20 Important Advances at Top Local Hospitals & Clinics
Problem: Managing pain in kids is a particularly tricky proposition, given that younger children may have trouble communicating the extent of their pain (making both diagnosis and treatment difficult), and by the fact that many physicians are not trained in the latest methods on how to properly dose and medicate children.
New Approach: In 2013, Children’s Hospitals and Clinics of Minnesota launched the state’s only “no needless pain” initiative through its Pediatric Pain and Palliative Care program, which is one of the largest of its kind among children’s hospitals in North America. The initiative’s “Open Pain Policy” allows parents, patients, relatives, and nurses—not just physicians—to request a pain-team consult. The team, which may include physicians, nurses, pharmacists, psychologists, child-life specialists, integrative-medicine staff, and social workers, can suggest an array of conventional and alternative approaches to pain management, from guided imagery to patient-controlled analgesic medications. An array of additional options, including conscious-sedation methods and techniques to numb skin for blood draws and IV therapies, are specifically designed to prevent and diminish pain in children.
Payoff: Kids heal faster and more comfortably—and parents regain a bit of control over the health of their children.
Problem: Few health numbers are tracked more consistently than our blood pressure—nearly every office visit includes the arm-mashing procedure. Yet for all its ubiquity, getting an accurate reading is surprisingly elusive. Not only can the numbers spike when we’re sitting anxiously in the exam room, but the most accurate readings occur while asleep.
New Approach: Ambulatory Blood Pressure Monitoring (ABPM), a procedure that monitors patients’ blood pressure away from the office over the course of a 24-hour period, can assess blood pressure more accurately. Though this option is typically only available to those seeing a specialist, physicians at Abbott Northwestern General Medicine Associates in Edina began offering the service at their primary-care clinic in 2012.
Payoff: Of the thousand or so patients who have had their blood pressure monitored through ABPM at Abbott, 30 percent have had results that required an adjustment of their medication levels.
Problem: Doctors and patients may have the same overarching goal, but they often speak different languages. Patients who misunderstand doctors’ guidance can end up doing a serious disservice to their own health.
New Approach: The Mayo Clinic is one of a small number of hospitals nationwide where some doctors read clinical notes to patients at the end of a visit to ensure both parties are on the same page about care and next steps. A simple miscommunication about the seriousness of a condition, for example, might lead to patients being cavalier about adhering to their specific care instructions. Going through the notes helps prevent confusion.
Payoff: Though Mayo Clinic hasn’t yet collected data on its own outcomes, a 2012 study from hospitals in three cities with similar practices revealed that the vast majority of patients reported more control and understanding of their conditions, and 99 percent of patients thought this transparency was the right approach for medical care.
Problem: Strokes are common—but they’re also deviously complex. In rural areas and small towns, the right subspecialist may live hours away. That can be devastating in these critical situations when every second counts.
New Approach: The HealthEast Telestroke Program at St. Joseph’s in St. Paul, the first of its kind in Minnesota, links other small and medium-size HealthEast hospitals with St. Joseph’s stroke neurologists, who virtually monitor details and provide evaluation and treatment. Consulting neurologists communicate with patients through a live video feed, which allows them to run through a series of speech and motion assessments. The system also gives neurosurgeons a detailed look at CT scans.
Payoff: Stroke patients outside major cities don’t need to be immediately transferred to larger hospitals to get the best possible care.
Take One Tablet and Call Us In the Morning
You may have thought iPads were mainly for watching cat videos and playing all 425 levels of Candy Crush Saga, but the technology also is having a big impact on the medical care we receive.
For new moms: At St. Luke’s Birthing Center in Duluth, new moms and their families can check out iPads during their stay. Not only can the tablets be used to watch educational programming on breastfeeding and newborn care, but moms can use them to Skype faraway family members and friends who want a real-time look at the new bundle of joy. A pre-loaded white-noise app disguises hospital noise to help new moms rest.
For heart-failure patients: The CentraCare Heart & Vascular Center at St. Cloud Hospital is the first in the country to lend out iPads with specific applications to heart-failure patients. The application helps them monitor their symptoms and weight, and offers daily tips; it also has an alarm to remind patients to take their medication at specific times. According to Dona Bloch, a cardiology-practice nurse at CCHVC, the technology and software makes a difference. “[Heart-failure patients] need to make many lifestyle changes,” she says. “This helps them get positive feedback, and it also helps us know that they are compliant.”
For information junkies: Through Minnesota startup Clear.md, patients can get “vidscriptions”: short, single-topic videos from doctors about their specific conditions and concerns. The videos are designed to give reliable information to patients who can’t always take in the vast amounts of information given at a single doctor’s appointment and don’t want to depend on unreliable information from the Internet. North Memorial was the first hospital in the country to partner with Clear.md for the service.
Problem: Prostate cancer is the most common non-skin cancer in men, and treating it via surgery can be complicated, often leading to such complications as incontinence and a difficult recovery.
New Approach: At HealthEast Cancer Care at St. John’s Hospital, doctors combine human insight with a robot’s mechanical precision. The hospital’s da Vinci Surgical System uses sophisticated technology that’s guided by surgeons to minimize incisions, target tumors more accurately, and reduce post-operation recovery times. Numerous studies have found that the surgery leads to less blood loss, fewer complications, and shorter hospital stays.
Payoff: More than 2,000 patients have successfully undergone prostate-cancer surgery with da Vinci at St. John’s—more than any other hospital in Minnesota.
Problem: Young patients (and their parents) don’t always feel they get enough input in their care, which can lead to communication gaps with medical staff.
New Approach: My Story, a pilot program tested at the University of Minnesota Amplatz Children’s Hospital, is a series of customized, computerized forms that allows children to share information about their lives with caregivers in their own words. Details include everything from favorite toys and activities to what they want to be when they grow up.
Payoff: Since the project officially launched in 2012, surveys have found that kids are more likely to report that their doctors found ways to make the hospital feel like home and that they liked how the doctors took care of them. Parents add that doctors are significantly more likely to discuss medical information with their children in a way that kids understand.
Problem: Surgeons use literally hundreds of sponges during a surgery to soak up fluids as they work on complex cases. Despite manual tracking systems, a sponge or other implement is left in a patient once every 6,000 surgeries—with significant medical consequences.
New Approach: Mayo uses a sponge counter with scannable barcode technology (not unlike that used at grocery stores) to keep an accurate inventory. All sponges must be accounted for before a patient gets sewn back up.
Payoff: Since Mayo became an early adopter of the system in 2009, no sponges have been left inside any of its patients.
An App a Day Keeps the Doctor Away?
Doctors and hospitals are increasingly harnessing the power of apps for everything from scheduling appointments to dispensing medical advice. Few, however, are taking up the challenge with as much zeal as the Mayo Clinic, which has tapped into its vast systems and expertise to develop more than a dozen uniquely helpful apps to schedule appointments and learn more about medical conditions.
Patient (free): Schedule an appointment without ever being put on hold. Users can book a checkup and get secure access to personal health information online. The app also includes maps and directions, appointment guides, medication instructions—even entertainment near clinics.
Mayo Clinic on Pregnancy (free): Any soon-to-be mom knows that pregnancy inspires everyone—everyone—to offer unsolicited advice. But for those who prefer guidance founded on actual medical evidence, this app offers sound counsel on topics from nutrition to delivery every week of your pregnancy plus the first three months after childbirth.
AnxietyCoach by Mayo Clinic ($4.99): Developed by clinical psychologists, this app helps users zero in on their specific anxiety profiles, learn hundreds of techniques to tamp down fears, and build a personal plan to move forward.
Problem: Nearly one in 15 Americans suffers from sleep apnea, a condition in which the airway collapses during sleep, causing breathlessness for 10 seconds or more. The ramification is more than just daytime sleepiness, says North Memorial’s Jason Cornelius, MD. “Sleep apnea promotes serious health problems, like high blood pressure, abnormal heart rhythms, diabetes, heart attack, and stroke,” he adds. The solution doesn’t always feel like an improvement, either: a device that can help people breathe (called CPAP) can be intolerable for patients who find the mask component claustrophobic.
New Approach: North Memorial Sleep Health Center is one of just two hospitals statewide (the other is St. Cloud Hospital) that tested an implantable device (pictured at left), much like the design of a pacemaker, to treat sleep apnea. Patients turn on the device before bed with a remote control; during sleep, it stimulates a nerve for the tongue that keeps the airway open.
Payoff: Though the device is still awaiting FDA approval, preliminary results have been promising. According to Cornelius, who monitored patients during the study, many participants are enjoying newfound energy and alertness, which has benefited not only their health but also their personal and professional lives.
Problem: In-person fitness coaching and nutrition counseling is great—except when it requires hiring a babysitter or enduring an hourlong drive through traffic.
New Approach: Last year, Ways to Wellness at Woodwinds Health Campus became, to their knowledge, the first program in Minnesota to offer Skype fitness and nutrition coaching sessions. “People have a lot of barriers when it comes to taking care of themselves,” says Brenda Navin, director of health and wellness at the HealthEast Care System, of which Woodwinds is a member. “So we’ve tried to eliminate some of those barriers and make [our services] accessible to everyone.”
Payoff: Clients can do full-body workouts from home or the office, even if they don’t have a single piece of exercise equipment. Coaches can help assess form and adapt the routine.
Problem: Some cancerous tumors—especially those in the brain, lung, and prostate—are considered surgically complex or even inoperable, leaving patients with few good options.
New Approach: St. Joseph’s Hospital is one of just two Minnesota sites to offer the CyberKnife system (the Miller-Dwan Medical CyberKnife Center in Duluth is the other), a non-invasive procedure that trains targeted radiation beams onto tumors. They system’s sub-millimeter accuracy and ultrahigh dose of radiation destroys cancer cells.
Payoff: Not only does the surgery-free approach have the potential for fewer complications, but it may give new options for those who have been told their tumors are inoperable.
Rooms for Two
The new Mother Baby Center, a joint venture between Children’s Hospitals and Abbott Northwestern, isn’t just about high-tech pediatrics—it’s also about comfort for parents and their newborns.
Media: Flat-screen TVs, DVD players, iPod docks, and in-room WiFi for all those new-baby Facebook updates.
Convertible chairs/beds: So everyone in the family can get a little sleep.
Specialists at the ready: The building’s circular layout allows top specialists to be crib-side in seconds.
Spacious showers: Bathrooms feel more like they belong in a boutique hotel than a hospital.
Food: Starz Café is the country’s first restaurant at a children’s hospital to support local, sustainable food through the Healthy Food in Health Care pledge.
Babies and moms, together: The Special Care Nursery allows premature newborns to stay with their parents in a private patient room after mom is discharged, instead of a separate care area.
Better Health Beyond Medicine
Western medicine and alternative approaches historically have had an oil-and-water relationship: they haven’t mixed. But many hospitals are now looking beyond pharmaceutical fixes to practice a more holistic care strategy. “It’s easy for people to treat physical conditions,” says Courtney Jordan Baechler, vice president at the Penny George Institute for Health and Healing with Allina Health. “But we never want to forget about the connection that our mind and spirit play in our body’s ability to heal and stay well.” Here’s how some hospitals are using the best of both worlds to help patients get—and stay—healthy.
Creating calm before the storm: Optional, free pre-surgical coaching appointments at Abbott Northwestern Hospital through the Penny George Institute help nervous patients regain a sense of calm and control before surgery, which can cause stomach-churning anxiety. Barb Hopperstad, one of the integrative health and wellness coaches at the institute, spends up to an hour with patients, by phone or in person, to help them reframe their concerns, such as feeling helpless about their condition or finding child-care while they’re in the hospital. “I help make sure they’re consciously aware of their resources—such as a supportive family or church members who will cook meals for them—to help them get through this experience,” she says. “I want them to see that their own strengths, something as simple as a high tolerance for pain, can help give them a sense of control and help them have the best possible recovery.”
Sticking to it: The millennia-old practice of acupuncture is finding its way into an increasing number of hospitals and clinics. At Woodwinds Health Campus and through Allina’s Penny George Institute, acupuncture is a regular part of the healing process. Acupuncturists at Woodwinds HealthEast make daily rounds alongside medical staff. Under the guidance of the Penny George Institute, all patients who get joint replacements at Abbott Northwestern are referred for acupuncture. Acupuncture is also frequently used to help patients relax and sleep more soundly in the bustling hospital environment.
Healing through scent: At the Penny George Institute, Allina physicians and nurses are offered training in the uses of aromatherapy, which can be prescribed to patients in the same way as drugs. Patients who have undergone bowel surgery, for example, frequently experience nausea post-surgery. Ginger aromatherapy, which has been shown to diminish post-operative nausea, is often prescribed instead of traditional anti-nausea medications. According to Courtney Jordan Baechler, Penny George patients who use these aromatherapy options see a 40-percent reduction in nausea and anxiety.
In August, Minnesota became the first state in the country to publish patient-satisfaction data on a large scale when the Department of Health and a nonprofit organization, Minnesota Community Measurement, released survey results for 651 clinics around the state. As with any consumer rating—whether you’re relying on Yelp to guide you to a great burger joint or Angie’s List to help you find a skilled mechanic—the results can be useful, though imperfect.
The new report from Minnesota HealthScores was compiled from 230,000 patients surveyed in 2012; to be listed, each clinic provided at least 120 patient responses. Patients were asked to rank their experience in four areas: timely availability of appointments, respectful clinic staff, communication with the doctor, and overall experience.
Generally, the results were quite good: 78 percent of patients gave their doctors “excellent” ratings. Results from individual clinics varied widely, with urgent-care clinics receiving the lowest ratings—not surprising since patients don’t have an ongoing relationship with the provider, as they would with a primary-care clinic. Specific health concerns can also affect the rankings. For example, a patient whose sore throat was quickly resolved with an antibiotic prescription would be more likely to provide positive feedback than a patient being treated for chronic pain. Some doctors have also expressed concern that the rankings will hinder their ability to deliver unpopular news, such as telling patients that they need to lose weight or declining to order unnecessary tests.
Patient experience is just one component of health care that Minnesota Community Measurement studies. The group also publishes survey data regarding how many patients received best-practice treatment for acute conditions, such as heart attacks, and how many patients are meeting treatment goals for ongoing conditions, such as diabetes. It also compiles data on the average cost of common medical procedures—everything from colonoscopy to chest X-rays—at hospitals and clinics throughout the state. Find all the data at mnhealthscores.org.