or another complication, Ms. Martinez springs into action, scheduling her appointments, dealing with necessary phone calls, attending doctor’s appointments as well as chemo and radiation sessions. “The minute a patient is diagnosed, I tell her ‘I’m going to be her best friend,’” says Ms. Martinez.

Dr. Chaterji credits part of the success of the program to Ms. Martinez’s personal involvement as the liaison between the patient, medical providers and community and most of all, her personal touch. “I wish every program had a dedicated patient navigator like Josefa,” she says. “Patients know her. They trust her. She’s someone who truly understands the patients.”

New this year: A grant from The Plastic Surgery Foundation to be used towards breast reconstruction surgery for uninsured women. Also added, a risk assessment program to identify breast cancer risk factors and provide education and interventions to help reduce risk and improve long-term breast care. The Breast Health Initiative is constantly evolving to better meet the needs in the community.

Interested in learning how you can support NWH? Please contact the NWH Foundation at 914.242.8352.

Learn more about breast health services at NWH, visit www.nwhbreastinstitute.org.

If you’re like most people, safety is a major concern when you choose a hospital. In its

all-out commitment to patient safety, Northern Westchester Hospital (NWH) goes beyond

federal mandates, pioneers rigorous safety programs, and surpasses safety practices within

most U.S. hospitals. There’s just one little thing… the hospital-wide safeguards protecting

you are largely invisible to patients! So what are these practices? And how do they benefit

you and loved ones? Come with us as we part the curtain and give you a glimpse of a

few key safety programs in action…

Safety at NWH: It’s All Around You!

Kate O’Keefe RN, MSN, FNP, CPHQVP, Quality ManagementNorthern Westchester Hospital

“If I needed surgery,I’d want Life Wingsin place.”

Victor Khabie, MD, FAAOS, FACSChief, Department of SurgeryCo-Director, Orthopedic & Spine InstituteDirector, Sports MedicineNorthern Westchester Hospital

“Here, your anesthesiologist is a patient safety expert.”David Miller, MDDirector, AnesthesiologyNorthern Westchester Hospital;American Anesthesiologyof New York

“If it is the right thingto do for the patient, we want to do it 100 percent of the time.”

Our seamless communication systems are a major component of patient safety, says Ms. O’Keefe. Everyone in contact with a patient – your physician, nurse, lab technician, the person transporting you down the hall – all have the necessary information to keep you safe. What’s more, each communication between staff – verbal, written or electronic – identifies you by full name and date of birth, a practice that “keeps us aligned with national safety standards,” she notes.

NWH also uses evidence-based programs to boost safety. For example, electronic “order sets” let your physician electronically retrieve continually updated protocols for every diagnosis. “No human being can keep up with all the changes, but electronic order sets keep our physicians up-to-date with the latest information.” NWH is “ahead of the game” in using technology to reduce risk. Nurses use hand-held devices that interact with your electronic medical records, right at your bedside, greatly increasing accuracy in a host of key tasks, from labeling your lab specimens with personalized patient data to verifying the medication being administered.

Safety and the Hospital’s philosophy of continuous improvement work hand-in-hand. The patient safety program, integrated across all hospital departments, includes numerous initiatives that promote an environment of safety, fostering the development of knowledge and skills. Multidisciplinary “huddles” are conducted throughout the day to ensure that the healthcare team, patient and family are informed of the current treatment plan. Techniques such as simulation drills help ensure constant readiness, preparing teamsto expertly handle even the most rarely occurring medical crises.

You don’t know it, but while you rest peacefully under anesthesia, your surgical team takes a “Time Out” to talk. This isn’t chitchat; it is a formalized review and preparation process that makes your surgery much safer. The advanced safety tool is part of the

“Through the process, a series of checks and balances are in place that virtually eliminates the potential for errors that anesthesiologists can make at any stage.” For example, if the surgeon is performing shoulder surgery, Dr. Miller needs to anesthetize (numb) the shoulder. “With Life Wings, we anesthesiologists have a specific check list – a set sequence of events that must occur – that makes it essentially impossible to block the wrong shoulder. People need to know that wrong-side surgery anesthesia blocks are still occurring in this country every single day. But because your anesthesiologist at NWH is an integral part of the Life Wings safety program, many layers of state-of-the-art processes are preventing mishaps from happening.”

Did you know that a person in an emergency room (ER) is in the most potential danger while they are waiting to be seen? “They’re at risk because they haven’t been evaluated yet,” explains Dr. Dwyer. “They can appear fine, but may be having atypical symptoms of a heart attack, for example.” That’s why the Emergency Department at NWH uses the innovative safety procedure called ‘Pull to Full’: “Every patient who walks into the ER is seen as quickly as possible and gets evaluated right away.”

How is this possible? “When a patient walks in, they don’t just sit waiting, but are seen by a nurse. If a room is available, they are brought directly there, so there’s no bottleneck. Only when the ER is full, do we triage patients in the waiting area to determine who needs immediate care.” Pull to Full has a safety-boosting ripple effect: If a patient arrives with chest pain, they’ll receive an EKG within an unheard-of three minutes. “You’ll probably get your EKG before we even put your name in the computer!” notes Dr. Dwyer. And because NWH’s highly experienced ER nurses are empowered to call for an EKG without consulting a physician, even more possibly life-saving minutes are shaved in providing this critical diagnostic test. Thanks to many layers of safety practices, the Emergency Department at NWH boasts a median time of 12 to 15 minutes “from door to provider.”

Life Wings Surgical Safety Program. Created by aviation experts, it is designed to integrate into hospitals the methodical approaches that let the airline industry achieve an unparalleled track record for safety.

NWH is one of the few U.S. hospitals to implement Life Wings, which incorporates extensive checklists, checks and balances, and scripted processes to bring a measurable culture of safety into the Operating Room. During “Time Out,” all activity stops and each team member reviews key information – the surgeon summarizes details of the procedure; the anesthesiologist reviews patient data; and nurses and surgical techs itemize all materials (medications, implants, needles, sutures) to be used during the surgery. The process not only mandates the sharing of essential information, but melds participants into a cohesive team. “Everyone has a role, everyone speaks up – it’s no longer assumed that the surgeon knows everything. We know that by working as a team of equals, we can provide a safer surgical environment for our patients.”

Importantly, the team uses a “safety word” – for example, Delta – which instantly halts the surgery if anything is of concern. “When accrediting organizations visit the hospital and review our safety procedures, they are blown away,” says Dr. Khabie. “Our surgical safety protocols are well beyond what they’ve seen elsewhere.”

If you think about it for a minute, as a surgical patient, you’re under the anesthesiologist’s supervision during all stages of your procedure, from pre-op through the operation and post-op. “Responsibility for patient safety ties into our specialty,” says Dr. Miller. The Life Wings Surgical Safety Program at NWH has dramatically increased these specialists’ capacity to provide an unprecedented level of patient safety during all three stages of your surgery.

“Don’t be alarmed if you’re in NWH’s labor and delivery area and hear an emergency code being called over the speaker system,” says Dr. Mootabar. “It’s likely we’re just practicing!” Constant “practice” drills are one piece of the large-scale MOREOB (Managing Obstetrical Risk Efficiently) safety program used by the Maternal Child Health Department to improve mother and child safety during pregnancy and birth.

The program – which actually consists of dozens of programs – systematically improves the clinician’s ability to deal successfully with a wide variety of emergencies. While most live births in New York State result in the discharge of a healthy mother and her baby, emergencies like extreme high blood pressure during labor, shoulder dystocia (the baby’s shoulder gets stuck during birth), maternal seizure during labor, and pre-term labor present serious hazards. To prepare for these instances, the department has established protocols for each situation that make communication and teamwork seamless, as well as identify and correct any issues that could reduce patient safety.

Remember that practice drill on the labor floor? “For each emergency code, we’ve created a treatment plan outlining steps to be taken, medications to be given, and all personnel who must be there,” says Dr. Mootabar. The drills have also helped create faster ways to access emergency medication, while speeding up communication and response times with departments such as the Blood Bank and Anesthesia. As one of the first hospitals in the U.S. to implement the MOREOB program, NWH didn’t stop there. In 2014, NWH added the Safe Motherhood Initiative (SMI) to develop and implement standardized protocols for saving the lives of women facing life-threatening complications of pregnancy and childbirth. “The Safe Motherhood Initiative dovetails nicely with MOREOB as we strive for continuous improvement in patient safety,” points out Dr. Mootabar.

Learn more about Northern Westchester Hospital’s commitment to quality and safety at www.nwhc.net/safety

“We see close to 90 percent of patients within 30 minutes.”

Jim Dwyer, MD, FACEPChief, Emergency MedicineNorthern Westchester Hospital

“We are exceeding expectations for mother and child safety.”Navid Mootabar, MD, FACOGChief, Obstetrics & GynecologyDirector, Institute for Robotic & Minimally Invasive SurgeryNorthern Westchester Hospital

Our seamless communication systems are a major component of patient safety, says Ms. O’Keefe. Everyone in contact with a patient – your physician, nurse, lab technician, the person transporting you down the hall – all have the necessary information to keep you safe. What’s more, each communication between staff – verbal, written or electronic – identifies you by full name and date of birth, a practice that “keeps us aligned with national safety standards,” she notes.

NWH also uses evidence-based programs to boost safety. For example, electronic “order sets” let your physician electronically retrieve continually updated protocols for every diagnosis. “No human being can keep up with all the changes, but electronic order sets keep our physicians up-to-date with the latest information.” NWH is “ahead of the game” in using technology to reduce risk. Nurses use hand-held devices that interact with your electronic medical records, right at your bedside, greatly increasing accuracy in a host of key tasks, from labeling your lab specimens with personalized patient data to verifying the medication being administered.

Safety and the Hospital’s philosophy of continuous improvement work hand-in-hand. The patient safety program, integrated across all hospital departments, includes numerous initiatives that promote an environment of safety, fostering the development of knowledge and skills. Multidisciplinary “huddles” are conducted throughout the day to ensure that the healthcare team, patient and family are informed of the current treatment plan. Techniques such as simulation drills help ensure constant readiness, preparing teamsto expertly handle even the most rarely occurring medical crises.

You don’t know it, but while you rest peacefully under anesthesia, your surgical team takes a “Time Out” to talk. This isn’t chitchat; it is a formalized review and preparation process that makes your surgery much safer. The advanced safety tool is part of the

“Through the process, a series of checks and balances are in place that virtually eliminates the potential for errors that anesthesiologists can make at any stage.” For example, if the surgeon is performing shoulder surgery, Dr. Miller needs to anesthetize (numb) the shoulder. “With Life Wings, we anesthesiologists have a specific check list – a set sequence of events that must occur – that makes it essentially impossible to block the wrong shoulder. People need to know that wrong-side surgery anesthesia blocks are still occurring in this country every single day. But because your anesthesiologist at NWH is an integral part of the Life Wings safety program, many layers of state-of-the-art processes are preventing mishaps from happening.”

Did you know that a person in an emergency room (ER) is in the most potential danger while they are waiting to be seen? “They’re at risk because they haven’t been evaluated yet,” explains Dr. Dwyer. “They can appear fine, but may be having atypical symptoms of a heart attack, for example.” That’s why the Emergency Department at NWH uses the innovative safety procedure called ‘Pull to Full’: “Every patient who walks into the ER is seen as quickly as possible and gets evaluated right away.”

How is this possible? “When a patient walks in, they don’t just sit waiting, but are seen by a nurse. If a room is available, they are brought directly there, so there’s no bottleneck. Only when the ER is full, do we triage patients in the waiting area to determine who needs immediate care.” Pull to Full has a safety-boosting ripple effect: If a patient arrives with chest pain, they’ll receive an EKG within an unheard-of three minutes. “You’ll probably get your EKG before we even put your name in the computer!” notes Dr. Dwyer. And because NWH’s highly experienced ER nurses are empowered to call for an EKG without consulting a physician, even more possibly life-saving minutes are shaved in providing this critical diagnostic test. Thanks to many layers of safety practices, the Emergency Department at NWH boasts a median time of 12 to 15 minutes “from door to provider.”

Life Wings Surgical Safety Program. Created by aviation experts, it is designed to integrate into hospitals the methodical approaches that let the airline industry achieve an unparalleled track record for safety.

NWH is one of the few U.S. hospitals to implement Life Wings, which incorporates extensive checklists, checks and balances, and scripted processes to bring a measurable culture of safety into the Operating Room. During “Time Out,” all activity stops and each team member reviews key information – the surgeon summarizes details of the procedure; the anesthesiologist reviews patient data; and nurses and surgical techs itemize all materials (medications, implants, needles, sutures) to be used during the surgery. The process not only mandates the sharing of essential information, but melds participants into a cohesive team. “Everyone has a role, everyone speaks up – it’s no longer assumed that the surgeon knows everything. We know that by working as a team of equals, we can provide a safer surgical environment for our patients.”

Importantly, the team uses a “safety word” – for example, Delta – which instantly halts the surgery if anything is of concern. “When accrediting organizations visit the hospital and review our safety procedures, they are blown away,” says Dr. Khabie. “Our surgical safety protocols are well beyond what they’ve seen elsewhere.”

If you think about it for a minute, as a surgical patient, you’re under the anesthesiologist’s supervision during all stages of your procedure, from pre-op through the operation and post-op. “Responsibility for patient safety ties into our specialty,” says Dr. Miller. The Life Wings Surgical Safety Program at NWH has dramatically increased these specialists’ capacity to provide an unprecedented level of patient safety during all three stages of your surgery.

“Don’t be alarmed if you’re in NWH’s labor and delivery area and hear an emergency code being called over the speaker system,” says Dr. Mootabar. “It’s likely we’re just practicing!” Constant “practice” drills are one piece of the large-scale MOREOB (Managing Obstetrical Risk Efficiently) safety program used by the Maternal Child Health Department to improve mother and child safety during pregnancy and birth.

The program – which actually consists of dozens of programs – systematically improves the clinician’s ability to deal successfully with a wide variety of emergencies. While most live births in New York State result in the discharge of a healthy mother and her baby, emergencies like extreme high blood pressure during labor, shoulder dystocia (the baby’s shoulder gets stuck during birth), maternal seizure during labor, and pre-term labor present serious hazards. To prepare for these instances, the department has established protocols for each situation that make communication and teamwork seamless, as well as identify and correct any issues that could reduce patient safety.

Remember that practice drill on the labor floor? “For each emergency code, we’ve created a treatment plan outlining steps to be taken, medications to be given, and all personnel who must be there,” says Dr. Mootabar. The drills have also helped create faster ways to access emergency medication, while speeding up communication and response times with departments such as the Blood Bank and Anesthesia. As one of the first hospitals in the U.S. to implement the MOREOB program, NWH didn’t stop there. In 2014, NWH added the Safe Motherhood Initiative (SMI) to develop and implement standardized protocols for saving the lives of women facing life-threatening complications of pregnancy and childbirth. “The Safe Motherhood Initiative dovetails nicely with MOREOB as we strive for continuous improvement in patient safety,” points out Dr. Mootabar.

Learn more about Northern Westchester Hospital’s commitment to quality and safety at www.nwhc.net/safety

The American Heart Association andAmerican Stroke Association recognizethis hospital for achieving 85% or higheradherence to all Get With The Guidelines®

Stroke Performance Achievementindicators for consecutive 12 monthintervals and 75% or higher compliance onat least 5 of the Get With The GuidelinesStroke Quality Measures to improve qualityof patient care and outcomes.

Collisions, physical contact and fast-flying pucks are all part of the game, but no one expects an injury during a routine high school hockey practice to result in a concussion and months of rehabilitation. However, that’s exactly what happened to one young athlete. His journey back to good health, and the ice, highlights some of the lesser-known symptoms and dangers of concussion that are important for all parents to know.

The Northern Westchester Concussion ConsortiumSpreading the word about gold-standard treatment

Seeing a widespread need among both parents and fellow medical professionals for up-to-date understanding of the nature of concussion and proper management of recovery, Northern Westchester Hospital has convened a multidisciplinary team of medical experts, forming a sports concussion council. The consortium’s primary goals are to standardize an approach to concussion management and educate the community in best care practices. Dr. Barsh and Dr. Small both participate in the council and believe that ongoing education is essential. These physicians still see many youngsters a full month after their injury who don’t know they’ve been concussed or whose injury has been mismanaged. “In the past, a young athlete was often told, ‘Go back to school and resume sports when you’re headache-free’ – that’s the old thinking,” says Dr. Small. “Parents are often unaware that a physician needs to make continued adjustments to a child’s school and sports activities to permit healing.” He stresses that NWH’s emergency physicians follow the latest protocols for recovery from concussion. The council has created discharge instruction sheets for ER staff describing concussion symptoms and informing parents of the need for a physician-supervised return to school and sports.

What You Don’t Know About Concussions Could Hurt

Concussions can occur in any sport or recreation activity. Learn the signs, symptoms and what to do at www.cdc.gov/concussion.

Elliot Barsh, MDPediatrician Northern Westchester Hospital

Eric Small, MD Pediatric Sports Medicine and Concussion SpecialistNorthern Westchester Hospital

While a headache is among the best-known and first symptoms of a concussion, there are often delayed symptoms that indicate ongoing mild brain damage and require treatment, says Eric Small, MD, Pediatric Sports Medicine and Concussion Specialist with Westchester Health Associates. Ten percent of symptoms don’t present for a week or more.

Today’s best concussion management involves monitoring all symptoms –early and late, including many that can seem unrelated to the injury –to determine the proper timing for a return to play and classes.

Often-overlooked symptoms of a concussion include sleep disturbances and personality changes, in which, for example, a sociable teen turns quiet. The young hockey-player we spoke of experienced this type of emotional change, recalls his mother, “My son mentioned to me that during one period after the injury, he had no emotion, he felt nothing. He admitted that he was afraid he’d never feel anything again.”

Cognitive impairment often causes academic difficulties to emerge over time. “An A student in math is now, two or three months later, a B student,” says Dr. Small. Symptoms may not surface until triggered by cognitive stress, such as back-to-back tests in school. Dr. Small cautions parents that an untreated concussion can worsen. This is why even a symptom-free child should see a doctor within 48 hours of the injury, and why visits should continue as the child is monitored for late-arriving symptoms.

Today’s best concussion rehabilitation often involves not only physical rest and rehabilitative therapies – but rest and rehab for the brain. Ideally, a physician prescribes personalized guidelines for modifying physical and mental activities, which encompass texting and computer screen time. “For day one post-concussion, I typically recommend the student go to school a few hours late. If they tolerate that, day two is a full day. But during non-core classes, such as gym and music, I recommend they rest in the nurse’s office. And no tests.” Similarly, a return to play might start with a little jogging, then add push-ups. “What you don’t want is the old method of rehab where the athlete stays out of school for period of time and then returns to a full regimen. A gradual progression is a must.”

In cases of concussion, a student’s private physician works closely with the school physician and nurse to manage their recovery, explains Dr. Elliot Barsh, pediatrician at NWH, who, as a school physician in Northern Westchester, collaborates frequently on such teams. However, while the school medical team follows state guidelines for return to play, no such

protocol exists for a paced return to learning, which is why cooperation between private physician, parents and school is critical. Dr. Barsh encourages private physicians to send continually updated suggestions to the school for a student’s measured reentry into classes. In New York State, the school physician must approve all recommendations and clear the student to return to activities.

Our young hockey player benefited greatly from a gradual and supported return to learning. “All my son’s tutors noticed how his concentration increased after he started therapy at NWH, from only being able to sit for 45 minutes of tutoring to two hours, to returning to half days of school, and finally to returning to school full-time,” recounts his mother. “He went from not being able to remember anything he learned in three years of Spanish to finishing the class without missing one assignment,” she adds gratefully.

The academic piece of the recovery process is “more subtle and complicated” than the physical piece, yet “equally important,” notes Dr. Barsh. “A concussion is the only injury that affects learning,” he stresses. “When it comes to return to learn, my concern for a youngster is very great. Their job as a student is to learn. As their doctor, I need to make sure they’re cognitively ready for each step.” He warns that recovery may be prolonged if a student is pushed too fast. “If they’re forced to learn more than their brain is ready to process, a one-month recovery can stretch to three or four. That affects their standing in class, how they cope with next year’s work, their SAT scores – their entire future.”

That is why, says Dr. Barsh, “although a concussion is a mild brain injury, mild doesn’t mean minor. Today, more physicians are aware of the great need to let the brain recover. Parents, school medical staff and teachers all need to be on-board with this very important part of healing from a concussion.”

All the many facets of recovery came together for our young athlete, culminating in one special day. His mother says, “My son finally returned to the ice in uniform. As he walked out the door with all of his equipment, I was so thankful.”

Quality, patient-centered care that’s close to home

400 East Main StreetMount Kisco, NY 10549914.666.1200 • www.nwhc.net

Ask the Doctor

IMPORTANT NEWS FOR ATHLETESWhat you should know about preventing knee injuries

Victor Khabie, MD, FAAOS, FACS Chief, Department of SurgeryCo-Director, Orthopedic and Spine InstituteDirector, Sports MedicineNorthern Westchester Hospital nwhorthoandspine.org/DrKhabie

Quiz: Sports-Related Knee Injuries

1. If you think you have a knee injury, wait

a few weeks to see if it heals by itself. 2. An ACL injury can be treated with

physical therapy.

3. Female athletes suffer the same rate of knee injuries as do male athletes engaged in the same sports.

4. If an athlete feels soreness in the knee

area, they probably should take a break from sports that day.

Answers 1. False: Two of the three most common knee injuries require surgery.If you are in pain, limping or have knee swelling after two to three days,get an x-ray and immediately see an orthopedist with expertise in sports medicine. 2. False: This common sports-related injury can only be repaired by surgery, which involves transplanting a ligament taken from the patient’s body. 3. False: Female athletes are two to ten times more likely to suffer an ACL injury. A probable cause is that they land differently than males after jumps, which places more tension on the ACL, leading to tears. 4. True: Soreness in the knee indicates it needs rest. The athlete probably should not play that day.

TRUE FALSE

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Did You Know?Female athletes are 2 to 10 times more likely to suffer an ACL injury than male athletes engaged in the same sport.

Visit www.nwhorthoandspine.org to view our orthopedic videos.

Q: What are the most common sports-related knee injuries?A: There are three:• An injury to the anterior cruciate ligament (ACL),

a key ligament stabilizing the knee, either tears the ACL in two or rips it from the femur (thighbone).

• Damage to the medial collateral ligament (MCL), which keeps the tibia (shinbone) in place, usually consists of a partial tear.

• Made of cartilage, the meniscus is the knee’s “shockabsorber,” and a tear causes pain and dysfunction.

Q: When should an athlete seek medical attention for a knee injury? A: If, after two or three days, your knee is swollen; you are limping; you can't put your full weight on the leg; or you are in pain, head to the ER for an x-ray to determine if there's a break or fracture. Whatever the outcome, you should see an orthopedic specialist without delay. Knee injuries often require surgical repair, and left untreated, can have long-term consequences.

At Northern Westchester Hospital, we treat the full range of sports-related knee injuries with the most advanced surgical procedures and rehabilitative physical therapies. The three injuries mentioned here require different treatment, and we are deeply experienced in each.

An injured ACL must be surgically replaced with a new ligament taken from the patient’s own body. An MCL injury normally heals with physical therapy, while a meniscus tear requires surgical repair.

Q: Is it possible to prevent sports-related knee injuries? A: Female athletes are much more likely to suffer an ACL injury. The good news is that a specific 20-minute warm-up called a neuromuscular injury-prevention and performance enhancement program can dramatically reduce ACL injuries among female athletes. Inquire at the local gym for personal trainers who have been trained in this protective conditioning program, and can offer it outside of normal practice. Male athletes can also improve stability from the warm-up.

Parents also need to monitor the number and type of sports a young athlete is involved in. It’s important to offset activities that stress the knee with others that offer respite. Be aware: Playing sports year-round with no break can stress the knee to the point of injury.

The soft wheeze or whistle as a child breathes. The chin tucked and chest pinched as he coughs incessantly. These are signs of childhood asthma, a maddening, frightening condition for kids and parents – and a leading cause of ER visits for children. While in the past, asthma has been difficult to treat and manage, advancements in medications and methods have allowed doctors and families to tame this potentially dangerous condition in children, says Lynne Quittell, MD, a pediatric pulmonologist who specializes in pediatric asthma at Northern Westchester Hospital.

The reasons why a child develops asthma can be murky, explains Dr. Quittell. Potential triggers can be allergies, exposure to secondhand smoke, or a family history of asthma. Premature babies who spend time on a ventilator appear to be at higher risk.

The reason a child struggles to breathe is that the airways can easily become inflamed, muscles that support the airways can constrict, and mucus production can increase. Some kids will have exercise-induced asthma, while others may find allergy season to be the source of troubles. Even a sudden change in temperature or a rise in humidity can set off an attack, warns Dr. Quittell.

Parents and children should work with their doctor to develop a treatment and medication plan, she advises. "This is the aspect of asthma treatment that has really changed over the years. The medications have improved greatly. We teach children and parents to recognize the earliest signs of an attack, and encourage them to treat symptoms promptly – before they worsen.” Dr. Quittell likes to use the analogy of smoke in the kitchen: "You wouldn't just let it go – you'd address it immediately. Asthma is the same: Stop the attack before the symptoms become more difficult to control."

When setting up a plan, a doctor must take into consideration the child's triggers and needs. "During the spring or fall allergy season, some children will require a daily preventive medication to minimize airway inflammation,"

Managing Childhood Asthma

advises Dr. Quittell, "while others may be okay using an inhaler to treat occasional flare ups linked to exercise." The next step is managing more serious flare ups and then, knowing when to seek emergency help. "No one leaves my office without a written treatment plan," explains Dr. Quittell. "It's one of the most important aspects of asthma care."

Children whose asthma isn't responding to treatment can benefit from a pulmonary exercise program, similar to what is offered at Northern Westchester Hospital. A respiratory therapist will create a program for your child to help him or her build physical strength and exercise capacity. An effective plan will be specifically tailored to your child’s needs and include education and advice for caregivers. The goal? To get your child to the point where they can play and participate in activities with their peers, without limitations.

With the excellent treatment available, Dr. Quittell says she expectsher patients to be able to take part in all age-appropriate activities with no restrictions.

Visit www.nwhrehab.org to learn about Pulmonary services available for children.