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Grand Rounds - Apr. 15, 2022
"Diet and Nutrition in CVD: What really works?"

Speaker: Zhaoping Li, MD, PhD. Professor of Medicine, Lynda and Stewart Resnick Endowed Chair in Human Nutrition, David Geffen School of Medicine at UCLA.

 

 

Objectives

  1. Understand concepts including Diet and Nutrition.
  2. Improve knowledge regarding the role of Diet and Nutrition in CVD.
  3. Review the evidence regarding the use of Diet and Nutrition to treat CVD.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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While St. Charles and other health systems are feeling the relief of fewer COVID-19 patients these days, we are also continuing to navigate a serious set of challenges that are the direct result of the pandemic.

In 2021, St. Charles Health System lost $16.4 million due to direct impacts from COVID-19. Even when we include the COVID-relief funding we received from the federal government, we ended the year with a negative operating margin for the first time since the financial crisis of 2008. Having a positive operating margin is critical, as it allows us to re-invest in our equipment, facilities and training for our staff.

There are two primary issues driving these challenges:

  • Inpatient and outpatient surgical volume – which we rely on for a large portion of our revenue – was 29.2% lower than expected in 2021 because of a lack of bed capacity and staff to care for patients after surgery. These limitations were due at least in part to the high number of COVID-19 patients in our facilities.
  • Our labor costs have skyrocketed as many health care workers have left the profession due to burnout. We spent nearly $70 million on contract labor in 2021, which is up from about $12.7 million in 2020. We are grateful that about $31 million of that cost was covered by the state of Oregon, but we are no longer receiving that funding and must now cover all labor expenses on our own.

The pandemic has also exacerbated problems within the health care system that existed previously. For years, the nation hasn’t produced enough health care professionals to replace those who are retiring. We know that additional behavioral health and skilled nursing services are critical, yet the infrastructure is not there to handle the current volume of patients. This means hospitalized patients often stay with us longer than necessary because beds aren’t available at facilities with a lower and less expensive level of care.

Hospitals are the safety net that catches people when they need these types of services and can’t receive them in other places. Yet, the holes in our net keep getting wider and more difficult to fill.

We are working vigorously to address these problems. Our voluntary turnover rate has decreased to 1.4% in March and thanks to an aggressive recruiting effort, our number of open positions is the lowest it has been in many months. We currently have 792 open positions and 232 candidates in the process of being hired. In addition, St. Charles has launched several programs to train our own health care workforce including a nurse residency program, a certified nursing assistant training program and a medical assistant training program.

We are actively implementing ideas to increase revenue and reduce expenses with a goal of minimizing the impact to our workforce and the services we provide.

I have the utmost confidence in our incredible team of caregivers. We will get through this next phase of the pandemic just as we have the past two years – by working together.

Sincerely,
Joe

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Update: The St. Charles Foundation has pledged another $5,000 to help cover the cost of shipping medical supplies to benefit Ukraine and has set up a fund to receive donations from the public. If you'd like to support the effort by donating, visit the Foundation's website and choose "Ukraine Medical Supply Support" from the drop-down menu.


Thanks to a multi-department effort spearheaded by two anesthesiologists, a steady stream of needed medical supplies has been flowing from St. Charles Bend to people in war-torn Ukraine for the past several weeks.

And there is no end in sight.

“This thing has kind of snowballed into something that’s bigger than I expected,” said Dr. Evan Sutton, who is overseeing the effort alongside Dr. Holly Graham, his colleague from the Bend Anesthesiology Group.

Sutton was inspired to start collecting donations by a physician friend who practices in Indiana, but is from Ukraine and still has family there. She is involved with a number of different organizations that are working to provide assistance to the Ukrainian people during the Russian invasion.

“She reached out to several of our friends and colleagues and asked us to consider helping the cause, and I immediately wanted to contribute,” Sutton said. “But I thought that instead of just giving money, maybe there’s something I can do that would be a little bigger and would get more people involved here in Central Oregon.”

Sutton’s idea: To collect unused medical supplies that are typically flagged for donation or disposal, package them up and ship them to the Ukrainian Medical Association of North America, which is gathering similar donations from across the country and distributing them in Ukraine. He worked with Graham and leaders from the anesthesiology group and St. Charles to bring the idea to life, and pretty soon, word of the effort was spreading, he said. Donations came in from the hospital’s Perioperative unit, the Family Birthing Center and beyond, including the Pharmacy, which donated medications that are due to expire and thus cannot be used in the United States, but can be used in a humanitarian crisis.

“There are several different departments involved now, so I think this is going to be an ongoing process,” Sutton said. “Hopefully, we can send supplies out weekly.”

It is not free to ship things across the country, of course, but the group got help on that aspect, too. Home Depot in Bend donated cardboard boxes, and the St. Charles Foundation has pledged up to $5,000 to cover shipping costs, Sutton said.

Helping the cause aligns nicely with St. Charles’ vision of creating America’s healthiest community, together, said Carlos Salcedo, manager of community partnerships for St. Charles.

“Our caregivers are a part of this community and this is something they’re very passionate about. You can tell because it’s been a grassroots effort; this wasn’t something they were prompted to do,” he said. “Giving to people and helping others is good for our health and it’s empowering, because it makes us feel like we have the ability to help from the other side of the world.”

So far, the help has totaled more than 20 boxes and about 450 pounds of supplies, Sutton said, with another large shipment planned for this weekend. In the meantime, the effort is spreading to other St. Charles campuses – caregivers in Redmond are now collecting items to send to Ukraine – and donations are piling up along a wall in a physicians’ lounge at St. Charles Bend.

“I’m just really humbled and honored to be a part of something like this,” Sutton said. “It’s been really cool to see a bunch of people want to participate, and it feels great to be able to help out in any way we can.”

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Months into the COVID-19 pandemic, St. Charles’ Clinical Practice and Professional Development department realized hundreds of caregivers’ CPR certification was due to expire—but in-person classroom learning wasn’t an option.

Without an updated CPR certification, caregivers can’t work on the floor. CPPD had to innovate, and fast.

“What we realized is that if we didn’t do that in about three or four months, we would have 1,000 caregivers—or we could possibly—that we would have to certify,” said Kelly Miller, a nurse educator.

The solution was a novel “high-frequency, low-dose approach” to CPR training that has boosted caregivers’ confidence administering CPR, saved the organization money and just last week earned it an award from the American Heart Association.

Miller said opportunity knocked when the AHA’s Resuscitation Quality Improvement Program (RQI) offered to partner with the health system, making its groundbreaking model for CPR training available at no cost during the pandemic.

Whereas the traditional model for CPR certification is to offer hours of in-person training in a classroom once every two years, the RQI program keeps caregivers’ certifications active by offering them short bursts of online education and hands-on practice using carts placed throughout the hospitals. And because the training happens quarterly, caregivers’ skills stay sharp.

“It’s … taking education to caregivers at the bedside,” Miller said. “You can’t beat that kind of training and that’s the way things are moving.”

The program is a win-win-win, she said: It helps caregivers feel more confident administering CPR, which when combined with defibrillation, is still the most effective way to revive a patient in cardiac arrest; it improves the survival rate of patients who experience cardiac arrest in a hospital, and it saves St. Charles about $1 million annually.

That estimated savings, Miller said, is based on how much money it costs to pull a caregiver off the floor for a four- to eight-hour CPR class, the cost of the CPR instructor and the cost to replace the caregiver on the floor.

“So, we delivered the best, evidence-based practice, helping the outcome of patients—(improving) survival rates—and we did it saving resources,” she said. “Til’ this day I have passion for it, no matter what. I just think it’s one of the best things AHA has ever done.”

St. Charles’ implementation of the program has been so successful that it recently earned RQI’s Lighthouse award for collaboratively demonstrating best practices with RQI Solutions.

The award recognizes hospital systems that “advocate for quality and culture of resuscitation excellence that serves as a beacon to other organizations looking to improve their resuscitation programs and patient outcomes.”

For Miller, it’s all about taking the best care of patients.

“I just appreciate St. Charles for seeing the power in the evidence and realizing how it could impact our community.”

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Quinoa Risotto

This vegetarian dish is both healthy and comforting.

Ingredients

4 oz. fresh mushrooms (any variety), trimmed and coarsely chopped
1 cup asparagus cut diagonally 1/2 inch
Kosher salt
1 medium clove garlic, finely chopped
Freshly ground black pepper
2 Tbsp. olive oil
2 cups quinoa, preferably white, well rinsed
1/2 cup dry white wine
4 cups low-sodium vegetable or chicken broth; more as needed
1/2 cup finely grated Parmigiano-Reggiano
1 cup baby arugula leaves
1 Tbsp. fresh thyme

Directions

Heat the butter in a 10-inch skillet over medium heat. Add the mushrooms, season lightly with salt, and cook, stirring occasionally, until lightly browned, about 2 minutes. Add the garlic, and cook, stirring occasionally, until the garlic is soft, about 1 minute.

Add the quinoa and cook, stirring, until the quinoa dries and begins to "pop" a little, about 2 minutes. Add the wine and cook, stirring, until absorbed, about 30 seconds. Add the broth, cover, turn the heat down to medium low, and cook until the quinoa is tender and the liquid is mothly absorbed, 10 to 15 minutes.

Stir in the cheese. When it is incorporated, add thyme and arugula, season with salt and pepper. When the arugula begins to wilt, serve immediately.

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Anyone aged 12 and younger may participate.

To enter, simply download and print the coloring sheet below, add your own artistic and creative talent to it, then take a photo of the finished product and email it to [email protected].

Please note: By submitting an entry for the contest, you're giving permission to share the artwork, the child's first name and their age on our social media channels Facebook, LinkedIn, Instagram and Twitter.

Deadline is Friday, April 15. Winner will be selected on Sunday, April 17.

Prize: Goodie bag with toys and special treats.

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Grand Rounds - Apr. 8, 2022
"Benzodiazepines - How They Work & How to Withdraw"

Speaker: Michael Levine, MD. University of California, Los Angeles.

 

 

Objectives

  1. Follow recommendations on CURES website for benzodiazepine prescribing.
  2. Manage the goals and limitations of benzodiazepine therapy with the patient, including the meaning of physical dependence and its implications.
  3. Recognize signs and symptoms of withdrawal.
  4. Implement validated clinical tools to assess and treat patients with these withdrawal symptoms and know when to refer.
  5. Utilize information relative to culture, age, and socioeconomics in indications and prescribing of benzodiazepines.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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St. Charles’ hospital visitor policy changes next week

Starting Monday, April 4, St. Charles’ hospitals will no longer require visitors to show proof of vaccination, though wearing a mask will still be mandatory.

Signage posted at hospital entrances will encourage some visitors to leave, including those who have respiratory symptoms, have a pending COVID-19 test or who have been in contact with a known or suspected COVID-19 case in the last 14 days. Visitor screening does not apply to those seeking medical treatment or COVID-19 testing.

Additionally, all patients—including those who are positive for COVID-19—will be allowed two visitors at a time, who may come and go from the hospital as needed. The exception is the Emergency Department, where only one visitor will be allowed.

In some cases, visitors may be required to wear additional personal protective equipment for their safety.

“Two years ago, we instituted visitor restrictions to keep our caregivers and patients safe,” said Debbie Robinson, chief nursing officer, St. Charles Bend Campus. “We’re in a different place now. The number of COVID-19 cases and hospitalizations are low in our community, and we have vaccines and many effective treatments available.”

Door screeners will continue to be posted at hospital entrances through April 8 to help educate the community as this transition takes place.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, La Pine, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,600 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

 

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St. Charles Prineville closing COVID-19 drive-through test site Thursday, March 31

BEND, Ore. – St. Charles Prineville is closing its COVID-19 drive-through test site on Thursday, March 31. After that time, tests will be available at the St. Charles Prineville Urgent Care on a walk-in basis, or by appointment at St. Charles Prineville Family Care.

St. Charles’ labs in Bend, La Pine, Madras and Redmond also offer COVID-19 testing, but a lab order is required.

COVID-19 testing is only available to those individuals who are symptomatic or who are scheduled for a procedure.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, La Pine, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,600 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

 

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Grand Rounds - Mar. 25, 2022
"Sleep Disorders"

Speaker: Natalia Usatii, MD. Medical Director of Sleep Medicine Clinics in Bend and Redmond, St. Charles Medical Group.

 

 

Objectives

  1. Discuss and overview the most common sleep disorders.
  2. Identify who and when a patient would require a formal sleep consultation and/or a sleep test.
  3. Review diagnostic approach for sleep disorders in pediatrics.
  4. Review management of adult and pediatric sleep disorders.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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