A major investment in training Madras and Prineville nurses over the past three months means more patients in Jefferson and Crook counties can get the care they need closer to home rather than transferring to Bend, Redmond or beyond.

St. Charles spent nearly $500,000 to train nurses at the two hospitals, giving them the additional breadth of knowledge they need to provide the same level of care patients receive at Intermediate Care Units (IMCU) in Bend and Redmond. IMCUs serve as an essential link in the health system, taking care of people who don’t need the long-term critical care of an Intensive Care Unit, but who need a higher level of care than is typically available in a Medical Services unit.

To provide IMCU care, nurses need to have a robust understanding of things like administering heart medications and advanced life support techniques.

“The skill set has always been there,” says Dr. Maggie King, chief medical officer at St. Charles Prineville. “We just expanded it.”

As an example, a patient with Type 1 diabetes who is experiencing diabetic ketoacidosis – a serious condition caused by lack of insulin – requires an insulin drip and, often, an overnight stay. That’s a treatment typically provided in IMCUs.

Before the new training, patients with diabetic ketoacidosis in the Madras and Prineville areas had to be taken to Bend or Redmond. Now, those patients can stay at their local hospital to get the treatment they need, saving them a trip across Central Oregon and keeping them closer to friends, families and other resources.

And to be clear, it’s not just diabetics who benefit. Any patient who needs hospital care, but not ICU-level care, can stay closer to home.

“It’s been a wonderful thing for our community,” says Kassidy Apperson, a registered nurse at St. Charles Prineville who was in the first cohort of IMCU trainees last summer.

The training took place in Bend over the course of three months, beginning with classroom instruction and then hands-on learning in patient-care units, said Todd Shields, vice president and hospital administrator for Madras and Prineville. Another cohort is scheduled to start in February.

IMCU-level care started in Madras and Prineville in August. Since then, more than 40 patients who would’ve previously transferred have been treated in the two hospitals, Shields said. This not only saves the patients and their families the hassle of moving hospitals, he said, it also frees up ambulances and emergency workers, as each transfer removes them from service for about three hours. Finally, keeping these patients close to home reduces patient load for caregivers in Bend and Redmond, opening space for people local to those towns.

Nurses in Madras and Prineville have greatly benefited from the training, too. “(We’ve) really seen from the staff this level of pride,” King said. “There is a stronger sense of capability in keeping patients here and a push to care for them locally.”

For caregivers who are wholly dedicated to doing what’s best for their patients, that’s a great feeling, said Apperson.

“Being able to keep (them) in the community … has been so good for our patients,” she said. “It’s just awesome.”

To kick off a new year, I want to tell you about a project that we’re really excited about at St. Charles – a project that aims to make Central Oregon healthier, now and for generations to come.

It’s called the Three Sisters Rural Track Program, and it’s a collaborative effort between St. Charles and our partners at Mosaic Community Health, Indian Health Services in Warm Springs and Oregon Health & Science University in Portland. Together, we are building a rural medicine residency program that will create a pipeline of uniquely trained doctors to Central Oregon.

This program – the first graduate medical education program in the region – will significantly transform access to health care in Jefferson, Crook and Deschutes counties and beyond, especially in outlying rural areas.

Why does this matter? Because rural communities across the United States are facing a critical shortage of primary care doctors. This shortage can force patients to drive long distances for care or visit Emergency Departments with routine health concerns. Even worse, they may forego medical care altogether.

Central Oregon is not immune to this shortage. In the tri-county area, we are expecting a shortage of at least 100 primary care doctors by 2030.

Which is precisely why we’ve prioritized the Three Sisters program, and a team of St. Charles caregivers has been working hard to bring it to life. Starting in July, residents will spend one year training at OHSU, and then two subsequent years in residency in Madras. These residents will complete core training and elective training at St. Charles, Mosaic Community Health and Indian Health Services in Warm Springs, giving them culturally inclusive, full-spectrum training in family medicine.

And here’s the long-term effect: Studies show that roughly 55% of physicians stay and practice within a 100-mile radius of their residency program site. Bringing them to Central Oregon to train significantly increases the chance they’ll choose to remain here, put down roots here, serve patients here and increase access to health care here.

That’s why I’m excited about this program, and I hope I’ve stirred some excitement in you, too. This is important, and the future of health care in the region is an issue that should matter not just to St. Charles, but to every person who lives here.

The St. Charles Foundation is raising funds for the Three Sisters program right now. If you’d like to invest in the future of health care in Central Oregon, you can donate through the Foundation’s website. To learn more about how you can help, please contact Angela Saraceno at [email protected].

As always, thanks for reading.
Steve

A cancer treatment now available at St. Charles has the potential to transform cancer care for women in our community who have gynecologic cancer, according to Dr. Whitney Sumner, a radiation oncologist.

For some types of gynecologic cancers, like cervical cancer, treatment using external beam radiation can limit the delivery of an effective dose due to damage to surrounding tissues as it passes through the skin and surrounding organs to get to the tumor or area that requires treatment.

This newly available treatment, called brachytherapy, reduces that risk by providing radiation from INSIDE the body. This reduces possible damage to skin, and nearby organs – and provides even more effective targeted treatment. It’s able to treat right at the site of the tumor with minimal spread of dose, according to Sumner.

Sumner has been working with physicist Dan Nicewonger and a team at St. Charles to bring this new treatment to St. Charles for more than a year. In December the team was able to treat their first patient and already have several more on the schedule. Before brachytherapy was available at St. Charles, patients would often travel for treatment or choose to forego radiation treatment all together.

For some patients with endometrial cancer, brachytherapy alone is the recommended therapy to reduce the risk of local recurrence. “External beam radiation therapy is too aggressive of a therapy for some of these early-stage patients – a lot of patients would forego any therapy or have to travel to Portland,” said Sumner.

Currently, St. Charles Bend is able to provide brachytherapy treatment to patients experiencing endometrial cancer, cervical cancer and other gynecologic cancers.

Nicewonger explains because the radiation is delivered through a closed system hollow tube inserted into the patient’s body, the patient never touches anything radioactive.

The patient does not feel or hear anything from the radiation source during treatment.

The radiation dose is delivered from a tiny radioactive source material, smaller than a rice grain, that travels along the hollow tube. The physicians are able to shift the direction and location of the dose allowing targeted treatment within a millimeter in accuracy.

“It’s actually kind of simple – it goes along a path and is very predictable,” said Nicewonger.

In the future, Sumner and Nicewonger would like to see brachytherapy also offered to treat skin cancer, prostate cancer and potentially gastrointestinal cancers. But for now, they are just excited to begin making a meaningful difference in the lives of many patients.

Sumner expects that they will treat about 25-30 patients a year, with each of those patients requiring about three to five treatments.

“Our hope and long term goal is to optimize our process and build on our expertise to become a destination for brachytherapy,” said Sumner.

For Sumner, this profession was a natural calling. As someone who always loved math and science, but also wanted to help people directly – radiation oncology, and particularly brachytherapy, is a perfect fit.

“How often do you get to use math and physics that are so profoundly interesting, in a way that has a real impact on this person sitting in front of you?” said Sumner. “I love this work. It means we get to keep our Central Oregon patients closer to where they feel comfortable to get the care they need.”

An ICU nurse is never really off duty, even at 35,000 feet.

Dalania Gastineau was on a flight from Chicago to Seattle last fall when the St. Charles ICU nurse heard an announcement asking for doctors or nurses to assist with a medical emergency. Gastineau and Lana Charles, a Seattle trauma nurse who was also on the flight, leapt into action to treat a passenger who had briefly lost consciousness.

In a letter written by the patient’s wife, Dalania and Lana were praised for their swift response and cool heads.

“They both assessed the situation quickly and maintained complete control,” she wrote. “They shared several smiles and even managed to crack some jokes to alleviate some anxiety and ease our fears. Despite not having all the necessary supplies, they improvised and found a way to provide the care they wanted to give. My husband was able to rest comfortably for the remainder of the flight.”

For Gastineau, it was just another day of caring for those who need it - no matter the altitude.

“This family was gracious, kind, and wonderful, and I am so appreciative of the kindness and recognition they have shown me,” Gastineau said. “I truly love what I do. Helping others is in my heart and soul. I am just glad I was there and able to assist in their time of need.”

St. Charles, like most health systems across the country, started 2023 facing significant challenges. But as the year comes to a close, I’m incredibly proud of how far we’ve come and am genuinely enthusiastic about the future of your local, Central Oregon health care provider.

At the beginning of this year our recovery efforts were taking hold but we still didn’t have enough people. And health care simply doesn’t work without people to provide the services. So we focused even harder on rebuilding our workforce by putting more resources into retaining our caregivers and physicians and recruiting more good people into the organization. As I told you last month, we’ve seen remarkable improvement with more than 1,100 new people joining the St. Charles family in the past year.

We’ve always cared about the wellness of our caregivers, but we really wanted to reaffirm that commitment after everything we’ve been through. So we took a fresh look at all of the programs we offer to support our people and we found ways to expand behavioral health services, earned time off, wages and many other benefits.

A year ago our finances were poor, and we needed to improve them quickly to ensure this local, nonprofit organization is here for the next 100 years, just as we’ve been here for the past 100 years. So we also had to maintain laser focus on our financial recovery efforts and recruit everyone across the organization to help out by doing their part – no matter how big or small.

Even with all of these efforts going on, every day our focus remained on our patients. Together, we surpassed our people and our financial goals and provided amazing care throughout the year.

I want to take this opportunity to thank each and every person across our health system for their commitment to our patients and our communities. Because of them, I can tell you with confidence that our ability to provide essential services to Central Oregon is as strong as ever.

Thanks so much for reading this year. See you in 2024.

Sincerely,
Steve

A silver lining of the COVID-19 pandemic is now up and running in parts of the Bend and Redmond hospitals.

In 2020, the U.S. Food and Drug Administration approved the use of continuous glucose monitors (CGM) in hospitals to help reduce contact between patients and caregivers and preserve personal protective equipment during the early days of the pandemic.

When worn by people with diabetes, CGMs provide a more robust picture of blood sugar levels than point of care testing, or finger pricks, and have been shown at St. Charles and elsewhere to have life-changing effects on diabetics’ health. Before the 2020 decision, however, the devices were only approved for outpatient use in clinics and personal use.

Now, a group of hospital-based clinicians and administrators at St. Charles has launched a pilot program aimed at using CGMs in Bend’s Progressive Care Unit, Redmond’s Medical/Surgical unit and, soon, Bend’s Medical Unit. The pilot was funded in full by a generous grant from the St. Charles Foundation.

Treating diabetes is complicated, said Dr. James Dayton, a hospitalist at St. Charles, but the team’s goals are simple:

“Our goal with any patient with diabetes is to take the best care of them we can to keep their blood sugar at a safe level and to prevent severe hyperglycemia and all hypoglycemia,” he said. “Finger pricks only tell you your blood sugar at one moment at a time. They don’t give you a trend. Continuous glucose monitors take a reading every five minutes to give you a real-time look at glycemic level.”

He continued: “It’s like driving with a windshield that opens a few times a day and then closes as opposed to one that’s open all the time.”

The Dexcom continuous glucose monitors being piloted at St. Charles can show providers if blood sugar is rising or plummeting, how it reacts to doses of insulin, and if it follows a pattern after meals or during a certain part of the day. That kind of information is invaluable when caring for diabetic patients, said Dr. Matthew Wiest, a St. Charles hospitalist.

“This is the next step in the evolution of diabetic management in general, because it gives us so much more information to act upon,” Wiest said. “When you can see the trends you can adjust the medication much more accurately and ultimately treat the patient much more effectively.”

The team has developed an algorithm for caregivers to follow that is designed to help guide decision-making by outlining next steps. During the pilot, continuous monitoring will not replace point of care testing and will not reduce the number of finger pricks for patients, which typically happen multiple times per day.

Fewer finger pricks is a possibility in the future, however, said Don Jacobs, manager of the St. Charles Progressive Care Unit, which would reduce pain for patients and save nurses a significant amount of time. But the potential benefits of a fully implemented CGM program don’t stop at the bedside.

“Patients get to practice with a device in the hospital and learn how it works, giving them confidence to use it at home. And at home, they can teach a family member about it so they can rescue them if they’re having a glycemic event,” Jacobs said. “And the hope is that if they continue to use it correctly that they won’t be readmitted because they’ll be able to see when they’re going in the wrong direction and treat themselves.”

Jacobs and Kelly Ornberg, St. Charles’ manager of clinical nutrition and diabetes education, have been working on adapting outpatient-focused technology for inpatient use. If they are able to demonstrate the value of CGMs to patients, caregivers and providers, they hope to expand and improve the program.

“The way it’s set up works really well in an outpatient setting,” Ornberg said. “The logistics of making it work well on the inpatient side is trickier (but this can be) another really great tool in our tool box and I think it’s really fascinating to see what’s going to happen for both patients and providers.”

Dayton, the hospitalist who has ordered more CGMs than any provider at St. Charles, has already seen the devices make a huge difference in the lives of some of his sickest patients. The pilot program, he said, will put St. Charles ahead of the curve when it comes to diabetic management.

“I think the writing is on the wall that … this is going to be the future of diabetes care at the hospital,” he said. “In terms of how we use them and how we make people comfortable with them, I would rather be ahead of the game than behind.”

They say a picture is worth a thousand words. Here’s a good one:

Now, let me provide a bit of context: The pandemic deeply impacted our workforce, just as it did businesses and health care organizations worldwide. We lost colleagues to COVID-related illness and death, many folks switched careers or left the workplace altogether, and the pipeline of new recruits all but dried up. By 2022, St. Charles was battling a significant workforce shortage that was hindering our ability to discharge patients and causing serious capacity concerns in our hospitals and clinics.

This trend started to stabilize last year, but as recently as 12 months ago, as you can see, we weren’t yet rebuilding. Last December, the health system saw two more people leave the organization (62) than we hired (60). Not good, and certainly not good enough to replenish our ranks and restore our teams and our culture.

Since then, we have significantly bolstered our retention and recruitment efforts, and the graph above shows that those measures are steadily paying off. October was our best month yet, with 132 caregivers hired and 37 departures. This is what rebuilding a workforce looks like.

The difference between those numbers – 95 more hires than departures in October – is the highest it has been in a year. Year to date, our number of voluntary departures and our number of new hires are vastly improved compared with during the pandemic.

Over the past year our overall vacancy rate has dropped steadily, from nearly 20% in January to 14% in October – again, our lowest number in the past year. We’ll never get to zero — some level of turnover is healthy — but we are back to pre-pandemic baselines and our pipeline of candidates remains strong.

How are we doing it? There is no simple answer, but factors include our health system’s re-commitment to building a great work culture, supporting our supervisors and managers, our recent expansion of behavioral health benefits for caregivers, our robust education and career-advancement programs and, of course, wage increases we implemented earlier this year. It also helps that, for most people, getting a job with St. Charles means getting to live and work in wonderful Central Oregon.

When we say our priority is our people at St. Charles, we mean it. The progress we are making with our workforce is proof that we back that belief up with action. And we take action because we know that to provide the best possible care for the communities we serve, we need world-class caregivers.

I am grateful to all of them – the new arrivals, the long-timers and everyone in between – for their tremendous work.

Sincerely,
Steve

The Bend hospital’s in-house program – known as Art in the Hospital, but dormant since before the COVID-19 pandemic – has been revived, thanks largely to the efforts of Lee Copeland, supervisor of guest services.

The current installation of wildlife photography can be viewed near the entrance to the cafeteria, where it wraps around toward the elevators on the hospital’s second floor.

With a goal of using local professional artists to create a cohesive program, Copeland visited area galleries and “looked at a lot of art,” she said. The first to accept her invitation to participate was Dawn Emerson, a Terrebonne artist whose art is displayed at the Peterson Contemporary Art gallery in Bend. She contributed pieces inspired by an article Emerson read about circuses no longer using elephants as part of their shows.

“Contemporary art isn't for everybody,” Copeland said, “but I know the bright colors were a welcome sight after years with blank walls.”

The latest installation features wildlife photography by Sue Dougherty of Off Leash Photography, a well-known former veterinarian in town who won the 2020 Audubon Award for Best Professional Photographer Picture. The theme is “fall/winter,” with photos taken in Alaska, British Columbia, Yellowstone National Park and Sunriver.

All the art is for sale, with contact information posted next to each piece, and there are also card packs and calendars of the art available in the Gift Store.

However the viewer engages with the art, Copeland believes the program can provide patients, visitors and caregivers with more than just something to look at as they move through the hospital.

“Whether you’re dealing with tragedy and loss, a stressful situation or just the everyday grind of life, seeing the beauty that can be created by humans is inspirational,” she said. “It's invigorating and is a catalyst to becoming your best self.”

Amanda Davis loves her job as a Certified Nursing Assistant (CNA) at St. Charles Madras, but has always been interested in the work that she saw the nurses doing. 

She frequently found herself wanting to be more hands-on in the patient care experience. Having also previously worked in hospice care and retirement homes, Davis had often experienced frustration at the limits to which she could help patients. 

“I wanted to be able to do more for my patients. I wanted to have the knowledge to explain things and work with the doctors to make sure (the patients) were comfortable and getting the best possible care. Getting into the CNA cohort fueled my drive to go further,” said Davis, 25. 

She hoped to complete her college prerequisites and then attend Central Oregon Community College's nursing program, but her life hit a rough patch. She struggled with housing and had to take a break from school without knowing how or when she would be able to continue paying tuition. She credits her manager Kelli Jo Hammack for informing her about all the resources St. Charles had for its employees, including a scholarship fund for employees through the St. Charles Foundation.

“I love Kelli Jo, I’ve never had any boss like her,” Davis said. “She supports everyone in what they want to do and will find ways to help. One day I was telling her that I was scared that I wouldn’t be able to pay for school, and she told me about the scholarship program and even wrote a recommendation letter for me.”

Davis quickly applied and was thrilled to be awarded a scholarship. Davis appreciated that the application, instead of focusing on numbers or basic yes/no questions, provided her with the chance to explain her circumstances and financial need.

“I don’t believe in taking money when I don’t really need it, but I definitely needed help with that," said Davis. “Something I love about St. Charles is the resources they have for their caregivers, and the support you can feel from management. You always have opportunities to train in other departments and grow to become more knowledgeable.”

Davis hopes to complete her nursing degree by 2027 and spend the first 5-10 years of her career getting experience in various fields like hospice, mental health and medical-surgery. She would like to eventually end up specializing in wound care, an area that she became passionate about in her job as a CNA. She also plans to spend her career at the Madras hospital, where she was born and where she spent many years volunteering as a child alongside her mother Angel Davis, who has also worked there for 30 years.

In the meantime, Davis keeps the letter announcing her scholarship pinned above her desk at home where she does her schoolwork. “I’m super grateful and thankful that I was able to get the scholarship and have that extra help to make sure I could afford to go to school. Maybe someone will read my story and be inspired to apply and follow their dreams too.”

Davis is one of 22 individuals receiving more than $55,000 in scholarships in 2023 from the St. Charles Foundation. The scholarship fund is one of many ways the organization helps support the health of Central Oregonians. Learn more about the efforts of the St. Charles Foundation.

I read a story today that warmed my heart.

It was about a St. Charles caregiver named Desiree, who works in our Prineville Family Care clinic, and her 12-year-old daughter Zoe, who was born with an aortic valve that didn’t quite work right.

Desiree always knew Zoe would need heart surgery someday, but a growth spurt accelerated that need to this past summer. The family learned in June that Zoe would need the procedure, and within days it was scheduled for mid-July.

That’s great from a care perspective. But for Desiree, it came with added stress: Not anticipating the surgery, she had used her available time off, and her situation didn’t qualify for family medical leave or short-term disability.

Suddenly, she found herself facing the prospect of a two-week stay with Zoe in Portland, and no paycheck to help cover the bills. For a moment, she thought she might have to choose between accompanying Zoe and paying her rent.

That’s where St. Charles Cares comes into the picture. A fund of the St. Charles Foundation, the Cares fund supports our caregivers who experience economic hardship and are unable to afford housing, utilities or other basic living needs because of circumstances beyond their control.

A colleague encouraged Desiree to apply for Cares funding, and she was awarded $1,500 to help cover her rent, reducing her bills and allowing her to take off work and be with her daughter in Portland, where she could focus on helping Zoe recover. (I’m happy to report that Zoe is doing great, by the way.)

St. Charles Cares distributes about $17,000 annually and is funded by donations from the community as well as our own caregivers, who give generously because they know their money will go to help one of their own when they need it most.

In fact, our annual internal fundraising campaign – Giving Together: One St. Charles – is underway as we speak. If you’d like to support our caregivers and their support of each other, you can do so on the Foundation’s website by using the drop-down menu to designate your donation for “Caregiver Support.”

It is this spirit – caring for each other as we care for the communities we serve – that makes St. Charles a special place. I’m incredibly proud to be a part of it.

Sincerely,
Steve