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Nursingmatters November 2017 • Volume 28, Number 9

Geothermal pays off for hospital Wisconsin News Connection




EDGERTON – It started as a big idea for a little hospital. In an energy-intensive industry, using geothermal technology is just what the doctor ordered to deliver patient comfort and reduce energy costs. Edgerton Hospital and Health Services was Wisconsin’s first hospital, and the nation’s first Critical Access hospital, to use geothermal heating and cooling. Critical Access is a designation given to certain rural hospitals that have 25 or fewer acute care inpatient beds and provide 24/7 emergency care services. The 18-bed Edgerton Hospital was built in 2011 to replace an outdated facility in the Rock County community of 5,000, located between Madison and Janesville. The complex features a ground-loop geothermal HVAC system that uses the earth’s natural temperature to provide heating and air conditioning. Edgerton Hospital received a financial incentive from Focus on Energy to install the vertical-bore geothermal system. Focus on Energy is a statewide energy-efficiency



Edgerton Hospital and Health Services was Wisconsin’s first hospital, and the nation’s first Critical Access hospital, to use geothermal heating and cooling. It’s surrounded by natural habitat with walking trails and water-efficient landscaping.

hospital. We can’t leave a penny on and renewable-energy program the table. funded by participating Wisconsin “No longer do we have to budutilities. Part of its mission is to proget for fluctuations in natural gas vide technical and financial support prices, but the large geothermal heat to energy-efficiency projects that exchange field and our eight waterotherwise would not be completed. Jim Schultz to-water geothermal heat pumps It has been five years since the provide a consistent heating and hospital first opened its doors cooling source.” to patients, and the cost savings Schultz was an early advocate for using from reduced natural gas consumption geothermal as a board director during the has already paid for the approximately hospital’s planning and construction phase $850,000 geothermal system. from 2005 to 2011. “Our monthly natural gas bill at the old “We’ve had no problems with frost and hospital was $14,000 per month. Today, tend to see our biggest savings occur during it is $450,” said Jim Schultz, Edgerton the hottest days of summer,” he said. Hospital CEO. “In today’s volatile healthThe use of geothermal fit well within care industry, that’s huge for a non-profit

the Edgerton Hospital’s “healthy village” concept to set a new standard in health care, with state-of-the-art technologies, sustainable building materials and systems, and exceptional patient care while promoting community health and wellness. Other sustainable features include a high-performance envelope, high-recycled content and low volatile-organic-compound materials, southern exposure and views for maximum natural light, natural ventilation, waste-water recovery, windows that open in patient rooms, ENERGY STAR® appliances in the kitchen and labs, and sophisticated lighting controls


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Making connections, working outside the box = solutions Brenda Zarth For Nursing Matters


OPINION Increased investment in mental health lauded Noel Deep, MD, FACP

I really enjoy listening to stories about creative solutions to complex problems. I like stories of thinking outside the box. I read a book, “Coming through the Fog” by Tami Goldstein, about a mother’s journey in helping her daughter Heather with Autism and Sensory Processing Disorder. What I most appreciated about the book were the details of the Brenda Zarth mother describing her child’s strengths and challenges – and her persistence in investigating every lead to see if it would help her child. She acknowledged that if she couldn’t make her child fit in her environment, she would adjust the environment to enhance her child’s learning ability. She amplified her daughter’s strengths to diminish her weaknesses to overcome challenges. Her daughter did not respond well to medication. Instead she responded best to a team approach of occupational therapy, a sensory diet, craniosacral therapy and bio-medical therapies. Her daughter produced life-threatening levels of ACTH, adrenal stress hormone. She was always on high alert until she became exhausted and shut down. Susan V. Kratz, the occupational therapist who worked with Heather, specializes in Sensory Processing Disorder. She

See WHAT IF, Page 3

President, Wisconsin Medical Society

The Wisconsin Medical Society applauds the efforts of Gov. (Scott) Walker and the Department of Health Services to increase reimbursement for outpatient mental and behavioral health services. Getting patients the care they need is paramount to addressing the devastating effects that mental and behavioral health conditions can have on patients and their families. The state’s action to raise reimbursement for these services to that of our regional peers will help improve access to care and potentially could increase the workforce in this important area – both top priorities for the Wisconsin Medical Society’s Mental and Behavioral Health Task Force. We look forward to continuing to work with the governor, the Legislature and the Department of Health Services to address these and other issues surrounding mental and behavioral health.

Craniosacral therapy can help reset a chaotic nervous system to help a person feel connected again.


Continued from page 1 throughout. The 60,000-square-foot complex includes emergency and urgent care services, a medical-office building, skilledcare facility, community rooms, imaging, surgery, lab and physical-therapy area. It’s surrounded by natural habitat with walking trails and water-efficient landscaping. Schultz said too often the outsides of large hospitals have a fog of exhaust, with airborne bacteria circulating inside of them. “It’s kind of ironic that people are coming for health care and are breathing pollution on the way in,” he remarked. That’s not the case in Edgerton, where windows can be opened in individual patient rooms. “A sensor in the ceiling maintains the

The Edgerton Hospital and Health Services complex features a ground-loop geothermal HVAC system that uses the earth’s natural temperature to provide heating and air conditioning.

room’s temperature,” Schultz said. “So it can be 80 degrees in one room and 60 degrees in the neighboring one, based on what the patient wants.” Rare hospital features like open windows and geothermal systems earned Edgerton a special citation from the Wisconsin Green

Building Alliance in 2014. Schultz said the State of Wisconsin’s Department of Health Services developed guidelines for the use of geothermal by hospitals as it was being built in a cornfield just east of Edgerton, near the Rock River and Interstate Highway 90. “With 285 holes bored, each almost 300 feet deep, it looked like a Texas oil field out here,” Schultz said with a chuckle. He admits being an early adopter of geothermal technology in the health-care industry came with skeptics. “We broke the paradigm,” he said. “We wanted to break the status quo and be a model of health care – not simply a provider of health care.” As for what’s next, the hospital’s sustainability committee is looking into Focus on Energy incentives for a lighting upgrade with LED bulbs, and the feasibility of a wind turbine or solar panels to lower their monthly $15,000 electric bill.

With more than 12,500 members dedicated to the best interests of their patients, the Wisconsin Medical Society is the largest association of medical doctors in the state and a trusted source for health-policy leadership since 1841.

In addition to a Focus on Energy incentive, key partners in the project included project manager Gilbane Construction Management, architect Eppstein Uhen Architects, Alliant Energy and Sustainable Engineering Group of Madison. Visit or call 800-762-7077 for more information.

Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713

What If

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To help with anxiety Heather has a fidget toy that she is allowed to hold in her hands during school to help her concentrate.

explained that behavior is a nonverbal way for a child to communicate who they are and what they need. Clothing texture, for example, can be irritating and make the child seem agitated due to trying to stop the irritation. Heather responded well to pressure on her body, so she wore the same type of tight clothing every day. When Heather’s stress level was out of control, she would hide in a quiet safe place for hours until she calmed down. She learned how to recognize the warning signs of an impending meltdown – and could excuse herself from a situation to go to a quiet room early before it became a crisis. The school identified a quiet place where she could go when she needed it. To help with anxiety she had a fidget toy that she was allowed to hold in her hands to help her concentrate. She was allowed to chew gum in class because it helped her to concentrate and decrease stress. Mornings were difficult for Heather so they arranged to start school late. She went to school for five hours a day and had tutors. She was hypersensitive to sounds. She didn’t tolerate chaos or loud unexpected changes, such as a fire drill or a noisy hallway between classes. When the school was going to have a fire drill, Heather stayed home. She was assigned support people in the school, including a mentor who knew her situation and could help her navigate hallways. The mentor could read the warning signs of when she was having difficulty. Heather had craniosacral therapy to help reset her chaotic nervous system and help her feel connected again. She learned how to do a craniosacral-therapy “still point” to herself, to help reset her overstimulation when she was having difficult phases. The book is full of resources and support. Heather is now living independently in her own home, and is working using her natural talents in customer service. I would love to cross-reference the information I learned in this book to sensory-processing disorder. I would try to apply it to others who are sensory-overloaded, such as patients who are chronically overwhelmed with stress. Email or visit with comments or questions.

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Future brings nurses, doctors together

Doctors increasingly oversee the work of a team of medical professionals, including nurses and medical assistants, who handle much of the direct interaction with patients. TOP: A nurse at Denver Health’s Federico F. Peña Southwest Family Health Center vaccinates a patient. BOTTOM LEFT: Medical assistant Becky Peterson, right, confers with doctors in training at the UCHealth internal medicine clinic in Denver. BOTTOM RIGHT: Dr. Benjamin Feijoo discusses the day’s workflow with staff in a primary-care clinic at Denver Health’s Peña clinic.

Wisconsin News Connection

DENVER – When patients go to see Dr. C.T. Lin for a checkup, they don’t see just Dr. Lin. They see Dr. Lin and Becky. Becky Peterson, the medical assistant who works with Lin, sits down with patients first and asks them about their symptoms and medical history – questions Lin once would ask. When Lin comes in the room, she stays to take notes and cue up orders for tests and services such as physical therapy. When he leaves, she ensures the patient understands his instructions. The division of labor allows Lin to stay focused on listening to patients and solving problems. “Now I’m just left with the assessment and the plan – the medical decisions – which is really my job,” Lin says in a quiet moment after seeing a patient at the Denver clinic where he works. For generations, when Americans sought health care, they went to see their family doctor. But these days they will often sit down with a physician assistant or nurse practitioner instead. Or they’ll spend a large part of their visit talking to a non-doctor, like Peterson, who takes care of an increasing number of tasks doctors once handled. Driven by efforts to control costs and improve outcomes, it’s one of the biggest shifts in the American health-care workforce. Medicine increasingly looks like a team sport, with duties and jobs that once fell to a family doctor now executed by a team – from nurses who sit down with patients to discuss diet and exercise to clinical pharmacists who monitor a patient’s medication. The doctor, in this model, is a kind of quarterback – overseeing care plans, stepping in mostly for the toughest cases and most difficult decisions. Under some models, the doctor may recede even further into the background, leaving advanced-practice nurses or other highly qualified professionals in charge. It’s no longer true “that you’re a sole cowboy out there, saving the patient on your own,” said Mark Earnest, head of internal medicine at the University of Colorado medical school. The shifting role of doctors is expected to accelerate in the coming decades, as the number of older Americans increases dramatically, many of them living longer with chronic diseases that need monitoring but not necessarily the expensive attention

See FUTURE, Page 4


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November • 2017

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Continued from page 3 of a physician at every visit. This isn’t the job many physicians trained for – or that some want. Even doctors who support team-based care have trouble adjusting to the new workflow. Some don’t like the idea that they aren’t always the ones in charge. Others, sick of industry pressures, are opting out and setting up independent practices that don’t accept health insurance. But most doctors will need to adapt. Change is coming, regardless of the fate of the Affordable Care Act or other laws designed to reward health systems for outcomes rather than the number of procedures performed, said Randall Wilson, an associate research director for Jobs for the Future, a nonprofit that advocates for increasing job skills. “People see the writing on the wall,” he said.

New models increase Americans spend more on health care than people in other wealthy nations. Yet Americans live shorter lives and are more likely to be obese or hospitalized for chronic conditions, such as asthma or diabetes. Health-care experts have long blamed those lousy results on our fragmented health-care system. Americans rely on a mix of specialists and settings for care, but those pieces of the health-care system don’t necessarily communicate or coordinate with each other. They also blame the high costs partly on the fee-for-service payment system, which rewards hospitals, clinics and doctors for the volume of procedures they provide. Health insurers will pay for a patient to sit down with a doctor. What they sometimes don’t pay for are other services that help patients stay healthy – such as a visit from a community health provider or a phone call with a nurse. Yet such services can prevent medical emergencies and save both her and her insurer a lot of money on expensive treatments. New payment models encourage health systems to deploy their workers more efficiently while also avoiding unnecessary services and costly errors. For instance, Medicare already gives some hospitals a single payment to cover everything that happens to a patient from the moment he enters a hospital for knee-replacement surgery to three months after he goes home. Distributing work across team members can help keep costs down, relieve doctors of the busywork that jams up their days and make everyone more productive. At least, that’s the idea. There isn’t yet strong research that proves teams provide better or cheaper care, said Erin Fraher, director of the Carolina Health Workforce Research Center, a national research center at the University of North Carolina. Studies do show that nurse practitioners can deliver care as well as physicians, “but talking


about substitution of one provider for another is not team-based care,” she said. Major physician associations support improving teamwork and collaboration among health-care professionals. So do medical-school leaders. For some years now, accreditors have required colleges and universities that train doctors, nurses, pharmacists, dentists and public-health experts to teach students to work in interprofessional teams. But when it comes to the question of who’s in charge, that’s where friction arises. Many doctors aren’t comfortable with the idea that they don’t always need to be in charge. The American College of Physicians will say a physician must always lead care teams, said Ken Shine, professor of medicine at the Dell Medical School at the University of Texas at Austin, but he disagrees. “My argument is there are situations where another health professional needs to be directing the team,” Shine said. For instance, a nutritionist could create and manage a care plan for a diabetic patient. Medical associations have also pushed back against proposals to expand the medical decisions non-doctors are able to do make on their own. Health professionals’ so-called “scope of practice” is governed by laws that vary from state to state. “While some scope expansions may be appropriate, others definitely are not,” the American Medical Association says on its website. In a statement, the association says it “encourages physician-led health-care teams that utilize the unique knowledge and valuable contributions of all clinicians to enhance patient outcomes.” It noted that top hospital systems are using physician-led teams to improve patients’ health while reducing costs. To be sure, doctors aren’t being

displaced anytime soon. But shifting tasks to other professionals reduces the need to train so many of them. According to a study by the Rand Corporation, a nonpartisan think tank, a standard primary-care-team model requires about seven doctors per 10,000 patients. Increasing the numbers of nurse practitioners and physician assistants can drop that ratio to six doctors per 10,000, and in clinics run by highly trained nurses – known as nurse-managed health centers – the ratio drops to less than one doctor per 10,000.

Culture changing slowly but surely Hospital systems like UCHealth, the University of Colorado-affiliated system where Lin and Peterson work, are betting that the future of health care involves a mix of professionals sharing responsibility for patients. Doctors will still run the show, but they’ll need to give up some control. That culture change makes many doctors uneasy at first. Doctors want to protect their one-to-one relationship with patients. They may not understand what their non-physician colleagues have been trained to do, or are legally able to do. And many worry that change will make them even busier, by forcing them to manage the lower-credentialed professionals around them. Lin is the chief information officer for UCHealth. As an administrator, he’s always pushing for change – his latest project is a system that releases certain test results to patients in real time. But as a practicing doctor, he also understands that change is hard. He said having Peterson in the examination room with him took some getting used to. “Like many doctors, I have a fear of letting go of all the things I traditionally do,” he said.

That includes documenting a visit. “I’m getting over it, because I don’t want to be the only one here at 8 o’clock at night, typing,” he said. Matt Moles, a doctor who practices in the same clinic, said he also initially felt uncomfortable. Sharing the examination room went against his medical training. “We’re trained to trust no one,” he said. It’s still possible for doctors to have jobs that resemble the Norman Rockwell era of long consultations – if they’re willing to opt out of the mainstream. A small but growing number are setting up or joining practices that, rather than taking health insurance, charge patients a monthly fee – typically about $75 – for unlimited visits. “I personally have the mentality of ‘leave me alone, I’ll take care of my patients,’” said Dr. Cory Carroll, when reached by phone at his family-care practice in Fort Collins, Colorado. He’s been a solo practitioner for most of his 25-year career. Carroll has about 300 patients, a fraction of the patient load of a typical doctor in a big health-care system. He sits with patients for more than an hour if he needs to. He visits them at home. He helps them connect with social services and community organizations. And he can focus on what he loves most – teaching patients to eat a healthier diet. His practice is proof that it’s still possible for a family doctor to do it all. But he emphasizes that his experience is unusual. “I’m absolutely an outlier,” he said. Less than a quarter of all internal-medicine doctors in the United States have a solo practice, according to the American Medical Association’s latest survey. And although the model Carroll has embraced is growing, it serves a more affluent slice of the patient population than a major hospital system such as UCHealth.

Future is team-based UCHealth’s leaders are so sure that team-based care is the future that newly built clinics, such as the one in Denver’s Lowry neighborhood at which Lin and Peterson work, are literally built for teamwork. Examination rooms don’t line long hallways. Instead they ring desk space where nurses, physicians and medical assistants sit side-by-side. But the clinic is still in the early stages of transforming its teams. The best place in Denver to watch a diverse set of health professionals working together is across town, at a facility run by Denver Health, the city’s public safety-net hospital system. The facility includes a primary-care clinic, an urgent-care center and a pharmacy. One recent morning, the distant wail of a baby in the waiting room announced the start of another busy day. Doctors, physician assistants, nurse practitioners and medical assistants were already typing away at the computers in their cubicles, trying to have a head start before the

See FUTURE, Page 7

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UW dean recognized, re-elected The American Academy of Nursing has elected Linda D. Scott, dean of the University of Wisconsin-Madison School of Nursing, to a second two-year term on its Board of Directors. The action was taken during the organization’s annual conference in October in Washington, D.C. Scott, a widely published researcher on nurse fatigue and holistic admissions, also earned an award for Linda Scott excellence in writing. She has been an American Academy of Nursing member since 2008. In 2016 she chaired the academy’s Policy Conference Planning Advisory Committee. She is the board liaison of the Diversity and Inclusivity Committee. The 10-member board provides strategic direction for and financial oversight of the association. Fellowship in American Academy of Nursing is widely considered one of the highest honors within the nursing profession. Board members are elected by the academy’s 2,500 member fellows.

“I am pleased that my fellow academy members valued my contributions to our organization’s success during my first term on the board, and I look forward to working on behalf of this esteemed group to advance nursing practice during my second term,” Scott said. “I value this opportunity to provide leadership to the American Academy of Nursing and to the nursing profession as a whole.” Now in her second year of leadership at UW–Madison, Scott has launched an ambitious plan to grow faculty ranks and to strengthen the school’s research enterprise. She plans to build upon expertise in geriatrics, a legacy of leadership in pediatric and family-care research, and a breadth of talents in wellbeing and social determinants of health. UW-Madison is a public-research institution; the School of Nursing develops nurse leaders to improve health outcomes across populations. Scott said she’s proud to be a part of the nationwide efforts to advance nursing education and the nursing profession.

Students recognized for leadership The Wisconsin Nursing Association Mentorship Committee has selected five recipients of the Future Nursing Leader Award. The award recognizes outstanding students who embody the ethics and values of nursing, and exemplary leadership qualities. It’s given twice each year to graduating pre-licensure students from the spring and fall semesters at the pinning ceremonies. Winners receive a complimentary year of membership in the Wisconsin Nurses Association, along with an appointment to an association council or committee of his or her choosing. He or she will also receive a certificate and lapel

pin presented at their pinning ceremony. The winners this fall are: Connor Stone – University of Wisconsin-Milwaukee Grant Skelnar – University of Wisconsin-Eau Claire Allyson McCann – Milwaukee Area Technical College Jenni Jacobs – Alverno College Heather Kempf – Blackhawk Technical College The Wisconsin Nurses Association congratulates them on their achievements, and is excited to welcome such promising leaders to the organization.

International Nurses Day 2018 theme chosen The International Council of Nurses has unveiled the theme it has chosen for the 2018 International Nurses Day. Health is a human right. With that strong statement, the International Council of Nurses seeks to raise awareness of the fact that access to health is not a given in every part of the world, and that nurses are key to achieving access. Despite the many treaties and conventions promoting the right to health, pervasive inequalities still constitute barriers to individual health. The 2018 edition of International Council of Nurses resources showcases the


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The theme for the 2018 International Nurses Day is ‘Health is a human right.’

instances in which the nursing profession has been critical to delivering health to all populations. Two posters are being released along with the International Nurses Day 2018 logo. A social

See NURSES DAY, Page 7

Find out more about this online program at: or email

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Foundation joins ‘Giving Tuesday’ The National League for Nursing’s Foundation for Nursing Education has again joined the “Giving Tuesday” movement, a global day of giving that harnesses the collective power of individuals, communities and organizations to encourage philanthropy and to celebrate generosity worldwide. Occurring this year Nov. 28, Giving Tuesday is held annually on the Tuesday following Thanksgiving and the widely recognized shopping events Black Friday and Cyber Monday. Through #NLNGivingTuesday, the foundation is raising awareness and funds by engaging with individuals and organization through social media. Participants may donate; take action on the National League for Nursing Advocacy Action Center; post a #UnSelfie; and call, text or email friends and colleagues with National League for

Nursing ready-to-send messages about the importance of providing financial support for the future of nursing education. The goal of the foundation is to raise $25,000 from #NLNGivingTuesday efforts. All funds will support the foundation’s nurse-educator scholarships and other important programs that promote excellence in nursing education. Collectively the programs advance the health of

the nation and the global community. “Giving Tuesday is an important call to action from the (National League for Nursing) Foundation to all nursing educators,” said Beverly Malone, National League for Nursing CEO, PhD, RN, FAAN and foundation Board of Trustees chair. “Your gift shows your commitment to investing in our industry’s future – a future of leaders in nursing education.

A digital pill to swallow

Investing in the next generation of nursing educators is paramount to the continuation of my passion, our passion of addressing nursing faculty shortage.” Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN, said, “Making a donation to the National League for Nursing Foundation on Giving Tuesday not only shows your support for the National League for Nursing Foundation, but also for the academic success of students pursuing advance degrees as full-time nurse educators.” The National League for Nursing Foundation for Nursing Education works to raise, steward and distribute funds to support the mission of the National League for Nursing – promoting excellence in nursing education; building a strong and diverse nursing workforce; advancing the health of the nation and the global community.

Regulators approve first drug with a built-in tracking sensor

during an emergency,” the statement said, “because detection may be delayed or may not occur.” Patients can track their dosage on their U.S. regulators have approved the first smartphone and allow their doctors, famdrug with a sensor that alerts doctors ily or caregivers to access the information when the medication has been taken, through a website. offering a new way of monitoring patients In a statement issued last May at the but also raising privacy concerns. time the FDA accepted submission of the The digital pill approved earlier this product for review, the companies said month combines two existing prodOTSUKA AMERICA “with the patient’s consent, this inforucts: the former blockbuster psychiatric PHARMACEUTICAL, INC. mation could be shared with their health medication Abilify — long used to treat care professional team and selected family schizophrenia and bipolar disorder — with and friends, with the goal of allowing a sensor tracking system first approved physicians to be more informed in making in 2012. treatment decisions that are specific to The technology is intended to help the patient’s needs.” prevent dangerous emergencies that can While it’s the first time the FDA has occur when patients skip their medicaapproved such a pill, various specialty tion, such as manic episodes experienced pharmacies and hospitals in the U.S. have by those suffering from bipolar disorder. previously “packaged” various drugs and But developers Otsuka Pharmaceutical sensors. But the federal endorsement Co. and Proteus Digital Health are likely increases the likelihood that insurers will to face hurdles. The pill has not yet been eventually pay for the technology. shown to actually improve patients’ medDrugmakers frequently reformulate “Could this type of device be used for ication compliance, a feature insurers are following instructions. their drugs to extend their patent life and real-time surveillance? The answer is of “It’s truth serum time,” said Arthur likely to insist on before paying for the to justify raising prices. For instance, course it could,” said Giordano. pill. Additionally, patients must be willing Caplan, a medical ethicist at NYU’s LanThe new pill, Abilify MyCite, is embed- Otsuka already sells a long-acting injectgone Medical Center. “Is the doctor going to allow their doctors and caregivers to able version of Abilify intended to last for ded with a digital sensor that is activated to start yelling at me? Am I going to get access the digital information. one month. The patent on the original by stomach fluids, sending a signal to a a big accusatory speech? How will that These privacy issues are likely to crop patch worn by the patient and notifying a Abilify pill expired in 2015. up more often as drugmakers and medical interaction be handled?” The Japanese drugmaker has not said The technology carries risks for patient digital smartphone app that the medicadevice companies combine their products how it will price the digital pill. Proteus privacy too if there are breaches of medi- tion has been taken. with technologies developed by Silicon Digital Health, based in Redwood City The FDA stressed however that there cal data or unauthorized use as a surveilValley. Experts say the technology could California, makes the sensor. lance tool, said James Giordano, a profes- are limitations to monitoring patients. be a useful tool, but it will also change Merrill Hartson in Washington contrib“Abilify MyCite should not be used sor of neurology at Georgetown University how doctors relate to their patients as uted to this report. to track drug ingestion in ‘real-time’ or Medical Center. they’re able to see whether they are MATTHEW PERRONE Associated Press

The Food and Drug Administration approved Abilify MyCite, the first drug in the United States with a digital ingestion tracking system, in an unprecedented move to ensure that patients with mental illness take the medicine prescribed for them.


Continued from page 4 first patients were shown in to examination rooms. “A lot of Denver Health patients are so complex,” said Dr. Benjamin Feijoo, looking up from his desk. Patients often have multiple health issues, too many to handle in a typical 20-minute visit. “It’s a bit of a crunch,” he said. So Feijoo turns to his colleagues for help. For instance, if a patient has both a medical and a mental-health issue, Feijoo can address the medical problem and then ask a mental-health specialist to step into the examination room and tackle the mental-health problem. If a patient needs, say, a crash course on prenatal health, she can meet with a nurse for an hour-long discussion. And if a living situation is compromising a patient’s health – such as unstable housing or insufficient access to healthy food – the clinic’s social worker will try to find a solution. The clinic also employs two community health workers, who spread the word about Denver Health in low-income neighborhoods, and a patient navigator, who calls the clinic’s patients when they leave a Denver Health hospital – and, for a subset of patients, other major local hospitals. The navigator helps them schedule follow-up appointments with their primary-care providers. Denver Health began expanding its care teams in 2012, when it received a $20 million federal grant. The system spent about half the money on hiring staff such

Nurses Day

Continued from page 5 campaign banner is also available for downloading and printing. Nurses can submit photos of themselves holding the banner. Show support to nurses and universal health coverage with the hashtags #VoiceToLead and #IND2018. In 2018 the International Council of Nurses will launch a website dedicated to International Nurses Day and will

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November • 2017 as social workers, patient navigators and clinical pharmacists. The rest was spent on software that identifies patients who are spending avoidable time in the hospital, including people who are homeless or have a serious but treatable condition such as HIV. New smaller clinics wrap even more services around those patients, allowing them to come in for multi-hour visits. The new system now saves Denver Health – an integrated system, which includes a health plan – so much money on hospital stays and emergency-room visits that it covers the salaries of the additional hires, said Tracy Johnson, director of health-reform initiatives for the system. Reconfiguring care teams has also made financial sense for UCHealth. Although the clinic where Lin and Peterson work has about twice as many medical assistants today as it had a year ago – plus a social worker and nurse manager – the configuration saves doctors so much time that they’re able to see more patients each day. The extra visits bring in enough money to cover the cost of adding more employees. “The reason a lot of this happened is physician burnout was significant, especially in primary care,” said Dr. Carmen Lewis, the medical director of the Lowry clinic. The redesigned teams launched earlier this year aim to make doctors’ lives less stressful. Patients across the UCHealth system don’t seem to mind the change. A few will ask to speak with their doctor in private, but others are more open with the medical assistant than with their doctor. “Sometimes, they don’t feel as judged,”

publish important resources and evidence to support this work. In addition, an International Nurses Day 2018 video will be available. The International Council of Nurses is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, the council works to ensure quality care for all and sound health policies globally. Visit www. for more information.

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A doctor examines a patient in a Denver Health primary-care clinic. Below, patients check in at the reception desk.

Peterson said. Lin said that since he’s started working with Peterson, his patients have been better able to keep their blood pressure and diabetes under control. “Patients will forget to tell me that they’re out of prescriptions,” he said – or he’ll be so busy tackling a more immediate problem that he’ll forget to ask. With a medical assistant methodically asking all the opening questions, crucial details such as prescription renewals no longer slip through the cracks.

Rethink medical school Medical-school leaders want to ensure the next generation of doctors has the skills

and mind-set the jobs of the future will require – such as the ability to lead teams effectively, draw insights from data sets and guide patients through a system full of bewildering treatments, care settings and payment options. Students traditionally spend the first two years of medical school learning science in classrooms and two years getting hands-on experience at clinical sites. That’s no longer enough, said Susan Skochelak, group vice-president for medical education at the American Medical Association. She said students need to understand “health-system science” – everything from how health insurance works to how factors such as income and education affect health. “We had medical students who were graduating, not knowing the difference between Medicare and Medicaid,” she said. So in 2013 the American Medical Association began issuing grants to medical schools that wanted to do things differently. One program allowed Indiana University to put anonymous patient data into an electronic health record students can use to search for clues to a patient’s health – such as whether he is showing signs of opioid addiction. Another grant allowed Pennsylvania State University to create a new curriculum that requires medical students to work as patient navigators. “Brand-new medical students – they totally get the need for this,” said Robert Pendleton, a professor of internal medicine at the University of Utah and the university hospital system’s chief

See FUTURE, Page 8

Registered Nurses Mile Bluff Medical Center currently has the following RN positions available: • Part time Charge RN in the Medical/Surgical department (12 hour shifts). Previous charge/supervisory experience required. • Full time positions available in the Medical/Surgical department (12 hour shifts) for Day and Night shifts. Experience preferred, new grads will be considered. • Full time Labor/Delivery RN (12 hour shifts). • Full time positions available for a Family Practice RN at Mile Bluff Clinic in Mauston and New Lisbon Family Medical Center. Minimum two years of experience preferred. • Full time and part time positions available at Crest View Nursing & Rehabilitation Center (New Lisbon). • Full time positions available at Fair View Nursing & Rehabilitation Center. Please visit our website at to learn more about our facilities, the benefits available to our employees, and to complete and online application. Resumes can be emailed to

Mile Bluff Medical Center 1050 Division St. Mauston, WI 53948

An Equal Opportunity Employer

November • 2017

Page 8

Help from the sky Company launches first drone defibrillator service in the US Associated Press


Medical assistant Becky Peterson, left, prepares to check a patient’s blood pressure.


Continued from page 7 medical-quality officer. At this year’s kickoff for an elective curriculum on data and performance measurement, he said, students packed the auditorium. And all medical schools are trying to emphasize teamwork. At the University of Colorado medical school, the idea that doctors should treat non-doctors as partners – not subordinates – is impressed on students from day one, said Harin Parikh, a second-year student. The medical school shares a campus with education programs for six other health professions. Students hang out on the same quad, grab lunch in the same places and even take some classes together. In a required first-year class, students from a mix of health fields are split into teams and are asked to plan a response to a given scenario. One day a nursing student might lead the team; the next, a pharmacy student. Parikh said the team-based approach makes sense to him. “From a provider perspective, it’s about checks and balances,” he said. When multiple people with different kinds of expertise come together around a patient, one may notice something the others don’t. Reorienting medical schools, like reorienting hospital systems, will take time. Scheduling barriers can make it hard to have students from different health fields in one room, for instance. Some faculty members aren’t prepared to teach a new kind of curriculum. And when students leave school for their clinical training, they work in real-life settings that are all over the spectrum when it comes to teamwork. “We’re working on an ideal,” said John Luk, assistant dean for interprofessional integration at the Dell Medical School at the University of Texas at Austin. “But the reality is, many of us have not been practicing at the ideal.” Sophie Quinton is a reporter for Stateline, a nonprofit journalism project funded by the Pew Charitable Trusts.

RENO, Nev. — A drone delivery service has announced a new partnership with a Reno, Nev.-based ambulance company to send out defibrillators and other emergency equipment by air during responses to cardiac arrest. The drone delivery company Flirtey announced in early October it is joining forces with the Regional Emergency Medical Services Authority, allowing responders to send an automated external defibrillator by air in addition to an ambulance dispatch for every emergency call involving cardiac arrest. The program uses a rapid drone deployment program that combines Flirtey’s flight-planning software technology with Regional Emergency Medical Services Authority’s patient care and transport programs, the Reno Gazette-Journal reported. The goal is to help improve response times, especially in locations where traffic

can slow down the arrival of paramedics on the scene. “We have the ability to deliver lifesaving aid into the hands of people who need it. Why aren’t we as a society doing it already?” Flirtey CEO Matthew Sweeny said. “This is one of the most important uses of drone-delivery technology, and we believe that by democratizing access to this lifesaving aid, our technology will save more than a million lives over the decades to come.” Every minute literally counts in increasing the odds of survival for a person experiencing cardiac arrest. The chance of survival drops between 7 percent to 10 percent for each minute that a cardiac arrest victim does not get CPR or defibrillation, according to the American Heart Association. An estimated 359,400 cases of cardiac arrest occur in the United States outside of a hospital setting each year. Less than 10 percent of such victims survive, according to the heart association. “Cardiac arrest occurs when the electrical activity of the heart stops,” said J.W. Hodge, chief operating officer of the Regional Emergency Medical Services Authority. “Someone in cardiac arrest will



Flirtey’s new delivery service aims to help improve response times at cardiac arrest emergencies.

be unresponsive with no pulse, no breathing, no movement at all.” “They’re technically clinically dead,” Hodge added. The joint delivery program will allow a person on the scene to use the defibrillator on the person suffering cardiac arrest before paramedics arrive. The equipment used for the program is designed to be used by anyone, including those without a health care or emergency background, Hodge said.

Is your MD the best in the hospital? Study shows benefits of family doctor over hospitalist care LINDSEY TANNER Associated Press

CHICAGO — The old-fashioned, family doctor style of medicine could be lifesaving for elderly hospitalized patients, a big study suggests, showing benefits over a rapidly expanding alternative that has hospital-based doctors overseeing care instead. Medicare patients with common conditions including pneumonia, heart failure and urinary infections who were treated by their own primary care doctors were slightly more likely to survive after being sent home than those cared for instead by hospitalists — internists who provide care only in hospitals. While hospitalist care can shorten stays and reduce costs, the new results suggest that, for at least some patients, getting taken care of in the hospital by a doctor who knows them can have important advantages. Almost 11 percent of patients cared for by a hospitalist died within 30 days of leaving the hospital, compared with just under 9 percent of primary care patients. While that difference was small, it “was certainly a startling finding,” said Dr. Jennifer Stevens, the study’s lead author at Harvard Medical School.

Also, among hospitalist patients, 36 percent were sent to a nursing home or other long-term care center, versus about 30 percent of primary care patients. Studies show that elderly patients who are discharged to nursing homes are less likely than others to ever return to their homes, Stevens said. Reasons for those advantages are unclear. Stevens noted that primary care doctors who know their patients’ health and family histories may be more attuned to how well they can manage at home after hospitalization and which potentially risky follow-up tests or medicines they can avoid. Stevens and her colleagues analyzed Medicare claims data on nearly 600,000 hospital admissions in 2013. Their results were published Monday in JAMA Internal Medicine. The researchers don’t advocate replacing hospitalists, but Stevens said the study “opens the door” to limiting their use with certain hospital patients, particularly the elderly. Patients in the study were aged 80 on average. The hospitalist specialty has grown since the 1990s amid insurance industry changes, rising demands on primary care doctors’ time and research showing hospitalists can shorten patients’ stays and reduce costs.

In 1995, hospitalists provided 9 percent of general medicine services in hospitals, but by 2013 that had grown to nearly 60 percent, a journal editorial noted. Hospitalists may bring “new eyes” to patients’ problems, but the study results, if valid, suggest there’s a trade-off, the editorial said. In the study, 60 percent of patients got their hospital care from hospitalists versus only 14 percent from their primary care doctors. The rest got care from other general physicians including partners of patients’ primary physicians. These were physicians who likely didn’t know the patients or the hospital well, Stevens said. The average length of stay was about 5 days for primary care or general care and about half a day shorter for hospitalists. Those treated by other general physicians were slightly more likely than the others to die within 30 days of discharge and to be readmitted to the hospital.

Nursingmatters November 2017  
Nursingmatters November 2017