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Grand Rounds - Jun 10, 2022
"Syncope: Evaluation and Management Update"

Speaker: Ann (Ania) C. Garlitski, MD, FACC, FHRS. Tufts Medical Center.

 

 

Objectives

  1. Apply Differential diagnosis of syncope.
  2. Identify benign vs malignant causes of syncope.
  3. Identify appropriate vs inappropriate testing.
  4. Review approaches to treatment.

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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Grand Rounds - Jun 3, 2022
"Congenital Syphilis"

Speakers: George A. Conway, MD, MPH, DABPM and Richard W. Fawcett, MD. Health Officers, Deschutes County.

 

 

Objectives

  1. Assess the recent increase in Syphilis incidence and its epidemiology.
  2. Identify risk assessment for Syphilis, and how to routinize this as part of one’s H&P.
  3. Apply laboratory screening for, and diagnosis of, persons with any stage of Syphilis.
  4. Prioritize Prevention of Congenital Syphilis (CS), and the importance of early identification of syphilis in women of childbearing age.

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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Grand Rounds - May 27, 2022
"Hemorrhagic Stroke Treatment Update"

Speaker: Jack Tzu‐Chieh Wang, MD, PhD. Instructor, Neurocritical Care, Stanford University Medical Center.

 

 

Objectives

  1. . Apply the latest research in treatment modalities for intracranial hemorrhages to improve patient care and outcomes.
  2. Recognize the importance of controlling risk factors for intracranial/subarachnoid hemorrhage, including hypertension.
  3. Apply proper direct oral anti-coagulants management.

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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For the second time, all four St. Charles hospital campuses have been recognized by the annual Healthcare Equality Index for their policies and practices related to the equity and inclusion of LGTBQ+ patients, visitors and employees.

The 2022 Healthcare Equality Index named St. Charles Bend, Madras, Prineville and Redmond each as a “Top Performer” in its annual report, which has been published by the Human Rights Campaign Foundation for the past 15 years. They are four of 251 health care providers nationwide to receive “Top Performer” designation.

The four St. Charles hospitals also made the list in 2020.

“At St. Charles, we are striving to create America’s healthiest community, together. And when we say ‘together,’ we mean together – with everyone having a seat at the table,” said St. Charles President and CEO Joe Sluka. “Across our health system and Central Oregon, we are committed to being a place where people feel welcome and accepted, whether they are receiving care or providing care. We still have work to do, but this recognition by the Healthcare Equality Index is evidence that we are on the right track.”

The HEI is a national benchmarking tool that evaluates and scores health care facilities on detailed criteria falling under four central pillars:

  • Foundational policies and training in LGBTQ+ patient-centered care
  • LGBTQ+ patient services and support
  • Employee benefits and policies
  • Patient and community engagement

Facilities are evaluated and scored on a scale of 100. Each of the four St. Charles hospitals received a score of 90 on the strength of their non-discrimination and staff training, their patient services and support and their employee benefits and policies.

Over the past few years, St. Charles has taken many steps to create an inclusive environment, including protecting LGBTQ+ caregivers and patients from discrimination in the workplace and in receiving care. Earlier this year, the health system hired a manager of caregiver inclusion and experience, Dr. Shilo Tippett, who oversees the organization’s work to establish and grow a culture of inclusion, diversity, equity and acceptance (IDEA).

Alongside the caregivers on St. Charles’ IDEA Council, Tippett is working on developing programs to educate managers and physicians on inclusivity, incorporating IDEA concepts into the health system’s orientation for new caregivers and annual education for all caregivers, and investing in IDEA training for key roles within the organization.

And in 2019, several members of St. Charles’ executive leadership group completed a three-part training on LGTBQ+ patient-centered care, while more than 350 caregivers went through the health system’s Sexual Orientation and Gender Identity Class.

“We’re doing more than just talking about this stuff,” Tippett said recently. “We’re taking action.”

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There is no sense in sugarcoating it: The past several days have been really tough.

We’ve been very open about the fact that St. Charles is facing significant financial challenges, and last week, we had to address those by doing something no organization wants to do: Reducing our workforce.

While we are heavy-hearted over the departure of our colleagues and grateful for their dedication to our community, it is important to remember that good work continues to happen at St. Charles.

One example of that work is recognized in the 2022 Healthcare Equality Index (HEI), an annual report that honors health systems for their policies and practices related to the equity and inclusion of LGTBQ+ patients, visitors and employees.

This year’s report names all of our hospitals – in Bend, Madras, Prineville and Redmond – as “Top Performers” with regard to our work to make St. Charles a welcoming and accepting place for LGBTQ+ people to both receive and provide care.

I’m very proud of this recognition, for a couple of reasons.

First of all, welcoming and accepting all people is simply the right thing to do. When we say St. Charles is committed to caring for all, we mean it.

Secondly, we didn’t make this list by talking about how important inclusion, diversity, equity and acceptance is at St. Charles. We made it by turning those priorities into action: We’ve held training for our medical staff, our leaders and our caregivers. We’ve updated our policies to protect LGBTQ+ caregivers and patients from discrimination. We’ve hired a dedicated caregiver to oversee this work. We’ve welcomed Nike’s vice president of global diversity and inclusion to our board of directors, and we are learning from him.

And to help celebrate LGBTQ+ Pride Month in June, St. Charles Foundation and the St. Charles IDEA (inclusion, diversity, equity, acceptance) Council are involved in Pride events in Bend and Prineville. We will also be flying the Progress Pride flag at our four hospitals, because we know it’s important to demonstrate our commitment to IDEA principles not only through action, but visibility in the community as well.

With all of that said, St. Charles’ appearance in the 2022 HEI doesn’t mean we have achieved our goal and are finished with this work. In fact, we can always do more, because we can always be more inclusive and more welcoming to our patients and caregivers.

It is work worth doing, and this recognition is evidence that St. Charles is willing to do it.

Thanks, as always, for reading, and for your support.

Sincerely,
Joe

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Grand Rounds - May 20, 2022
"Is There Such a Thing as Proper Pain Management?"

Speaker: Michael Bottros, MD. Clinical Operations & Medical Director of Pain Services, Associate Professor Division of Pain Management, Department of Anesthesiology, Keck School of Medicine of USC.

 

 

Objectives

  1. Integrate multidisciplinary approaches to pain management.
  2. Incorporate various drug classes used in multi-modal pain management..
  3. Utilize pain management physicians when appropriate.

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’ mounting financial challenges lead to workforce reductions 

Faced with skyrocketing contract labor, equipment and supply costs—and flat revenue—St. Charles Health System leadership has made the difficult decision to reduce its workforce. The reduction will impact 105 caregivers through layoffs. An additional 76 positions that are currently vacant have also been eliminated.  

The 105 layoffs—which will take place over the next three days—are targeted to mostly non-clinical areas where the organization found through a benchmark data review process that it has more staff than other health systems of a similar size.  

“For the past two years, our caregivers have taken on and conquered unprecedented challenges to care for our community, which is why it feels particularly unfair that we now find ourselves in this position,” said St. Charles President and CEO Joe Sluka. “While our financial situation isn’t unlike many other health systems around the country, this decision hurts. These are our people.” 

Even after taking aggressive steps to address its current financial challenges, which have included both reducing expenses and identifying revenue improvement opportunities, the health system hemorrhaged $21.8 million through April. Year to date, St. Charles is facing a –6.7% operating loss. 

The organization’s expenses and revenue began deteriorating in the spring of 2020, when its contract labor, equipment and supply costs began to soar at the same time it was forced to significantly reduce the number of surgeries it performed due to pandemic-related restrictions and the need to preserve bed capacity to care for critically ill COVID-19 patients. This imbalance persisted through 2021 as St. Charles experienced three significant surges of COVID-19 patients—at times operating up to 107% of its capacity—making it difficult to resume its pre-pandemic level of surgeries and other services. Further compounding St. Charles’ financial stress is the repayment of the more than $95 million in federal funds it received over the last two years to support its operations. 

Though the workforce changes the health system is making this week are projected to reduce its expenses by approximately $20 million annually, St. Charles will still end 2022 with a substantial operating loss. With a sustained focus on improving the efficiency of its operations, the organization is working toward achieving a positive operating margin by the end of 2023 or early in 2024.  

“It has taken two long years of the pandemic to get us into this situation,” Sluka said, “and it will take at least two years for us to get out of it. But we will. And we will continue to take excellent care of our community now and in the future.” 

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, La Pine, Madras, 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 4,500 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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Over the past two years, St. Charles caregivers have worked tirelessly to care for the people of Central Oregon when they needed it most: during a global pandemic – a public health crisis unprecedented in our lifetime.

They turned a parking lot into a COVID-19 testing site.

They converted an empty conference room into a community vaccine clinic.

They’ve taken care of the sickest COVID-19 patients in our hospitals and provided the latest treatments at our clinics.

Along the way, St. Charles – with support from the community – did everything we could to take care of our caregivers, so that they could take care of you.

All of that, of course, came at a price:

  • Our labor costs have skyrocketed, largely due to our need to bring in expensive contract clinical staff from other areas of the country to help us meet the community’s needs.
  • Equipment and supply costs have also increased, as they have in every industry.
  • Our surgery volumes have been down for two years, which means significantly decreased revenues.
  • Last but not least, we are now paying back federal pandemic relief funds to the tune of more than $1 million every week.

We’ve been working hard to reduce expenses for a few months, and those efforts have helped. But they are not enough to dig us out of this financial hole. We ended the month of April with a $21.8 million loss.

We are now at the point where we have to take additional action to ensure the long-term financial stability of the health system.

It pains me to tell you that we must reduce our workforce this week. We are eliminating 76 positions that were already vacant, but that isn’t enough. We are also reducing 105 positions that will result in layoffs.

First and foremost, that is not just a number. Those are our colleagues and our friends. We are grateful to them for their dedication to our community and we are saddened to see them go.

Over the past few weeks, we have gone through a thorough process in which we compared every area of our organization to industry benchmark standards.

Where we are out of line with those standards, we must make changes. In particular, many leadership positions are being eliminated to bring our structures into alignment with other health systems of our size.

These reductions are projected to reduce expenses by more than $20 million annually.

Still, we will likely end 2022 in the red. It has taken us two pandemic years to get us into this situation, and it will take at least two years for us to recover. And sadly, we are not alone. Organizations across Oregon and the country are facing similar financial challenges.

To the communities we serve, I want to reassure you of a few things:

  • We have a responsibility to ensure our community has access to high-quality health care and are focusing these reductions in mostly non-clinical areas to minimize the impact on patients.
  • We are still recruiting and hiring new caregivers to rebuild our workforce and reduce our need for expensive contract labor.
  • We are reviewing all of our service lines to ensure they are financially sustainable, which could result in additional changes.

While these decisions are incredibly difficult, we are making them because we are committed to becoming a more efficient health system that is well-equipped to continue what we’ve done for the past 104 years: Care for the people of Central Oregon.

As always, we greatly appreciate your support.

Sincerely,
Joe

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Grand Rounds - May 13, 2022
"Updates in Outpatient Diabetes Management: Standard Medications, Insulin, and New Therapies"

Speaker: Marilyn Tan, MD, FACE. Chief, Stanford Healthcare Endocrine Clinic; Clinical Associate Professor, Department of Medicine, Division of Endocrinology, Stanford University School of Medicine

 

 

Objectives

  1. Identify the importance of early diagnosis and treatment of diabetes.
  2. Discuss the updated guidelines and protocols for treating a patient with diabetes.
  3. Describe the new medications and their mechanism of action (MOA).
  4. Appropriately prescribe new medications when using combination therapy.
  5. Compare the safety and efficacy of diabetes therapies in patients with Type 2 Diabetes.
  6. Identify patients at higher risk of diabetes based on age, gender, ethnicity, and/or family history.

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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"I think St. Charles has evolved into a big organization compared to what it was 30 years ago, and we've had growing pains a couple of times. But I think right now we've definitely found a way to adapt to our growth. I think we've got nice people here that really enjoy what they're doing, and I I love that."

- Greg, manager of the Biomedical department, which takes care of all 15,000+ pieces of medical equipment used for patient care across the health system. Greg's 30th anniversary with St. Charles is this month.

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