Grand Rounds - March 7, 2025
"The Human Touch: Enhancing Patient Experience Through a Culture of Belonging"

Speaker: Ian Jenkins, MD. SFHM Chair, Patient Safety Committee, Associate Professor of Medicine, Division of Hospital Medicine, UCSD School of Medicine.

Objectives

1. Utilize AIDET techniques to improve the patient experience and sense of belonging.
2. Implement empathetic listening rather than only focusing on tasks/problem-solving.
3. Review evidence relating patient experience with clinical outcomes.
4. Navigate barriers to communicate effectively.
5. Reflect on how patient care and outcomes is most affected by inadequate listening and communication and consider how implicit bias may impact appropriate care.

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].

St. Charles is committed to a team-based approach to your care. These providers are working together to help you get back to living the life you want to live:

Physiatrist

Your care will be directed by your physiatrist – a doctor who specializes in rehab medicine and treats a variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. The physiatrist will see you regularly to assess and adjust your individualized treatment plan and will coordinate consultations with specialists, all with the ultimate goal of helping you maximize your function and quality of life.

RN case manager

An RN case manager works with the physiatrist to ensure consulting specialists receive the information they need to provide you with the best possible care. They handle care coordination, follow-up appointments and referrals, can provide expertise on rehab nursing care and will meet with you to discuss your goals and discharge date. 

Rehab nurse

A rehab nurse will provide 24/7 nursing care during your stay in the hospital, including administration of medications, wound care, bowel and bladder management and managing chronic conditions. At the same time, your nurse will teach these skills to you and your caregivers to help you regain your independence and wellness.

Speech therapist or speech language pathologist

Our speech specialists will work with you on various aspects of cognition and communication, including remembering, paying attention, problem solving, understanding what you hear and read, expressing yourself verbally and in writing, and making your words sound clear. They will also work with you to improve chewing and swallowing if needed.

Occupational therapist

An occupational therapist will help prepare you for day-to-day activities at home, such as bathing, grooming, getting dressed, going to the bathroom and preparing food. That means working to improve your strength, body control, visual perception, hand-eye coordination and cognitive processes. They’ll also identify equipment needed for you to be successful.

Physical therapist

A physical therapist will work with you to increase your physical strength, balance and endurance. The goal: To get you back to standing and moving to the very best of your ability. They’ll also identify equipment needed to enhance your mobility and will provide guidance on using equipment like a walker or wheelchair.

Neuropsychologist

A neuropsychologist specializes in caring for people with brain injuries, strokes and other brain-related issues. They’ll work with other members of the care team to create a plan just for you — to help you think more clearly, manage your emotions and improve your overall quality of life. They’ll also give your family advice on how to best support you at home.

Social services specialist

A social services specialist will work with you and your family to support your transition home. They’ll order mobility and bathroom equipment you may need, set you up with home health therapies, connect you with community resources and assist with advanced directives. They’re your best point of contact for all things related to your discharge.

It’s official: The Center Orthopedic & Neurosurgical Care & Research — a longtime provider of orthopedic, neurosurgical, occupational and physiatric care in Central Oregon — is now a part of St. Charles Health System.

Its new name is the St. Charles Center for Orthopedics and Neurosurgery, and about 250 people who worked for The Center — including 27 physicians and 29 advanced practice providers — decided to join our team. They work in clinics in Bend, Redmond, Sisters, La Pine and John Day, and the surgeons among them provide surgical care at the Bend and Redmond hospitals, Cascade Surgicenter and Bend Surgery Center.

I want to thank those folks for their patience as we’ve worked through this complicated integration process. We are excited to have them on our team and are making every effort to make sure they feel welcome at St. Charles.

I also want to thank the many St. Charles caregivers who worked hard over the past few months to make this transition as seamless as possible. We are stronger today because of their efforts.

The history of The Center and of St. Charles are deeply intertwined. The Center physicians and providers have always been essential members of the St. Charles medical staff, and over the years many served in St. Charles leadership roles, including on the boards of St. Charles and the St. Charles Foundation. And yet this integration is still a big change for all of us — providers, employees and patients. I believe it was absolutely necessary. 

Over the past few years, Central Oregon experienced a rapid reduction in access to care across many different types of medicine, due in part to increasing costs to provide care and flat or declining reimbursements. The number of orthopedic, neurosurgery, physical medicine and rehabilitation providers in the region has decreased dramatically, making access to necessary care a significant burden for patients and their families.

The Center tried to fill care gaps as best they could, but as a stand-alone practice found it very difficult to recruit and retain providers at a pace fast enough to stabilize the service. Their leadership was concerned that without immediate financial support, more providers would leave the region, worsening the long delays patients are experiencing for care.

Like The Center, St. Charles is committed to providing the best possible care in the communities we serve. So, it made sense for us to step in and help shore up these critical services and ensure care remains locally owned and operated.

It’s the right thing to do, not just for St. Charles, but to ensure Central Oregonians continue to have access to a wide variety of health care services close to home.

As a patient or visitor, your experience should largely remain the same as it has been in recent years. You may notice a new sign on the building, but once inside, you can expect to encounter great people and receive great care.

That’s what we do here at St. Charles. As always, I’m proud to be a part of it.

Sincerely,
Steve

Today, St. Charles Health System announces that its integration with The Center Orthopedic & Neurosurgical Care is officially complete, helping to secure and stabilize access to orthopedic, neurosurgical, physical and rehabilitation medicine throughout Central Oregon. The Center is now part of St. Charles Health System and is operating under a new name – St. Charles Center for Orthopedics and Neurosurgery.

One primary goal of this integration is to restore and expand access to orthopedic care, addressing the significant reduction Central Oregonians have experienced over the past two years. Now that the integration is complete, the St. Charles team can turn its attention to recruiting additional providers in these specialty areas to serve the region and provide more access to care for patients.  

“Today we are celebrating this integration as securing and stabilizing a critical health care function for our region. We are thrilled that 27 physicians and 29 advanced practice providers will be part of the new St. Charles Center for Orthopedics and Neurosurgery,” said St. Charles President and CEO Dr. Steve Gordon. “We anticipate it will take some time for patients to see an improvement in access to orthopedic care as we work to recruit additional physicians to fill the gap in the community. Please be patient with us during this time of transition.”

Dr. Christopher Healy, former Board President of The Center, now Senior Medical Director, Orthopedics, Neurosurgery & Physiatry, has helped lead the transition.

“Leadership teams from both The Center and St. Charles have put forth a profound effort to help ensure a smooth transition. The former physicians and staff of The Center have been proud to provide excellent care to the Central Oregon community for several decades, and while the name is changing, our commitment to exceptional care remains. Without any loss of providers or staff with this transition, we look forward to maintaining and expanding services for our beloved region.”

All locations where The Center formally operated remain open under the St. Charles Center for Orthopedics and Neurosurgery name. The phone number for appointments remains the same at 541-382-3344. Patients with questions about appointments, billing or medical records can find information on our website. Teams answering the phones are expected to have high call volumes and appreciate understanding as they work to address each and every call.

Imaging

When you see a provider at the St. Charles Center for Orthopedics & Neurosurgery for pain or an injury, your exam will often start with questions to understand your medical history. After a thorough physical evaluation, your provider may order diagnostic imaging to evaluate and confirm the location of any damage that may be causing your symptoms. This may include:

• X-rays
• MRI (magnetic resonance imaging)
• CT (computed tomography)

MRI, or Magnetic Resonance Imaging, uses radio waves, magnets, and a computer to provide an in-depth look at your bones and tissues. Insurance approval is required prior to booking an appointment. Once we receive authorization, our staff will contact you to schedule your MRI.

The St. Charles Center offers MRI at our Neff Road and Medical Center Drive clinic locations in Bend. To learn more about what to expect, please watch this video.

Grand Rounds - February 21, 2025
"Management of Heart Failure"

Speaker: Reza Ardehali, MD, PhD. Professor and Chief of Cardiology, Baylor College of Medicine.

Objectives

1. Define heart failure.
2. Review expected clinical assessment findings for patients with heart failure.
3. Apply nonpharmacological therapies for the management of heart failure.
4. Examine expected outcomes for the therapeutic management of patients with heart failure.
5. Apply strategies to prevent and reduce readmissions effectively.
6. Communicate prevention strategies to patients and their families adequately, taking into consideration age, ethnicity, and comorbidities.

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].

St. Charles is bringing critical pediatric health care closer to home by now offering outpatient pediatric infusion and transfusion services within the inpatient pediatric unit at St. Charles Bend.

Families would previously have to travel to Portland or to specialists even further away to receive treatment as the St. Charles primary outpatient infusion center is unable to treat patients under the age of 18.

The new services were the result of the collaboration and dedication of the St. Charles pediatric teams. Dr. Suzanne Mendez, Clinical Division Director of Pediatrics for St. Charles, worked closely with outside care teams and specialists to bring these much-needed treatments to Central Oregon. Mendez and her team also worked to create greater awareness among local pediatricians and care teams about the availability of these services and to coordinate closely between a child’s primary care provider and specialty teams.

Available treatments include blood and platelet transfusions, iron infusions, enzyme therapies to slow disease progression and infusions for autoimmune diseases. These therapies cover a broad range of chronic medical conditions and autoimmune and genetic disorders and are essential for managing complex conditions and significantly improving quality of life.

"In collaboration with our outpatient providers, it is wonderful to have this Pediatric Infusion and Transfusion service right here in our community. Having access to these resources close to home makes a world of difference for families," Mendez said.

Foot and ankle specialists

At the St. Charles Center for Orthopedics & Neurosurgery, our orthopedic physicians are experienced in all facets of foot and ankle injuries and degenerative conditions. If you have a foot or ankle problem and are deciding which type of provider to see, read this blog about the difference between a podiatrist and an orthopedic surgeon. Treatments for foot and ankle problems can range from a simple change of footwear to surgical repair of damaged bones or tendons.

When to see a foot and ankle specialist

The foot and ankle are highly specialized structures that are integral to human locomotion. The combination of mobile and stable joints allows us to adapt to any surface form. By supporting the weight of your body, the feet undergo a lot of wear and tear in the course of a normal lifetime and the complex interaction of muscles, tendons, ligaments, nerves, and bones make this area highly susceptible to injuries.

When an injury occurs or these structures become weakened from chronic overuse or disease, it’s important to see a qualified orthopedic foot and ankle surgeon promptly to evaluate and treat the condition.

Schedule an appointment to explore what treatment path is right for you.

Six tips to maintain healthy feet

• Replace your shoes: Replace your walking or exercise shoes every six months or 500 miles – whichever comes first. This will help you avoid foot pain as your shoes begin to wear down and lose support.
• Maintain a healthy weight: Maintain a healthy weight by eating right and regular physical activity. Excess weight puts more pressure on your feet, which can lead to foot pain.
• Stretch your feet: Stretch out your feet, ankles, and lower legs before and after exercising to avoid injury. This can help avoid other injuries such as shin splints and stress fractures as well.
• Keep blood flowing: Keep the blood flowing to your feet to reduce circulation problems. Wiggle your toes, move your ankles, and avoid sitting with your legs crossed for long periods of time.
• Keep feet dry: Keep your feet dry. Wear socks that wick away moisture and let your feet breathe. Always dry your feet well after getting them wet, especially between the toes where fungal infections can develop.
• Trim toenails: Trim your toenails regularly and cut straight across the nail rather than into the corners – this is how ingrown toenails often develop.

Common conditions

Achilles Tendonitis

Ankle Fracture

Ankle Sprain

Anterior Tibialis Tendonitis

Bunions

Hallux Rigidus

Mallet, Hammer or Claw Toes

Neuroma

Peroneal Tendonitis

Plantar Fasciitis

Posterior Tibial Tendon Dysfunction

Posterior Tibialis Tendonitis

Treatments

Ankle Replacement

Knee specialists

Our specialty trained knee doctors at the St. Charles Center for Orthopedics & Neurosurgery are recognized leaders in the diagnosis and treatment of knee injuries and conditions. Offering each patient individual attention, our board-certified knee surgeons are able to offer a thorough diagnostic evaluation and a variety of effective treatment options – from minimally invasive techniques to advanced knee surgery.

From sprains to arthroscopic surgery to total knee replacement, the orthopedic surgeons at the St. Charles Center are ready to get you back to being your best.

When to see a knee specialist

Knee pain can be debilitating, affecting your ability to do everyday activities. It can be caused by overuse, traumatic injury, or a degenerative condition, such as arthritis. Patients with knee problems report symptoms such as:

• Unstable joint that is not able to support your weight when you walk or stand
• Numbness or pain in knee joint
• Popping or crunching sounds
• Swelling and stiffness
• Pain when extending leg

If you are experiencing any of these symptoms, it may be time to see one of our orthopedic surgeons. Treatment will first be approached from a nonsurgical standpoint. Should pain reach the point of disability for a patient and nonsurgical treatment is no longer effective, your doctor may recommend surgery to help restore function. Together you will discuss if surgery is right for you.

Common conditions

• Anterior Cruciate Ligament (ACL) Tear

• Arthritis of the Knee

• Arthroscopic Knee Surgery

• Medial Collateral Ligament (MCL) Injuries

• Meniscus Tear

• Total Knee Replacement

• Partial Knee Replacement

• Patella Fracture

• Patellar Tendon Tear

• Patellofemoral Pain (Runners Knee)

• Posterior Cruciate Ligament (PCL) Tear

• Quadriceps Tendon Tear

• Sinding-Larsen-Johansson Syndrome