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Grand Rounds - March 20, 2020
"The Ethics of Dialogue and Communication in Health Care: Lessons Learned from A Street Medicine Program in Portland Oregon"

Speakers: 

  • Drew Grabham, LCSW - OSHU
  • Sara Weith, RN - OHSU
  • William Toepper, MD
  • Anna Solotskaya, MD - OHSU

Objectives:

  1. Review the policy decisions that have led to increased homelessness: how did we get here?
  2. Review the importance of social determinants of health.
  3. Illustrate the role of adverse child and traumatic events in the management of the "difficult patient."
  4. Description of street medicine as an alternative approach for healthcare delivery.
  5. Provide the argument that street medicine helps restore the humanity of the healthcare provider and thus improves healthcare delivery for all.

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association 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.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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FOR IMMEDIATE RELEASE   |   March 27, 2020

St. Charles asks for public’s help with donating personal protective equipment

BEND, Ore. – St. Charles Health System is continuing to ask for the public’s help with donations of much-needed personal protective equipment (PPE).

Hospitals around the country are facing critical shortages of such supplies due to COVID-19 pandemic-related interruptions in manufacturing and distribution as well as a dramatic increase in global demand. As a result, St. Charles is actively working to both conserve and to acquire more protective equipment for its caregivers and patients.

“Our supplies are running critically low and there doesn’t appear to be much relief in sight. Our vendors are unable to deliver on our orders and the state’s stockpile is depleted,” said Iman Simmons, chief operating officer. “We are taking advantage of every opportunity we have to safely conserve PPE. But there’s simply no getting around the fact that we need more supplies—and we need them soon.”

Specifically, St. Charles is seeking the following:

  • N95 masks
  • NIOSH-approved respirators, including:
    • N95, N99, N100
    • P95, P99, P100
    • R95, R99, R10
  • Any type of surgical mask, including pediatric ear loop masks
  • Isolation gowns
  • Nitrile exam gloves
  • Hand sanitizer (any brand is fine, but cannot have glitter)
  • Rubbing alcohol
  • Pure aloe vera gel
  • Lactated ringers
  • Medical face shields

Full boxes of these items are preferable, but partial boxes can be accepted if clean.

“We are thankful for our incredible community partners in education who are helping to get the word out and managing drop-off locations for these critical supplies,” Simmons said.

Please do not take donations to St. Charles hospitals or clinics. Starting Saturday, March 28, donations can be dropped during specified hours at the following sites:

Bend area

Albertsons North
1800 N.E. Third Street
Donations accepted during store hours

Albertsons South
61155 S. Highway 97
Donations accepted during store hours

Sisters area

St. Charles Family Care
630 N. Arrowleaf Trail
Donations accepted Monday to Friday, 8 a.m.-noon and 1 p.m.-5 p.m.

Prineville area

Wagner's Market
930 N. Main Street
Donations accepted during store hours

Redmond area

Logan's Market
900 S.W. 23rd St.
Donations accepted during store hours

Madras area

Erickson's Thriftway
561 S.W. Fourth Street
Donations accepted during store hours

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, 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 4,200 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 limits outpatient visits; Community Pharmacy encouraging use of other pharmacies

BEND, Ore. — St. Charles Medical Group is joining many partner health care clinics in the region in canceling or delaying preventive and routine outpatient visits for those patients that are stable. The goal is to encourage patients to stay home unless they are sick.

“This is a critical moment in the evolution of the growing COVID-19 outbreak and we need to do our part to encourage social distancing. Keeping patients out of our facilities if they don’t truly need to be here is an important step,” said Dr. Doug Merrill, chief medical officer for St. Charles Bend and Redmond. “We greatly appreciate the support of our partner medical providers in the region who are doing the same and joining us in this effort.”

Community Pharmacy asks for public’s help

Because of the pharmacy’s limited capacity in its temporary, outdoor location at St. Charles Bend, it must focus first on filling prescriptions for caregivers and patients who are being discharged from hospitals.

Those who have the ability to move their prescription pick-up to a different outpatient pharmacy are encouraged to do so. The pharmacy looks forward to serving the entire community again 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, 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 4,200 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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The arrival of COVID-19 in Central Oregon has already forced us to make some tough decisions at St. Charles. And we are not done making them. More are coming as more COVID-19 cases are discovered in our region.

Here’s the good news: We have the right people making these decisions. They are smart, experienced and dedicated to the well-being of the communities we serve. They’re also prepared. As I told you in my last message, we’ve been planning for this outbreak for months.

Right now, our most urgent priority is keeping our frontline caregivers healthy and our facilities safe and functioning so we can deal with COVID-19 cases, as well as all the people who come to us with other medical issues. We need to continue to care for all, including pregnant women, trauma patients and people with cancer or heart disease. Those things will not stop because there’s a global pandemic.

Protecting our health care resources is very much at the heart of some of our recent decisions:

Visitor restrictions
Simply put, we cannot allow most visitors to St. Charles hospitals at this time. It is crucial that we limit who is entering our facilities, for both the safety of the people working inside and for the health of our community.

There are a few exceptions. But for the foreseeable future, we must tightly enforce these restrictions, including our new rule that no visitors below age 12 be allowed on premises and that no visitors will be allowed for patients in isolation for infection prevention.

If you have a loved one at a St. Charles hospital, we understand you may have a very strong desire to come see them in person. For now, please use the telephone or video to call them. Our caregivers can help get them connected to our Wi-Fi if needed.

Elective surgeries
All elective surgeries and other select non-urgent outpatient services have been postponed through March 28 to free up as much space as possible in our facilities and to preserve critical supplies in case there is a surge of COVID-19 patients.

We understand this decision will cause inconvenience and frustration for people whose surgeries and services must be rescheduled. Please know we’re doing it to protect you and your loved ones, and we certainly wouldn’t take this step if we didn’t think it was an important part of our preparedness plan.

Patients impacted by this decision will be contacted by St. Charles or their physician to discuss next steps.

Testing
The swabs we use to test for COVID-19 are running very low throughout the state of Oregon, and we believe it is unlikely that we’ll be able to get more. Therefore, we simply cannot test people who are worried but feel fine.

This is important to remember: If you have symptoms of COVID-19 (cough, fever, shortness of breath) but you are not so sick you need hospitalization, the best thing you can do is stay home and call your primary care physician or your county’s public health department.

That brings me to a term that may be new to you: social distancing. Not only do we need you to stay away from St. Charles unless you are a patient in need of hospitalization, we need you to stay away from each other. Social distancing means staying away from each other, especially by avoiding public gatherings and public places.

This is not a joke. It’s not “just a suggestion.” Social distancing is the one thing that experts say will help the most in combating the spread of COVID-19. If we can slow the spread of the disease through social distancing, then we can reduce its impact on our community and our health care system. If we don’t slow COVID-19, we face the very real risk of our facilities filling up, our staff being overwhelmed and our supplies running out. That is the disturbing scenario playing out in some areas of Europe right now, and we want to do everything we can to avoid it here.

To be clear, you can still do things like going outside, enjoying nature, playing board games with your family and video chatting with friends. But we need you to avoid public gatherings and public places for the time being so we’re able to care for those in our community who are sickest and need us most.

As I’m sure you know by now, this public health situation is evolving not just daily, but hourly, and we need everyone’s help in managing it. Truly, we are all in this together.

Sincerely,
Joe

P.S. We made another video of things you should know about this rapidly evolving situation, this time with Dr. Doug Merrill, our chief medical officer for St. Charles Bend and Redmond. I hope you'll watch it.

Note: Replies to this message will go to a general St. Charles email address. That address is being monitored for frequently asked questions and, if appropriate, answers will be provided in a future communication.

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FOR IMMEDIATE RELEASE   |   March 16, 2020

St. Charles proactively takes additional steps in response to COVID-19  

BEND, Ore. – In response to the COVID-19, St. Charles Health System is proactively taking a number of steps this week to protect its caregivers and patients, to preserve medical supplies and to prepare for a surge of patients.

Protecting caregivers and patients

  • The Community Pharmacy at St. Charles Bend is now offering drive-up service. Starting today, from 11 a.m. to 6 p.m., Emergency Department patients, community members and caregivers will be able to pick up their prescriptions at an RV trailer located behind the triage tent outside of the Emergency Department. (Prescriptions for discharging patients will continue to be picked up at the Community Pharmacy inside the hospital.)
  • St. Charles Outpatient Rehabilitation has closed its services and canceled appointment for two weeks. The goal is to reduce the number of people visiting facilities in order to reduce the potential spread of COVID-19. Patients will be notified of the cancelations by the Rehab team.
  • Visitor restrictions in effect. Simply put, visitors are not allowed at the four hospitals save for a few exceptions. Read more about visitor restrictions here.
  • Caregivers are entering St. Charles Bend through access control points. The health system is requiring all caregivers and providers to enter the Bend hospital through the Family Birthing Center/Medical Diagnostic Unit entrance on the south part of the campus where they are being screened for fever and cough.
  • All four hospitals are starting to use external triage tents. The Bend hospital is now triaging patients outside the Emergency Departments, and other campuses will begin shortly.

Preserving supplies

In response to a growing nationwide shortage of medical supplies, including personal protective gear like masks, as well as nasopharyngeal swabs, which are used to collect samples to test for COVID-19 and other respiratory viruses, the health system has changed its criteria for testing.

In order to be tested, a patient must have a fever above 100.4 within the past 24 hours, a cough, shortness of breath AND one of the following:

  • Age greater than 60 years, or
  • Immunosuppressed or
  • A chronic disease of one of the following:
    • Cardiovascular system, or
    • Pulmonary system, or
    • Diabetes Mellitus

Preparing for a surge of patients

In anticipation of an influx of patients, the health system is making some significant changes to how and where patients are cared for in our communities. To best manage patient flow across the system, the following will occur starting this week:

  • High-acuity patients, as well as all pediatric patients, will be cared for at the Bend hospital.
  • Lower-acuity patients will be cared for at the Madras, Prineville and Redmond hospitals. This will include hospice patients, as well as patients who need long-term care but cannot be transferred to a skilled nursing facility.

All four hospitals have begun to evaluate their patient counts and identify which patients may need to be transferred to another St. Charles facility. These changes are being made proactively to ensure there are adequate beds in the event of a patient surge.

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, 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 4,200 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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FOR IMMEDIATE RELEASE   |   March 13, 2020

St. Charles implements restricted visitor policy and entrance screenings, and postpones elective procedures for two weeks

BEND, Ore. – To protect patients and caregivers and to preserve critical safety supplies, St. Charles Health System is adopting significant changes in both visitor restrictions and care guidelines at all of its hospitals.

“This is a difficult decision, but for the health of our community and all those who need to be present in the hospital, we have made the tough decision to limit access,” said Aaron Adams, president of the Bend and Redmond hospitals.

As an alternative to visiting a family member or friend at a St. Charles facility, please telephone or video call them.

Unless an exception below is satisfied, visitation will not be permitted starting Saturday, March 14, and will continue for the foreseeable future. For safety considerations, no visitors below age 12 will be allowed on premises. Further, no visitors will be allowed to visit patients in isolation for infection prevention. 

Exceptions:

  • Obstetric, Neonatal Intensive Care Unit (NICU) and pediatric patients may have one visitor accompany them.
  • Patients who are at end of life may have one visitor at a time.
  • Patients undergoing surgery or procedures may have one visitor who must leave the hospital as soon as patient recovery is complete.
  • Patients who have an appointment at a St. Charles clinic, laboratory, radiology, or who are seeking care in the Emergency Department, may have one person with them if required for physical or mental assistance.
  • Case-by-case exceptions will be considered by the unit’s nurse manager based upon unusual circumstances. 

Guests who meet one of these exceptions will be allowed inside the hospital, but are restricted to the patient’s room and direct travel to and from the patient’s room and hospital entrances/exits, unless clinically required diversions are necessary, such as to the pharmacy to pick up a prescription. 

Entrance screenings:

St. Charles caregivers are performing respiratory illness screenings at the entrances of all St. Charles hospitals and clinics. Caregivers and approved visitors will be subject to these screenings by answering a series of questions. St. Charles hospitals will restrict visitor access to main entrances and Emergency Department entrances only. Caregivers will be asked to enter in an alternate designated entrance. 

Elective procedures:

Elective surgeries and other select non-urgent outpatient services will be postponed starting today for the next two weeks through March 28. Patients who are impacted by this decision will be contacted by the health system or their physician with additional details. We will review and revisit this decision as the situation with COVID-19 continues to evolve. 

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, 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 4,200 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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Visit our COVID-19 page

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Earlier today, Deschutes County announced the first presumptive positive case of COVID-19 in Central Oregon.

I know many of you are concerned about the spread of this disease, but I want to let you know that St. Charles Health System has been expecting this moment for many weeks, and we have been preparing for just as long. We are ready.

Our excellent hospitals, clinics and teams care for patients with infectious illnesses every single day, and they know exactly what to do. I have no doubt that this patient – like all of our patients – is receiving the best possible care.

Now, I have a few messages I want to pass along to you:

Stay calm and resist misinformation
COVID-19 is a new illness, and new illnesses often lead to fear and concern for some. The glut of information online – some accurate, some inaccurate – can increase anxiety.

When you seek information about the virus, look to credible sources like Deschutes County Health Services and the Oregon Health Authority. I assure you the officials at both of those organizations are committed to keeping the public safe, healthy and informed. You can also find links to credible resources on our COVID-19 webpage.

And for those of you on social media, please resist the urge to speculate, share rumors or post misinformation. All of it makes it harder for the credible sources to cut through the clutter.

Unless you’re a patient seeking care, please avoid visiting St. Charles hospitals 
One of the threats presented by COVID-19 is the possibility of overwhelming our health care infrastructure. It is vitally important that we keep our hospitals functioning and our caregivers safe so they can take care of not only COVID-19 patients, but all the other people in our community with health issues.

As a result, this message is very simple: Do not go to a St. Charles hospital if you are not a patient with a reason to be there. This includes vendors, delivery services, business partners and other non-essential visitors. Even family members of current patients should consider whether now is the best time to visit. And if you are sick, please stay home and call your primary care physician or your local public health department to discuss your symptoms and next steps.

Signs and symptoms of COVID-19
After my last message, many of you wrote me to ask about the symptoms of this virus. They are pretty basic: fever, cough and shortness of breath. For more information, visit the symptoms page of the CDC’s website.

Lastly, we recently asked one of our physicians, Dr. Bob Pfister, to answer some of your most common COVID-19 questions. You can watch him do that in this video:

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Watch the press conference with Gov. Kate Brown, dated March 8, 2020.

 

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Our community is understandably concerned about the spread of COVID-19 disease, caused by a novel coronavirus. As the region’s safety net health care provider, St. Charles Health System is prepared to care for patients arriving with respiratory illnesses, including COVID-19.

It’s important to note that while Oregon has had 14 confirmed cases of COVID-19, there are currently no known cases in Crook, Deschutes or Jefferson counties. That doesn’t mean there is no risk, however, which is why St. Charles is working closely with local public health departments, the Oregon Health Authority and the federal Centers for Disease Control and Prevention to coordinate a regional response and contain the spread of the virus if it arrives in our communities.

What we’re doing now
St. Charles is working hard every day to be prepared.

Our patient access support specialists are asking symptom-screening and travel questions, and our caregivers are using that information to appropriately triage and isolate patients with respiratory symptoms.

Our health system has initiated its Hospital Incident Command Structure (or HICS as we call it), which is meeting daily to effectively manage our communications, logistics and planning efforts.

We’ve begun controlling access to our facilities to ensure the safety of our patients, visitors and caregivers. At each access point, we are requiring individuals to sanitize their hands, as well as put on a mask if they show up with a fever, cough or cold symptoms. Those who are visitors, and not patients seeking care, may be asked to leave.

We’re also part of the Central Oregon Emergency Information Network (COEIN), which has established a Joint Information Center where many local and state agencies (including us) are working alongside one another to deliver timely, accurate communication and debunk myths. If you’re not already following this group, I encourage you to do so.

We are taking these steps out of an abundance of caution and with the goal of being proactive in the protection of our community. As the situation with COVID-19 changes rapidly, our response will also evolve. As always, your safety and quality of care is at the forefront of all we do.

Helpful resources
We know you continue to have many questions, and our partners in public health have done a great job of putting together resources, including the Oregon Health Authority’s COVID-19: Frequently Asked Questions.

Up-to-date information is also available here:

I know it’s not high-tech, but the best way for all of us to prevent the spread of the new virus is the same as we prevent the spread of influenza and other viruses: Wash your hands, cover your coughs and stay home when you’re ill.

To stay informed about what we’re doing at St. Charles, keep an eye on our website or follow us on Facebook and Instagram.

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Grand Rounds - March 6, 2020
"Coordinated Care Organization 2.0
"

Speaker: Leslie Neugebauer

Objectives:

  1. Explaining the regional and state priorities and implications of CCO 2.0 for managing Medicaid over the next five years.

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association 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.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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