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St. Clair’s New Chief Nursing Officer I Quality Exchange: Working Together To Improve Quality HPV Vaccine Is Cancer Prevention I Donor Spotlight I Ask The Doctor



2 I HouseCall I Volume IX Issue 1

The Emergency Room (ER) at St. Clair Hospital is a dynamic, complex, fast paced and often dramatic setting. Its doctors and nurses treat every age group, with every kind of problem imaginable: chest pain and heart attack, stroke, asthma attack, cancer complications, dehydration, sports injuries, and more. Not all problems treated in the ER are life-threatening, but they are all urgent to the individual coming through the sliding glass doors. St. Clair’s ER doctors, nurses and other allied health personnel have to be prepared at all times for every possibility. They must constantly keep up with the latest advances in emergency medicine and technology. In this issue of HouseCall, readers will get an in-depth look at what makes St. Clair’s one of the leading ERs in the country. Readers will also hear “True Stories” from four ER physicians working to save lives night and day. t’s a tall order, and it’s not for everyone. But those who have chosen

the first line of defense for an acutely ill or injured patient; the first

emergency medicine thrive on it and welcome the immense

physician to see that patient, make a diagnosis and initiate treatment.

challenges. Jason Biggs, M.D. loves his position as Chair of

After that initial visit, we refer to and rely on our excellent network of

Emergency Medicine at St. Clair. He has been an attending physician at St. Clair since 2009; as a resident, he completed a rotation in

primary care physicians and specialists.” Emergency medicine was not officially recognized as a medical

St. Clair’s ER and was drawn to its environment and culture. “St. Clair

specialty until 1979. Before that, ERs were mostly staffed by general

is an exceptional hospital with a very busy ER that brings a lot of

practitioners and surgeons, who were often moonlighting, explains

variety,” he says. “We see lots of children and we treat a lot of geriatric

St. Clair ER physician Kyra Kilpela, M.D. She says that the standards

patients, and every age in between. A good ER doctor is well rounded,

of care have improved tremendously since then and there is great

a jack of all trades. We have to stay on the cutting edge and our

respect for emergency medicine today.

expertise encompasses many other fields. An ER doctor is often

Continued on page 5 Volume IX Issue 1 I HouseCall I 3


true stories JASON M. BIGGS, M.D.

Jason M. Biggs, M.D.

Not just the flu... but a ticking time bomb

more tell me the history of his illness, and he did: ‘I was in my kitchen, and all of a sudden I had a headache, and then nausea…’” — there it was, the clue that had been eluding Dr. Biggs. It was the word ‘sudden’ — a red flag, a word previously omitted from the history, and a word that changed everything. This man’s problem, Dr. Biggs realized, was probably not a simple case of the flu. He ordered a CT scan to look for a cause of the headache. Normal. He performed a lumbar puncture

The middle-aged gentleman in the exam room did not

(spinal tap) to examine and test the cerebrospinal fluid (CSF).

appear to be in acute distress. His vital signs were stable;

The CSF was discolored, and testing revealed that there were

his lab results were within normal limits; and his diagnostic

blood cells in the CSF that did not belong there. Another CT

studies were unremarkable. He complained of cough, muscle

scan was ordered, this time with contrast (dye) so that blood

aches, headache, nausea and fatigue; he was a little dehydrated

flow could be visualized.

and seemed, like so many others who had visited the Emergency Room that day, to be suffering from the flu. But Jason M. Biggs, M.D., Chair of Emergency Medicine

The testing revealed a cerebral aneurysm with sentinel bleeding, essentially a ticking time bomb in the patient’s brain. An aneurysm is a ballooning or bulge in the wall of a blood vessel

at St. Clair Hospital, was not satisfied. To his expert eyes,

that occurs when the wall has been weakened, sometimes from

something was off, although he could not point to anything

high blood pressure. That weak spot can leak or even rupture;

specific. It was an instinctive reaction, and Dr. Biggs knew,

it can kill you, or it can cause a hemorrhagic stroke, which may

from his years of experience, to follow it. Dr. Biggs stayed with his patient and did what felt right

produce catastrophic consequences due to the interruption of the brain’s blood and oxygen supply. Long-term effects can

to him: he started over. “I did a re-approach,” he explains.

include paralysis, blindness, speech and language impairment,

“I went back to the beginning with this patient, to try and

memory loss, and other disabling problems. The key symptom

determine if I had missed something. I asked him to once

is a sudden, severe headache, often with nausea and vomiting.

4 I HouseCall I Volume IX Issue 1

Dr. Biggs explained the finding to the patient and his wife, and immediately

Continued from page 3

referred him to a neurosurgeon. The patient underwent endovascular coiling, a procedure that involves threading a thin, flexible, spiral wire through a micro-catheter into the aneurysm, where it forms a coil that creates blood clots. The clots prevent blood from flowing to the aneurysm, closing it off. The coil procedure is an alternative to clipping the aneurysm, a surgical procedure that may require a craniotomy, the surgical removal of part of the bone from the skull to expose the brain. A year later, Dr. Biggs happened to run into the patient and was pleased to see he had made a nearly full recovery, with minimal residual deficits. It was an ideal outcome, which could have been drastically different, even tragic. It was all the result of the insight and persistence of an ER physician who acted at the highest level of expertise and with confidence in that expertise. At that level, clinical medicine becomes the art of medicine. “In emergency medicine, we have to always be on the cutting edge, keeping up, with knowledge in acute patient care that spans the breadth of medicine,” says Dr. Biggs. “We are frequently the first line of defense, the first to see the patient. There are common threads, but sometimes we see something we were not expecting. The patient may come in with one

Jason M. Biggs, M.D., Chair of Emergency Medicine at St. Clair Hospital (with mask), prepares to examine a patient who was just transported to the ER by paramedics.

complaint, and something bigger is actually going on. Often, the real problem is hidden; we are trained to look for the needle in the haystack. Every day, we make decisions that may be life-changing for someone. It’s tremendously rewarding.” n

At St. Clair, Dr. Kilpela and other members of the ER medical staff are board-certified in emergency medicine, including pediatric emergency medicine.

Dr. Kilpela’s colleague Kevin Friend, M.D. likes the pace and the scope of emergency medicine. “I chose



emergency medicine because I like the breadth of it,” he says. “We treat the entire continuum of human illness; we see every aspect of medicine in the ER, in its most raw forms. Every day, I come to work not


knowing what is going to happen. There can be a lot of


pressure: when we have people in critical condition, we



are working feverishly, trying to figure out what is wrong. We have a strong bond as a staff in this ER and that is invaluable; we could not do the work we do without that.” Dr. Biggs agrees that human relationships are one


of the great rewards of his work. “I like the ER culture, the teamwork and camaraderie; staff members stay here a long time and become a family.” Relationships with patients are different in the ER, he says. “We are JASON M. BIGGS, M.D. Dr. Biggs earned his medical degree at Jefferson Medical College, Philadelphia. He completed a residency in emergency medicine at UPMC. Dr. Biggs is board-certified by the American Board of Emergency Medicine. He serves as Chair of Emergency Medicine at St. Clair Hospital.

with patients for only a brief period of time, but we still connect with them. It’s a tough skill set to develop, but when someone really needs your help, you forge an immediate relationship. We see people every day on what may be the worst day of their lives, and we never forget that. We make decisions here that may be life changing for patients.” Continued on page 7 Volume IX Issue 1 I HouseCall I 5


true stories

Emily L. Brown, M.D.

An unexpected arrival It was one of those harsh winter days when snow, gusty winds and icy roads made travel hazardous. It meant a busy day for the Emergency Room at St. Clair Hospital, with a non-stop flow of patients coming through the doors. The staff knew that many of these patients would have weatherrelated problems: broken bones from falls on icy sidewalks; chest pain after snow shoveling; and bumps and bruises from car accidents. They anticipate these types of injuries and problems and have all the resources to treat them. The staff did not, however, anticipate one patient who entered those doors that day. A baby boy was barely breathing. He developed respiratory distress at home, and was brought to St. Clair’s ER by his frantic parents. He was born a full-term, healthy baby just 16 days earlier, but something had gone very wrong. His skin was ashy gray and his lips were blue. His tiny body, on the exam table, was still; it formed an X shape: arms and legs fully extended and limp, in sharp contrast to the toned fetal flexion of a healthy baby. He was in severe respiratory distress. There was no time to lose. Immediately a team of St. Clair’s highly trained and seasoned ER nurses and technicians were at the baby’s side. They administered oxygen; they took his vital signs; they inserted intravenous lines — an artful task with veins so small. They placed electrodes on him to monitor pulse, blood pressure and oxygen levels; they began infusions of fluid; and they drew blood for the lab, all of this taking place simultaneously. The nurses worked in intense near-silence, totally focused on the baby, speaking to each other in quiet, controlled voices, and only when necessary. Their focus was absolute. They knew exactly what to do and they did it exactly right. After a long 15 minutes, the baby’s color began to improve and his oxygen levels rose; he was “pinking up.” His vital signs stabilized. He was turning the corner, and as his respirations improved, everyone breathed a little easier. Emily L. Brown, M.D., the attending physician for the baby, ordered diagnostic tests and oversaw the resuscitation. Suspecting bronchiolitis due to a respiratory virus, she knew he needed intensive care. “What made this admission more

St. Clair Emergency Room physician Emily L. Brown, M.D. treats a young girl in the ER. 6 I HouseCall I Volume IX Issue 1

difficult was the fact there was no EMS involved to call ahead and alert the staff, as is often the case with the highest-

acuity patients,” she says. “We had no lead time, no heads up, and the situation

Continued from page 5

was dire. It was our job to resuscitate and stabilize him. We determined the baby needed to go to the Pediatric Intensive Care Unit at Children’s Hospital. I contacted them to make arrangements for transport.” The baby was admitted to the ICU at Children’s and successfully treated; he was discharged after six days. He has made a full recovery and his grateful parents expressed their emotions to Dr. Brown in a note “from the baby.” — Dr. Brown, I’m not sure if you recall, but you helped save my life. You and your team got me stabilized to go to the ICU. Thanks for choosing a career that really helps people; thanks for giving me a chance to grow up to help others. Dr. Brown cherishes the note, but says the credit goes to the nurses. “I want to make it clear that the nurses saved the baby. They were so effective, and it’s rare for us to see a blue baby in our ER. In a complicated resuscitation, you need one person who stands by and oversees all that is taking place. These nurses made it possible for me to do that, and to be able to think about the situation and make calls while they took care of the baby. Their response was magnificent.”


Dr. Brown notes that the design and processes of St. Clair’s ER had an impact on the outcome of this case. “The baby’s parents did not walk into a

Life changing and lifesaving. In the ER, wounds are

crowded waiting room or face a hallway full of waiting patients. There is no

repaired, diagnoses are made, problems are solved,

chaos or disorganization here, and a lot of people work together to make that

pain is eased and above all, lives are saved. St. Clair’s

happen. Our patient flow is excellent because we can mobilize resources very

ER excels in the emergency care of the most common

quickly, as we did with this baby. Our efficiency is not an end in itself; it impacts the quality of the care. Efficiency facilitates excellence, so that when that blue

baby unexpectedly shows up, we are ready to go.” n

cardiovascular problems: heart attack and stroke. Both can result in significant disability or death unless the victim receives appropriate, specialized intervention as soon as possible after the appearance of symptoms.

St. Clair’s ER has been honored by the Hospital & Healthsystem Association of Pennsylvania for having



the fastest “door-to-balloon” rates among all southwestern Pennsylvania hospitals that treat heart attack victims with balloon angioplasty, which opens a blocked coronary artery to restore blood flow to the heart. “Doorto-balloon” refers to the time that elapses from the moment a patient enters the ER until he or she is treated


with balloon angioplasty in the Cardiac Catheterization


Lab, located next to the ER to expedite care. “We are among the best-performing hospitals in the U.S. in the treatment of heart attack and stroke,” says David Kish, R.N., MHA, Executive Director of EMILY L. BROWN, M.D.

Emergency Services and Patient Logistics at St. Clair.

Dr. Brown is board-certified in emergency medicine and serves as Vice Chair of Emergency Medicine at St. Clair Hospital. She earned her medical degree at the University of Pittsburgh School of Medicine, and completed the Harvard-Affiliated Emergency Medicine Residency at Massachusetts General Hospital, and Brigham and Women’s Hospital in Boston, Massachusetts.

We share credit for this with our cardiologists and the five Emergency Medical Services (EMS) teams (MRTSA; Tri-Community; Kirwan Heights; Southbridge; and Scott Township) for whom we provide medical command. Continued on page 9 Volume IX Issue 1 I HouseCall I 7


true stories St. Clair Emergency Room physician Kevin D. Friend, M.D. examines a patient in St. Clair’s ER.

Kevin D. Friend, M.D.

Connected for life ”I think my heart just stopped.” Those might have been the last six words ever spoken by the 15-year-old boy sitting with a buddy at the South Park Skate Park on an October weekend. The boys were hanging out, waiting for the skate park to open, when Parker Lewis, a high school sophomore, clutched his chest and turned to his friend and Peters Township High School classmate, Walter Virany, speaking those ominous words. He then collapsed and fell to the ground. Walter did not waste a moment. Remarkably, with the poise and self-possession of someone twice his age, he took all the right actions to help Parker. He called 911 on his cell phone and calmly spoke to the operator, providing the essential information. To the operator’s query, “Do you know CPR?” he gave a confident affirmative, and proceeded to perform

The Allegheny County Police Department, St. Clair Hospital and Peters Township School District recognized Walter Virany, a student at Peters Township High School, for performing CPR on his friend Parker Lewis, helping to save his life. Walter (second from right, with award) and Parker (second from left) are shown during a ceremony at the high school where Walter was presented the St. Clair Hospital Health Care Hero Award. Asked what he was thinking when he learned that Parker was going to be okay, Walter said, “I was relieved and overjoyed when I saw my friend was on his way to a full recovery. It was like a darkness had lifted.”

cardiopulmonary resuscitation, by himself. Local police, paramedics and EMTs arrived quickly; they assessed Parker and performed defibrillation — a shock to the heart to jump

Kevin D. Friend, M.D. was the attending physician in the ER that day. “The boy arrived in the ER with a pulse, but he

start it, using electric current to restore a normal heart beat.

was unresponsive,” Dr. Friend recalls. “The nurses and I did

They communicated with the Emergency Room physicians at

an assessment, stabilized his heart with medication, intubated

St. Clair Hospital, transmitting the boy’s EKG and vital signs

him and placed him on a ventilator. His parents came to the

as they rushed Parker to the ER.

ER; this was an apparently perfectly healthy child, with no

8 I HouseCall I Volume IX Issue 1

previous history of heart problems. Cardiac arrest (when the heart stops

Continued from page 7

beating) in that age group makes one think immediately of drugs or trauma, and we were able to quickly rule those out. We stabilized him in the ER before sending him to a Pediatric Intensive Care Unit under the specialized care of

The EMS companies provide pre-hospital care and are an important contributor to our ER. All of those

a pediatric cardiologist.” Ultimately, the pediatric cardiologist found that Parker had a congenital

emergency services teams have outstanding skills.

electrical conduction abnormality, a very rare condition that predisposed him

The physicians in the ER have tremendous trust in EMS.

to sudden cardiac arrest. He received an implanted defibrillator and was in

For example, paramedics typically transmit an EKG

the hospital for just a few days of recovery; the following week, he was back

from the field when evaluating whether a patient is

in school, perfectly fine — with his friend Walter. “This story could have had a

having a heart attack. If for some reason the EKG

very different ending,” Dr. Friend says. “The outcome was the best possible

can’t be sent, and the paramedics call into the ER

one, because everyone at every step did their part exactly right.

and recommend that personnel in the Cardiac

Dr. Friend did not forget that there were two boys in this story, and that Walter needed some attention too: “Walter also came to the ER that day; he

Catheterization Lab stand ready, the trust level is such that the system is activated.”

said he had learned CPR in freshman wellness class, when his school provided

St. Clair is certified as a Primary Stroke Center by

training to all the students. I told him how great he was; he had played a major

the Joint Commission, which means the Hospital has

role in saving his friend’s life. He is the hero of this story. “We felt it was important to reach out to the school, to let them know that

met rigorous requirements and has been recognized for its exceptional efforts to improve outcomes for

their effort — teaching CPR to high school students — had paid off, big time.

stroke patients. Survival — and more importantly,

I was able to go to Peters Township High School to present the St. Clair Hospital

neurologically intact survival — following a stroke is

Health Care Hero Award to Walter at an assembly, and to acknowledge the

contingent upon immediate, accurate diagnosis and

school for offering CPR training. This story demonstrates the importance of

intervention in the ER, using advanced technology

bystander CPR — in this situation, it made a critical difference. It also shows

and clinical procedures.

the importance of the Hospital’s relationship with the community; in the ER we all have a strong sense of the community and this is invaluable.” The system worked flawlessly at every step and, as a result, one young life

The ER’s reputation has brought professionals from all over the world to tour its facilities and learn from its care model and efficient practices. The

was saved, a tragedy was averted and a friendship was solidified forever. The

30,000-square-foot space has many outstanding

entire experience was enormously gratifying, says Dr. Friend. “Being an ER

features, including 46 treatment rooms, all of which

doctor is such a great job. To me, there is simply nothing better.” n

are equipped to handle patients of all ages. With so many families living in the region, the

ER is well known and respected for its outstanding care of children, treating some 10,000 children every


year. Parents are comforted knowing that St.Continued Clair on page 10


has a pediatrician on-site 24/7.


The ER features state-of-the-art monitoring capabilities in every room, the most advanced imaging technologies, and a low nurse-to-patient ratio. David says St. Clair’s ER saw 64,315 patients in 2016, making it one of the busiest ERs in western Pennsylvania. “The efficiency of care is outstanding even with such a high volume of patients,” says David,

KEVIN D. FRIEND, M.D. Dr. Friend specializes in Emergency Medicine. He earned his medical degree at New York University School of Medicine and completed his affiliated residency in Emergency Medicine at Presbyterian Hospital, Pittsburgh. Dr. Friend is board-certified by the American Board of Emergency Medicine.

noting that St. Clair’s ER treats approximately 27 percent more patients than it did in 2008 and is ranked in the top 10 percent nationally for patient satisfaction. “The ER is designed to dramatically reduce wait time; and in Emergency Medicine, minutes matter.”

Continued on page 11 Volume IX Issue 1 I HouseCall I 9


true stories St. Clair Emergency Room physician Kyra M. Kilpela, M.D. (left) and Melissa Erkel, R.N., BSN, CEN examine an elderly patient.

Kyra M. Kilpela, M.D.

Seamless Critical Care


The patient was a man in his 60s who had

This was a cardiac emergency. Ventricular

walked to the Emergency Medical Services station

tachycardia occurs when there is abnormal

near his home. On arrival there, he complained

electrical activity in the heart’s lower chambers,

of chest pain and a racing heart. To the paramedics

the ventricles. It is associated with coronary heart

and EMTs, he appeared pale and sweaty, but he

disease, heart attack or electrolyte imbalance.

was alert with stable vital signs. They did an EKG,

It may cause chest pain and it can worsen into

a tracing of the heart’s electrical pattern, right

a life-threatening condition. Immediate

on the spot; it revealed that the patient was in

intervention is needed to prevent damage to

ventricular tachycardia, or V tach, an arrhythmia

the heart muscle.

(abnormal heart pattern) showing the heart

Kyra M. Kilpela, M.D., a board-certified

beating erratically and much too fast. They called

emergency medicine physician at St. Clair, led

the Emergency Room physicians at St. Clair

the team of ER doctors and nurses who brought


Hospital to inform them of the impending arrival

the man and his wife to a state-of-the-art exam


of the patient and forwarded the EKG electronically.

room. A “crash cart”and advanced life support


10 I HouseCall I Volume IX Issue 1

Continued from page 9

equipment were already in place, ready for use. The patient’s EKG showed that despite anti-arrhythmia medication, he remained in ventricular tachycardia. Dr. Kilpela consulted with a St. Clair interventional cardiologist, informing him that the ER had a patient who might require an urgent cardiac catheterization. As Dr. Kilpela consulted with the cardiologist, the patient’s condition began to worsen. He stopped speaking and his blood pressure fell rapidly. Dr. Kilpela and the ER staff performed a procedure called synchronized cardioversion, which delivers a therapeutic amount of electrical current to the heart at a specific moment in the cardiac cycle. The treatment was successful, returning the heart to normal sinus rhythm. The patient rallied: he resumed speaking and his vital signs stabilized. The cardiologist came immediately to the ER and ordered the patient be transported to St. Clair’s Cardiac Catheterization Lab, where advanced diagnostic and therapeutic technology helped him identify an occluded (blocked) coronary artery. A stent, a tiny mesh tube, was placed to prop open the artery and restore the flow of blood to the heart. The procedure went perfectly. The patient was monitored in the Cardiac Care Unit and went home a few days later. This was, says Dr. Kilpela, a seamless Emergency Room case. Everything worked exactly as it was designed to work; all the members of the emergency response system and St. Clair’s outstanding cardiac care services fulfilled their roles perfectly. “This wasn’t an unusual or exceptional case,” Dr. Kilpela explains. “But it was a perfect one. The EMTs and paramedics did a great job; our staff was totally prepared and capable; the cardiologist we needed to consult was available right away; and the Cath Lab was ready to go. The patient was stabilized, diagnosed and treated immediately. It was the best it could be. This case demonstrates how well St. Clair’s ER works with the community; it also reflects the high quality of cardiovascular services here. This patient was dying right in front of us, but we were able to intervene with expertise and turn things around,” Dr. Kilpela says. “I’ll never forget the look of joy on his wife’s face when he responded to the cardioversion.” n

David attributes the transformation in the ER to lessons learned from the principles of Lean engineering and adopting a culture of continuous improvement throughout St. Clair. Key elements of the ER’s success include: • Tight coupling of staffing models with patient volume; • Committing to a high level of standardization for every process of basic patient care; • Using technology and real-time visible data to drive performance; and • Investing in training to further develop employees. David says one of the first benefits of Lean engineering involved a patient’s wait time. “At St. Clair, on average, it only takes 4 minutes for a patient to walk in our front door to be taken to a treatment room,” David explains.

KYRA M. KILPELA, M.D. Dr. Kilpela specializes in Emergency Medicine. She earned her medical degree at Drexel University College of Medicine, Philadelphia, and completed her residency at Beth Israel Medical Center, New York City. Dr. Kilpela is board-certified by the American Board of Emergency Medicine.

“Then the average time span until he or she is seen by a physician is 18 minutes.” “The ER is patient-centered,” says Diane Puccetti, R.N., BSN, MS, the Hospital’s Vice President and Chief Nursing Officer. “We have designed our care model to make sure patients get into a room and see a provider as quickly as possible in order to initiate care. We have a proven system for caring for patients safely and efficiently and the entire staff takes great pride in serving the community.” Volume IX Issue 1 I HouseCall I 11



St. Clair’s New Chief Nursing Officer Brings

Vision,Leadership and W

hen Diane L. Puccetti, R.N., BSN, MS embarked on a career in nursing, she knew

just what she wanted to do. She envisioned

herself as an intensive care nurse, caring for the most critically ill patients, and looked forward to working on the front lines of health care, at the bedside. She did exactly that: after graduation from Mercy Hospital

School of Nursing, she became a staff nurse in the Intensive Care Unit (ICU), and eventually found her clinical home: the operating room (OR). At Children’s Hospital of Pittsburgh, Diane specialized in the care of infants and children undergoing complex, high risk cardiac surgery. Her 18 years of experience made her an expert clinician and earned her the advanced position of specialty nurse in pediatric cardiac surgery. “I loved everything about the OR,” she recalls. “I loved the technology, the constant advances with new equipment, and new, lifesaving procedures. I never stopped learning.”

Nursing is a high-tech career, but it is equally about the humanity. DIANE L. PUCCETTI, R.N., BSN, MS, CHIEF NURSING OFFICER, ST. CLAIR HOSPITAL


12 I HouseCall I Volume IX Issue 1


Chief Nursing Officer Diane L. Puccetti, R.N., BSN, MS (left) reviews clinical notes with Sandra Kennedy Mock, R.N., a nursing unit coordinator on the Sixth Floor of St. Clair Hospital.

collaborative relationship between nurses

education staff which continually supports

were not part of her early plans but when her

and physicians. “The nurses at St. Clair know

the nurses in all areas of the Hospital.”

manager at Children’s left suddenly, she was

they are valued by their physician colleagues,”

offered the position and quickly realized that

she says. “This is not a teaching hospital,

she liked management. “I learned that I could

so the physicians don’t have residents and

to maintain our level of excellence and, also,

have a far greater impact as a manager. I could

fellows; the nurses have a clearly defined role

to stay aware of the big picture, of where the

shape the caregiving environment to support

and the physicians respect them and rely on

nursing profession is going. There are many

nurses and enable them to give the highest

them. We have many tenured staff at St. Clair;

complex issues confronting nursing: the

quality care.” Diane joined St. Clair Hospital

the average is 11 years. They have deep

coming retirement of the baby boomer nurses;

Nursing management and administration

As CNO, Diane’s vision for the future of nursing at St. Clair is two-fold: “My goal is

in 2004 as manager of the OR, and in 2010, was

experience and they develop tremendous

advanced practice roles; increasingly complex

promoted to Director of Perioperative Services.

clinical skills. The Hospital keeps growing

technologies; and national trends in recruit-

She served for a year as Executive Director of

and expanding our specialty services, so the

ment and retention. Nursing is a high-tech

Nursing and last fall, was named Vice President

nurses are constantly being challenged to

career, but it is equally about the humanity

and Chief Nursing Officer, succeeding longtime

learn new technologies and procedures.

of the patient; the emotional skills are harder

Administrative VP and CNO Joan Massella,

We are fortunate to have a great nursing

to teach.” n

R.N., M.ED., MBA who, now retired, is largely responsible for St. Clair’s stellar reputation for high-quality nursing care and award-winning patient satisfaction. As Chief Nursing Officer, Diane is a champion of the bedside nurse and provides vision, leadership, direction and resources to St. Clair’s nursing staff, providing them with a practice environment that supports their learning, enables their professional advancement and empowers them to continue providing patients and families the outstanding level of care Joan nurtured throughout the Hospital. Throughout the proud history of St. Clair Hospital, nursing has always played a prominent role and continues to do so as the Hospital evolves. Diane believes that nursing at St. Clair is exceptionally rewarding and satisfying, due in no small part to the

Chief Nursing Officer Diane L. Puccetti, R.N., BSN, MS confers with Jeffrey S. Burket, M.D., who specializes in infectious diseases.

Volume IX Issue 1 I HouseCall I 13


Working together to improve


A few short months from now, St. Clair Hospital will mark the first anniversary of its clinical collaboration with the world-renowned Mayo Clinic in Rochester, Minnesota. As the exclusive member of the Mayo Clinic Care Network in western Pennsylvania, St. Clair’s goal is to enhance patient care by sharing medical knowledge and clinical expertise. To that end, a delegation of St. Clair clinical leaders and staff recently journeyed to Mayo Clinic for a Quality Exchange with their Mayo peers. HouseCall talked to several members of the delegation upon their return to discern what they learned, what they shared, and how St. Clair can improve upon its status as one of the nation’s leaders in quality and patient satisfaction.

St. Clair Hospital clinicians and staff who participated in the recent Quality Exchange at Mayo Clinic included, left to right, Anne Mitchell, R.N., BSN, MS, CPHQ, CPPS, Director, Patient Safety & Regulatory Affairs; Ashley Butler, R.N., MHA, Manager, Quality Improvement; Monica Miller, R.N., BSN, CCM, ACM, Manager, Care Management; Cyndi Havrilak, R.N., MSN, Executive Director, Nursing; Laura Morris, MT, (ASCP), CIC, Senior Infection Preventionist; Diane Puccetti, R.N., BSN, MS, Vice President and Chief Nursing Officer; Stephen Colodny, M.D., Chief, Infectious Diseases; Louis Civitarese, D.O., MMI, Chief Medical Information 14 I HouseCall I Volume IX Issue 1


he air temperature was well below zero in

standard of excellence in the delivery of health care

Rochester, Minnesota, when St. Clair Hospital’s

services. QI focuses on the quality of clinical care,

first large scale clinical delegation arrived on

patient safety and patient satisfaction. Key indicators

January 5 for an historic visit to Mayo Clinic. The multi-

of clinical quality include infection rates, patient falls,

disciplinary group of 14 had traveled to Rochester at the

medication errors and complication rates, while patient

invitation of David L. Hayes, M.D., Medical Director of the

satisfaction focuses on the patient’s experience. QI

Mayo Clinic Care Network, for a two-day Quality Exchange. The purpose of the trip was to learn the Mayo approach

enables hospitals to improve their own performance and compare their quality to that of similar hospitals;

to patient-centered care and to share best practices at

it motivates them to work harder to achieve excellence.

the respective institutions.

Quality information empowers patients to make

According to Nicolette E. Chiesa, M.D., FACP,

Continued on page 16

St. Clair’s Associate Chief Medical Officer and Chair of the Medical Staff Quality Committee, the experience was validating and energizing. “It was a fantastic experience for all of us,” she said. “Everyone who went to Mayo is deeply invested in quality improvement and our peers at Mayo were generous and open in sharing their experience and expertise with us.” Quality improvement — often referred to as QI —


is a primary force driving the American health care


industry. It refers to the effort to define, achieve,


measure, interpret, report and maintain a specific


Officer; Karl Bushman, M.D., FACP, Medical Director, Care Management; and Richard Schaeffer, Vice President and Chief Information Officer. Not pictured: Nicolette Chiesa, M.D., FACP, Associate Chief Medical Officer and Chair Medical Staff Quality Committee; Jose Christlieb, M.D., Medical Director, Hospitalists; Mario Fatigati, M.D., Medical Director, Post-Acute Care; and Gregory Fino, M.D., Co-Medical Director, Critical Care.

Volume IX Issue 1 I HouseCall I 15


informed health care decisions for themselves and


Stephen Colodny, M.D., Chief of Infectious

their families. Ultimately, QI is about giving the best

Diseases at St. Clair, directs the Hospital’s Infection

possible care in the safest possible environment,

Prevention program. He says the visit to Mayo

in a way that meets or exceeds the personal needs

revealed similarities between the two institutions,

and expectations of patients.

as well as differences. “Mayo Clinic has a remarkable

Ashley M. Butler, R.N., MHA., Manager of Quality

culture and it was interesting to learn about how


Improvement at St. Clair, believes that the Mayo Clinic

they cultivated that. Mayo and St. Clair do many of


experience affirmed St. Clair’s quality and offered new

the same things; we deal with the same types of

opportunities for quality improvement. “We have a very

problems and find similar solutions. I was interested

high and well documented level of quality at St. Clair;

in their antibiotic stewardship program; their anti-

we are in the top 10 percent nationally for quality

biotic team is led by a clinical pharmacist trained

measures and we lead in numerous regional and

in Infectious Diseases. I was curious about their

national studies. Being in the top 10 percent means

approach to decreasing the incidence of C. Difficile

our quality is better than that of 90 percent of the

(C.diff) infection. Mayo is tracking disease pathways

nation’s hospitals. St. Clair has garnered numerous

with molecular tools; insights that could benefit

awards, honors and scores that validate our high

patients at St. Clair.”



quality, including getting our eighth consecutive ‘A’ grade in patient safety from The Leapfrog Group,

as an excellent opportunity for peer-to-peer conver-

an independent, third-party evaluator. While we are

sations on best practices and reciprocity. “St. Clair

pleased with this, we’re always seeking to improve.

synergy between St. Clair and Mayo in regard to this.

Mayo is only going to

We have great examples in our antibiotic stewardship

take us further in our

team and our sepsis team, and much of our QI is

constant quest to


Ashley is eager to incorporate the lessons

Members of the St. Clair Hospital delegation listen intently at the recent Quality Exchange at Mayo Clinic in Rochester, Minnesota.

excels in interdisciplinary teamwork. There can be

Our relationship with

enhance quality.”

16 I HouseCall I Volume IX Issue 1

Dr. Colodny viewed the engagement with Mayo

For Diane L. Puccetti, R.N., BSN, MS., Vice President and Chief Nursing Officer at St. Clair, this was her second trip to Mayo since the collaboration was

learned from Mayo

announced. “This trip had a deeper clinical focus

at St. Clair. “We were

and I was especially interested in how Mayo developed

impressed with their

its collaborative care model on the patient units.

emphasis on patient

At St. Clair, we do a daily collaborative report on

education and their

the patient units with the charge nurse, social worker,

success in reducing

and case manager; Mayo Clinic takes it further and

re-admissions. I liked

includes the physician and pharmacist. I liked how

the way that Mayo

Mayo pairs a nurse manager and medical director

physicians and staff

on every unit; this gives them joint accountability

are committed to the

for quality and an immediate resource for problem

patient-centric culture;

solving. St. Clair’s collaboration with Mayo is great

it permeates everything there, just as it does at

and we came away with a lot of information and ideas;

St. Clair. Everyone there and at St. Clair is engaged

the variety of disciplines from St. Clair meant that

in quality improvement.

there was diversity in the topics we explored there.”

Most impressive to Jose I. Christlieb, M.D., Medical

For Dr. Bushman, the visit generated ideas about

Director of St. Clair’s Hospitalist program, was the

improving primary care, case management and

quality and amount of patient education offered at

re-admission rates. “There are many programs and

Mayo. “Tremendous resources are put into patient

practices at Mayo Clinic that we can adapt to St. Clair.

education at Mayo Clinic,” he says. “There are models of organ systems throughout the campus, facilitating the patient’s understanding of their condition. There are two medical libraries just for patients; one is dedicated entirely to cancer education. Every waiting room has a patient education center, as does the cafeteria. Patient education is a well-developed, comprehensive and constant process at Mayo. With our clinical collaboration with Mayo Clinic, we now have access to a wealth of patient education materials, in addition to our own valuable resources.” Dr. Christlieb also found that outpatient care, which forms the bulk of patient care at Mayo and is a growing national trend in health care, is extremely efficient there, and he likened it to St. Clair’s Outpatient centers in Bethel Park and Peters Township, where patients have been enjoying “one stop” health care services for years. In the outpatient center at Mayo

St. Clair Hospital clinicians and staff interact with their peers at the recent Quality Exchange at Mayo Clinic in Rochester, Minnesota.

Clinic, patients are immediately evaluated, referred to a specialist consultant, diagnosed and given a

For instance, Mayo Clinic uses an Elderly Risk Assessment

treatment plan. Everything that is needed for that

Index to determine the likelihood of re-admission for

to happen is right there, geographically convenient —

elderly patients; they are given a score that helps

the lab, radiology and physician specialist offices are

identify those at greatest risk. Mayo has managed to

in the same building, or within walking distance, as

reduce re-admissions by 80 percent by using this tool and

the outpatient clinic, so a patient can literally walk

by automatically providing care and home visits from a

from place to place.

nurse practitioner for elderly patients. Along with others

Physicians and staff at Mayo Clinic have a reverence for their history, notes Karl E. Bushman, M.D., FACP, Medical Director of Care Management at St. Clair.


using this risk assessment tool in my practice.”


Dr. Chiesa, St. Clair’s Associate Chief Medical Officer and Chair of the Medical Staff Quality Committee,

brothers and is their legacy. They’ve made distinct

says she returned home eager to implement quality

choices to build their patient-centered culture, and it

improvements at St. Clair.

centered approach is in every detail, even the artwork,


in the St. Clair system, I’m exploring the possibility of

“The Mayo Clinic was built on the vision of the Mayo

is evident that they continue to do so. This patient-


“There are several things that we would like to make happen fairly quickly,” she explained. “For me,


as it creates a supportive and comfortable feeling.

a priority is the restructuring of the Medical Staff

There is clearly a strong sense of confidence in their

Quality Committee, to get more physicians involved


mission, their quality, and their endurance.”

and use the group as a think tank for projects.



Continued on page 18

Volume IX Issue 1 I HouseCall I 17


At Mayo, all QI projects are physician-led. Our medical staff

but also motivated to do more. The St. Clair community

more systems-based approach, integrating quality across

will benefit from our experience at Mayo Clinic because

the continuum, with less segmentation and duplication.” Mayo has another, special kind of interconnectivity



“I came home feeling very good about our Hospital,

has about 90 QI projects right now, and I’d like to adopt a

we will continue to improve as we respond to the needs of the community. The Quality Exchange experience makes

that pervades and unites the entire system, generated by

it easier for our physicians to reach out to individual

their cherished history, their patient-centered approach

physicians at Mayo, in order to better perform our work

to care, and their culture of excellence. “The entire culture

here. The personal connection with our Mayo Clinic counter-

is dedicated to patient care,” says Dr. Christlieb. “Every

parts makes a difference, and we will promote that.”

aspect of care, every process, and even the physical environment reflects this. There’s an aura of serenity and

At both Mayo Clinic and St. Clair Hospital, excellence is no accident. Each institution has a robust QI program

peace. Efficiency of processes and the confidence of the

that takes hard work, meticulous attention to detail, and

staff give the patient a sense of security and confidence,

an unrelenting commitment to quality and safety from the

a feeling throughout that, ‘These people really care about

board, administration, physicians and every member of

me.’ I believe that patients leave Mayo Clinic with a feeling

the staff. Ashley, St. Clair’s Manager of Quality Improvement,

that the system is there for them.”

says, “Our quality of care is among the very best in the

Dr. Chiesa echoes those sentiments. “I was inspired

nation but we are not sitting back and congratulating

to see how pervasive the patient-centered philosophy is

ourselves. We are tough on ourselves, always seeking

throughout the Mayo Clinic organization,” she says. “Everyone

to do better. The trip to Mayo Clinic strengthened our

cares about what the patient and family are experiencing.

commitment, but not because we want to be Mayo Clinic;

The culture is one of humble pride, meaning that they don’t

there is only one Mayo Clinic, and it is an extraordinary


say, ‘We are the best’ but rather, ‘We want to be the best.’

institution. But there is only one St. Clair Hospital and it,


They are always striving to do better and to help others do

too, is unique and extraordinary. We are strong in our



better. They never teach down; instead, they pull you up.

identity and we keep pushing to be better and better.” n

Representatives from Virginia Hospital Center visit St. Clair

Membership in the Mayo Clinic Care Network (MCCN) provides St. Clair Hospital with not only access to clinical expertise at the world-renowned Mayo Clinic, but also opportunities to share best practices with other members of MCCN. In January, executives from the highly awarded Virginia Hospital Center, located outside of Washington, D.C., met with their counterparts at St. Clair to gain insight into clinical areas in which St. Clair excels. Pictured left to right are Virginia Hospital Center officials Pam Kane, VP and COO for Physician Services; Robin Norman, Sr. VP and CFO; Jim Cole, President and CEO; Jeff Dilisi, M.D., Sr. VP and CMO; and Darlene Vrotsos, Sr. VP and CNO.

18 I HouseCall I Volume IX Issue 1

Editor’s note:

Q&A with

Rich Schaeffer, Chief Information Officer St Clair Hospital

Q: A:

While the majority of St. Clair Hospital personnel who recently attended a Quality Exchange at Mayo Clinic in Rochester, Minnesota, were doctors and nurses, the Hospital’s Chief Information Officer (CIO), Richard J. Schaeffer, was also part of the official delegation. His role in overseeing electronic health records at St. Clair is increasingly important as the power of information technology to enhance clinical quality grows. HouseCall asked Rich what he learned and shared at the Quality Exchange.

What did you learn about Mayo Clinic’s approach to Quality Improvement? The Mayo Clinic team made the point that ‘the quality department functions as the eyes and ears of clinical practice.’ Mayo not only observes its own clinical practice, but they also look outside of its system, across the entire health care industry, at what can be learned from others. This simultaneous internal and external examination helps them maintain their industry-leading outcomes. It struck me that our St. Clair team, visiting the Mayo Clinic, was doing the same thing; looking outside our facility to learn from the Mayo Clinic. Although the campus and facilities are very different, much of the work we are doing is remarkably similar, and it was a great opportunity to exchange ideas. For example, both Mayo Clinic and St. Clair are in the process of implementing systems that will facilitate team-based care and shareable care plans for outpatients. This design enables access by the entire care

Q: A:

Q: A:

How did Mayo Clinic’s culture compare to that of St. Clair Hospital? I had the impression that everyone is on the same team there, just like here, working collaboratively to achieve the best outcome for the patient.

What is your most lasting impression of your visit? Mayo Clinic is an amazing place. Our visit merely scratched the surface of all that is there, but my impression is that everything they do, they do very well. Our trip created relationships and gave us a launching pad for future endeavors; I expect to sustain the momentum of this trip through regular contact, continued exchanges, and follow-up on all the initiatives that were discussed during the visit. n

team of providers across the continuum (acute, ambulatory, post-acute, home care, etc.), so that members of the care team are all working from the same plan for the patient. Considering Mayo Clinic’s vast experience, the opportunity to share ideas, and both successes and challenges, on this common goal of transforming the care model, can only help us to be

Q: A:

The Plummer Building in Rochester, Minnesota, is one of many architecturally significant buildings on the Mayo Clinic campus.

more successful for the patients in our community.

What did you learn about Mayo Clinic’s information technology? Dr. Louis Civitarese, St. Clair’s Chief Medical Information Officer, and I had a chance to meet with Mayo Clinic’s CIO. We were interested in knowing where they are in their IT journey, what is being implemented, and what we might be able to leverage as a member of the Mayo Clinic Care Network. Mayo Clinic’s CIO was open in sharing their IT roadmap with us. Of particular interest, we learned that Mayo Clinic is implementing systems to mine knowledge from ‘big data.’ Big data in health care involves taking huge troves of medical information and making it available to physicians and other clinicians to treat their patients. Although, here at St. Clair we have our own tools in place, it would be advantageous to be able to tap these high-end Mayo Clinic tools and systems to help us identify big data trends. The benefits of big data analysis could further help us to improve our focus on patient wellness, reduce costs and transform health care. Volume IX Issue 1 I HouseCall I 19



A safe, effective vaccination against cancer


any people in the United States are at risk for a deadly but

HPV vaccine is cancer prevention — that is the bottom line in the

preventable form of cancer. And the way to prevent it is by

ongoing effort to provide this invaluable protection to the nation’s

making sure pre-teen children receive the HPV vaccine.

youth. Pediatricians, including local HPV expert Sarah E. Kohl, M.D.,

HPV stands for human papilloma virus — actually a group of viruses

Chair of the Department of Pediatrics at St. Clair Hospital, recommend

that cause cancer, especially oral and cervical cancer. HPV is

a series of HPV vaccinations for pre-teens, ages 11-12, to initiate

common; according to the Centers for Disease Control and Prevention,

and establish long-term protection. HPV vaccine is safe, it’s effective

nearly 80 million people in the United States and nearly half of

and it’s incredibly important for the future health of children; it

American men are currently infected with it. It’s a slow-growing

protects their lives, their health and potentially their ability to have

infection that can take decades to develop into cancer, but when that

children. And yet, misinformation and myths are keeping parents

cancer shows up, it’s likely to be in the prime of life — the early 30s.

from getting their teenagers vaccinated.

Nearly 80 million Americans are currently infected with HPV

HPV causes



cancer deaths every year in the U.S.

27,000 14 million infected each year

New cases of HPV-related cancer are diagnosed each year in the U.S. 20




will get HPV at some 2 point in their life

nearly half of American men are currently infected with HPV

20 I HouseCall I Volume IX Issue 1

That’s 1 person every 20 minutes of every day, all year long

% The HPV vaccine 70 protects against HPV types that cause 70% of cervical cancers

Source: cdc.gov/hpv/parents/whatishpv.html

“In western Pennsylvania in 2015, immuniza-

screening for it,” Dr. Kohl explains. “About

the factors which help kids grow around age

tion rates for boys ages 13-17 was 38 percent;

30 percent of women who get cervical cancer

11 to 12 also help their immune systems

for girls, it was 47 percent. For pre-teens,

from HPV have a normal Pap smear one year

respond better to vaccines.”

the rate varies from 14 to 20 percent for both

prior to diagnosis. Prevention is critically

genders,” Dr. Kohl says. “Parents are not getting


their kids vaccinated. This is a highly effective

Dr. Kohl emphasizes that getting HPV vaccine for a preteen is something all parents

Dr. Kohl says some parents have concerns

vaccine, but it is being underutilized. At age 11,

about safety. “There is a lot of misinformation

should include in their child’s vaccination scheduling. “Parents can literally protect the

kids should get TdaP (tetanus, diphtheria,

about side effects and safety, because people

child’s future. Parents already do this in count-

pertussis), plus meningitis vaccine and HPV

are not sticking to the science. The fact is,

less ways — HPV vaccine is one more way to

vaccine. Of the three, the disease most likely

there are no serious side effects; there may

help your child become a healthy, thriving adult.

to kill you is HPV.”

be a local irritating effect only. There may be


temporary dizziness;

this to our patients. The vaccine, known as

we have the patients sit

Gardasil, lines up exactly with the strains of

for a few minutes to

the virus which cause cancer, giving long

make sure they’re okay.”

lasting protection. Just think: there is a way

It is important for

to prevent your child from potentially getting

parents to remember that although cancers


caused by the HPV virus


may not appear until


“Physicians are excited to be able to offer

patients are in their 30s,

one of the deadliest cancers in their future, and it is simple, very safe and effective.” n Parents can find more information on HPV at www.preteenvaccine@cdc.gov.

the most effective time to receive the vaccine is between 11 to 12 years

Every year in the U.S., HPV causes 6,000

of age. The idea that a preteen is at risk for a

cancer deaths. In addition, 27,000 new cases

sexually transmitted virus may be uncomfort-

of HPV-related cancer are diagnosed annually,

able for parents, but there are solid medical

and the numbers are growing. HPV is trans-

reasons for giving the vaccine at that age.

mitted through intimate contact and can cause

Preteens are far less likely to already have the

cancer of the cervix, vulva, vagina, penis and

virus, so by getting the vaccine at the prescribed

anus, plus oral cancer. “Oral cancer from HPV

age, they are protected from potentially ever

is the number one oral cancer in men, causing

getting it. Even better, says Dr. Kohl, is this

more oral cancer than smoking. There is no

recent development: “The latest data show

screening for it and it shows up far back in

that, by getting your HPV started on time at

the throat, so you’re not going to be aware of

age 11, it works so well that the child only

it until it is rather large. In girls, HPV is the

needs two doses, six months apart, instead

number one cause of cervical cancer and oral

of three. If you get it later, after your 15th

cancer. It is a deadly cancer and there is no

birthday, you still need three. This is because


SARAH E. KOHL, M.D. Dr. Kohl is Chair, Department of Pediatrics, St. Clair Hospital. She earned her medical degree at Thomas Jefferson University, Philadelphia, and completed her residency at University of California Hospitals, San Francisco. Dr. Kohl is board-certified by the American Board of Pediatrics and practices with Pediatric Alliance, Chartiers/McMurray Division. To contact Dr. Kohl, please call 412.221.0160.

Volume IX Issue 1 I HouseCall I 21


attracting new doctors and adding new services, all to serve the people of the Pittsburgh area.” It is also important to Mrs. Kutsenkow to carry on her husband’s legacy, and so she donates

___ ___ ___WHY I ___

to St. Clair in his memory. Dr. Mike was a general


practitioner, but he was also a rare breed of


physician who personified the very best qualities of “the good doctor.” In the tradition of the times, Dr. Mike opened a solo practice, in Carnegie, where he cared for patients of all ages for 55

Rose Kutsenkow Donor

years. A true family doctor, he did it all: obstetrics, pediatrics, geriatrics, internal medicine and minor surgery. He delivered thousands of babies

R “

The community-at-large

and he made house calls, long after that practice ose Kutsenkow believes in St. Clair Hospital.

had become obsolete.

She has witnessed the Hospital’s growth

In addition to supporting St. Clair Hospital,

and evolution for several decades with

the Kutsenkows have long been dedicated

great pride. A longtime resident of the area

donors to the arts community in Pittsburgh, and

and a mother and grandmother, her family has

Mrs. Kutsenkow continues that tradition to this

received excellent care there. “My most recent

day. She supports the Pittsburgh Opera, Civic Light

great-grandchild was born at St. Clair; my daughter

Opera, Pittsburgh Ballet Theatre and the Andrew

recently had knee replacement surgery there,”

Carnegie Free Library and Music Hall in Carnegie.

she says. Her connection to St. Clair goes deeper,

She encourages everyone to find an organi-

can feel secure in

however. Mrs. Kutsenkow’s late husband, Michael

zation that enriches their interests and begin

knowing that we have

Kutsenkow, M.D., was a member of the St. Clair

supporting it, as a donor or a volunteer. “It’s

the best medical facility

Hospital medical staff and also served on the

amazing how easily one can become entrenched

right here in our

Hospital’s board of directors. “Dr. Mike,” as he

in the volunteer corps and in the organization

was affectionately known, was among the first

itself. It can be invigorating and exciting, and it

physicians to join the medical staff in the 1950s,

makes the community a better place.”

backyard, and I encourage everyone to support St. Clair.


and he remained active on the staff until his retirement in 2000.

generosity of donors like Mrs. Kutsenkow, who,

Mrs. Kutsenkow says she supports St. Clair

among other generous donations, provides a

Hospital in part because she appreciates what it

weeklong stay at a condo in the Cayman Islands

means to the people of the region. “St. Clair is

to be auctioned to the highest bidder at St. Clair’s

our hospital,” she says. “It has wonderful doctors

annual Summer Swing gala.

and facilities. We are fortunate to have a hospital

“St. Clair Hospital is the best choice,” she

of this caliber so close to home. We are attached

says. “The community-at-large can feel secure

to St. Clair and its physicians. With its reputation

in knowing that we have the best medical facility

for quality, along with its new clinical relationship

right here in our backyard, and I encourage

with Mayo Clinic, St. Clair continues to grow by

22 I HouseCall I Volume IX Issue 1

St. Clair Hospital is a better place due to the

everyone to support St. Clair.” n


Ask the Doctor ROBERT W. BRAGDON, M.D.


Botox has long been used by plastic surgeons for cosmetic purposes, but are there other uses in health care?

Botox is onabotulinumtoxinA, a highly purified version of

Interestingly, as a result of these cosmetic treatments,

the neurotoxin which is commonly associated with food

some patients who suffered from migraine headaches

poisoning, or botulism. It was originally developed to

noted relief of their headache symptoms following Botox

treat ocular problems like strabismus, in which a patient’s

injections. This led some physicians to start using Botox

eyes don’t look in exactly the same direction at the same

to treat migraine headaches.

time. It also was used for blepharospasm, a neurological

Other so-called “off-label,” or non-FDA-approved, appli-

condition involving forcible closure of the eyelids. Simply

cations for Botox include treating back pain, depression

put, Botox works by blocking signals between nerves

and teeth grinding, among others.

and muscles.

But the growing list of FDA-approved uses for Botox

Botox treatments, as well as other “injectables,” have

include hyperhidrosis, or excessive sweating of the

become the most common procedures performed by

underarms and the palms of the hands, particularly when

plastic surgeons in the United States. Botox for cosmetic

topical agents are no longer effective.

purposes was developed to weaken the muscles

And some specialists incorporate the use of Botox in

which cause creases between the brows,

treating muscular disorders involving spasticity of the

frequently called the 11s, as well as forehead

upper extremities, as well as the neck. It has also been

creases. As a result of the muscles not being

utilized for symptomatic relief of urinary incontinence and

contracted as frequently, or forcefully, those

overactive bladder.

creases smooth out, making lines less evident

As always, though, there are contraindications to

or refreshed. When used for cosmetic purposes

any type of procedure, so patients need to inform their

and improving one’s appearance, the benefits of

physicians of all medications and supplements they are

Botox primarily revolve around a feeling of

taking and any type of neuromuscular disease they

better self-esteem and well-being, which are the

might have prior to commencing any type of treatment

desired outcomes for any type of aesthetic

with Botox, whether that treatment is FDA-approved or

procedure or therapy.

off-label. n


ROBERT W. BRAGDON, M.D. Dr. Bragdon specializes in plastic and reconstructive surgery at St. Clair Hospital, where he is Chief of Plastic Surgery. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his surgical residency training at its affiliated hospitals. Dr. Bragdon completed his plastic surgical residency training at The Western Pennsylvania Hospital. He also completed a burn fellowship at West Penn Hospital and was the first fellow in plastic surgery at Dartmouth. Dr. Bragdon is board-certified in plastic and reconstructive surgery. He practices with Plastic Surgical Associates of Pittsburgh, P.C. To contact Dr. Bragdon, please call 412.572.6164.

Volume IX Issue 1 I HouseCall I 23

1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org

| Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 General & Patient Information: 412.942.4000 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400


St. Clair participates with every major insurer in almost every product. That means ST. CLAIR IS AN IN-NETWORK PROVIDER for these insurers and products. And, if you have a health insurance product (like a high-deductible health plan) that requires you to share in the cost of paying for services, you’ll be pleased to know that ST. CLAIR IS OFTEN THE LOWEST COST PROVIDER. For more information, please call Customer Service at 412.344.3408 to speak to a St. Clair representative. For a complete list of insurers currently contracted with St. Clair to provide IN-NETWORK services to their members, please visit WWW.STCLAIR.ORG.









in the region

St. Clair Hospital is consistently rated as the market leader for quality, patient safety, patient satisfaction, value, and cost transparency. These accomplishments reflect St. Clair’s culture of continuous improvement, one that has been recognized by a host of independent third-party evaluators. It’s patient-focused care that is propelling us to not only be the best regionally, but among the best in the nation as well. It’s all part of our pledge to provide the best health care to our patients. Sources: Comparion Medical Analytics; The Leapfrog Group; Press Ganey; CMS


is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.


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St. Clair Hospital_HouseCall Vol IX Issue 1  

St. Clair Hospital's news magazine sharing new medical technologies, patient stories and health tips.

St. Clair Hospital_HouseCall Vol IX Issue 1  

St. Clair Hospital's news magazine sharing new medical technologies, patient stories and health tips.

Profile for dymun