Category: Clinical Trends

Chest Pain Accreditation: Why Is It Important?

By Bernnie Kennedy, RN, BSN
Director, Cardiology/Nursing Supervision
Methodist Mansfield Medical Center
And Karen Yates, RN, BSN
Cardiac Stroke Coordinator,
Methodist Mansfield Medical Center

While amazing advances have been made in diagnosing and treating heart disease, the fact remains that it is the number-one killer of men and women in the United States. February is Heart Month, and offers the chance to highlight not only the stark facts behind this disease, but also the spectacular successes that have been made in preventing and treating it.

One of those successes is qualifying as a certified chest pain center (CPC) with percutaneous coronary intervention (PCI). This level of accreditation means the hospital has an interventional cardiologist available 24/7 and meets or exceeds national cardiovascular standards. It signifies streamlined processes for improved outcomes and demonstrates that it is an environment that encourages professional development and growth.

The accreditation process usually takes a year to complete, but Methodist Mansfield Medical Center received the designation in only five months thanks to extraordinary teamwork, attention to documentation, commitment to ongoing communication, and redesigning care processes to achieve the shortest door-to-balloon time possible while achieving the best possible outcomes. The local EMS providers became our true partners and continue to support our efforts to raise the bar for cardiovascular care. Within the Methodist Health System, Methodist Richardson Medical Center also has an accredited CPC with PCI.

Why is a CPC important to clinicians? Clinicians want to provide the best care possible for their patients in the shortest amount of time.

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Nothing’s more frustrating than having to transfer the patient to another facility during a life-threatening cardiovascular emergency. If your career has taken you down the cardiovascular care path, wouldn’t you rather work for an organization that has achieved CPC status?

In a 168-bed hospital like Methodist Mansfield, clinicians don’t usually expect to see the kind of cardiovascular diagnostics and treatment we are providing such as vascular surgery, open-heart procedures, valve repairs, atrial septal defect repair, and more. Instead of transferring patients to other facilities, we’ve become a regional referral center for heart care.

We’re proud that Methodist Mansfield has earned this prestigious CPC designation, and we think it’s important for the community to know what this means. That’s why we have taken on the challenge of educating women about their heart health. Even today, with all of the recent attention to heart disease, many women are not aware of the facts.

Women often experience atypical heart attack symptoms. With the CPC designation, women coming to Methodist Mansfield for emergency heart care are treated by clinicians who are trained to look for atypical symptoms such as exhaustion, back pain, and jaw pain as opposed to male-associated heart attack symptoms such as left arm and chest pain.

This month, we are again supporting the American Heart Association’s Go Red for Women activities. We invite you to join us in our journey to improve cardiovascular care in Mansfield, the Dallas-Fort Worth area, and North Texas.

Maybe it’s time to do something good for your heart and join us. To learn more, visit Jobs.MethodistHealthSystem.org.

©Methodist Health System

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Planning our first open heart procedure fed my needs as a critical care nurse

By Pam Blaney, MSN, RN, CCRN
Director of Nursing, Methodist Charlton Medical Center

November 1, 2011, was finally here. The day we had all been planning for. The day of our first open heart procedure at Methodist Charlton Medical Center. This was truly one of the highlights of my career as a critical care nurse.

Planning for the big day began more than 12 months earlier. As a member of the planning team, I had a key role in reviewing the needs of cardiovascular surgery patients in terms of drugs and equipment. I hired an experienced team of caregivers that included cardiovascular nurses and a cardiovascular educator. Our team knew that education and training were critical to the success of our open heart program, so we conducted many trial runs with staff pretending to experience various cardiac events. We trained extensively, at both Methodist Charlton and at Methodist Dallas Medical Center. Our goal was to launch a top-quality, smoothly run cardiac surgery program, and I’m happy to say that’s what we have achieved.

Our new cardiac surgery program offers three things that really appeal to me as a critical care nurse. First, it requires attention to detail. Second, it is challenging. And third, it provides an opportunity to get completely involved with the patient and his or her family, from admission to the cardiac critical care unit to discharge from the hospital through recovery.

I love working at Methodist Charlton because I feel like we are a family taking care of our extended family in Duncanville, DeSoto, and the surrounding area. I knew that our first open heart surgery patient was a local pastor. That day I was at my usual coffee shop, and an employee who knew where I worked said her dad was going to have open heart surgery at Methodist Charlton, and that he was going to be our first patient. I realized the pastor was her dad. Following the months of work leading up to the procedure, it was a surprising coincidence that I had this connection to the patient. It made the experience even more important to me.

Bringing this new service to our area is important because we have a significant portion of the population that needs cardiovascular surgery. In fact, in just the first two months of the program, we’ve nearly doubled what we expected to do in the first year. These patients require one-to-one care that’s very demanding on the caregivers. Clinically, it’s a challenge and that’s what critical care nurses love.

Nurses want to work for a health care system that prides itself on providing exceptional care. At Methodist Charlton, we’re raising the bar on our clinical standards. We’re a vibrant and growing hospital, offering our nurses a lot of opportunity for career growth. We’re constantly looking for clinicians who show an interest in learning and growing. It’s these individuals that we’ll want to take ownership of this program and lead it into the future.

February is heart month. Maybe it’s time to do something good for your heart and join us. Visit Jobs.MethodistHealthSystem.org.

© Methodist Health System

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The EHR: Realities of Implementation

By Sam Ruffing, Assistant Vice President, Clinical and IT Services, Methodist Health System

EHR implementation challengesIn a perfect world, we’d flip a switch and the electronic health record (EHR) would be magically implemented across the health care spectrum. Every user would automatically know how the software works and would consistently enter accurate, comprehensive data.

Truth be told, the EHR has its implementation challenges and a steep learning curve, but the rewards for streamlining patient care are high.

EHRs offer an opportunity to reduce confusion and errors when coordinating care from setting to setting and provider to provider. The first step is getting everyone used to navigating, entering, and reviewing data in the EHR. Overall, the goal is to make the most up-to-date electronic records available at the time medical decisions are being made to improve patient safety. A secondary goal is to analyze discreet data from EHRs that can then be used to improve care. But we have a long way to go.

The vast majority of health care systems and physician practices throughout the country are just now adapting EHRs. At Methodist Health System, we’re ahead of the curve. We’ve been ramping up with electronic software since the ’90s. We installed the EHR in our clinics last year and in our nonclinical patient settings two years ago. As we have transitioned to EHRs, we’ve learned a few things:

1.   Never underestimate the amount of effort it takes to move people away from paper.

2.   EHRs drastically change workflow at every level.

3.   For the first several months of implementation, EHRs reduce productivity.

4.   We tend to think EHRs save time, but in actuality they reallocate time.

EHRs are creating many new questions, discussions, and dilemmas within hospitals across the country. What’s more, we’re struggling to develop standardizations in terminology between systems and physicians. For instance, in our current system it’s possible for a patient to present in multiple clinical settings and receive multiple medications for the same symptom if the patient doesn’t accurately communicate what medications he or she is taking. The EHR system will help prevent those types of occurrences.

Eventually, we will be able to utilize the discrete data and integrate it into decisions support so it becomes more mature at alerting clinicians when there is a concern or question about a patient’s health. Time and patience are critical as we build our understanding of and proficiency in EHR utilization.

If an EHR implementation is in your future or you are just entering the workforce, here are some tips to help you during the transition:

1.   Understand the systems your organization is using — not just how to enter data, but how to retrieve data.

2.   Keep your brain engaged at all times. Remember, software is not infallible and does not replace human intellect.

3.   Enter quality information into the system. It’s critical to the next user, so it must be accurate.

4.   Enter real-time data. Gone are the days when we used to wait until the end of the shift to chart. It will be increasingly critical to enter data in real time.

5.   Be patient with yourself and others. Remember, we’re all learning a new skill together.

The EHR is here to stay, and I believe it will become one of the most valuable patient care and process-improvement tools available to us. At some point down the road, we may wonder how we ever worked without it.

To learn more about a health care system that’s charting the course for the future, visit Jobs.MethodistHealthSystem.org.

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© Methodist Health System

 

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Technology Trends and Patient Care: A Win-Win

By Kathleen Hazlett, RN, Director of Enterprise Applications, Methodist Health System

Information technology (IT) is dramatically changing the face of health care, offering a new set of challenges for nurses and other clinicians. While it may seem like the learning curve is fast and furious right now, in the long run the payoff for patients and clinicians will be significant.

For hospitals, the pressure is mounting to meet demands of new governmental regulations and the American Recovery and Reinvestment Act’s meaningful use requirement for electronic health record technology. We must meet certain standards and report specific quality metrics, all of which require total dependence on technology.

That’s where nursing informatics comes in. Even though nursing informatics is in its third decade as a specialty within nursing, the definition has continued to change. Today, nursing informatics refers to a specialty that facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings. This includes the use of information and technology in delivering direct patient care, establishing administrative systems to support lifelong learning, and supporting nursing research.

As we continue the process of training staff to help them embrace technological changes, it’s also affecting time management. For example, in the early stages of computer integration on patient floors, clinicians complained that they were spending more time on computers than with patients. But today, we want clinicians to take technology to the patient bedsides to scan medications, scan the patient ID, and document at the same time. Nurses have more demands on their time than ever. The good news is, now they can have the best of both worlds – the technological tools to help them document quickly and consistently while spending more time with the patient at the bedside.

In spite of the challenging change process, the benefits of IT in nursing are clear. Legibility is huge. We no longer have to struggle to read someone else’s handwriting. The formats are structured. All information is reportable in data fields, analyzed, and retrievable. And IT reduces potential errors through warnings built into the system to give alerts to staff and physicians.

Since IT is here to stay, what can you do to make it easier on yourself? Here are a few tips to help you become more engaged:

  1. Volunteer to be involved in large IT initiatives. Be on a core team or join a committee. It’s a great way to make recommendations that come directly from a clinical user’s perspective.
  2. Connect with the hospital’s education department to help

    implement a new initiative such as a bedside medication rollout.

  3. Use every resource available. For example, at Methodist Health System we trained extern nurses to navigate with the computers, so even as students they gained valuable experience in both their career and in the IT arena. These nurses were also exposed to many different nursing units so they had a chance to see a variety of medical areas. In addition to enhancing their experience, it was a big win for us to have their help.

My role today is to be a translator between IT and the realities of bedside nursing, so I have a foot in both camps. I never dreamed I’d still be at Methodist 34 years after starting my career as a staff nurse, but I’ve had the opportunity for so much growth. Truly, the key is understanding the patient care side, which, when it’s all said and done, is what this technology era in health care is all about.

Methodist has been setting the bar in IT. CIO Pam McNutt was nationally recognized as one of the top 25 women in health care by Modern Healthcare, and most recently was one of three Methodist leaders recognized as Hospital and Healthcare System Leaders to Know by Becker’s Hospital Review magazine. In addition, we were named one of the Most Wired health care systems in 2010 and 2011 by Hospitals & Health Networks magazine. If you’re ready to make a brilliant move, visit Jobs.MethodistHealthSystem.org.

 

© Methodist Health System

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Advanced Digestive Diagnostics

By David Hambrick, BSN, RN, CGRN, Manager, GI Lab, Methodist Dallas Medical Center

If it seems like more people are diagnosed with digestive diseases these days, it’s true. An aging population and higher levels of obesity and diabetes are just a few of the reasons for the increase. Greater awareness of screening procedures to help detect conditions that might lead to colon cancer, such as colonoscopy, along with advances in digestive diagnostics and treatments also enable us to detect potential problems earlier and provide effective, timely intervention.

Gastroesophageal reflux disease (GERD), for example, is the fastest growing upper GI issue, primarily because of the aging population and obesity. Patients who have long-term GERD are at risk for Barrett’s esophagus, which has been identified as a precursor to esophageal cancer. If clinicians tests detect precancerous cells in the esophagus, patients can receive advanced treatments such as tissue ablation using radio frequency or cryotherapy or surgery with minimally invasive endoscopic procedures.

Other trends in treating digestive diseases include the following:

  • Endoscopic ultrasound to examine the pancreas, suspicious lesions of the GI mucosa, and local lymph nodes assist with fine-needle aspirations to obtain tissue diagnosis without surgery and help to stage cancers
  • Confocal microscopy (a probe with a laser-based microscope on the end) to examine cellular changes or atypical cells during endoscopy and cholangioscopy
  • Cholangioscopy with the SpyGlass® System to visualize the biliary ducts
  • Esophageal motility studies to help diagnose swallowing disorders or as a presurgery check to make sure the esophagus is working as it should[1]

Methodist Health System is a regional leader in diagnosing and treating digestive disorders. Patients can benefit with earlier diagnoses and the initiation of appropriate treatment that can often be started during diagnostic procedures. When indicated, physicians can remove tissue containing atypical or cancerous cells or insert a stent to open an obstruction in the bile or pancreatic duct, esophagus, duodenum, or colon.

For clinicians considering a job in the area of digestive diseases, here are some things to consider:

  • Does the center offer leading-edge technology to diagnose disease as well as provide appropriate intervention?
  • Does it have support from the rest of the hospital and other departments such as anesthesia, surgery, and lab?
  • Do other departments appreciate the work they do? This is important because a good diagnostics department is a portal to the hospital for other procedures that might be identified.
  • Does the facility participate in professional organizations and research projects? Methodist, for example, is one of six centers in the country participating in a National Institutes of Health gastroenterology study.

Ultimately, advanced digestive diagnostics may provide patients with quicker identification of disease processes, quicker intervention and treatment, and quicker recovery and return to

daily activities. As caregivers, our goal is to mitigate the problem or identify the appropriate plan of care, the sooner the better.

To join a team of clinicians who lighten the load for patients and co-workers, visit Jobs.MethodistHealthSystem.org.

Texas law prohibits hospitals from practicing medicine. The physicians on the Methodist Health System medical staff are independent practitioners who are not employees or agents of Methodist Health System.

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© 2011 Methodist Health System

Methodist Health System does not endorse or recommend any specific tests, products, procedures, treatments, or other information that is included in this article or on this website. The content is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Clinical Trends in Neurosurgery

By Brian T. Asmussen, Director of Neurosurgery Services, Methodist Health System

Neurosurgery is one of the most exciting areas in medicine today. It’s one where technology is driving advanced care and treatment for patients while

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providing a challenging and fulfilling career path for health care professionals.

Progressive health systems are guided by leading neurosurgeons trained in innovative diagnosis and treatment techniques, and Methodist Health System is among them. Methodist is committed to building a broad interdisciplinary approach to specific patient needs that improve mobility and function, reduce pain, and restore lifestyle. Our team of neurosurgeons provides diagnostics and treatment to treat the entire spectrum of brain and spinal conditions.

Technologically speaking, minimally invasive procedures for the spine are the name of the game. Smaller incisions mean less blood loss, shorter surgeries, quicker recovery times, and shorter hospital stays for patients. In the area of scoliosis, for example, we are now treating patients using a technique called DLIF (direct lateral interbody fusion). With DLIF, surgeons access the spine through a small incision approximately two inches long on the side of the body. With the older technique, patients would have incisions four to five inches long on their backs or abdomen. Since we no longer go through the stomach muscles to access the spine, patients experience an easier recovery and there is less chance for infection.

In terms of bedside care, we’re seeing much greater specialization for clinicians, and there are specialized teams in the operating room and

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for treatment. This enables clinicians to provide better care for more unique patient procedures and a targeted team approach in spine care.

Methodist has pioneered diagnosis and treatment for brain and spine conditions since 1978. In 1995, Methodist opened the first neurocritical care unit in North Texas at Methodist Dallas Medical Center. Methodist Dallas is one of only three adult trauma centers in the city, and it is the only hospital in the Dallas–Fort Worth area with a dedicated neurointensivist on staff.

On the horizon, we anticipate there will be more algorithms in how we treat back pain. Independently practicing spine surgeons, primary care physicians, physical medicine and rehabilitation physicians, and pain management physicians at Methodist Dallas have been working on care pathways to help patients receive the most appropriate referrals to the right doctors at the right time. Ultimately, patients will be treated better and faster, with even more positive outcomes.

What sets Methodist apart in the area of neurosurgery?

  1. Attention to quality indicators that tell us how we’re performing and where we need to improve.
  2. A dedicated unit with care teams specializing in neurological disorders.
  3. A designated trauma center that provides care for some of the most complex and challenging cases.

The science of neurosurgery combined with the art of patient care is what makes this such an exciting area in which to be a health care provider. It’s all about great partnerships with physicians, staff members — whose No. 1 priority is the patient, and a collaborative relationship among the entire of team of neurosurgical providers.

 

To explore your options and become one of the shining stars at Methodist, visit Jobs.MethodistHealthSystem.org.

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© Methodist Health System

 

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