St. Clair Hospital HouseCall Vol VIII Issue 2

VOLUME VIII ISSUE 2

HouseCall Pulmonologists are

breathing new life

into patient care at St. Clair Hospital

inside

Ask The Doctor I Expanding Patient Access With Convenient Locations And Services Outpatient Services: Delivering Uncompromising Outpatient Care I Healthcare Costs Made Transparent Managing Cancer With Yoga I Mobile Device Stations: Stay Connected

RESPIRATORY HEALTH

BR

The respiratory system is one of the body’s most complex.

Every other system, indeed every single cell, is inextricably tied to the lungs.

2 I HouseCall I Volume VIII Issue 2

EATH OF LIFE Experts estimate that the average person draws between 17,000 and 23,000 breaths a day.

Our inhalations and exhalations are so inborn that, in large part, we do not even notice them.

The lungs are a quiet and efficient machine. That is, until something goes wrong. In this issue of HouseCall magazine, we explore some of the conditions that cause severe and often life-altering breathing problems, and feature several of the specially trained physicians at St. Clair Hospital who are helping their patients to overcome them.

B

reath is life. From the shock of the first breath to the whisper

specialists, respiratory therapists, nurses and others to deliver

of the final one, human beings breathe continuously, our

excellent, progressive care to those with respiratory diseases and

breath an invisible, gentle tide of air that flows, in and out,

conditions, including chronic obstructive pulmonary disease (COPD),

back and forth, so soft and subtle that we barely feel it. It seems so

asthma and lung cancer.

simple. There is nothing simple, however, about the lungs, the organs of breathing. The lungs are one of the largest organs in the body; they contain 1,500 miles of airways, 300 to 500 million alveoli

Experts in battling lung disease Lung disease is pervasive in western Pennsylvania and St. Clair

(air sacs) and, if laid out flat, would be equal to 80 to 100 square

Hospital has superlative resources to address it. This includes the

meters, about half of a standard tennis court and twice the surface

most advanced diagnostic and therapeutic technology, preventive

of the skin. Physiologically, the respiratory system is one of the

and rehabilitative programs, and an exceptional Sleep Disorders

body’s most complex. Every other system, indeed every single cell,

Center. Most importantly, St. Clair has highly credentialed, caring

is inextricably tied to the lungs, so that when lung health is compro-

pulmonologists, including Stephen G. Basheda, D.O., Chief,

mised, the entire body is at risk.

Pulmonary Diseases, at St. Clair Hospital, Gregory J. Fino, M.D.,

Together with the upper airway, the lungs allow us to breathe,

a pulmonologist who is Chief, Critical Care, at St. Clair, and

speak, laugh and sing. We take our breath for granted, mostly

a group of pulmonologists who practice as Pittsburgh Chest

unaware of it until we are short of it and we must struggle to

Physicians: Patrick G. Reilly, M.D.; Andrew Perez IV, M.D.;

breathe. Breathlessness feels awful, and lung disease can be quite

Laurie A. Kilkenny, M.D.; and Zachary T. Young, M.D.

debilitating, say the experts who endeavor to relieve, reverse or

Pulmonology is the diagnosis and treatment of disorders of the

mitigate it. Chief among those experts are pulmonologists, specialist

lungs and breathing, and at St. Clair, pulmonary care is dynamic

physicians with extensive training in lung disease, heart disease,

and fast-paced. To Dr. Young, pulmonology is an appealing mixture:

sleep medicine and critical care medicine. At St. Clair Hospital,

the fast pace and challenge of critical care, and the human relation-

pulmonary care is a Center of Excellence, with a team of board-

ships of patient care. “I love the technology, and it is constantly

certified pulmonologists who collaborate with other physician

advancing. At St. Clair, we have all the latest technology and an Continued on page 4

ABOUT THE COVER St. Clair Hospital lung patient James “Jim” Bennett with a French horn before a recent rehearsal by Community Band South, which Jim directs.

Volume VIII Issue 2 I HouseCall I 3

RESPIRATORY HEALTH Continued from page 3

all-inclusive program — everything related to pulmonary care, from sleep

more than 23 million Americans have COPD, but Dr. Young states that

studies to pulmonary rehab, and the quality of these programs is excellent.”

the majority of them don’t know they have it. “COPD is an insidious

The most common lung conditions that Dr. Young and his colleagues treat

and progressive disease. The onset is so gradual that people make

are COPD, asthma, lung cancer, pneumonia, pulmonary fibrosis and other

modifications to it without realizing they are doing so. They take longer

forms of interstitial lung disease (disease that affects the network of tissue

to do things, take more breaks or perform tasks differently. They

that supports the airways). “COPD is quite common. We are seeing an

unconsciously adapt their lifestyle to their breathing, until they cannot.”

increase in COPD patients because it is being recognized more; primary care physicians (PCPs) are more aware of it.”

Tobacco smoke is a primary factor in the development and progression of COPD, but genetic factors, air pollution, occupational exposure and infections can also play a role. There are many treatment options for the condition, Dr. Young says, including new medications,

COPD is insidious and progressive COPD is an umbrella term for a group of diseases that cause

oxygen, smoking cessation and pulmonary rehabilitation that builds

obstructions to airflow and subsequent breathing problems; emphysema

strength and conserves energy. “The goal of treatment is to improve

and chronic bronchitis are two common types of COPD. Symptoms

quality of life, to help people continue with their activities of daily life

include shortness of breath, fatigue and coughing. It’s estimated that

as much as possible.”

St. Clair Hospital’s registered respiratory therapists are often referred to as the “firemen” of the Hospital because they are called upon — day and night — to respond to STAT calls involving patients suffering respiratory distress. But they also have regularly scheduled rounds with patients, as well as appointments.

In the photo at right, Eric Martos, RRT, and Diane Smith, RRT, examine inpatient Ernest Rapp, 71, of Upper St. Clair, who was hospitalized with breathing issues.

At left, Mark McDermot, RRT, demonstrates a pulmonary function test in the Respiratory Care Department at the Hospital.

4 I HouseCall I Volume VIII Issue 2

THE BREATHTAKING NUMBERS OF COPD [CHRONIC OBSTRUCTIVE PULMONARY DISEASE]

1.5 MILLION

EMERGENCY DEPARTMENT VISITS ARE MADE FOR COPD ANNUALLY

8590%

OF ALL COPD DEATHS ARE CAUSED

BY SMOKING

13 MILLION

3RD

COPD IS THE LEADING CAUSE OF DEATH IN THE U.S.

U.S. ADULTS HAVE DIAGNOSED COPD

34% MEN 66% WOMEN

12 MILLION

WOMEN ARE MORE SUSCEPTIBLE TO LUNG DAMAGE THAN MEN

U.S. ADULTS HAVE UNDIAGNOSED COPD

Source: American Lung Association

“

Patients have easier, safer experience Advancing medical science and new technological capabilities in pulmonology are facilitating diagnosis and fostering unprecedented progress in treating lung disease, such as COPD, says fellow pulmonologist Dr. Reilly. “I’ve been a pulmonologist for a long time, and it’s exciting to have the new technologies and to work with a group of young physicians.

We’re a strong team and we learn from each other; we’re able

WHILE THERE IS NO

CURE FOR COPD, MOST ASPECTS OF THE DISEASE ARE TREATABLE.

”

to help a lot of people. The newer diagnostic studies make a big difference; we can visualize and access very complex, deep, hard-to-reach sections of the lung. The new procedures are more precise and less invasive, and patients have an easier and safer experience. In the past, surgery, under general

PATRICK G. REILLY, M.D., PULMONOLOGIST, PITTSBURGH CHEST PHYSICIANS

anesthesia, was necessary to obtain lung biopsies. These newer procedures are done on an outpatient basis, with light sedation; the patient recovers quickly and goes home.”

The new minimally invasive diagnostic technologies are known collectively as interventional pulmonology and include

Patrick G. Reilly, M.D.

Continued on page 6 Volume VIII Issue 2 I HouseCall I 5

RESPIRATORY HEALTH Continued from page 5

endobronchial ultrasound (EBUS), navigational bronchoscopy and trans-

a CT scan, and enter that information into a computer,” Dr. Reilly says.

bronchial biopsy. EBUS is a sophisticated interventional procedure that

“With a special probe through the bronchoscope, we gather more

combines bronchoscopy with ultrasound (diagnostic sound waves):

information that goes to another computer. The two computers are

a special bronchoscope with a light, an ultrasound probe and a tiny needle

linked and together they create a three-dimensional reconstruction of

at the tip is placed through the mouth and into the trachea and large

the lung. It uses GPS-like technology to give us a map of the lungs and

airways. “It’s an ultrasound from within,” explains Dr. Reilly. “It enables

navigates the end of the probe right to the lesion, while we watch it on

us to locate something on the other side of the trachea or bronchial wall.

screen. We can get very far out in the lung and get a biopsy. Without it,

We can locate lesions in the lung and can actually see through the probe.

the patient would have to have surgery.”

We obtain tissue and fluid samples for biopsy and have cytology studies

A transbronchial biopsy is done with fluoroscopy (real-time X-ray).

done, to diagnose cancer, infection and other things like lymphoma

This, says Dr. Reilly, is most useful for looking at more diffuse, interstitial

and sarcoidosis. It’s very helpful for patients with known cancer, for

lung disease, such as sarcoidosis, rather than looking for a specific

determining the stage of the cancer.”

lesion. “With the bronchoscope, we are able to go as far out as possible

Navigational bronchoscopy utilizes special software to identify targets in the lung and then guide a probe right to them. “First, we do

“

with biopsy forceps and take a number of biopsies that are very sensitive for certain diseases.”

These technologies enable the pulmonologists at St. Clair to make

PULMONARY REHAB IS ONE OF OUR BEST

a diagnosis with greater accuracy

ASSETS AT ST. CLAIR AND IS VITALLY

and speed. They expedite the earlier

IMPORTANT IN THE TREATMENT OF COPD . . .

IT HAS GREAT VALUE FOR PATIENTS. STEPHEN G. BASHEDA, D.O. CHIEF, PULMONARY DISEASES, ST. CLAIR HOSPITAL

”

diagnosis of lung cancer and thus improve survival. For the patient, they also mean there is no need for diagnostic surgery and all that that entails: anesthesia, an incision, post-operative pain and an overnight admission.

Having access to the latest technology to help patients is one of the great rewards of being a pulmonologist at St. Clair, says Dr. Perez.

“Pulmonary medicine is a great field,” he says, “and pulmonary medicine at St. Clair is outstanding. All of the physicians in our division are high-caliber medical professionals who could be in any academic center.

I chose this specialty because I’m interested in the complex physiology of the lungs and the mechanics of breathing. It’s a broad field that intersects with cardiology, infectious disease, oncology and other specialties, and I enjoy that. Sleep medicine can be very rewarding — when you treat a person with narcolepsy, for example, you see a dramatic change in the patient. We are also critical care physicians who treat the sickest of the sick, using agents that have an immediate impact; I believe that being trained in critical care makes me a better pulmonologist.”

Diagnostic challenges are common in pulmonology, says Dr. Perez.

“Why do people get short of breath? There are so many possibilities.

I teach medical students and residents that they should never write off shortness of breath as anxiety — in fact, that should be the last thing to consider. Shortness of breath creates anxiety for most people.

Breathing comfortably impacts quality of life.”

6 I HouseCall I Volume VIII Issue 2

Stephen G. Basheda, D.O.

“

Pulmonary re hab has mad e the biggest d ifference.

My COPD is s table …

I think I’m do ing very well.

”

PAUL MEURER, PATIENT

COPD patient Paul Meurer relaxes with his wife, Vickie, on the back deck of their home in Bridgeville.

Restoring quality of life While advanced technologies are essential to diagnosing and treating lung disease, the simple exercises associated with pulmonary rehabilitation are key elements in restoring quality of life to patients with lung disease, according to Dr. Basheda. “Pulmonary rehab is one of our best assets at St. Clair and is vitally important in the treatment of COPD. People with lung disease become

PATIENT PROFILE

PAUL MEURER

Breathing Better Paul Meurer, 73, of Bridgeville, has COPD that requires

deconditioned, which worsens their shortness of breath and

continuous use of supplemental oxygen, but that hasn’t stopped

depletes their energy. They become progressively more sedentary,

him from enjoying the Lebanese food at his favorite restaurant,

which leads to further deconditioning. Pulmonary rehab breaks that

Shouf’s Café, with his wife Vickie and their friends. The retired

cycle. When you build strong leg muscles through exercise, you

Duquesne Light supervisor and father of two sons was diagnosed

can actually reduce shortness of breath and improve quality of life.”

with COPD four years ago, and he is enthusiastic about St. Clair’s

At St. Clair, all COPD patients are referred to the Pulmonary

Pulmonary Rehabilitation Program. ”It hasn’t been too hard to

Rehabilitation Program. “At St. Clair, we are aggressive about getting

adjust,” he says. “Pulmonary rehab has made the biggest difference.

patients into the program early,” Dr. Basheda says. “It’s a fantastic

I learned breathing exercises and physical exercises to improve

program and gets excellent results. Patients who join the program

my overall muscle strength. I go on the bike and treadmill and I lift

have fewer exacerbations of their disease and fewer re-admissions.

weights, all at my own pace. The clinical staff there checks on

They benefit equally from the exercising and education, and there

you frequently, making sure your blood pressure, heart rate and

is a significant social element: they make friends, have peer support

oxygen levels are all right.”

and thus are more likely to commit to continued exercising. Studies

Paul smoked for 50 years and was able to quit “cold turkey”

have shown that people are less likely to exercise on their own, but

after his diagnosis. He sees Dr. Young on a regular basis, and

when they join an organized group, they make the commitment.

gets pulmonary function testing before each visit, to assess the

People who have lung disease often are reluctant to go out and they

performance of his lungs. “My COPD is stable,” he says. “At first,

can become isolated. When they go to pulmonary rehab, they enjoy

there was some trial and error with different medications; I did get

seeing the others, they feel better and want to keep going. It has

help from inhalers, but oxygen helps the most and I am on oxygen

great value for patients.” ■

all the time now. I think I’m doing very well.” ■ Volume VIII Issue 2 I HouseCall I 7

RESPIRATORY HEALTH Continued from page 7

PATIENT PROFILE

JAMES BENNETT

Staying in tune French horn players are masters of the art of breathing. The instrument demands effectively using the lungs, lips and abdominal muscles, coordinated to produce beautiful sound. James Bennett, 72, of Upper St. Clair, understands this well: he is a musician, music teacher and former band director who has taught the dynamics of proper breathing to countless music students at Upper St. Clair High School, where he worked for more than 40 years. “Mr. Bennett” was a popular figure at the school, where he served as chairman of the Fine Arts Department, and can proudly claim that he has students playing in symphony orchestras around the globe.

“I know how to breathe better than most people,” he

rehab was great. I went twice a week for 60- to 90-minute

says; “I know how important it is.” But in the spring of

sessions. I did walking and stretching and went on the

2015, he suddenly found himself short of breath. He saw

machines,” he recalls. “Your program is as vigorous as

his primary care physician (Frank A. Civitarese, D.O. of

you choose to make it, and the staff is attentive; they

Preferred Primary Care Physicians, Inc.) who treated

watch you closely, monitoring your oxygen levels and

him with antibiotics and bronchodilators, providing some

heart rate. I feel much better now.”

initial relief. But his condition worsened, he needed oxygen,

Jim is no longer in need of supplemental oxygen, and

and he was admitted to St. Clair Hospital. Dr. Young, the

is back to making music with the group he co-founded,

pulmonologist with Pittsburgh Chest Physicians, ordered

Community Band South. He also works part-time as the

a battery of diagnostic tests, suspecting a lung infection,

manager of the Upper St. Clair Theatre, and keeps up

but the tests were inconclusive. A biopsy was obtained by

with the 1,200 former students who are his Facebook

St. Clair Hospital thoracic surgeon Richard H. Maley, Jr., M.D.

friends. “My condition is not chronic; it was an acute

via thoracotomy, and a diagnosis of interstitial hyper-

condition, but I may need rehab forever to keep my

sensitivity pneumonitis was made.

lungs healthy. I’m pretty active; I drive and go out. I had

Hypersensitivity pneumonitis is an acute inflammatory

a great experience in St. Clair Hospital. When you are

condition that occurs when a toxin or irritant of some kind

in the hospital, it’s a negative experience — something

enters the lung. In Jim’s case, the exact nature of that

is wrong with you, and you’re scared. The team at

causative agent remains unknown. But Jim recovered,

St. Clair turned that all around for me; I had excellent

after a months-long course of steroids and an individualized,

doctors, nurses, and therapists who resolved my

comprehensive pulmonary rehab program. “Pulmonary

illness and I am very happy with the results.” ■

8 I HouseCall I Volume VIII Issue 2

“

I had excellent doctors, nurses, and therapists who resolved my illness and I am very happy with the results.

”

JAMES BENNETT, RESPIRATORY PATIENT

Respiratory patient James “Jim” Bennett directs members of Community Band South at a recent rehearsal in the Band Room at Upper St. Clair High School. The band, now in its 29th season, performs numerous concerts every year throughout southwestern Pennsylvania.

Volume VIII Issue 2 I HouseCall I 9

RESPIRATORY HEALTH Continued from pages 8-9

PATIENT PROFILE

LINDA VANCE

Early screening proves lifesaving

T

hanksgiving is always a special day for Linda Vance, and the

mammograms and colonoscopies, are considered an integral part of

2015 holiday was an exceptionally memorable one. Linda

preventive care. Until very recently, there was no screening test for lung

celebrated the holiday with her extended family and friends,

cancer, one of the most common, and most deadly, forms of cancer

and she had good reason to celebrate and give thanks. Just a week

and the leading cause of death from cancer. Lung cancer takes years

before, Linda was in an intensive care unit of St. Clair Hospital,

to develop, and tends to be asymptomatic until it has reached the

recovering from surgery to remove a tumor. Linda’s experience

advanced stages. Now, screening is available in the form of low-dose

illustrates the value of low dose CT scans, the new, early detection

computed tomography scanning, or CT scan, which utilizes low

lung cancer screening that is available at St. Clair.

doses of radiation to create detailed images of the lungs.

Everyone is familiar with healthcare screening: testing for the

“This represents a very

presence of a disease, usually cancer, in the absence of symptoms,

significant advance,” says

in order to detect and treat the disease in its earliest stages.

Heather Martorella, RN, MSN,

Cancer screening exams, including

OCN, Oncology Nurse Specialist at St. Clair. “Low dose screening for lung cancer means that we will get people into treatment earlier and that will have a positive impact on survival rates.

A CT scan provides far more

LUNG CANCER NUMBER ONE KILLER CANCER IS THE

and is responsible for over 28% of cancerrelated deaths

information than a chest X-ray, and gives us images of the lungs with great detail and clarity.”

Lung cancer, says Heather, is a weighty disease to screen for, and some people are afraid to have the screening. “People sometimes say, ‘I don’t want to find out,’ but if you have lung cancer, a CT scan can catch it in the earlier stages. You can get treatment in a timely manner that may well be lifesaving. Don’t wait for symptoms, because symptoms occur when the cancer is advanced.”

Low-dose CT scanning is the only screening test for lung cancer, and it was approved by Medicare last year. The test is not for everyone, but Linda Vance

for those who are high risk and meet specific criteria. According to the Centers for Medicare and Medicaid Services, this means people who: 1) have a history of heavy smoking, with “heavy” defined as 30 or more pack years (a pack year = an average of one pack per day for one year; two packs per day for 15 years would be 30 pack years); 2) are smoking now or have quit within five years; and 3) are between the ages of 55–77.

This CT scanner at St. Clair Hospital Outpatient Center–Peters detected cancer in Linda Vance’s lung.

10 I HouseCall I Volume VIII Issue 2

Heather recommends several steps: “First, try to identify your risk

In mid-November of 2015, Linda had a thoracotomy and a left lower

factors. Have a conversation with your primary care physician about having

lobectomy, with biopsy. Post-operatively, she was admitted to an intensive

a low-dose CT scan; share the decision and discuss the risks and benefits.

care unit with a chest tube inserted in her left lung, to drain and re-expand

Your PCP must give you an order for the test. Many health insurance

it, and she was discharged to home on the third post-op day. “I only had a

providers are covering it, so check with your carrier. St. Clair Hospital offers

three-inch incision and the experience was nearly pain-free. Dr. Maley was

low-dose CT scans at both of its Outpatient Centers, in Bethel Park and

wonderful. The biopsy showed that it was adenocarcinoma, Stage I. The cancer was well contained,

Peters Township.”

Linda describes herself as a “closet smoker” who

SHOULD YOU BE SCREENED FOR LUNG CANCER?

there was no lymph node involvement and I did

never had problems related

not need chemotherapy

to smoking and was in

or radiation. I will be

general good health. “I

Current smoker?

YES

monitored with CT scans

NO

for the next five years, with

was healthy; I felt fine and rarely went to the doctor.

But when I retired, I began

55+

Former smoker?

Are you between the ages of 55 and 77?

decreasing frequency.”

Just months later, the

to have annual physical

vivacious Linda is healthy

exams, which were normal.

and active, playing golf

YES

YES

NO

and traveling. Until her

But I had not had a chest X-ray in all my years of

YES

smoking, and my PCP (M. Sabina Daroski, M.D.,

Did you smoke an average of one pack a day for 30 years or two packs a day for 15 years.

retirement, she served Avoid second hand smoke and stay healthy.

Associates) suggested getting a low-dose CT scan, to check my lungs.”

St. Clair’s Coronary Care Unit, and was on the St.Clair

FACP of St. Clair Medical Services– Fatigati/Nalin

as nurse manager for

The most effective strategy for quitting smoking is enrolling in St. Clair’s smoking cessation program, “Smoke-Free for Life.”

nursing staff for 44 years.

YES

Schedule your lung screening today, so you can be here tomorrow.

An expert, experienced manager and clinical nurse, she took pride in giving patients skillful,

Linda met all the

compassionate care.

criteria, and in September 2015, had a screening CT scan at St. Clair. It revealed a nodule in

“I have a lot of nursing experience, but this was my first experience as

the lower lobe of her left lung, and she was referred to Dr. Young, the

a patient. I was impressed by the teamwork — every specialist was on

pulmonologist with Pittsburgh Chest Physicians. “Dr. Young saw me

the same team, MY team. The communication was flawless, and the

and explained all my options. He spent forever with me, talking to me in

care felt extremely personal.

depth, answering every question. He explained that I needed to have a biopsy and he referred me to Dr. Maley, the thoracic surgeon.”

Dr. Young prepared Linda for her consult with Dr. Maley, a thoracic

“I want people to know that there is nothing to fear. I was well cared for and my experience was essentially painless. My cancer was asymptomatic; CT screening saved my life. If you meet the criteria,

surgeon at St. Clair. “Dr. Young got everything done that Dr. Maley

talk to your PCP and get the screening — if there is something there,

might possibly want or need, including an echocardiogram, so that

the sooner they find it, the better off you will be. Delaying only will

when I saw Dr. Maley, he had all the information ahead of time. He

make things worse.

even ordered pulmonary function tests pre-op, so that they would

“I loved my work, but I really love retirement. It’s like a permanent

know what my lung capacity was going in, in case I needed to have

vacation. Thanks to low-dose CT screening and the excellent care I had

lobe removed. They thought of every detail.”

at St. Clair, I’m healthy now, and it’s a wonderful life.” ■

Volume VIII Issue 2 I HouseCall I 11

RESPIRATORY HEALTH Continued from page 11

ST. CLAIR CAN HELP YOU BECOME

for Life

It’s never too late to quit smoking. No matter how long you have smoked, or how many cigarettes you smoke every day, you can improve your health and longevity by quitting. And you can improve your chances of quitting permanently by enrolling in St. Clair Hospital’s highly regarded smoking cessation program, “Smoke-Free for Life.”

S

usan Harshbarger, R.N., M.S.N., T.T.S. (Tobacco

The emotional support provided by group classes is a

Treatment Specialist) directs St. Clair Hospital’s

significant resource, says Susan, as is the coaching that

Smoke-Free for Life program. She was inspired

“The individual does all the work, and it is hard work.

the Hospital’s Intensive Care Unit, where she frequently

The achievement is theirs, and seeing them get that

found herself caring for patients in the end stages of

reward is my reward.” Susan follows clinical practice

lung cancer and chronic obstructive pulmonary disease

guidelines in her program, with three main components:

or COPD. “Over and over again, I listened to patients

medication, emotional support and education/counseling.

say that they wished they had quit smoking. Eventually I transferred into pulmonary rehabilitation, and those

The Tar Jar graphically demonstrates the amount of tar the average packa-day smoker takes into their lungs every year.

she provides. “I’m there as a guide,” she explains.

to focus on smoking cessation by her experiences in

St. Clair’s smoking cessation program was developed

by Breathe PA. There are group or individual sessions,

patients also had regrets about smoking and often

offered on-site at the Hospital. Groups are small, with three

expressed their need for help with it. When I had an

to six participants. The smoking cessation program also

opportunity to work in smoking cessation, to help prevent

has a community outreach initiative, offering workshops

COPD, lung cancer and other diseases, it was a natural

to businesses, schools, health fairs and community groups.

fit for me.”

Quitting smoking has challenges, but many people have done it. The brain becomes addicted to nicotine

Quitting is a process Smoking is the single largest cause of preventable

and craves it. Dealing with the craving and finding new

disease and death in the U.S., says the Atlanta-based

ways to cope with stress is the most challenging part.

Centers for Disease Control and Prevention. Most lung

12 I HouseCall I Volume VIII Issue 2

diseases are associated with smoking. And yet, 42

Susan wants healthcare professionals to be

What happens when a smoker quits?

million adults and 3 million middle and high school

more pro-active in encouraging patients to quit:

students smoke. Western Pennsylvania has the

“When you quit smoking, it has a positive impact

20 MINUTES after quitting

dubious distinction of having a smoking rate that

on all the major chronic diseases and lung diseases.

is above the national average. Approximately

Smoking doesn’t simply take one’s life: it takes

The heart rate and blood pressure drop to normal levels.

23 percent of Allegheny County residents smoke,

one’s quality of life long before death. The worst

while the national rate is 18 percent. “A lot of people

part may be what you lose before you die — life on

want to quit but become discouraged when they

your terms, independence, and doing things you

2 WEEKS after quitting

relapse. Quitting is a process, not an event, and the

enjoy. We need to encourage patients to quit at

Circulation and lung function improve.

process of quitting sometimes demands multiple

each visit and offer resources to help them.”

attempts,” Susan says. “It gets better each time.

St. Clair also has a program called Second

Every quit attempt is a success if you have learned

Wind which is the educational component of the

something. Try something different the next time,

Pulmonary Rehabilitation Program. It consists of

but never quit quitting.”

three classes taught by a multidisciplinary team

12 HOURS after quitting Carbon monoxide levels in the blood drop to normal.

1-9 WEEKS after quitting Coughing and shortness of breath decrease; lungs start to regain normal function.

1 YEAR after quitting

that includes Susan, a dietician, and an occupational

The risk of coronary heart disease is half that of a smoker’s.

classes present a lot of information and each person

therapist. Topics include healthful eating, managing

5 YEARS after quitting

can choose the combination of strategies that will

activities of daily living, relaxation, and energy

Susan says that the St. Clair smoking cessation

work for them. “Everyone quits differently. We

conservation. You don’t have to be in the pulmonary

prepare people for the pitfalls. Taking a class,

rehab exercise program to participate in Second

Risk of cancer of the mouth, throat, esophagus and bladder are half that of a smoker’s.

Risk of cervical cancer and stroke fall, too.

joining a group or even taking a telephone course

Wind, but everyone in the exercise program also

10 YEARS after quitting

can help. This is a good time to quit, as there are

receives this education program. ■

many helpful resources and most are free. You can call 1-800-QUIT-NOW (784-8669) for information about smoking cessation.”

Tobacco Free Allegheny (TFA) provides tobacco

For more information on quitting smoking and to contact Susan Harshbarger, please call 412.942.2008 or email her at susan.harshbarger@stclair.org.

The risk of dying from lung cancer is half that of a smoker.

The risk of cancer of the larynx and pancreas decreases.

15 YEARS after quitting The risk of heart disease is that of a non-smoker’s.

prevention and cessation programs throughout Allegheny County and helps raise community awareness about the importance of clean indoor air laws. For those enrolled in TFA-sponsored cessation programs, nicotine replacement therapy (patch, gum, or lozenge) is provided at little or no cost. St. Clair has been a subcontractor with TFA for over seven years, and through this relationship has been able to provide programs related to tobacco and smoking cessation, not only in the South Hills but throughout Allegheny County.

At the present time, there may be vouchers available to help defray the cost of Nicotine Replacement Therapy through Tobacco Free Allegheny, for people enrolled in the program.

WANT TO QUIT?

> TOBAC CO-FREE A

1.800.Q U

LLEGHE

IT.N OW (784 NY .8

> SMOKE -FREE FO R LIFE / SECOND WIND

4 1 2 .9 4 2 .2

008

669)

Susan Harshbarger, R.N., M.S.N., T.T.S., with pig lungs and other tabletop displays she uses to demonstrate the destructiveness of smoking.

Volume VIII Issue 2 I HouseCall I 13

RESPIRATORY HEALTH Continued from page 13

Treating the nightmare of

sleep apnea A disrupting condition that robs millions of people of restful sleep each night

W

hen we sleep, our bodies take care of us, regulating

OSA not only robs one of sleep, but also robs the cells

hormones, growing new cells, repairing tissues and

throughout the body of the oxygen they need to perform their vital

keeping our brains healthy. In sleep, both quantity

processes. Apnea results in hypoxia: an abnormally low level of

and quality matter; poor sleep and sleep deprivation adversely affect

blood oxygen. When one is deprived of deep sleep and adequate

energy, mood, appearance, and overall health and functioning.

oxygen, the effects are numerous and serious, and the long-term

For those who have sleep apnea, however, a good night’s sleep

consequences can be dire. OSA is associated with hypertension,

is merely a dream. There are two types of sleep apnea — central

coronary artery disease, atrial fibrillation and other heart rhythm

sleep apnea is rare and originates in the brain, while obstructive

disorders; stroke, memory loss and dementia; diabetes and

sleep apnea (OSA) is a breathing disorder. When OSA is undiagnosed

metabolic syndrome; and erectile dysfunction. It can cause

and untreated, sleep tends to be light and erratic, punctuated by

“drowsy driving,” leading to motor vehicle accidents, and it may

snoring and interrupted by periods of apnea — literally, the

shorten the lifespan.

cessation of breathing. These apneic episodes vary in length,

OSA is a common and chronic condition that affects an

some lasting for minutes, and are often followed by gasping and

estimated 18 million American adults. It is highly treatable, but

choking. People with OSA don’t reach the deep level of sleep that

usually requires lifetime management. OSA happens when the

is so restorative and essential to health and optimum functioning.

airway becomes blocked by excess tissue and lax airway muscles.

With OSA, one never feels well rested and may experience fatigue,

When the person relaxes during sleep, this excess tissue creates

headaches and shortness of breath during the day.

a blockage. Obesity is a primary cause, but not the only cause.

Continued on page 15

SLEEP APNEA IS A COMMON DISORDER, AFFECTING OVER

18 MILLION AMERICANS, OR 1 IN 15.

FOR MORE INFORMATION

ABOUT SLEEP DISORDERS OR THE SLEEP DISORDERS CENTER AT ST. CLAIR HOSPITAL, PLEASE CALL

412.942.2035.

14 I HouseCall I Volume VIII Issue 2

DID YOU KNOW?

APNEA IS GREEK FOR “WITHOUT BREATH,” AS WHEN YOU STOP BREATHING.

Sometimes, it is simply a characteristic of an individual’s personal anatomy, such as a small

AIRWAY BLOCKAGE DURING OBSTRUCTIVE SLEEP APNEA OXYGEN CARBON DIOXIDE

airway, large uvula or tonsils. According to Karen S. Gannon, BSRT, RPSGT, Manager, Respiratory Care/Sleep Disorders Center at St. Clair Hospital,

BLOCKAGE

“Weight loss can substantially improve and even reverse sleep apnea, but if a person who has been diagnosed loses weight, they need to be re-tested rather than deciding for themselves to stop treatment.”

At St. Clair, a state-of-the-art Sleep Disorders Center provides diagnosis and treatment of obstructive sleep apnea, narcolepsy, periodic limb movement disorder (restless leg syndrome) and other sleep-related conditions. The center operates seven days a week.

A sleep apnea test, or polysomnogram and analysis, is diagnostic for OSA. It also determines the severity of the condition and guides the initiation of treatment. During a sleep study, which involves an overnight stay in the center, monitors record the patient’s apneic

During sleep, gravity and muscle relaxation allow the tongue and surrounding soft tissues to fall back into the throat area, obstructing air flow.

episodes, oxygen levels, vital signs, eye movements, EEG (electroencephalogram) and leg movements, gathering an abundance of clinical information. The technicians will often wake the patient once they have identified apneic episodes, and will have them try wearing a nighttime device that delivers continuous positive airway pressure (CPAP), preventing tissue collapse and subsequent obstruction.

CPAP or BiPAP, the latter of which delivers two levels of pressure to the airway, uses a small compressor to blow humidified air into the upper airway; some patients will also have oxygen blended in.

The patient wears a mask that can go over the nose and mouth, or just the nose, held in place with straps.

“The demand for testing is high, and we are very busy,” Karen says.

“St. Clair’s Sleep Disorders Center has a reputation for excellence in conducting and interpreting sleep studies, so physicians from all over the region refer patients to us. Every member of our staff is certified as a sleep technologist, or polysomnographic technologist. The training and certification process is intense and demanding; you really have to know the specialty to become certified or registered.”

The St. Clair Sleep Disorders Center also offers home sleep studies.

The home study requires the patient to come in for instruction. If the test is indicative of OSA, the patient will need a full, overnight study. ■ See more stories on sleep apnea, pages 16–17

Karen S. Gannon, BSRT, RPSGT, Manager, Respiratory Care/Sleep Disorders Center, St. Clair Hospital.

Volume VIII Issue 2 I HouseCall I 15

RESPIRATORY HEALTH Continued from page 15

PATIENT PROFILE KEN MITTEREDER

A Better Night’s Sleep Often, it is not the patient but the patient’s partner who alerts them to the problem. For Ken Mittereder, 50, it was his wife Diane who first noted his apnea. “Diane woke me up to tell me that I had stopped breathing,” he says. “She was used to hearing me snore, and when the snoring stopped, she woke up. I didn’t know I had symptoms of sleep apnea.

I was active, I exercised and coached soccer; I felt fine. But I saw my primary care physician and, after I was tested and began treatment, I realized that, in fact, I had been experiencing symptoms; I just didn’t know it. I thought I felt good, but with BiPAP I felt so much better.”

Ken Mittereder

Ken, a Mt. Lebanon resident, is an engineer whose job involves business travel. “St. Clair’s Sleep Disorders Center has rooms that are like the hotel rooms that I’m used to; it’s comfortable. I fell asleep easily there.

After three hours the tech woke me to tell me I had had many episodes

“

of apnea. He put me on BiPAP and adjusted it, and I slept well with that.

You’ll feel better, sleep better, and live longer . .. do it for your family, so that you will be around longer for them.

”

FIRST PERSON:

Obstructive Sleep Apnea

BY BOB CRYTZER

Like most people suffering from obstructive sleep

KEN MITTEREDER, PATIENT

I still use that same mask.”

Ken has been using BiPAP for five years. “BiPAP is not a problem for me; I use an auto-BiPAP for travel. If you’re not using your device because of discomfort, find out how to make it fit better. Fix the problem. You should do this for yourself — you’ll feel better, sleep better, and live longer.

Or do it for your family, so that you will be around longer for them.

I believe that using BiPAP has added years to my life.” ■

Finally, about six months ago, I could not keep

After being wired

walking past St. Clair’s Sleep Disorders Center

to a host of monitors

on my way to the Marketing and Development

and having a CPAP

Department without stopping in for some profes-

mask

sional advice.

placed

fitted

and

over

my

apnea, I was first alerted to the problem by my

Told by the sleep experts there that my self-

face, I settled in for

spouse, who complained for years, nay, decades,

described symptoms were classic signs of

the night in a com-

about my explosive snoring and warned that I

obstructive sleep apnea, I was advised to meet with

fortable bed while

appeared to be struggling for breath in my sleep.

my primary care physician and see if a physician’s

the sleep techni-

referral for a sleep test was in order. It was.

cian watched me in

An overnight sleep apnea test more than

Bob and his CPAP at the Sleep Disorders Center.

20 years ago proved inconclusive, and an exam by

My test was actually a take-home, in which I

an ear, nose and throat physician suggested having

placed a high-tech band over my head that

via the camera on the wall. She also recorded all

my adenoids and tonsils removed might curb the

recorded my brain waves, breathing, and the

of my vital signs as the proper air pressure was

problem, but I was cautioned that the recovery

sounds of my snoring (and gasping). I returned

determined, and more.

time from those surgeries is a lot harder on adults

the test kit the next day to the Sleep Disorders

than children.

Center. The results showed that I was suffering

machine to use at home. The folks from medical device supplier MedCare showed me how to use

the control room

The next step involved being fitted for a CPAP

So, I went on snoring. And gasping for breath.

from obstructive sleep apnea and that an

And waiting for that night when a pillow would be

overnight stay in the center was needed for me to

and clean my CPAP and gave me the telephone

pushed into my face and firmly held there until the

be fitted for a CPAP and to undergo my first

number of a “sleep coach” whom I could call to

cacophony stopped. Permanently.

“treatment.”

discuss any issues I might be having with using the

16 I HouseCall I Volume VIII Issue 2

PATIENT PROFILE JUNE VANUCCI

Feeling Rested June Vanucci of Green Tree was surprised when her cardiologist

of something on their face while they sleep. You have to give it a chance; patients tell me that they feel so much better once they start using it that the initial discomfort goes away. In my experience, about 90 percent of intolerance has to do with the interface. If patients are finding it

(Mark J. Greathouse, M.D. of St. Clair Medical Services South Hills

difficult to adjust to wearing the mask, they simply contact the Sleep

Cardiology in Bethel Park) suggested that she have a sleep study.

Disorders Center or their equipment vendor to see if a mask in another

“I had no symptoms. I was a light sleeper, but I thought it was normal

style or size will work better.”

for me. I didn’t realize that my sleep was of poor quality, but when

June says it took her about a month to get used to

I look back, I remember that I often felt like I wanted to stay in bed

using BiPAP, but it has definitely helped her. “Now, I

in the morning. I took a lot of naps.” June, 85, a retired secretary

would be afraid not to use it. I think there are lots of

for Alcoa, is an active wife, mother and grandmother who attributed

people like me, who have sleep apnea but don’t

her need for naps to simply getting older. But when she saw

know it. I’m grateful that Dr. Greathouse ordered a

Dr. Greathouse, he did an echocardiogram and told her

St. Clair last summer,” she recalls. “Everyone in the Sleep Disorders Center was nice and very skilled. They put a number of sensors on my face and head. The study showed that I have sleep apnea, so they put me on BiPAP. I go to bed at midnight and I sleep through the night now! I sleep soundly and I no longer need to take naps. When I get up, I stay up.”

“It may take time to get used to wearing the appliance,” Karen, the manager of the Sleep Disorders Center, says. “Some people have trouble with the idea

machine. (My sleep coach has actually called me a

90%

OF SLEEP APNEA DISORDERS HAVE BEEN UNDER-DIAGNOSED.

Continued on page 18

there were some signs that suggested sleep apnea.

“I didn’t think I needed it, but I had my study done at

IT IS ESTIMATED THAT OVER

“

I think there are lots of people like me, who have sleep apnea but don’t know it.

”

JUNE VANUCCI, PATIENT

couple times to make sure I am comfortable with using the device.)

I must admit that strapping a mask over your face and having air continually pushed through your nose and down your throat for five to six hours a night took a little getting used to. But the benefits certainly outweigh any inconvenience. I now wake up refreshed and, for the first time in decades, feel like I have had a solid, uninterrupted night’s sleep. And that sleepiness that creeps in every day between 2 and 3 p.m. is, for the most part, a distant memory.

So, for those of you who might still be on the fence about whether to pursue testing for possible obstructive sleep apnea, my advice is to not put it off any longer. If it turns out you have obstructive sleep apnea, you will greatly appreciate the benefits of using a CPAP or BiPAP, as will your

June Vanucci

long-suffering bed partner.

Bob Crytzer is managing editor of HouseCall.

Volume VIII Issue 2 I HouseCall I 17

RESPIRATORY HEALTH Continued from page 17

sleep study for me; I have more energy and I feel

can be subtle, completely absent or ambiguous,

potential implications of OSA and more and

rested when I wake up.”

suggesting other medical conditions. OSA impacts

more people are talking about it with their

everyone, as it costs society billions in lost

PCPs. As there is no blood test or definitive

Blood Institute of the National Institutes of Health

worker productivity, inefficiency and accidents.

physical sign of OSA, the physician relies

indicate that OSA affects at least 18 million

But the good news is that physicians are more

largely on a good history from the patient in

Estimates by the National Heart, Lung and

Americans, but is underdiagnosed and under-

aware of the pervasiveness of the condition and

deciding to order a sleep test. Treatment for

treated. OSA can be devious; it does its harm

are screening for it with increasing regularity.

OSA is effective, non-invasive, and has many

while we are asleep and unaware, and symptoms

In addition, the public is learning more about the

health benefits. ■

ST. CLAIR HOSPITAL PULMONOLOGISTS INCLUDE ...

STEPHEN G. BASHEDA, D.O.

ANDREW PEREZ IV, M.D.

Dr. Basheda specializes in pulmonary diseases.

He earned his medical degree at the Philadelphia College of Osteopathic Medicine and completed a residency in internal medicine at Geisinger Medical Center, where he served as chief resident. Dr. Basheda also completed a fellowship in pulmonary diseases/ critical care at the Cleveland Clinic. He is boardcertified by the American Board of Internal Medicine, including in pulmonary disease, and by the American Board of Sleep Medicine. Dr. Basheda practices with Basheda Pulmonary, LLC.

Dr. Perez specializes in pulmonary diseases and critical care medicine. He earned his medical degree at University of Texas Medical Branch and completed his residency at UPMC Mercy Hospital of Pittsburgh and a fellowship at University of Pittsburgh School of Medicine.

Dr. Perez is board-certified by the American Board of Internal Medicine in critical care medicine and pulmonary disease. He practices with Pittsburgh Chest Physicians.

To contact Dr. Basheda, please call 412.572.6168.

To contact Dr. Perez, please call 412.942.5620.

GREGORY J. FINO, M.D.

PATRICK G. REILLY, M.D.

Dr. Fino specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the University of Pittsburgh School of Medicine, where he also completed a residency and fellowship. Dr. Fino is board-certified by the American Board of Internal Medicine, including in pulmonary disease. He practices with Clinical & Occupational Pulmonary Associates, LLC.

Dr. Reilly specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the Royal College of Surgeons in Ireland and completed his residency at UPMC Mercy Hospital of Pittsburgh and a fellowship at UPMC Presbyterian Hospital. Dr. Reilly practices with Pittsburgh Chest Physicians.

To contact Dr. Reilly, please call 412.942.5620.

To contact Dr. Fino, please call 412.942.2025.

LAURIE A. KILKENNY, M.D.

ZACHARY T. YOUNG, M.D.

Dr. Kilkenny specializes in pulmonary diseases and critical care medicine. She earned her medical degree at New York University Medical Center, where she completed her residency. Dr. Kilkenny also completed a residency at Memorial Sloan Kettering Cancer Center in New York City and a fellowship at UPMC Presbyterian Hospital. She is board-certified by the American Board of Internal Medicine in critical care medicine and pulmonary disease. Dr. Kilkenny practices with Pittsburgh Chest Physicians.

Dr. Young specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the American University of the Caribbean School of Medicine and completed his residency at University of Illinois–College of Medicine at Peoria and a fellowship at Allegheny General Hospital, Pittsburgh.

Dr. Young is board-certified by the American Board of Internal Medicine, including in pulmonary disease and critical care medicine. He practices with Pittsburgh Chest Physicians.

To contact Dr. Kilkenny, please call 412.942.5620.

To contact Dr. Young, please call 412.942.5620.

18 I HouseCall I Volume VIII Issue 2

ASK THE DOCTOR

Ask the Doctor ANTONIO J. RIPEPI, M.D., F.A.C.S.

Q A

I have an abnormal lump in my groin and have been told that I have an inguinal hernia. What is an inguinal hernia? Is it dangerous?

What are my treatment options?

Approximately 20 percent of men and 10 percent of

approach in which a full incision is made. In either

women will suffer an inguinal or so-called groin hernia

case, a piece of mesh is placed in the groin to repair

in their lifetime and many are asymptomatic. Inguinal

the hernia. The success rate of these two treatment

hernias are a very common cause of groin pain.

options is nearly identical. However, many studies

Hernias tend to develop with increasing age, but

have shown that a minimally invasive repair has a

some people are born with them. They occur when

much faster recovery with less pain and faster

the abdominal muscles weaken, allowing fat or

return to normal activity.

intestine to protrude through the abdominal wall that

It is important

normally helps hold the abdominal and pelvic organs

to ask your specialist

in place. Patients will typically see or feel a bulge in

whether or not he

the groin area, while some may only feel heaviness or

or she offers a

discomfort in the groin. Other people might have no

posterior repair

symptoms at all and are diagnosed with a hernia by

and, if so, what

their primary care physician during a routine visit.

is his or her

Treatment is primarily based on symptoms with

experience with it.

a variety of options available. In the past, it was

The number one

thought that all inguinal hernias needed to be

correlating factor

repaired, regardless of symptoms. Today, simply

with successful

watching and waiting may be all that's necessary in

minimally invasive

people with a small, asymptomatic inguinal hernia.

repair is surgeon

Surgical repair comes into play when patients

experience. â–

complain of groin pain, if the hernia is rapidly increasing in size, or if they are experiencing gastrointestinal side effects.

At this point, patients have the option of a minimally invasive (laparoscopic) posterior repair, in which the hernia is repaired from behind the abdominal wall, or the open anterior surgical Antonio J. Ripepi, M.D., F.A.C.S.

ANTONIO J. RIPEPI, M.D., F.A.C.S. Dr. Ripepi specializes in general surgery. He earned his medical degree at Jefferson Medical College, Philadelphia, and completed his residency at Case Western Reserve University, Cleveland, before completing a fellowship in minimally invasive surgery at the Cleveland Clinic. He is board-certified by the American Board of Surgery.

Dr. Ripepi practices with St. Clair Medical Services.

To contact Dr. Ripepi, please call 412.942.7880.

Volume VIII Issue 2 I HouseCall I 19

PHYSICIAN UPDATES

Expanding patient access with ACCESSING MANY OF ST. CLAIR HOSPITAL’S LEADING PRIMARY CARE PHYSICIANS AND OB/GYN SPECIALISTS JUST GOT A LOT EASIER.

T

he team of primary care physicians from Dobkin/Riccelli

of Pittsburgh, P.C. have opened a joint office at Caste Village

Associates (a part of St. Clair Medical Services) and the

that conveniently serves patients in the Whitehall, Baldwin,

obstetricians/gynecologists with Advanced Women’s Care

Castle Shannon, Bethel and Brentwood areas.

LOCATION: CA STE VI LL AG E

PRIMARY CARE Larry A. Dobkin, M.D. Nadia N. Khan, M.D. Antonio M. Riccelli, M.D. Mallory Ciuksza, M.D.

412.563.5560

OB/GYN Michelle L. Harvison, M.D. Shannon H. McGranahan, M.D. Stephanie S. Brown, M.D. Patricia J. Bulseco, M.D. Deborah A. Lenart, M.D. Douglas H. MacKay, M.D. Kristen E. M. Peske, D.O.

412.942.1866

CASTE VILLAGE • 5301 GROVE ROAD • PITTSBURGH, PA 15236

20 I HouseCall I Volume VIII Issue 2

convenient locations and services Also, the PCPs of Mt. Lebanon Internal Medicine and the OB/GYNs

Internal Medicine moved to the Outpatient Center from its longtime

of Zubritzky & Christy OB/GYN Associates, both part of St. Clair

offices on Cedar Boulevard in Mt. Lebanon. Dobkin/ Riccelli Associates,

Medical Services, now have offices in the St. Clair Hospital Outpatient

Advanced Women’s Care of Pittsburgh, P.C. and Zubritzky & Christy

Center–Village Square in Bethel Park. In addition to its centralized

OB/GYN continue to operate their other respective offices.

location in the South Hills, the Outpatient Center at Village Square offers a full spectrum of diagnostic services and more. Mt. Lebanon

To schedule an appointment with these leading physicians at their newest locations, please call the phone numbers listed below.

LOCATION: ST. CLAIR HOSPITAL OUTPATIENT CENTER–VILLAGE SQUARE

PRIMARY CARE David R. Sacco, M.D.; Sapna Vasudevan, M.D.; Carol Showalter Myron, M.D.; Karl E. Bushman, M.D.; Aimee K. Marmol, M.D.; Beth Ann Schneider, M.D.

412.942.8500

OB/GYN Paul M. Zubritzky, M.D. Tera S. Conway, M.D. Patrick T. Christy, M.D. Paula A. Duncan, M.D. Kerra M. Doyle, D.O.

412.942.1066

VILLAGE SQUARE • 2000 OXFORD DRIVE • BETHEL PARK, PA 15102

Volume VIII Issue 2 I HouseCall I 21

OUTPATIENT SERVICES Continued on pages 24-25

Delivering uncompromising outpatient care

The bustling lobby of the St. Clair Hospital Outpatient Center–Village Square.

22 I HouseCall I Volume VIII Issue 2

EDITOR’S NOTE: In a previous issue, HouseCall profiled some of the people and methods that have catapulted St. Clair Hospital into the top 2 percent of the nation in patient satisfaction. In this issue, HouseCall looks at how these same factors have also made St. Clair’s Outpatient Centers among the nation’s best. As the following stories illustrate, helping patients progress quickly and efficiently through the outpatient system without compromising quality requires careful design and a dedicated staff.

A

‘Nobody wants to wait’ s the head baseball coach at Duquesne University

Joe, who oversees operations at Village Square, the Outpatient

for 18 years, Mike Wilson, 68, of Mt. Lebanon knows

Center in Peters Township, and the Hospital’s MRI facility on

something about efficiency. Having to prepare a team

Broughton Road in Bethel Park, says today’s patients have more of

to compete in a Division I sport means he had to be deft at moving

a “retail” mentality about healthcare services than they did even a

players in and out of the lineup with ease. Whether it was guiding

few years ago. And that means patients — pressed for time like

the offense or defense, Mike knew that a well organized game

never before — want the same convenience at an outpatient center

plan was key to his team’s success.

that they enjoy while purchasing something at a mall, or, online.

So when he recently walked into the Diagnostic Center at St. Clair Hospital Outpatient Center–Village Square for an X-ray of his balky back, Mike, now retired, was hoping to find those same efficiencies that he demanded on the baseball diamond when he was the skipper of the Dukes.

“You want to get in and out as efficiently as possible,” Mike says, as he settled into a chair with a copy of the latest Sports Illustrated after a quick stop at the registration counter. “Nobody wants to wait.”

“

WE ARE CONSTANTLY ASKING:

IS THERE SOMETHING WE CAN

DO BETTER?

”

JOE THANER, DIRECTOR OF OUTPATIENT FACILITIES, ST. CLAIR HOSPITAL

And, that, says Joe Thaner, Director of Outpatient Facilities at St. Clair, sums up St. Clair’s philosophy of moving patients through

Joe insists, though, that being fast mustn’t detract from the

the process, from registration to testing or treatment, to check-out.

quality of services being delivered. That’s why he and his managers

“After the quality of the services, the No. 1 concern of the men and women who use our outpatient services is the ability to get in and out, without feeling rushed, and to be treated with respect,”

work on designing systems that scrupulously maintain the delicate balance between efficiency and quality.

Which takes us back to Mike, the college baseball coach, in the

says Joe, who diligently tracks, analyzes and responds to feedback

waiting room at Village Square. No sooner had he kindly answered

from patients on a host of categories, including waiting time in

a few questions for this story, an outpatient care assistant alerted

registration, ease of finding their way around the building, staff

Mike that she would escort him to his X-ray. Time elapsed from

concern for comfort, response to concerns, and overall rating of care.

when Mike walked through the Center’s automatic sliding doors

“We are constantly asking: Is there something we can do better?”

to being called: 5 minutes. ■

At the St. Clair Hospital Outpatient Center-Village Square in Bethel Park, teams of highly skilled board-certified physicians, registered nurses, physical therapists, technologists and technicians collaborate to provide compassionate, personalized care for a wide range of outpatient medical services.

Volume VIII Issue 2 I HouseCall I 23

OUTPATIENT SERVICES Continued from pages 22-23

Science + Culture of Care adds up to

high patient satisfaction at Outpatient Centers

S

t. Clair Hospital’s stellar reputation for high patient

processes using the scientific method. We try to make it easier

satisfaction was built on many factors, starting with its

for our staff to meet our patients’ needs.”

outstanding physicians and employees. But process

To improve the throughput of patients coming for lab work,

redesign, technology, and training have played important roles, too.

With both its inpatient and Emergency Room (ER) patient

St. Clair employees analyzed each step in the process of having blood drawn. Even though the average waiting room time was less

satisfaction rankings among the nation’s best, St. Clair

than 8 minutes, they identified opportunities to reduce

brought the same tools to its Outpatient Centers

delays for patients and improve communication

in order to improve patient satisfaction with its diagnostic services (lab, radiology, cardiac testing, and more).

between Registration and lab personnel. Addressing

ST. CLAIR RANKS IN THE TOP

“Our efforts with outpatient services were satisfyingly successful,” says Tania Lyon, Director, Organizational Performance Improvement at St. Clair, and a leader of

4%

“We exceeded our initial goal by ranking in the top 6 percent in the nation among outpatient centers last fiscal year. And, in the most recent quarter, St. Clair’s outpatient satisfaction ranked in the top 4 percent in the nation.”

Improving ‘Patient Flow’ Tania, who holds a PhD from Princeton University and has practiced lean engineering methods (the ”science” of optimizing processes) for more than 10 years, emphasizes that a key component to improving patient satisfaction is efficient patient flow.

“Our goal is to train every employee at St. Clair to be continuous problem solvers. We teach them how to identify inefficiencies in any process — patients waiting, missing information, hunting and searching for equipment, etc. — and how to improve those

improvements in patient flow for other services.

For example, the movement of patients from

IN THE NATION FOR OUTPATIENT SATISFACTION.

St. Clair’s culture of continuous improvement.

those issues for lab patients led to similar

the waiting room to their diagnostic service, or between one test and another, depended on the availability of paperwork. Registration personnel would place completed paperwork in a designated area, but there was wasted time as technicians would

check and recheck to see if these documents were available.

The creation of an electronic patient status board, developed by the Hospital’s award-winning Health Information Services Department, eliminated this inefficiency.

With a glance at any computer screen, employees can now see the color-coded location and status of a patient throughout his or her care. This is especially helpful

ST. CLAIR OUTPATIENT CENTERS:

6 MINUTES BLOOD DRAW AVERAGE WAIT

when a patient requires multiple services in a single visit. A change in the patient’s status color alerts the employees to take action.

“One of the lean principles we use at St. Clair is visual management,” Tania explains. “Once an improvement is

ST. CLAIR OUTPATIENT CENTERS:

established as the new way of doing things, we put visual cues

AVERAGE TIME TO COMPLETE AN X-RAY

in place that guide staff to get it right and help us catch any

24 MINUTES

24 I HouseCall I Volume VIII Issue 2

problems with patient flow immediately. The goal is to make every process crystal clear and reduce the amount of time staff spends determining next steps.”

Breast MRI

“We saw an immediate improvement as employees could

ST. CLAIR OUTPATIENT CENTERS:

quickly determine the patient’s availability and escort them to the next stage of their service,” says Joe Thaner, Director of Outpatient Facilities at St. Clair. The current average waiting room time for any service is now about 6 minutes — a 23 percent

6 MINUTES

IMAGING SERVICES AVERAGE WAIT

decrease from before the process improvement work. “If you are having surgery and need to get the pre-surgical bundle of

Breast MRI Guided Biopsy Breast 3D Tomosynthesis Cardiac Rehabilitation ComputerAided Detection (CAD) Mammogram CT/CTA

testing — X-ray, lab work, and EKG — the average time to get

Diabetes Center

in and out with all three services completed is 31 minutes,” adds Joe.

Echocardiogram

Enhancing the Patient Experience While technology and process redesign reduced wait times, training employees to listen and respond to patients’ needs led to improved satisfaction in other areas. Survey data revealed that personal issues such as “concern for privacy,” “sensitivity to needs,” and “response to concerns/ complaints” were the most important to patients, and these became top priorities for improvement.

Alyshia Inks, Manager of Outpatient Facilities at St. Clair, created visual information boards in all staff lounges so that weekly and monthly trends, along with specific patient comments, would be visible to all. Alyshia then conducted ST. CLAIR OUTPATIENT CENTERS:

weekly “huddles” around these boards

AVERAGE TIME TO COMPLETE PRE-SURGICAL TESTING BUNDLE (X-RAY, EKG AND LAB)

that kept the patient experience part

31MINUTES

of an ongoing conversation. She broke down survey results by each of the centers’ services to connect the feedback more directly to the work of

individual departments. Both team discussions and one-on-one training sessions helped Registration

EKG GI Infusion Center IVP LAB MRA/MRI OB Ultrasound Occupational Medicine Occupational Therapy Osteoporosis Center

and clinical staff become more attuned to ensuring that patients feel cared for and safe. The results of this data-driven, customized training can be seen in our high patient satisfaction scores.

Bottom line: Patients experience fewer delays during their visits to St. Clair’s Outpatient Centers, and are highly satisfied with their experience overall. And by using process redesign, technology and training, St. Clair will only continue to improve the patient experience. ■

PET CT Physical Therapy Psychiatric/ Mental Health Pulmonary Function Testing Screening Mammogram Sleep Disorders Center/Home Sleep Testing Speech Therapy Ultrasound Urgent Care Vein Care Center Wound Healing Center

The St. Clair Hospital Outpatient Center in Peters Township provides exceptional outpatient healthcare services in a high quality facility that is convenient and easily accessible.

X-Ray

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Bone Densitometry

St. C

SERVICES

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OUTPATIENT SERVICES AVAILABLE AT ST. CLAIR HOSPITAL AND THREE SATELLITE CENTERS

Volume VIII Issue 2 I HouseCall I 25

EALTHCARE COSTS MADE

St. Clair’s Patient Estimates takes the mystery out of healthcare costs As a national leader in quality and patient satisfaction, St. Clair Hospital recently introduced the region’s first price transparency tool for hospitals. Why wonder what healthcare services are going to cost when Patient Estimates gives patients the ability to learn, in advance, what their estimated out-of-pocket costs will be for services at St. Clair or the Hospital’s Outpatient Centers. Patient Estimates is highly accurate and based on information provided by each patient’s health benefit plan. For more

ST. CLAIR ACCEPTS ALL MAJOR INSURANCES 1 0 0100 0B0OB WOW E REH RI H LL I LR L ORAOA DD

26 I HouseCall I Volume VIII Issue 2

information, please visit stclair.org.

..

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412 4 1 .942 2 . 9 4.4000 2.4000

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COMMUNITY SERVICES

MANAGING CANCER WITH YOGA

S

t. Clair Hospital’s Cancer Care Center launched an

specialized treatment from clinical experts such as Dr. Reyes.

innovative new program this summer for persons

Restorative yoga classes are a means of caring for the whole

who have cancer or are cancer survivors. Yoga for Patients

patient, says Dr. Reyes, and recognizing their human needs

with Cancer is a series of sessions in restorative yoga,

as well as the needs of their families and caregivers.

a form of hatha yoga that is designed to meet the

Yoga for Patients with Cancer classes are conducted

special needs of people with cancer, chronic illness

at the Dunlap Conference Center on the Fourth Floor

or disability. The program was developed for

of the Hospital. Family members and caregivers are

St. Clair by Vincent Reyes, M.D., board-certified

welcome. Classes are free of charge. Yoga mats,

oncologist/hematologist and Heather Martorella,

fruit and water are provided. Participants should

R.N., M.S.N., O.C.N., Oncology Nurse Specialist,

bring two bed pillows and wear comfortable

in collaboration with South Hills Power Yoga, a yoga school with locations in Dormont and Peters.

At St. Clair, patients with

clothing that moves with their bodies. ■ For a schedule of sessions and more information, please call 412.942.5082.

cancer receive advanced, highly

Courtesy mobile device charging stations help patients and visitors...

STAY CONNECTED

P

atients and visitors to St. Clair Hospital no longer have to worry about having forgotten their cell phone (and other electronic devices) charging cords at

home. That’s because St. Clair Hospital employees recently paid for the purchase of 13 courtesy charging stations that are deployed throughout the Hospital and St. Clair’s Outpatient Centers in Bethel Park and Peters Township.

Each station has eight cords to fit a variety of Apple and Android devices, ranging from cell phones to tablets. The funds were raised as part of a campaign dubbed My St. Clair/My Idea in which employees throughout the organization submitted monetary donations, along with ideas for products/services that benefit patients and visitors. ■

Volume VIII Issue 2 I HouseCall I 27

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

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

MAKE SURE ST. CLAIR HOSPITAL IS IN YOUR HEALTH INSURANCE NETWORK.

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.

THE REGION’S OSPITAL LEADING IN PATIENT SAFETY. Awarded the only ’A’ Grade four years in a row.

HouseCall

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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