St. Clair Hospital HouseCall Vol XI Issue 3

VOLUME XI ISSUE 3

ST. CLAIR HOSPITAL FAMILY BIRTH CENTER

Delivering Family-Centered Care PLEASE SEE PAGE 2

FAMILY BIRTH CENTER

2 I HouseCall I Volume XI Issue 3

Family-Centered Care is the rule at St. Clair Hospital’s Family Birth Center The Family Birth Center at St. Clair Hospital is well-known for its exemplary services

provided by leading health care professionals. There are obstetricians/gynecologists

(OB/GYNs). Certified nurses who have specialized training. Anesthesiologists to temper

and relieve pain. Pediatric hospitalists who are in-house 24/7. And experienced lactation

consultants, who patiently help with the ups and downs of breastfeeding.

Together, this team delivers and cares for more than 1,500 babies and their moms every year. While the Center can get busy, the focus is always clear — the patient comes first.

That is the mantra that guides every decision. It’s also what makes the Center so unique.

“We provide the highest quality of care,” says Michelle L. Harvison, M.D., Chair of

Obstetrics & Gynecology, at St. Clair. “The difference is, we’re more patient- and familycentered. We can provide a more personal experience to patients and their families.”

Continued on Page 4

“

I’m most proud of the patient experience here. Our staff truly cares about their patients and providing quality care to everybody.

”

MICHELLE L. HARVISON, M.D. CHAIR OF OBSTETRICS & GYNECOLOGY, ST. CLAIR HOSPITAL

About The Cover:

St. Clair Hospital OB/GYN Paul M. Zubritzky, M.D. interacts with baby Collin, while mom Jennifer Boal and 7-year-old big brother Conner look on. Dr. Zubritzky delivered both boys.

Please see their story, Page 10.

Volume XI Issue 3 I HouseCall I 3

FAMILY BIRTH CENTER Continued from Page 3

The culture at St. Clair Hospital creates a special atmosphere for moms and their babies One way the Center ensures that is to offer consistent, one-on-one care.

Patients are generally in the same room with the same team throughout their stay. “We have highly skilled and dedicated nurses who give patients a great experience the entire time they’re here,” says Dr. Harvison. “When the same nurse takes care of the patient and her baby, they can have a better bonding experience. It’s the same with our physicians. The physicians you see in the office deliver the patients, as well.”

The Center’s practice of “Rooming-In” — having your baby with you from delivery to discharge — is shown by research to be the best way for moms and babies to establish a routine. Studies also show that moms are just as likely to get the same amount of rest with the baby in the room. “Rooming-In helps both moms and babies sleep better and get to know each other,” says Shawndel Laughner, MHA, BSN, CNML, RNC-OB, C-EFM, Director of Women and Children Services, at St. Clair. “The babies seem less stressed. They love to be near their mom. And we find that Rooming-In helps mothers feel more confident caring for and handling their baby.”

Dr. Harvison credits the culture at St. Clair Hospital for creating an atmosphere that results in a better experience for patients and staff. “It’s a great place to work,” she says. “It’s not so big that you lose a sense of purpose. You have the opportunity to build an emotional connection. The atmosphere here allows our staff to continue to enjoy their jobs and that makes everybody better.”

Shawndel agrees. “I’m most proud of the communication between the physicians and our nursing staff. We rely so heavily on one another. It’s a well-oiled machine. We can know what each other needs just by a look.”

Continued on Page 6

Michelle L. Harvison, M.D.

MICHELLE L. HARVISON, M.D. Dr. Harvison specializes in obstetrics/gynecology. She earned her medical degree at the Joan C. Edwards School of Medicine at Marshall University, Huntington, W.Va. Dr. Harvison completed a residency in OB/GYN at Riverside Methodist Hospital, Columbus, Ohio. She is board-certified by the American Board of Obstetrics and Gynecology. Dr. Harvison practices with Advanced Women’s Care of Pittsburgh, P.C. To contact Dr. Harvison, please call 724.941.1866.

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THE FAMILY BIRTH CENTER OFFERS: 12

10

OB/GYNS

PEDIATRIC HOSPITALISTS

5

11

LACTATION CONSULTANTS

SUITES FOR LABOR AND DELIVERY

23

56

52

REGISTERED NURSES

ANESTHESIOLOGISTS/ CERTIFIED REGISTERED NURSE ANESTHETISTS

St. Clair Family Birth Center

The Family Birth Center

DELIVERED OVER

NURSE-TO-PATIENT RATIO IS

BABIES LAST YEAR

DURING LABOR & DELIVERY

1,500

1:1

Volume XI Issue 3 I HouseCall I 5

FAMILY BIRTH CENTER Continued from Page 4

Nurses make all the difference The Family Birth Center has 52 registered nurses, and each one takes the time to develop special relationships with patients, often going above and beyond to support moms, families, doctors and each other.

“We learn and grow from everything we do,” says Shawndel, who adds that many of the Center’s registered nurses have earned certification in advanced knowledge and skills. “Nurse certification in inpatient obstetric care is a choice for a nurse. It shows she has a level of excellence in a specialty area of care. We have inpatient obstetrical nurses, certified nursery nurses and certified breastfeeding counselors.”

One example of the exceptional care these nurses provide is a follow-up phone call to patients who’ve returned home after delivery.

“We talk to moms to see what it’s like for them at home,” says Dr. Harvison. “The nurses call the moms after discharge and check in to see how they’re doing.”

St. Clair’s collaborative, compassionate environment is one of the reasons why the Family Birth Center has so many tenured

Alex Shipper, Level II R.N., left, and Debbie Moon, Charge R.N. prepare a Labor and Delivery Suite in the Family Birth Center.

nurses. In fact, two nurses just celebrated their 30-year anniversary, and many others have reached their 5-, 10- and 15-year milestones.

happy here, which promotes a warm teaching environment. For

All that experience is of great benefit to new moms and their babies.

patients, that means they’re getting care from very experienced

It’s also helpful to new staff. “As new nurses come in, we want

nurses, who can coach them through something that’s often very

them to be taught by people who are very good at their job,” says

emotional, painful and stressful.”

Dr. Harvison. “If someone is here for a long time, they’re obviously

Shawndel Laughner, MHA, BSN, CNML, RNC-OB, C-EFM, Director of Women and Children Services, left, confers with Chelsea Tessitore, Staff R.N. in the Family Birth Center.

The Family Birth Center’s pediatric hospitalists keep at-risk babies safe Sometimes, when the unforeseeable occurs, a newborn at St. Clair needs extra help.

For those times, the Family Birth Center offers a Special Care Nursery, a Level II nursery designed for babies who are born prematurely or who need individualized care and close monitoring.

For some families, the 10 pediatric hospitalists and specially trained nurses who work there are nothing short of heroes.

“Although we hope that every baby is born healthy, we are aware that some babies will need assistance during their first few hours or days of life,” says Dayle B. Griffin, M.D., Medical Director, Pediatric & Newborn Services, at St. Clair. “We have an incredible team of people who do their very best to help families go home with a healthy baby. We have experienced, well-trained pediatricians in the Hospital 24/7, along with a group of exceptional, specially trained nurses, all of whom have expertise in caring for sick infants. They provide excellent, compassionate, attentive nursing care to our patients and their families.”

Continued on Page 8

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Pain Management During Labor & Delivery

BY JOHN T. SULLIVAN, M.D., MBA SR. VP & CHIEF MEDICAL OFFICER, ST. CLAIR HOSPITAL

Bringing new life into the world produces a range of emotions

The most effective form of pain relief from labor in the United

from joy to anxiety. A common source of anxiety for a woman facing

States is epidural analgesia. Epidural analgesia refers to a technique

the approach of labor and delivery is uncertainty related to pain

whereby a small tube or catheter is placed by an anesthesiologist in

management. Choices for pain relief during labor include nothing,

a mother’s low back to deliver pain medicine to block transmission of

non-medical techniques such as massage and meditation, narcotic

pain signals from the birth canal to the brain. A combination of local

pain medicine, and epidural pain relief. It is important for new

anesthetic and narcotic pain medicine are injected with the goal of

mothers to be knowledgeable about their options and be in control

blunting the discomfort of labor while maintaining the ability of the

of their choices. Conversations with obstetricians, anesthesiologists

mother to feel the pressure of contractions, move her legs, and

and nurses prior to active labor provide the best opportunity for

effectively push her baby out. The most common side effects of

meaningful dialogue.

epidural analgesia are headache that occurs in approximately 1 in

Pain that develops during labor begins as intermittent, crampy

150 mothers, blood pressure changes, and itching. All of these are

abdominal pain that gradually builds in intensity. The pain is caused

routinely managed. Receiving epidural analgesia does not increase

by contractions of the uterus which result in stretching and dilation

the risk of receiving a cesarean delivery regardless of when it is

of the cervix, facilitating passage of the fetus. Pain experience

requested in labor, and the technique has the benefit of limited

is different among women, and between subsequent labors in the

medication reaching the baby.

same woman, and is often very different over the course of a single labor. Having a thoughtful plan about its relief can help reduce anxiety about the unexpected.

If a cesarean delivery is required, alternative techniques to provide denser pain relief for this surgical procedure include spinal anesthesia or using higher doses of medication in an epidural

Non-medical forms of pain relief are employed by many women

catheter to achieve anesthesia. These regional anesthesia techniques

for a portion or the entirety of labor. These techniques are often

are preferred in most women because they are statistically the safest

taught in childbirth classes, involve no medication or procedure, and

form of pain relief, and they offer the social advantages of being awake

add value in reducing anxiety and limiting the pain experience. Narcotic medicine is requested by some women in labor and it is moderately effective in reducing

during delivery. A small minority of women require general anesthesia for cesarean delivery, usually for a specific medical indication.

Well-trained professionals are available at St. Clair Hospital day and night to help make a mother’s birth experience more

the pain experience. It is accompanied

comfortable and safe. Our team is honored to participate in one

by the side effects of sedation and

of life’s most special moments, and dedicated to making delivery

itching in mothers, and can affect the

at St. Clair a treasured experience. n

baby’s well-being when administered close to delivery.

JOHN T. SULLIVAN, M.D., MBA Dr. Sullivan specializes in obstetric anesthesia. He earned his medical degree at the University of Michigan Medical School and completed a residency in anesthesiology at Massachusetts General Hospital, an affiliate of Harvard Medical School. Dr. Sullivan also earned a master’s in business administration from the Kellogg School of Management at Northwestern University, Evanston, Ill. Prior to joining St. Clair, he served as Associate Chief Medical Officer for Academic Affairs at Northwestern Memorial Hospital and as Professor of Anesthesiology at Northwestern University Feinberg School of Medicine, Chicago, Ill. Dr. Sullivan serves as a Commander in the Naval Reserve, following 31 years of active duty.

John T. Sullivan, M.D., MBA Sr. VP & Chief Medical Officer, St. Clair Hospital

Volume XI Issue 3 I HouseCall I 7

FAMILY BIRTH CENTER Continued from Page 6

complimentary meals, a bed to sleep in and a quiet space while the

The team often extends to include other physician specialists in

baby is hospitalized,” says Dr. Griffin. “The Nesting Program makes

the Hospital, such as anesthesiologists and radiologists.

it easier for the mom to breastfeed and to recover after delivery. It’s

“Having a baby in the Level II Special Care Nursery can be a scary time for families,” says Dr. Griffin. “So we strive to take care

a luxury we can offer at St. Clair, and it shows how supportive the

of the parents as well as their babies. We try our best to be supportive

administration is of newborns and their families.”

These capabilities are a great comfort to families who choose

and make certain that parents understand what’s happening with

St. Clair. Dr. Harvison adds, “Patients want to know that whenever

their baby.”

they deliver, if there’s any concern, we have a team ready to take

The Nesting Program is one way the Nursery offers support in

excellent care of their baby.”

this difficult time. “If a baby needs to stay at the Hospital longer than

Dr. Griffin says all babies born at the Hospital receive high

the mom, the Hospital allows her and her partner to stay in one of the available rooms at the Family Birth Center. They offer the mother

quality care. “All the infants born at St. Clair are special,” she says.

“They are each screened for hearing, congenital heart disease and jaundice. Of course, they also receive a metabolic screen before they are discharged to home.”

To give a sense of the dedication and passion that the pediatric staff offers, Shawndel points to Dr. Griffin as a prime example.

“Dayle Griffin is the most amazing person I’ve ever encountered,” Shawndel says. “She’s brilliant and so attentive to her patients’ needs. The comfort and care she gives in the small window of time we have with the babies is incredible. Her compassion is felt by all.”

Teamwork and communication: a combination that gives birth to better care At the Family Birth Center, teamwork is on display every moment of every day. Doctors from various practices jump in to consult or assist with difficult deliveries. Nurses, when changing shifts, take the time to introduce the incoming nurse to the patient.

Shawndel, who began her career as a bedside nurse, regularly puts on her scrubs to assist during busy days. “If I can be that one extra person to help, it doesn’t matter if I have a meeting to go to — that patient comes first.”

Good communication is pivotal to sustaining a great team and offering the best care possible. Dr. Harvison has opened dialogs with the other physicians to make information sharing easier. She initiated debriefings to discuss difficult cases. “We meet regularly,” Dr. Harvison says. “We discuss what went well and what didn’t and how we can improve. We also review the best practices and recent innovations in the field of obstetrics,” which often includes taking advantage of St. Clair’s clinical collaboration with Mayo Clinic to glean its expertise.

Dayle B. Griffin, M.D. examines a newborn in the Family Birth Center.

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LOWERING C-SECTION RATES PROVES BENEFICIAL FOR MOM AND BABY

Sometimes a cesarian section (C-section) is the best, safest option for a mother and baby. Sometimes a medical emergency makes one unavoidable. But when vaginal delivery is possible, it’s also preferable.

“Having a C-section is major abdominal surgery,” says

But it’s not all about convenience. Sometimes we have to let the baby call the shots.”

According to the American College of Obstetricians and Gynecologists (ACOG), one in three women in the U.S. gives birth by C-section. Their study notes there is no clear evidence

Michelle L. Harvison, M.D., Chair of Obstetrics and Gynecology,

of improved outcomes for moms and babies, and states a

at St. Clair Hospital. “The healing time is longer. There are in-

significant concern that C-sections are being overused.

creased pain medication requirements. There can be short-term

Statistics from the Centers for Disease Control and Prevention

complications like infection, and long-term complications, such

(CDC) agree, citing a 60 percent increase in C-sections from

as scar tissue and pain.”

1996–2009 with no demonstrable benefits.

St. Clair Hospital makes sure patients understand the benefits

It’s an issue St. Clair is successfully tackling. In fact, the

of vaginal delivery. “The more we can promote a vaginal birth to

Hospital has reduced C-sections. Last year, the Hospital’s average

mom, the more likely she’s going to be home faster and recover

rate of C-sections was 21 percent, significantly below the national

more quickly,” says Shawndel Laughner, MHA, BSN, CNML,

average of 30 percent.

RNC-OB, C-EFM, Director of Women and Children Services, at St. Clair. “In the past, there was a trend toward elective C-sections.

People thought the idea of scheduling their birth would be great.

Dr. Harvison also focuses on strengthening the communication among nurses. She’s instituted drills, which are conducted monthly and teach the nursing staff what to do in the event of obstetrical emergencies.

“We drill as a team emergency C-sections, umbilical cord prolapse, postpartum bleeding and shoulder dystocia —

Staff at the Family Birth Center try to avoid elective inductions, and make sure women go at least 39 weeks into pregnancy. They don’t rush the labor process, giving moms ample time to push. n

...UP NEXT

While the vast percentage of pregnancies and deliveries at St. Clair Hospital’s Family Birth Center are free of complications, patients can rest assured that the Hospital’s

some of the serious obstetrical emergencies. We run

highly trained physicians, nurses and other health care

through them as a team to make sure we all know our

professionals will use their exceptional skills and expertise

roles and how to facilitate the best and fastest care for the patients in those situations.” The team goes over a new topic each time and meets until every nurse has a chance to perform the drill and ask questions. n

to provide a family-centered experience. What follow are stories of three patients who benefitted from the Center’s one-on-one care.

Continued on Page 10

Volume XI Issue 3 I HouseCall I 9

FAMILY BIRTH CENTER Continued from Page 9

JENNIFER BOAL:

A challenging three days

W

hen Jennifer “Jenn” Boal wanted to have a second

“I was scheduled to be induced for a normal, vaginal delivery,”

child, she knew exactly who she wanted her

recalls Jenn. “I felt great. Everything was going amazingly well.

doctor to be and where she wanted to deliver. Jenn

Then suddenly things went awry.” Dr. Zubritzky had broken Jenn’s

and her husband, Ryan, had had their first child, Conner, with

water and was working with an anesthesiologist to perform an

St. Clair Hospital OB/GYN Paul M. Zubritzky, M.D. The Mt.

epidural. During that time, Jenn’s nurse, Laura Kelsch, R.N., was

Lebanon couple had struggled with fertility and Dr. Zubritzky

positioning her for the epidural. Then Laura asked them to get

had helped them conceive through medication. “You’re not just

Dr. Zubritzky. “He came into the room cool, calm and collected,”

a patient with Dr. Zubritzky. You’re like part of his family,” says

remembers Jenn. “He said we had to do an emergency C-section.”

Jenn. “He listens to what you have to say. His medical knowledge

The baby was in fetal distress.

and skill give you the confidence you need as a patient struggling with a medical issue.”

When the couple had trouble conceiving again, they

Within six minutes, Jenn was moved to one of the operating rooms in the Family Birth Center, and Dr. Zubritzky, along with OB/GYN Amy B. Turner, D.O., delivered baby Collin.

ended up needing extra help, and Dr. Zubritzky referred them

“My husband was still putting on his gown!” says Jenn. She

to a fertility clinic for advanced testing. The fertility clinic

remembers the baby came out screaming, crying and hungry.

recommended In Vitro Fertilization (IVF) for the best chances

“The pediatric hospitalists let me know that he was doing great

of conceiving. “After five failed attempts, the sixth embryo finally

and very healthy. As soon as I heard that, I relaxed.”

decided to stick,” says Jenn of Mt. Lebanon. “Obviously, it was worth the effort.” It was the beginning of baby Collin.

At the time, Jenn was 35 years old. She developed

But Jenn’s feeling of peace was short-lived. Although the C-section had gone well, Dr. Zubritzky had noticed that Jenn’s blood wasn’t coagulating as well as expected. He suspected

gestational diabetes and high blood pressure, which led to more

her blood pressure problem, a condition called preeclampsia,

frequent monitoring. “Her blood pressure had started to creep

was to blame.

upward,” says Dr. Zubritzky. “That required more surveillance to make sure it wasn’t affecting her or her baby.”

Throughout the pregnancy, Jenn was monitored twice weekly with ultrasounds, non-stress tests and biophysical

In the recovery room, Jenn felt light-headed. Her blood pressure dropped when she tried to sit up. Dr. Zubritzky felt she might have lost more blood due to the emergency C-section.

He recommended a blood transfusion. She did not respond.

profiles, which all check to make sure the baby is active and

He ordered another transfusion. “After the second one, I started

healthy. Due to her complications, she and her doctor scheduled

to feel a little better,” Jenn says. “Then I started getting

an induction date of July 8. But an ultrasound on July 5 changed

stabbing pains, and I knew something wasn’t right.” She asked

everything. The amniotic fluid around the baby was lower than it

the staff for help. Dr. Turner came in to check on her. “When

had been in previous ultrasounds. Dr. Zubritzky determined that

she walked in with the nurses, she immediately said I was

they needed to move the induction date up and scheduled Jenn

hemorrhaging. She said they were going to have to do

for July 6.

another surgery.”

Continued on Page 12

10 I HouseCall I Volume XI Issue 3

“

Everything was going amazingly well, until...

”

JENNIFER BOAL, MOM Jennifer Boal, with son, Collin.

Volume XI Issue 3 I HouseCall I 11

FAMILY BIRTH CENTER Continued from Page 10

Drs. Zubritzky and Turner reopened the incision, re-sutured

the retroperitoneal space behind the covering that lines the

areas and removed blood that had pooled in Jenn’s abdomen. She

abdomen. She required a transfusion of red blood cells, plasma

was returned to the recovery room. Lab work showed her blood

and platelets.”

count had dropped significantly, so Dr. Zubritzky ordered another

Dr. Zubritzky explains that retroperitoneal bleeding can occur due

transfusion and ordered her to be moved to the Intensive Care Unit

to extreme preeclampsia, the blood pressure condition which had

(ICU). “We were satisfied with how the procedure went, but we

worsened throughout Jenn’s pregnancy. “It’s something you don’t

weren’t quite sure she was out of the woods,” remembers

see very often,” he says. “But you have to be prepared. Luckily at

Dr. Zubritzky. “She had lost a fair amount of blood and still

St. Clair, we have great teams that work together. The nurses that took

wasn’t coagulating well.”

care of her were wonderful. The team was outstanding as usual.”

Jenn stayed in the ICU until the following morning. She was weak and groggy, but she was determined to see and breastfeed

By this time, Dr. Zubritzky had stayed at the Hospital for three days to keep an eye on Jenn. “I kept having a feeling that something

her new baby. “I had the most amazing nurse in the ICU,” says

wasn’t right with her,” he remarks. “Being at the Hospital was

Jenn. “Emma Campbell (R.N., BSN), along with nurses from the

better than being at home and monitoring her on a computer. Here

Family Birth Center, helped me see Collin a couple of times to feed

I could watch the lab tests as they came in. I could go in and check

him. Emma brought me a breast pump and learned how to use it

on her. I wanted to be sure that I was able to give her the attention

just to help me. She made sure I was comfortable all night.” When

that she needed.”

Emma’s shift was up, she stopped by Jenn’s room, handed her the

Jenn was sent back to the ICU, where she continued to gain

call button and reminded her to alert the nurses if she needed

strength. Eventually, she returned to the Family Birth Center,

anything. “At 7:36, I remember looking at the clock and thinking

where she could be closer to her baby. One final challenge awaited

I was going to die,” Jenn says. She called for help and remembers the room immediately filling with doctors and nurses.

Jenn’s vital signs were deteriorating. The ICU team provided the resuscitative

put in a warming bed and treated preventively with antibiotics.

Despite incredible pain after her three surgeries, Jenn visited

efforts that stabilized her. But her

Collin as often as she could. “The Special Care Nursery staff was

abdomen was starting to swell. She

amazing. They always made me feel like I was doing everything

was bleeding again.

I could as a mom,” says Jenn. She also fondly remembers nurses

This time, Dr. Zubritzky called for assistance from Thomas A. Simone, M.D., a vascular surgeon at St. Clair. “We got the team together and went to the main operating room at the Hospital,” says Dr. Zubritzky.

“This time, the bleeding was coming from

Paul M. Zubritzky, M.D.

her. Collin was having trouble keeping his body temperature up.

He was sent to the Family Birth Center’s Special Care Nursery,

in the Family Birth Center who continually checked on her and even procured a more comfortable bed for her in the middle of the night.

Today, Jenn is happily home with her new baby, her six-yearold son and her husband. She’s still recuperating, and in fact, goes to the Hospital’s Wound Care Center for help with healing after all her surgeries. She’ll never forget her experience at St. Clair.

“Everybody became like family to me. They really, truly cared about me,” she says. “Everyone was so encouraging and positive.

They made me feel like I really mattered. I don’t think you get that everywhere.” n

PAUL M. ZUBRITZKY, M.D. Dr. Zubritzky specializes in obstetrics/gynecology. He earned his medical degree at Temple University, Philadelphia, and completed a residency at West Penn Hospital, Pittsburgh. Dr. Zubritzky is board-certified by the American Board of Obstetrics and Gynecology. He practices with St. Clair Medical Services.

To contact Dr. Zubritzky, please call 412.942.1066.

12 I HouseCall I Volume XI Issue 3

One-on-one care helps recognize and treat Postpartum Depression While there are plenty of joys in welcoming a new child into the

“Because our nurses provide one-on-one care and are able to be

family, there are also many life changes that can cause stress, anxiety

with the moms during most of their stay, they can really pick up

and panic. In fact, an estimated 80 percent of new moms experience

on which women are more at risk or having any concerns,” adds

the “baby blues,” characterized by feelings of sadness or stress that

Dr. Harvison. “We can get them help right away if they need it.”

appear off and on.

Nurses at the Family Birth Center look for women who seem

However, some moms suffer a more extreme version of the blues called postpartum depression. “Twenty percent of patients have

disconnected from their babies or who are not as animated as expected.

If the situation is severe, they’ll call for a consult.

diagnosed postpartum depression,” says Michelle L. Harvison, M.D.,

Regardless of whether symptoms are mild or severe, support and

Chair of Obstetrics & Gynecology, at St. Clair Hospital. “That means

treatment are available through Women and Children Services and the

the problem (stress, anxiety and panic) is probably significantly greater.”

Hospital’s Psychiatry and Mental Health Services, which offer a specialized

According to the American College of Obstetricians and Gynecologists

team of psychiatrists, licensed counselors, and mental health and specially

(ACOG), postpartum depression is caused by a number of

trained obstetric nurses. The Hospital also offers a support group for

factors, including changes in hormone levels, a history of depression,

moms called Baby Steps, a group that meets every month and is

emotional factors, fatigue and lifestyle factors, such as lack of support

facilitated by a mental health registered nurse, along with two Family Birth

or stressful events.

Center nurses. Baby Steps is open to pregnant women, concerned family

Like other hospitals nationwide, St. Clair is doing more to

members and new moms — even if they didn’t deliver at St. Clair.

recognize, prevent and treat the condition. It starts with screening

Education is also key to helping new mothers deal with feelings of

before, during, and after pregnancy. “But we go beyond that. We call

stress or inadequacy. “We try to provide appropriate expectations,” says

moms after discharge to see how they’re doing at home.”

Dr. Harvison. “A lot of women come into pregnancy with certain expec-

“Every mom who comes in is screened,” says Shawndel Laughner, MHA,

tations, which aren’t realistic. As moms, everyone wants to do everything

BSN, CNML, RNC-OB, C-EFM, Director of Women and Children Serv-

perfectly for their babies, so if something doesn’t go as planned — they

ices, at St. Clair. “We want to know if she had postpartum

have an unplanned C-section or breastfeeding is more difficult than they

depression in another pregnancy. Does she have any mental health

thought — they put excessive blame on themselves. It’s our job to have

concerns? We keep a pulse check on it as much as possible.”

those discussions as to expectations and to make moms understand that

things don’t always go as planned. It’s still okay.” n

Some postpartum depression warning signs:

Struggles to bond with baby

Struggles to engage with family

Some danger signs:

Feelings of hopelessness or despair

Believes baby would be better off without her

Thoughts of hurting baby or herself

If you or someone you know is exhibiting any of the signs above, please contact your personal health care professional.

Sad most of the time

Frequent crying

Anxious, angry or irritable

Feelings of inadequacy

Volume XI Issue 3 I HouseCall I 13

FAMILY BIRTH CENTER Continued from Page 12

MICHAL ROUP:

Things can get complicated

M

ichal Roup had been planning her pregnancy for five

“I really think it was early recognition, aggressive treatment and

years. She was on medication for bipolar depression,

a team effort that saved her life,” the doctor adds. “We aggressively

and she wanted to be sure she could have a pregnancy

replaced the products she was losing — blood, fluids, cryoprecipitate,

that would be safe for her and her baby.

Finally, after years of discussion with her St. Clair Hospital OB/GYN, Deborah A. Lenart, M.D., Michal and her husband, Ian, decided it was time.

The pregnancy went well, and the baby was growing well. In fact, ultrasounds toward the end showed the baby might weigh as much

fresh frozen plasma and platelets.”

Michal stayed in the ICU for two days. Ian remembers her having IVs all over. “Every day, she had fewer tubes, so I knew she was going to be okay.” When she began to pass urine, Dr. Lenart knew Michal had reached a turning point.

Michal went back to the Family Birth Center, where she stayed

as 10 pounds. “At that point, we had to talk about options,” says

another five days. Ian was constantly by her side. “They have a pretty

Dr. Lenart. “Michal’s cervix was unfavorable. She wasn’t going into

comfy couch, and they let you order meals,” he says with a chuckle.

labor. The question became whether to opt for induction or a

On a more serious note, he adds, “I got to know everybody at the

C-section.” After considering all the factors, Michal and Dr. Lenart

Family Birth Center. They would do whatever they could for you.”

decided to schedule a C-section.

For any patient in that situation, even the smallest acts of

On October 11, 2018, Michal and Ian arrived at St. Clair for the

kindness make a big difference. Michal recalls a nurse who went

surgery. “Everything went wonderfully,” says Michal. “Daphne Marie

above and beyond. “I have naturally curly hair. After being at the

was born weighing 9 pounds, 10 ounces.” The couple went back to

Hospital for seven days, it was a frizz ball. I couldn’t take a shower.

their suite, where the new mom tried to breastfeed. Her blood

One nurse helped me wash my hair in the sink. She understood and

pressure was low, so the team ordered fluids and medication.

made me feel so much better.”

“An hour later, things weren’t looking right,” says Dr. Lenart. Michal’s

Once Michal gained enough strength to care for Daphne, the

nurse, Lauren Bodnar, R.N., felt the same way. She stayed with

family returned home. Unfortunately, her depression returned as

Michal, one-on-one, for longer than usual. Another hour later,

well. “I had continued my regular medication for bipolar depression

Michal felt like she was going to pass out. Her blood pressure had

throughout my pregnancy,” she says. “But I had lost so much blood,

dropped, and she became critically ill. “Lauren checked my incision,

there was nothing left in my system.” Fortunately, she received help

and then everything went south,” Michal says. She was bleeding inter-

relatively quickly from her psychiatrist.

nally. Ian adds, “Everyone came rushing in, just like you see on TV.” Dr. Lenart had Michal transferred to the Intensive Care Unit (ICU),

Today, the family is happy and healthy. Recently, Dr. Lenart ran into Michal and Ian as they were taking Daphne for a walk around a

where they rapidly began replacing her blood. “I ended up taking her

local lake. For a moment, she was overcome with emotion. “I know

back to the operating room,” remembers Dr. Lenart. “Another

that a patient who comes to St. Clair is going to get excellent care,”

OB/GYN helped with the surgery. She was bleeding. She didn’t have

Dr. Lenart says. “I don’t doubt that for a minute. Bad things happen

the ability to clot her blood.” The doctors applied some clotting

sometimes. Things can get complicated. But if you’re in a place

products and sent her back to the ICU.

where the people are capable of managing it, you can have a great

Michal was experiencing a rare case of anaphylactoid syndrome

outcome. This is a high-level hospital that can take care of nearly

of pregnancy, a severe reaction to amniotic fluid entering the

anything, whether it’s anticipated or unanticipated. You’re always

mother’s blood stream. Approximately 50 percent of women

going to get personalized, excellent care.”

who experience the syndrome die from it. “It was terrible,” says Dr. Lenart.

Michal is living proof. “The individual care you get there is really

unique,” the new mom says. “It’s a top-of-the-line facility.” n

Continued on Page 16

14 I HouseCall I Volume XI Issue 3

“ ”

It was touch and go for awhile.

MICHAL ROUP, MOM

Michal Roup with husband, Ian, and their daughter, Daphne, in their Chartiers-Houston Township home.

Volume XI Issue 3 I HouseCall I 15

FAMILY BIRTH CENTER Continued from Page 14

HEATHER MCNAMARA:

A delicate situation

H

eather and Ryan McNamara already had two beautiful girls —

and walked us through our options. We were hoping to do a live

Ellie who was four and Abby who was two. Both children were

transplant, but there were certain criteria Patrick would have to meet.”

Thanks to a family member, Heather also got in touch with the Still

born at St. Clair Hospital, and both times, labor and delivery

were normal. When Heather became pregnant with a third child, the

Remembered Project, a local miscarriage and infant loss group. The group

couple was excited. The new baby was going to be a little boy. They

made a number of very helpful recommendations, including setting up a meeting at the Hospital to review a birth plan. “I spoke with the Director

decided to name him Patrick.

On March 31, 2017, at 18 weeks, Heather and her husband went to the

of Women and Children Services at St. Clair, Shawndel Laughner, MHA,

Hospital for a routine ultrasound. “I remember the date like it was yester-

BSN, CNML, RNC-OB, C-EFM, and she was phenomenal,” recalls Heather.

day,” says Heather. “I was already showing. I was feeling kicks from the

“She set up the meeting with my doctor, a nurse, a grief counselor and a

baby. Everything felt normal. But immediately after the ultrasound, the

pediatrician. It was nice to meet with people who were on our team, on our side, who were letting us know that they would honor our wishes and

tech sent us to our doctors.”

The Peters Township couple walked to the office of St. Clair Hospital

accommodate us as much as possible.” The Still Remembered Project gave

OB/GYN Deborah A. Lenart, M.D., who delivered a heart-wrenching

Heather and Ryan a special care package, with an angel gown, sibling

diagnosis. The baby had anencephaly, a condition in which the baby’s

gifts for her children and items to make memories with Patrick. They

skull and brain don’t develop normally. Their baby would not live long

also gave her a book called “I Was Going To Have A Baby, But I Had An

after birth. “It’s really hard to explain to a couple that their baby has a

Angel Instead.” In the weeks leading up to delivery, the family read it

defect which is incompatible with life,” says Dr. Lenart. “It’s a very rare

together every night. “Our kids had a lot of questions. They were trying

condition. I suggested they take some time to think and read about it

to make sense of it all. The book helped us process the whole situation,”

before deciding what to do.”

says Heather.

Throughout her pregnancy, Heather received monitoring from the

“The doctor was so kind. She was as informative as possible,” says Heather. “But hearing that there was no possibility for Patrick to live was

Hospital’s maternal fetal medicine specialist. Everything was going well

an absolute shock. It was easily the worst day of our lives.” Heather and

until she reached 30 weeks, when an ultrasound indicated she had

Ryan went home and researched anencephaly. They elected to go through

polyhydramnios, an excessive amount of amniotic fluid. “It can lead to

with the pregnancy. “We decided to make every day count and celebrate every little thing.”

They also decided they wanted to do

higher risk conditions,” explains Dr. Lenart. “In this case, the baby wasn’t growing.” With this new development, the doctor and couple chose to induce labor at 35 weeks. “We always said that as long as Patrick was

everything they could to make Patrick’s life

happy and healthy inside of me, we weren’t going to do anything,” says

as meaningful as possible. Contacting the

Heather. “As soon as it became a risk, it was an easy decision to induce.”

On July 26, when the couple arrived at the Family Birth Center, a nurse

Center for Organ Recovery & Education (CORE), the couple began to explore organ

was waiting to greet them. Heather also gratefully recalls another nurse

donation. “A CORE representative called

who spent time in their room, making them feel welcome. “It was such a good experience, considering what was going to happen,” says Heather.

Deborah A. Lenart, M.D.

“It felt nice to have that connection and feel like we were in good hands.”

Continued on Page 18

DEBORAH A. LENART, M.D. Dr. Lenart specializes in obstetrics/gynecology. She earned her medical degree at Wright State University, Ohio, and completed a residency at the University of Texas. Dr. Lenart is board-certified by the American Board of Obstetrics and Gynecology. She practices with Advanced Women’s Care of Pittsburgh, P.C. To contact Dr. Lenart, please call 724.941.1866.

16 I HouseCall I Volume XI Issue 3

“

I just wanted to enjoy each moment, knowing what was coming.

HEATHER MCNAMARA, MOM

�

Heather McNamara with husband, Ryan, and their children, from left, Ellie, 5, Abby, 4, and baby Colin. The teddy bear that Ellie holds has an audio device inside that plays the recorded heartbeat of son Patrick, who died shortly after birth.

Volume XI Issue 3 I HouseCall I 17

FAMILY BIRTH CENTER Continued from Page 16

The following morning, another OB/GYN from St. Clair helped Heather deliver Patrick. Complications

family. “It’s a testament to how wonderful the nurses are

arose when the baby was slow to move down. The

in the Family Birth Center. They really do strive to make

doctor needed to break Heather’s water, but she had

sure you have the best possible experience. And it

to be careful due to the excess amniotic fluid. The Family

should be. It should be the happiest experience of your

Birth Center was well prepared. “You don’t want the

life when you give birth. I wouldn’t go anywhere else.”

fluid to come gushing out because the umbilical cord could prolapse,” explains Dr. Lenart. “The OB/GYN

say in their delivery experience is one of the reasons the Family Birth Center is so special. “In the face of a horrific

slowly, so you can guide the baby’s head toward the

situation, these parents had the power to play a key role

cervix. This way, the head is the first thing coming

in their delivery experience. It wasn’t the outcome they

not the umbilical cord.”

wanted, but it was the experience they wanted,” she says.

“It was an unusual case. We deliver hundreds and

He weighed 3½ pounds, and he lived for approximately

hundreds of babies every year that are normal and

5 minutes. “It was the most serene five minutes of my

perfect. There are unexpected complications and

whole life,” says Heather. “Everyone in the room stood

expected complications like this, where we can plan and

there silently. They backed away and gave us our time.

make everything as perfect as possible. We’re capable of

I liked how delicate they were in handling the whole

those extremes, as well as anything normal in between.”

situation. It allowed us to enjoy those five minutes as

After Patrick, Heather and Ryan knew they wanted another baby. When she became pregnant with Colin,

fully as possible.”

Heather and Ryan had prepared their daughters for

it opened a whole floodgate of emotions. “I needed the

what was to happen, and had chosen to have them come

support of my OB/GYN. I needed them to hold my hand

in after the delivery. “My daughter Ellie ran up to me.

again,” says Heather. This time, her doctor was

She hugged me while I was holding Patrick. I was afraid

St. Clair Hospital OB/GYN Douglas H. MacKay, M.D.

she would be terrified, but she looked at him and said,

Douglas H. MacKay, M.D.

Dr. Lenart believes allowing parents to have a greater

used a tiny trumpet that makes the fluid come out

Once they broke her water, Patrick came quickly.

These family photos are of baby Patrick, shortly after his birth.

make ink hand prints and foot prints for everyone in the

“The first ultrasound was reassuring,” Dr. MacKay

‘I just love him. He’s so beautiful.’ I knew then my family

remembers. After a healthy pregnancy, Colin was born

was going to be okay.”

in February of 2019. “My experience with Patrick was

Because Patrick was born early, he did not meet the

unique,” says Heather. “But I didn’t feel like I got any

requirements for a live organ donation. However, he was

different care with my three other babies. I always felt

able to donate for research. That meant there was no

like they were the most welcoming, warm people.”

rush to take the baby. Patrick was placed in a special

Dr. MacKay agrees. “We offer the kind of compassionate

‘cuddle cot,’ a bassinet that has a cooling feature. The

care that you don’t get everywhere. It’s more of a family

couple stayed in the room with him until the following

atmosphere with a personal touch. We have all the

morning. They had time to make memories, such as clay

specialists you need, but we also provide more of the

hand prints and foot prints. They cut a tiny lock of hair

physical, social and psychological services that

from around his ears. A nurse stayed and helped them

women need.” n

DOUGLAS H. MACKAY, M.D. Dr. MacKay specializes in obstetrics/gynecology. He earned his medical degree at The Ohio State University School of Medicine and completed his residency in obstetrics and gynecology at West Penn Hospital, Pittsburgh. Dr. MacKay is board-certified by the American Board of Obstetrics and Gynecology. He practices with Advanced Women’s Care of Pittsburgh, P.C. To contact Dr. MacKay, please call 724 .941.1866.

Douglas H. MacKay, M.D.

Douglas H. MacKay, M.D. 18 I HouseCall I Volume XI Issue 3

ELIZABETH J. PRONESTI, M.D.

Welcome home Growing up in Scott Township, St. Clair Hospital OB/GYN Elizabeth J.

Dr. Pronesti also enjoys the long-term relationships she forms with

Pronesti, M.D. always knew she wanted to be a doctor. “For two summers

women as an OB/GYN, a specialist who doubles as a primary care physician

in high school, I volunteered at St. Clair Hospital,” recalls Dr. Pronesti,

for many women. “You become a provider they see for years and years,

who recently joined Drs. Paul M. Zubritzky, Patrick T. Christy, Tera S.

from the time they’re teenagers through menopause, and beyond. That

Conway and Paula A. Duncan in St. Clair Medical Services.

was my goal — to become an OB/GYN, get to know my patients, and

Her exposure to the health care environment at St. Clair proved

allow them to get to know me. I love working with women,” she adds.

pivotal for Dr. Pronesti, who would go on to graduate from Chartiers

“Women are the cornerstones of their families. My patients are so inspiring.

Valley High School, then earn a bachelor’s degree in neuroscience at the

It’s great to hear everyone’s story and get to know them.”

University of Pittsburgh, as well as a medical degree from Pitt’s School

Growing up amidst a family dominated by women, Dr. Pronesti sees

of Medicine. While she originally wanted to be a pediatrician, her medical

choosing this career as life coming full circle. “My mom was a working

school rotations prompted her to reconsider. “I did my surgery rotation

mom, who raised me and my sister with the help of my aunt and

first, and I fell in love with it. Then I did my obstetrics rotation in my third

grandmother. It was always the five of us together,” she says. “I was

year. I was thrilled by the joy of labor and delivery,” Dr. Pronesti remembers.

raised by strong women, and now I’m advocating for women in my career.

“It’s an honor to be a part of a family’s life, welcoming a baby into the

That’s another reason why St. Clair Hospital was the right choice for me.

world. I teared up watching my first few deliveries. I still do sometimes!”

Dr. Pronesti completed her OB/GYN residency at UPMC Magee-

All of the OB/GYNs here are laser-focused on the health care needs

of women.” n

Womens Hospital in Pittsburgh. Even before finishing, she knew exactly where she wanted to work. “I wanted to go back to the community where I grew up and serve the patients of my hometown,” she says. “St. Clair was the hospital my family went to, and, to me, it feels like home.

I signed my contract a year before I finished my residency, because I knew I wanted to work there.”

Being an OB/GYN allows Dr. Pronesti to practice her favorite aspects of being a physician — caring for women, delivering babies and performing

“

surgery. Along with these passions, she also brings the latest in medical

I REALLY DO

skills and knowledge. “I practice medicine based on the most up-to-date

TREAT EACH PATIENT

research. I’m proud that I can offer that to my patients,” she says. “I’m comfortable performing minimally invasive surgeries, like laparoscopic hysterectomies. Giving patients that option helps them get back on their feet more quickly and have an easier recovery. I’m also proud of the fact that I really do treat each patient as if they are family. I open every visit by asking what their questions and concerns are. I listen and want them to know they are heard.”

AS IF THEY WERE FAMILY.

”

ELIZABETH J. PRONESTI, M.D. OB/GYN, ST. CLAIR HOSPITAL

ELIZABETH J. PRONESTI, M.D. Dr. Pronesti specializes in obstetrics /gynecology. She earned her undergraduate degree in neuroscience from the University of Pittsburgh and her medical degree from the University of Pittsburgh School of Medicine. She then completed her residency training in obstetrics and gynecology at UPMC Magee-Womens Hospital, where she served as administrative chief resident. In training, Dr. Pronesti earned awards for excellence in high risk obstetrics, female pelvic medicine, and laparoscopic surgery. Dr. Pronesti practices with St. Clair Medical Services.

Elizabeth J. Pronesti, M.D.

To contact Dr. Pronesti, please call 412.942 .1066.

Volume XI Issue 3 I HouseCall I 19

FAMILY BIRTH CENTER Continued from Page 19

New health issues are being addressed expertly at St. Clair Hospital’s Family Birth Center As health changes in the population at

One way St. Clair is demonstrating its

large occur, they often have repercussions for

commitment to tackling today’s challenges in

pregnancy, labor, delivery and recovery.

obstetrics is to participate in the PA Perinatal

identifying problems early to make sure patients get the extra care they need.

“Being part of this collaborative gives us

St. Clair Hospital stays on top of these trends

Quality Care Collaborative (PA PQC), a

the opportunity to utilize evidence-based tools

and actively participates in ways to address

statewide initiative to decrease maternal

that are working for other organizations,” says

new health issues that arise from these changes.

“The big trend we’re seeing now is more

mortality and morbidity and to help moms and

Shawndel Laughner, MHA, BSN, CNML,

babies affected by opioid abuse disorder.

RNC-OB, C-EFM, Director of Women and

women with more health problems,” says

The collaborative is designed to help hospitals

Children Services, at St. Clair. In regard to

OB/GYN Michelle L. Harvison, M.D., Chair

throughout Pennsylvania share information and

opioid abuse disorder, the OB/GYNs are using

of Obstetrics and Gynecology, at St. Clair.

develop best practices regarding these nascent

a tool to help identify patients who are at risk.

“Chronic hypertension, obesity and diabetes

problems.

“This is about asking the right questions at the

can make pregnancies more complicated.” She

As a participant in PA PQC, St. Clair is

right intervals,” Shawndel says. St. Clair starts

also points out the national trend of women

addressing a range of health problems that

putting off getting pregnant until they’re older.

affect mothers and their babies, from postpartum

each time the patient comes to the office. “It’s

hemorrhage, hypertension disorders and

important to let women know these screenings

“We stay up-to-date on all the new data,” Dr. Harvision says. “All of our obstetricians meet

reducing C-sections to neonatal abstinence

and share the information we’ve learned.”

syndrome. Much of the work revolves around

Alex Shipper, Level II RN, prepares a bassinet in a Labor and Delivery Suite in the Family Birth Center.

20 I HouseCall I Volume XI Issue 3

screening at the first prenatal visit and continues

are solely for the purpose of helping them,”

adds Dr. Harvison. n

The Family Birth Center offers the region’s finest OB/GYN doctors At St. Clair, you’ll find some of the region’s finest OB/GYN doctors, state-of-the-art technology, and warm and comfortable Labor, Delivery, Recovery and Postpartum suites. Our Level II Special Care Nursery and specially trained pediatricians are available 24/7 to ensure your baby is always in good hands. It’s why St. Clair is consistently ranked as a national leader in quality, safety, patient satisfaction and value.

MEET OUR OBSTETRICIANS/GYNECOLOGISTS ADVANCED WOMEN’S CARE OF PITTSBURGH, P.C.

ST. CLAIR MEDICAL SERVICES

Physicians from left to right: Michelle L. Harvison, M.D.; Kristen E. M. Peske, D.O.; Stephanie S. Brown, M.D.; Deborah A. Lenart, M.D.; Douglas H. MacKay, M.D.; and Amy B. Turner, D.O.

Physicians from left to right: Paul M. Zubritzky, M.D.; Tera S. Conway, M.D.; Patrick T. Christy, M.D.; Paula A. Duncan, M.D.; and Elizabeth J. Pronesti, M.D.

MT. LEBANON St. Clair Hospital 1000 Bower Hill Road Suite 213 Mt. Lebanon, PA 15243 412.942.1866

MT. LEBANON St. Clair Hospital Professional Office Building 1050 Bower Hill Road, Suite 205 Mt. Lebanon, PA 15243 412.942.1066

CASTE VILLAGE 5301 Grove Road Pittsburgh, PA 15236 412.942.1866

PETERS TOWNSHIP St. Clair Hospital Outpatient Center 3928 Washington Road Suite 230 McMurray, PA 15317 724.941.1866

ARTHUR P. SIGNORELLA, M.D., P.C.

ROBINSON TOWNSHIP 6000 Steubenville Pike, Suite 105 McKees Rocks, PA 15136 412.788.1330

VILLAGE SQUARE St. Clair Hospital Outpatient Center 2000 Oxford Drive, Suite 415 Bethel Park, PA 15102 412.942.5380 KENNEDY TOWNSHIP 1767 Pine Hollow Road McKees Rocks, PA 15136 412.331.1623

Arthur P. Signorella, M.D. St. Clair Hospital 1000 Bower Hill Road Suite 311 Mt. Lebanon, PA 15243 412.572.6595

Delivering Family-Centered Care

Volume XI Issue 3 I HouseCall I 21

THIRD ANNIVERSARY

Healthy Partnership Continues to Grow with Mayo Clinic St. Clair Hospital recently celebrated its third anniversary as a member of the Mayo Clinic Care Network (MCCN), a clinical collaboration between Mayo Clinic and more than 40 high-performing health systems across the country and the world that share Mayo Clinic’s values and commitment to excellence in patient care. Through this collaboration, St. Clair has special access to the expertise and resources of Mayo Clinic. The unique, reciprocal relationship has numerous benefits for member hospitals, including the ability to obtain second opinions from expert medical specialists and scientists; clinical consults for complex and challenging cases; access to patient education materials, tools and to a database of leading practices, protocols and policies; and numerous opportunities for staff development and professional enrichment, at every level.

T

he positive impact of the St. Clair-Mayo Clinic collaboration

This readmission prevention protocol effectively addresses

permeates the entire Hospital, through each clinical

a costly and common issue for hospitals. By implementing

specialty area. Mayo Clinic has provided unique

measures such as complex care management and coordination

professional growth opportunities for staff through Quality

of community resources to support patients post-discharge,

Exchanges, a Patient Safety Forum, and a Professional Lead-

the care team positions the patient for a successful outcome.

ership Development program. Visits to Mayo Clinic in

This is an example of High-Value Health Care — getting the

Rochester, Minnesota, and to member hospitals throughout

best outcome at the lowest cost — as described by Henry H.

the U.S. have provided opportunities for staff to learn from

Ting, M.D., MBA, Chief Value Officer and Chair, Department

their peers and to share St. Clair’s leading practices with Mayo

of Quality and Affordability, at Mayo Clinic. Dr. Ting visited

Clinic and other MCCN members.

St. Clair in late September to meet with St. Clair physicians

Every encounter with Mayo Clinic has enabled the St. Clair

and other clinicians to discuss Mayo Clinic’s transformative

staff to experience the “Mayo Way” — the culture, values and

strategic vision for the future of health care. Connecting quality

standards that have made Mayo Clinic the exemplary

to cost will improve health care and will be brought about by

institution that it is — and to integrate those values into their

addressing gaps in the system, he says, increasing standardi-

own practice through clinical protocols, leading practices and

zation and reliability, and recognizing the critical significance

program development. The Mayo Way essentially means

of culture and values in health care.

consistently practicing the values expressed by the mission

For St. Clair, the relationship with Mayo Clinic has been

statement, particularly that “the needs of the patient always

fruitful and energizing. St. Clair’s physicians, executive

come first.” Inspired by the Mayo Way, St. Clair recently

leadership and staff have taken advantage of the exceptional

developed a Readmission Risk Assessment Tool, which iden-

opportunities, embracing the clinical collaboration with

tifies older adult patients at high risk for re-admission. A high

enthusiasm, always with the singular goal of providing each

score automatically deploys interventions to facilitate a

patient with excellent care and an experience that is second

successful, efficacious discharge.

to none. Through the Hospital’s clinical connection to Mayo

22 I HouseCall I Volume XI Issue 3

The Pittsburgh Business Times recently published an article on Mayo Clinic’s clinical collaboration with St. Clair Hospital.

Henry H. Ting, M.D., MBA, Chief Value Officer, Mayo Clinic, discusses high-value health care with physicians and other clinicians at St. Clair Hospital.

Clinic, St. Clair physicians can confirm or fine tune a diagnosis or get expert, validating input on the treatment plan; they can obtain a second opinion by connecting electronically and immediately with Mayo Clinic’s expert specialists. Patients themselves can even request a second opinion by asking their physicians to consult a Mayo Clinic specialist on their behalf, at no charge.

In addition, as Mayo researchers translate scientific breakthroughs into improvements in care, St. Clair physicians have an opportunity to partner in cutting-edge treatments. One such example is precision medicine, that is, individualizing a patient’s treatment based on the patient’s unique genetic make-up.

The initial phase of this collaboration will be available at St. Clair in early 2020.

With their physicians able to directly access medical expertise from the most highly regarded medical institution in the world, St. Clair patients are getting the combined capabilities of their local, trusted physicians plus Mayo Clinic physicians and scientists. This translates into the highest quality care possible — right at home,

with no extra costs and no inconvenience. n

CELEBRATING

YEARS

WORKING TOGETHER. FOR A HEALTHIER YOU.

Reprinted by pe

rmission of the Pit

tsburgh Busines s Tim

es.

Volume XI Issue 3 I HouseCall I 23

ASK THE DOCTOR

Ask the Doctor CLARENCE D. LIN, M.D.

Q A A

Should I have my gallbladder surgically removed for gallstone disease?

About 1 out of 10 adult Americans have one or more stones in

their gallbladder, a small organ that sits just under the liver and stores

bile, which helps break down fat from food in the intestine. The

medical term for gallstone disease is cholelithiasis. For adults over age 65 the rate is even higher, with 1 in every 5 having gallstones.

Interestingly, 80 percent of people who have cholelithiasis may not

realize that they do because they do not experience any symptoms.

The ultimate result is relief from gallstone/gallbladder pain that will

not recur. In addition, with the laparoscopic technique, patients

experience a much shorter hospital stay, decreased postoperative

discomfort, and improved cosmesis (i.e., less visible scars compared to the traditional “open cholecystectomy,” which uses a longer

abdominal incision under the ribcage).

To minimize post operative pain, I will pair the operation with a

For those who become symptomatic from their gallstones, they often

TAP (Transverse Abdominis Plane) nerve block. Under laparoscopic

or in the middle of their upper abdomen below the breast bone. This

very satisfied with this technique, as they have significantly less pain

report pain in the right side of their abdomen just below the ribcage,

pain may radiate farther to the right side and wrap around to the back

or up to the right shoulder blade. The quality of the pain can be sharp

and intense or dull and pressure-like. They often also experience

abdominal bloating, nausea, and vomiting. The pain may be triggered

soon after eating a heavy meal or rich foods.

When I evaluate patients who have this constellation of symptoms

and have stones identified in their gallbladder (usually by ultrasound

or CT scan), I consider them to have gallstone disease. My recommendation is usually surgical removal of their gallbladder.

This is partly because these symptoms will frequently recur and become life limiting.

Another reason that I advocate for surgery is that

1 percent to 2 percent of patients per year develop major

complications from gallstones, such as cholecystitis,

choledocholithiasis, cholangitis, and gallstone pancreatitis.

In counselling my patients about the surgical options for gallstone disease, I offer the “minimally invasive”

approach, which is a laparoscopic cholecystectomy.

visualization, I inject a numbing medication. My patients have been immediately

following

the

operation, and pain control at

home

is

easily

managed

without a narcotic prescription.

Most patients just use over the

counter ibuprofen and Tylenol for a couple days.

After elective surgery, I tell

my patients that they can

GALLSTONE RISK FACTORS Over age 40 Family history Female Pregnancy Taking estrogen

resume their normal daily

Obesity

next day after surgery. There

Rapid weight loss

activities that evening, or the are very few limitations to life after gallbladder removal. I do

however recommend avoiding

foods that are fried or have high fat content, as this

High fat or cholesterol diet

Diabetes Sickle cell disease and other hemoglobin disorders Cirrhosis of the liver Certain medications

can cause abdominal pain,

This operation involves visualizing and removing the

discomfort or diarrhea, as the body adjusts to not having a gallbladder.

instruments that work through 3 or 4 abdominal

restriction as a catalyst for improving their food choices and jumpstart

gallbladder utilizing a small video camera and thin incisions that are very small (less than the width of a dime).

Some of my patients, at their follow-up visit, report using this diet

their efforts for better wellness and health. n

CLARENCE D. LIN, M.D. Dr. Lin specializes in general surgery. He earned combined bachelor’s and master’s degrees in biophysics at Johns Hopkins University, followed by a medical degree at New York University School of Medicine. Dr. Lin then completed his general surgery residency training at Yale New Haven Hospital, as well as a fellowship in general surgery at Brown University, where he also served as a clinical instructor of surgery. Along with partners Raye J. Budway, M.D., FACS, and Antonio J. Ripepi, M.D., FACS, Dr. Lin practices with St. Clair Medical Services.

To contact Dr. Lin, please call 412.942.7880.

24 I HouseCall I Volume XI Issue 3

T U O K N PI Each year, local schools and companies come together and show their support for St. Clair Hospital’s breast cancer patients and the St. Clair Hospital Breast Care Center. This year, 16 organizations made a difference in the lives of our patients by selling pink bandanas, hosting PINK OUT days, and holding raffles to benefit the Breast Cancer Fund of the Hospital.

Bethel Park High School Girls Volleyball

Bonita Schmidt and Vincent Reyes, M.D., on behalf of the Baldwin High School Cross Country Team

South Park Middle School

ST. CLAIR IS THE ONLY HOSPITAL IN PENNSYLVANIA TO RECEIVE STRAIGHT As SINCE 2012

THE REGION’S

The Leapfrog Group, a national, independent, patient-safety watchdog,

IN HOSPITAL PATIENT

SAFETY

STRAIGHT

15

awarded St. Clair special recognition for the 15th consecutive period, making St. Clair the region’s only hospital to consistently earn an ‘A’ grade for patient safety for more than seven years running. The grades rate how

As

well hospitals protect patients from preventable medical errors, injuries and infections. To learn more about our Hospital Safety Score, or St. Clair Hospital’s performance as a national leader in quality and patient satisfaction, please visit stclair.org.

TIMES IN A ROW 2012-2019 Volume XI Issue 3 I HouseCall I 25

SUMMER SWING

Nate and Kate Balzer, Kate Lin and Clarence Lin, M.D. with St. Clair Senior VP and Chief Medical Officer John Sullivan, M.D. and Barbara Scavone.

ST. CLAIR HOSPITAL’S 22 ND ANNUAL SUMMER SWING ita l st cl aprireshoenspts

In July, St. Clair Hospital Foundation held its 22nd Annual Summer Swing, the Foundation’s largest fundraising event to support the Hospital.

This year’s theme, Boots & BBQ, attracted more than 600 guests who reveled in a Nashville-inspired culinary and country music scene at a decked out St. Clair Country Club in Upper St. Clair.

Event co-chairs Beth Evron and Tricia Hammel, a dedicated event committee, valued sponsors, and all of the attendees contributed to make this year’s Summer Swing an outstanding success. More than $330,000 was raised to support the Foundation’s Groundbreaking Growth capital campaign to benefit the new Dunlap Family Outpatient Center, opening late 2020 adjacent to the Hospital.

Next year’s Summer Swing is Friday, July 17 at St. Clair Country Club. For more information or to donate to the Groundbreaking Growth campaign, please contact St. Clair Hospital Foundation at 412.942.2465 or visit stclair.org/giving/.

Simona Pautler, M.D. and John Gibbons, M.D., Partner Sponsor.

26 I HouseCall I Volume XI Issue 3

Laura and Phillip Freedman.

Event Co-Chair Beth Evron with her husband Wayne Evron, M.D., and Event Co-Chair Tricia Hammel with her husband Bob Hammel.

Jack Piatt, Millcraft, Bronze Sponsor, with St. Clair Senior VP and Chief Operating Officer Michael Flanagan.

Mark Gleason and St. Clair President and CEO James Collins with Kim and Tim Steinhauer.

THANK YOU TO OUR EVENT COMMITTEE Beth Evron, Co-Chair & Wayne Evron, M.D.

Nina Fatigati, M.D. & Christopher Pray, M.D.

Julie Perricelli & Brett Perricelli, M.D.

Tricia Hammel, Co-Chair & Bob Hammel

Sue & Mark Gleason

Carla Capozzi Riccelli, D.M.D. & Antonio Riccelli, M.D.

Katherine Biggs & Jason Biggs, M.D. Bunny Bragdon & Bob Bragdon, M.D. Susan Bradley Brown & Steven Williams Heidi Buzzelli & Mark Buzzelli, M.D. Katie & Dan Caste Wendy & Steve Denenberg

Emily Gleason, M.D. & Colin Gleason Tara Grahovac, M.D. & Erik Grahovac Veronica & Louis A. Guarino, Jr. Emily & Michael Hammel

Megan Shilling Suzy & Rich Sieber Marilynn Shogry & Robert N. Shogry, M.D. Gail & Andy Vater

Laina & Brian Hammel

JoEllen Yeasted & G. Alan Yeasted, M.D.

Tara & Robert Hammel, Jr.

Michelle & Ron Yost

Katie & Tom Lamb

Susie & Dick Wyatt

Vicki & Mark McKenna

Anne & Sam Zacharias

Lisa Vujevich and Justin Vujevich, M.D.

Country music dominated the evening’s entertainment.

Edward Ruane, Jr., M.D. and Liliana Camison, M.D. with Bunny Bragdon and Robert Bragdon, M.D. Volume XI Issue 3 I HouseCall I 27

1000 Bower Hill Road Pittsburgh, PA 15243 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 To find a doctor, please visit stclair.org and click on Physicians.

DUNLAP FAMILY OUTPATIENT CENTER

GOING

UP!

Construction of St. Clair Hospital’s new Dunlap Family Outpatient Center (pictured) and the supporting Central Utility Building continue on the Hospital’s main campus.

The 280,000-square-foot, six-story outpatient center is slated to open in late 2020. To date, more than $33 million in grants and private support, including a $1 million grant from the Richard King Mellon Foundation and $5 million from Pennsylvania’s Redevelopment Assistance Capital Program (RACP), has been raised to assist in financing the $150 million project. Funding for the outpatient center is being supported by tax-exempt bonds, accumulated funds and philanthropy. To donate, please visit: stclair.org/giving/groundbreaking-growth/.

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.

@StClairHospital