SPECIAL REPORT 2015
THE REGION’S BUSINESS MAGAZINE
Northwest Healthcare Expands Through Greater Tucson
Northwest Medical Center and Oro Valley Hospital
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Healthcare Closer to Home Plus Nationally Accredited Specialized Care
PHOTO: TOM SPITZ
By Donna Kreutz Northwest Medical Center and Oro Valley Hospital are the hospitals in an ever-expanding community health system that now includes satellite urgent care centers dotting the metro area, along with physician offices and other facilities to serve patients throughout Southern Arizona. These flagship hospitals are the anchors of a network that is expanding to bring healthcare to the places where people work and live – including east and west sides and Green Valley. The next expansion will be a freestanding emergency center in Vail. This healthcare network has steadily expanded the scope of specialty services that meet rigorous national standards – ranging from chest pain and cardiac care to strokes, joint replacement, breast health, spine care and bariatric surgery. Also offered are a freestanding women’s center, special-care nursery, pediatric emergency care and in-patient rehabilitation services. New programs include sports medicine, senior behavioral health and occupational medicine. This is comprehensive contemporary healthcare designed to meet the specific needs of the greater Tucson community.
2 Hospitals
6 Urgent Care Centers +1 Freestanding ER Coming Soon By Dan Sorenson Two hospitals in northwest Tucson have steadily expanded their medical facilities and capabilities over the past five years and now serve patients throughout the metro area and as far away as Sierra Vista. In addition to the flagship hospitals – Northwest Medical Center and Oro Valley Hospital – this growing healthcare network now has six urgent care centers, including one in Green Valley, as well as physician offices and other facilities. Next up is the area’s first freestanding emergency department – a $7.2 million facility to be built in Vail. Construction is scheduled to begin in February. “We have been serving more than just northwest Tucson for many years. This is another example of our commitment to expand healthcare in the greater metropolitan area,” continued on page 138 >>>
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BizHEALTHCARE
Northwest Healthcare
Expands to Serve Greater Tucson
Jae L. Dale
CEO Oro Valley Hospital
Kevin Stockton
CEO Northwest Medical Center
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BizHEALTHCARE Area’s First Freestanding Emergency Center Northwest Medical Center plans to build the first freestanding emergency department in greater Tucson. Ground will be broken in February for the $7.2 million facility in Vail. Construction should be completed by late 2015. The Northwest Emergency Center at Vail will offer emergency medical care 24 hours a day, seven days a week. Board-certified or board-eligible emergency physicians, registered nurses and other patient care providers will staff the center. More than 30 new jobs will be created to serve patients at the new center, including registered nurses and staff for lab, imaging, admitting and environmental services. Kevin Stockton, CEO of Northwest Medical Center, said this new facility “will provide faster access to emergency care for people living in the Rita Ranch and Vail areas.” The facility will have 12 private patient rooms and be equipped with radiology and lab services. This center will treat patients with illnesses and injuries that require a higher level of care than what is available through urgent care facilities, he said. The emergency center will be built in the Houghton Town Center at the intersection of Houghton and Old Vail Roads. The developer of the Houghton Town Center is Diamond Ventures. “Southeast Tucson is growing rapidly, so providing services like emergency care is an important part of our strategic plan for this community center,” said Shannon Murphy, director of sales and marketing for Diamond Ventures. Dr. Jim Hassen is medical director of the emergency department at Northwest Medical Center. He said, “Our team of emergency physicians is looking forward to being part of this exciting new venture. This facility will be a first in Tucson. We look forward to offering high-quality emergency care at a location convenient for residents in the southeast area of the metro region.”
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continued from page 136 Oro Valley Hospital, at 1551 E. Tangerine Road, celebrated its 10th anniversaid Kevin Stockton, CEO of Northwest sary on Jan. 12. It has a growing campus Medical Center. of its own, including an adjacent medical “Both Northwest Medical Center and building with offices for 65 physicians. Oro Valley Hospital have patients that The 146-bed hospital continues to grow come from areas as far south as Sierra in services and recognition – including Vista,” said Jae L. Dale, CEO of Oro an 18-bed Level IV trauma certificaValley Hospital. They also come from tion and pediatric-prepared emergency Pinal County. department, a 17-bed senior behavioral “It’s becoming more of a destination, health unit, a certified total joint proa real magnet. They’ll bypass a couple gram, sleep center and accreditations for of hospitals to come to us. We’re not chest pain and stroke. just serving the northwest community. Perhaps the single most telling statisWe have stronger and stronger connectic defining the scope of the Northwest tions to the outlying areas.” Dale said Healthcare network is this number – that’s particularly true for elective sur2,600. gery. “They may have “We have 2,600 ema neighbor that had a ployees in our health good experience.” For system,” Stockton said example, “we have one – and that’s only countof the strongest oring regular employees thopedic programs in at the two hospitals, town.” staff at other facilities Patients do have on those campuses and choices, particularly if that growing network they’re already making of urgent care centers. the trip to Tucson from What Stockton calls out of town, Stockton “the team” goes beyond added. “It’s word-ofthose 2,600 employees mouth marketing. Ofto include physicians ten they talk among who have privileges at their friends and they’ll the hospitals, voluntalk to the physician teers and emergency who goes to the hospiservice providers. tal where they want to Northwest Medical go. If they need some Center is the adminiskind of procedure, trative base hospital for – Kevin Stockton, CEO they’ll see what Oro several EMS and fire Valley or Northwest Northwest Medical Center agencies who provide Medical has done to elservice to the community. evate the services in certain specialties.” While Northwest Medical Center and In the ever more consumer-oriented Oro Valley Hospital are the key hospitals healthcare market, both Northwest in the healthcare system, the network exMedical Center and Oro Valley Hospital pands into – and even beyond – the surhave set out to attract patients by estabrounding community. Those six urgent lishing what are known as “centers of care centers span from the northwest excellence” in several specialties over the to the Catalina foothills, to the westside past eight years. on Silverbell Road near Speedway BouNorthwest Medical Center, formerly levard and to the Duval Mine Road in Northwest Hospital, is now 30 years old. Green Valley. The 300-bed facility has been steadily Maintaining quality in a network of adding national accreditations – for that size, both in terms of the number of bariatric surgery and joint replacement highly specialized professionals and mulas well as centers for heart failure, chest tiple physical locations, requires borrowpain, stroke, spine surgery and breast ing approaches used in other industries. imaging, including the first 3D mamStockton said, “We have initiated some mography in Tucson. The campus, at lean management principles, working 6200 N. La Cholla Blvd., also includes a with frontline staff to identify barriers to freestanding women’s center with labor and delivery, and a special-care nursery continued on page 140 >>> for babies born 28 weeks and above.
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We’re trying to get the care in the places people live and work – so that patients seek out care before they get into the emergency room.
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Northwest Medical Center
BizHEALTHCARE
Oro Valley Hospital
By the Numbers • Salaries, Wages and Benefits – $173.7 million • Taxes Paid – $19.3 million • Uncompensated Care – $54.9 million Northwest Healthcare also provides a variety of free services to the community including:
• Periodic cholesterol screenings • Periodic flu shot clinics • Periodic sports physicals • Pregnancy testing • Annual stroke screening • Monthly health education seminars Source: Northwest Healthcare, 2013
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continued from page 138 them doing their jobs.” The goal “is to provide the best and quickest care to the patients. It’s multidisciplinary, not just in nursing but pharmacy, transportation, and other clinical areas that impact our patients.” Maintaining quality while attaining efficiency to control costs requires extending systems outside the hospitals, according to Stockton and Dale. “The trend in healthcare is that hospital systems are becoming more and more integrated with community-based systems,” Dale said. In their case, that means working with local EMS providers from Northwest Fire, Golder Ranch Fire District, Rural Metro and other local emergency services agencies. “It’s a real collaborative effort to go beyond the walls of the hospital.” He said as part of a national trend, some EMS providers actually partner with their local hospital and “go out to a discharged patient’s home and do a healthcare check. That provides continuity.” Oro Valley Hospital piloted such a program in Fall 2014. Some of this reaching outside the hospital takes novel forms. For instance, Northwest Healthcare runs what these administrators refer to as “black-and-blue clinics” during high school football season. That seasonal weekend readiness deals with injuries from Friday night high school football games – and to address an emerging national trend – concussion management. “And we’re expanding to the adult community,” Stockton said. Northwest Healthcare’s Sports Medicine program will care for adult athletes, too. He said there’s a new attitude about that group. “They’re not sick – they’re injured,” he said of weekend warriors, runners, triathletes and other adult athletes. The modern medical answer to an injured amateur and older athletes is no longer to just to tell them “to stop doing that.” Northwest’s Occupational Medicine services also may bring people from outside into the network. Occupational medicine services – treatment of on-the-job injuries, preemployment drug tests and physicals – are offered at three of its urgent care centers. Those services are offered at the Continental Reserve Urgent Care on Silverbell Road, Rancho Urgent Care in Rancho Vistoso and Northwest Urgent Care near Green Valley. As with other healthcare services, “we’re making occupational medicine much more accessible,” Dale said. “It’s part of the same urgent care centers we already have. It’s one-stop convenience.” And the growth spurt is far from over, most notably with the freestanding Vail emergency center, set to open in late 2015. “We will continue to expand. We own 57 acres up in Marana near Tangerine Road and Interstate 10. We’ll be looking to build on that and in other parts of Southern Arizona,” Dale said. Stockton added, “We’ll be opening a QuickMed walk-in clinic in the first quarter of 2015 on Valencia Road for the southwest markets. We’re looking at ways to provide more access to care. “We’re trying to get the care to the places people live and work – so that they seek out care before they get into the emergency rooms,” Stockton said. Biz www.BizTucson.com
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Northwest Urgent Care now includes six urgent care centers staffed with on-site physicians and registered nurses. Appointments are not necessary and patients are seen on a walk-in basis. The growing network spans the metro area from the northwest to the foothills to Green Valley. 1. Northwest Medical Center 6200 N. La Cholla Blvd.
5. Rancho Vistoso Urgent Care 13101 N. Oracle Road
9. Lazos de Familia 344 W. Ajo Way
1a. The Womenâ&#x20AC;&#x2122;s Center at Northwest 1920 W. Rudasill Road
6. La Paloma Urgent Care & Physician Offices 4001 E. Sunrise Drive
10. Healthy Beginnings 333 W. Fort Lowell Road, Suite 120
2. Northwest Urgent Care at Orange Grove 3870 W. River Road 3. Continental Reserve Urgent Care 8333 N. Silverbell Road 4. Oro Valley Hospital 1551 E. Tangerine Road Oro Valley www.BizTucson.com
7. Northwest Urgent Care at Duval Mine Road 1295 W. Duval Mine Road 8. Northwest Urgent Care at Speedway 1370 N. Silverbell Road
11. Northwest Emergency Center at Vail Houghton and Old Vail Roads opening in late 2015 12. QuickMed Walk-In Clinic 3000 W. Valencia Road future expansion 13. Marana â&#x20AC;&#x201C; 57 acres near Tangerine Road and Interstate 10 Winter 2015 > > > BizTucson 141 future expansion
Focus on Excellence at Every Level Rigorous National Certifications Set Standards
In today’s environment, navigating the healthcare system is hard work. Patients have a choice of where they receive care – but how do they choose? Northwest Medical Center and Oro Valley Hospital strive to make the choice simple by staying focused on delivering high-quality care every step of the way. Combined, the hospitals are home to 12 national accreditations, sometimes referred to as “Centers of Excellence.” A steadily increasing number of the hospitals’ specialty areas have been certified for meeting high national standards – and their ongoing performance is continually monitored to make sure that level of performance is maintained. The certifications, which are offered in many medical specialties, do not come easily, say Registered Nurses Kay Stubbs and Julie Hunt, the chief nursing officers at Northwest Medical Center and Oro Valley Hospital respectively. If these certifications could be compared to a standardized quality system in another line of work, it would probably be the rigorous ISO – International Organization for Standardization – certifications for engineering and precision manufacturing. They involve the kind of scrutiny and standardized qualification of systems by outside auditors that give staffers from the operating room to the executive offices headaches and sleepless nights. Delivering quality care is all about details, process, training, best practices and ongoing patient communication before, during and after the hospital stay. Stubbs and Hunt agree that national certifications and other evolving practices and standards at their hospitals “absolutely make a difference” to patients and the care they receive. One way the hospitals are focusing on the patient experience is through education. For instance, patients scheduled for a knee or hip replacement are encouraged to take 142 BizTucson
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a class at the hospital a week or more before coming in for the actual surgery. And patients love the classes. Patient education handbooks were piloted at Northwest Medical Center with bariatric surgery, and now extend to robotic, cardiac, and joint and spine surgeries. Each patient receives a handbook that prepares them in every possible way. Stroke and chest pain patients also receive educational handbooks to guide them through managing their conditions and recovery processes. Oro Valley Hospital provides patient education handbooks to their stroke, total joint and chest pain patients as well. “Patients like that because then they know what to expect before, during and after and they’re better prepared when they go home,” Stubbs said. And, it helps improve outcomes. “It’s empowering patients to maximize their recovery in collaboration with their medical team,” she added. The upgrading of specialized care at both hospitals is a continuing process. “Every area that has a center-of-excellence capability is something that we want to look at – because it does make sure your processes are evidence-based, current and exceptional,” Stubbs said. Oro Valley has upgraded its Emergency Department with a designation as a Level IV Trauma Center from the Arizona Department of Health Services. Hunt said the Oro Valley Hospital ER is also accredited for pediatrics through the Arizona Chapter of the American Academy of Pediatrics. This means the staff and physicians have received specialized training and are equipped to handle pediatric patients, which she said is relatively unique for a small hospital. Another crucial area that improves both the patient experience and outcomes is communication – and that has changed dramatically. continued on page 144 >>>
PHOTO: TOM SPITZ
By Dan Sorenson
www.BizTucson.com
BizHEALTHCARE
Julie Hunt
Chief Nursing Officer Oro Valley Hospital
Kay Stubbs
Chief Nursing Officer Northwest Medical Center
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BizHEALTHCARE continued from page 142 “It’s really evolved,” Stubbs said. “We encourage family members to participate. We have the patient’s care plan on a white board in the room. Both Northwest and Oro Valley hospitals have communication boards in every room – and that’s really to communicate with the family. Your wife can’t be with you the entire time you’re in the hospital, usually. She comes in and we have your care plan for the day on the board. So she knows what’s planned for you and who your nurse is. We know when the next pain medication is due. We know if you have been given any new medications. It’s all on the white board today, so your family is aware. And we know how to contact them.” “Even the handoff at shift change is at bedside – so the patient can listen to the report that the nurses are giving to each other,” Hunt said. “The outcomes are better for patients when they know what we’re going to do, what side effects of drugs to look out for,” Stubbs said. “If you’re part of the care team, if you know about possible complications, you’re going to speak up.” She said this communication is part of the commitment to providing quality care – an approach where “each patient is ensured to receive the same level of care – so there are certain steps along the way that have to be measured and met as the patient advances to being discharged. It’s a really strong program.” And there is follow-up after discharge, Hunt said. There is “discharge planning to make sure that patients get to the right setting, either at home with outpatient therapy if that’s appropriate, or to a rehab center if they meet criteria, or to some sort of assisted support if necessary.” Hunt said, “We do discharge phone calls on all of our inpatients – so someone in the hospital contacts them after they go home to make sure they understood their discharge instructions. At either facility, two to four days after discharge, they get a phone call to see if they have any questions about discharge instructions. That’s how we try to ensure their recovery continues after they leave the hospital.”
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National Accreditations Northwest Medical Center
• Bariatric Surgery Accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.
• Breast Imaging Center of Excellence by the American College of Radiology.
• Chest Pain Center Accreditation recognized by the Society of Cardiovas-
cular Patient Care. The protocol-driven approach to heart care allows the medical team to reduce time to treatment during the critical first stages of a heart attack.
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Heart Failure Accreditation by the Society of Cardiovascular Patient Care. The hospital’s protocol-driven and systematic approach to patient management allows physicians to reduce time to treatment, and to risk-stratify patients to decrease their length of stay. One of Northwest’s unique answers to meet the needs of these patients is through its Heart Failure Clinic, which helps patients manage their condition, improve quality of life and slow the progression of the disease.
• Primary Stroke Center Gold Seal Designation by The Joint Commission
as a Primary Stroke Center. Accredited stroke centers have demonstrated expertise in the early assessment, rapid diagnosis and treatment of stroke emergencies. The “brain attack” team collaborates with local emergency medical services to provide patients with quick access to advanced diagnostic and treatment technology.
• Spine Surgery Gold Seal Disease-Specific Care certification by The Joint Commission.
• Total Knee and Total Hip Replacement Gold Seal Disease-Specific Care certification by The Joint Commission.
Oro Valley Hospital
• Southern Arizona Emergency Medical Services, Level IV Trauma Center • Chest Pain Center Accreditation recognized by the Society of Cardiovas-
cular Patient Care. The protocol-driven approach to heart care allows the medical team to reduce time to treatment during the critical first stages of a heart attack.
• Primary Stroke Center Gold Seal Designation by The Joint Commission as
a Primary Stroke Center. The “brain attack” team collaborates with local emergency medical services to provide patients with quick access to advanced diagnostic and treatment technology.
• Top
Performer on Key Quality Measures (Heart Attack, Heart Failure, Pneumonia and Surgical Care), 2011 and 2013,The Joint Commission
• Niche Certified ER means the hospital is more “user-friendly” for senior
patients. The mattresses are thicker, oversized amplified pillow speakers make it easier to hear the TV, larger clocks make it easier to see what time it is.
• Total Knee and Total Hip Replacement Gold Seal Disease-Specific Care certification by The Joint Commission
• Pediatric-Prepared Emergency Care by the Arizona Chapter of the American Academy of Pediatrics
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Dr. Robert Poston
Cardiothoracic Surgery
Dr. Megan Nelson General Surgery
Dr. Sanjay Ramakumar
PHOTO: TOM SPITZ
Urology
NMC Leads in RoboticBy Mary Minor Davis
When it comes to surgery, bigger is not always better. In fact, large incisions and long hospital stays are just two of the downsides of traditional, open surgeries – and most patients would agree they would prefer neither. Today patients have new options. Innovation has evolved and many surgeons have adopted the philosophy “less is more” by utilizing robotic-assisted surgery techniques – with potential patient benefits such as less blood loss, less pain and less time in the hospital. These benefits are apparent to many of the surgeons at Northwest Medical Center. They are committed to robotic technology and it shows. The hospital has attracted some pretty heavy hitters to its surgical ranks, allowing it to offer a comprehensive robotic-assisted surgery program. With two dedicated robotic operating rooms, NMC has 23 surgeons on staff performing robotic-assisted surgery for general surgery – including gall bladder 146 BizTucson
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and colorectal procedures, as well as gynecologic oncology, gynecology and, most recently, cardiac. NMC is also the first hospital in Tucson – and the second in the state – to upgrade its robotic surgery platform to an ergonomic system that allows for multi-quadrant surgeries where the instruments must be able to reach from the pelvis to the chest. The result is less time under anesthesia for patients compared to the previous robotic surgery platform. The newer system also provides greater magnification of the surgical area and better access to some of the hardest areas to reach in the body. Robotic-assisted surgery utilizes computerized technology that is operated by surgeons. It is the next evolution in minimally invasive surgery, said Dr. Sanjay Ramakumar, a urologist and independent member of the medical staff at NMC. This advancement allows surgeons to make smaller incisions and precisely
access areas within the body that previously have been difficult to reach or would cause greater trauma to internal organs during surgery. For the patient, using robotics tools typically reduces pain, the risk of bleeding and other complications, and time spent in the hospital. “This results in better patient outcomes,” he said. Ramakumar brought robotic-assisted surgeries to Tucson in 2005 when he performed the first procedure. “To date I have performed more than 630 prostatectomies,” Ramakumar said. “Well-done surgery gives you good results” no matter what tools you use, he said. “When you have a good surgeon who is adept at using the technology of the robotic-assisted instruments, you have the best of both worlds,” he said. “The more technically complicated the surgery, the better the robotic-assisted surgery option is for the procedure.” Dr. Robert Poston specializes in the use of robotics technology for cardiowww.BizTucson.com
BizHEALTHCARE
-Assisted Surgery Two Dedicated Operating Rooms vascular surgery. “Since 2006, I’ve performed more than 800 cardiac procedures using robotics,” Poston said. “I’ve seen patients recover as much as two times more quickly than those who choose the more traditional procedure where the sternum is cracked open,” Poston said. Dr. Megan Nelson was in the final two years of her residency in Michigan when she was introduced to roboticassisted surgery. Although she knew the robot was a mainstream option for urological and gynecological procedures, she had never considered the robot for general surgery. At NMC, she was mentored by Ramakumar and now uses the tool for certain types of gallbladder removal, colorectal surgery and for inguinal, abdominal or hiatal hernias. “I was excited by how much more I could see with the robot,” she said. “That was an a-ha moment for me. It’s such beautiful technology that you are able to do exactly what you want to www.BizTucson.com
do without compromising any of your techniques.” Poston said he’s seeing more patients who want to know about the robotics
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The more technically complicated the surgery, the better the robotic-assisted surgery option is for the procedure.
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– Dr. Sanjay Ramakumar, Urologist
option – because they are more educated about the types of procedures that can be done, and they know they may recover more quickly and with less risk.
“We’ve gone away from the Marcus Welby days where patients will just listen to their doctor and do what is recommended,” Poston said. “Patients know what they want – and they want the least amount of trauma and less time in recovery. They want to get back to doing the activities they love. Smaller incisions are what they want.” Brenda Franks, a retired school bus driver, lived with gallbladder issues for nearly five years before making the surgery decision. Franks said the robotic-assisted procedure was one option presented to her, but she wanted to research it to find out more. After briefly looking into the procedure online, she met with Nelson who was so “kind, compassionate and caring,” she said. “Dr. Nelson took the time to educate me on the procedure and the expected outcome, using language I could understand,” Franks said. continued on page 148 >>> Winter 2015 > > > BizTucson 147
BizHEALTHCARE continued from page 147 After hearing the difference between the traditional open procedure and the more simplified robotic-assisted approach, she chose to go with the less invasive procedure. “She went through the belly button – an incision of a half-inch or so,” Franks said. “I found it remarkable. I don’t have any complaints.” Franks spent one night in the hospital and she said her recovery was “cut and dried.” “I would encourage anybody to use this procedure,” she said. “If the surgeon has the skill and you live in an area that has the technology, why wouldn’t you take advantage of that?” Nelson said that while the learning curve to operate the robot can be “challenging,” once surgeons are comfortable with the equipment, the surgery time is comparable to many traditional and laparoscopic procedures. Ramakumar agrees. “Once you have the experience with the machine, operating times are the same. “Balance comes from speed and precision,” he said. Ramakumar said 90 percent of his patients go home the next day, com-
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pared to traditional open-surgery procedures where patients are hospitalized for two or three days or longer. “Onethird of the hospital time is reduced – those are huge numbers,” he said. Some in the medical profession criticize the cost of robotic-assisted surgery. “What is often not included in those cost reports is time and money saved in extended hospital stays,” Ramakumar said. “Longer return-to-work time, the cost of complications that come from higher risks of blood loss, longer healing time for open surgeries – none of these considerations are included in most cost analyses.” NMC has two of the nine robotics systems in use in Pima County. Ramakumar said it’s not enough to just offer robotic-assisted procedures. Hospitals must have a program in place that incorporates three important elements – hospital commitment, surgeon commitment and a dedicated operating-room team that is familiar with the robotics system and can support the surgeon. NMC has all of these elements – and that is attractive to surgeons such as Poston and Nelson.
“I was very impressed with how the OR team has embraced robotics,” Poston said. “NMC is being innovative and that is seen in the depth and the breadth of the program. I’ve been at some of the top hospitals in the country and I can tell you the team here is the best I’ve ever had.” Poston said hospitals that look at making critical quality improvements and that are bringing innovative techniques forward are “what make good hospitals these days. It’s a good transition into the future of healthcare. NMC has an infrastructure for innovation.” Currently, there are 2,153 robotic systems throughout the United States. There were 422,000 robotic-assisted procedures performed in the country in 2013 – up 15 percent from 2012. “For this generation of surgeons, robotics is going to be the new technology that becomes the norm – just as generations before have transitioned from traditional procedures to the more minimally invasive procedures such as laparoscopy,” Nelson said.
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Advanced Care for Moms and Babies By Mary Minor Davis Northwest Medical Center’s Women’s Center has developed a long-standing reputation of offering a comforting environment for moms, dads and their newborns. Yet in the last year, the center has gone even further – completing voluntary certification from the Arizona Perinatal Trust. This certifies the special care nursery as a Level IIE, which means the center can offer perinatal care for mothers and babies born as early as 28 weeks. What’s more, the hospital invested in a number of technological advances and expanded its special care nursery for premature infants. In addition to more space, The Women’s Center added five continuing-care beds, with 15 dedicated to premature newborns needing medical attention, two well-baby beds for stabilization of newborns, and one isolation bed for babies with infectious illness upon delivery. Stateof-the-art monitoring equipment and portable nursing stations round out the technology upgrades. Overhead cyclic lighting may help develop a premature infant’s circadian rhythm, sleep schedule and neurologic function. Lights change color depending on time of day from shades of amber at sunrise to blues and purples at dusk. The lights were the first of their kind in Southern Arizona, according to hospital officials. “We provide an environment of neurodevelopmentally appropriate, family-centered care,” said Dr. Alan Bedrick, neonatologist and medical director of the special care nursery at The Women’s Center. He is also a professor of pediatrics and chief of the division of neonatology and developmental biology in the pediatrics department at University of Arizona Medical Center. “We’ve learned that babies do very, very well in a less chaotic environment. No more machines that beep and send off sig-
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nals or that ring out in the night,” he said. “We cluster care – trying to get labs, monitor blood pressure, etc. when the baby is already awake. The adjusted lighting helps keep babies relaxed, and we even adjust to day/night lighting as the baby gets closer to going home,” Bedrick said. In this kind of environment, studies have shown that babies are taken off respirators and other machines earlier, go home earlier and “just have better outcomes,” Bedrick said. The freestanding women’s center on the hospital campus also has a new addition to help mothers through issues that can arise before delivery. Dr. Christopher Sullivan is the medical director of The Women’s Center as well as a maternal fetal medicine physician. Sullivan serves as a case consultant for mothers in distress or facing high risks with pregnancy. He said that high-risk pregnancies are on the rise because some women are waiting longer to have babies. This can lead to hypertension, type 1 and gestational diabetes and genetic issues. Older moms have a higher risk of delivering children with Down syndrome or other genetic issues. Another challenge is obesity. “There are a lot of moms coming into pregnancy with weight issues. This creates its own set of complications for mother and baby.” Sullivan has been on staff at The Women’s Center for two years. He said that NMC has “always been perceived as being a nice birthing center – but with the changes the hospital has implemented, they now offer families so much more. I’d like to say that if you have any type of obstetric complication, with the exception of a few rarities, we can take care of you.” Bedrick agreed. “We are one big multidisciplinary team that offers seamless care before, during and after delivery.”
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Breast Health Saving Lives with Early Detection
Breast cancer is a diagnosis no woman wants. Knowing this, Northwest Women’s Imaging recently invested in the latest technology for breast cancer screening – tomosynthesis – otherwise known as 3D mammography. “Early detection of cancer can dramatically improve a woman’s chance at surviving breast cancer – and 3D mammography improves the rate of early detection. We believe this can potentially save lives,” said Dr. Gary Wood, radiologist and medical director of NWI. The new technology produces a three-dimensional view of the breast providing greater visibility for the radiologist to see tissue detail in a way not possible before. 3D mammograms offer exceptionally sharp breast images reducing the need to call women back for a “second look” by up to 15 percent, according to recent studies. 3D mammography also finds cancers earlier than traditional 2D mammography alone – with a 27 percent increase in cancer detection and 41 percent increase in invasive cancer detection. The radiation dosage of NWI’s 3D equipment is about the same as 2D mammography. Wood said breast tomosynthesis can benefit all screening and diagnostic mammography patients. The 3D technology is especially valuable for women receiving a baseline screening, those who have dense breast tissue and/or women with a personal history of breast cancer.
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Patient Engagement Improves Joint & Spine Outcomes By Mary Minor Davis Knees, hips and backs. For many people if their back isn’t bothering them, their knee or hip joint is. Physical pain is often accompanied by the hesitation and anxiety related to having surgery, the recovery process and more. Northwest Medical Center and Oro Valley Hospital strive to alleviate these fears through one basic principle – patient education. From the moment the patient decides to move forward with surgery at either hospital, the educational process begins. “It’s no secret that patients who are actively involved in their care have better outcomes. So we took this principle and applied it one step further. We came together as a team – surgeons, nurses and staff – to develop comprehensive patient protocols that would measure outcomes for our joint and spine patients,” said Mary Sotelo, a registered nurse and the total joint and spine coordinator at Northwest Medical Center. All joint or spine patients receive comprehensive education to prepare them for surgery and, more importantly, recovery. This includes attending a class that outlines what to expect before, during and after surgery. Each patient receives a handbook and is encouraged to use it as a journal and reference guide through the process. Additionally, every patient undergoes a thorough pre-procedural screening appointment, which ensures they are medically ready for surgery. “Being able to connect with patients one-on-one before their surgery is huge,” Sotelo said “Patients walking 152 BizTucson
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out of class are astonished.” Registered nurse and medical/surgical manager Jennifer Miller is one of
Partial Knee Resurfacing When Oro Valley Hospital announced the introduction of the robotic-assisted partial knee resurfacing system in the fall of 2012, there were two surgeons trained in its use and only a dozen or so procedures had been performed. Just two years later, five surgeons are now using the surgeon-controlled technology, and more than 100 patients have undergone the partial knee resurfacing procedure. Partial knee replacement surgery is an option in lieu of a full knee replacement if conditions are caught early. Surgeons go into a single compartment of the knee and remove early stages of osteoarthritis before it damages the entire knee. The minimally invasive procedure with the robot allows for the greatest precision to save as much of the natural knee as possible. Orthopedic surgeon and Oro Valley Hospital’s Section of Orthopedics chair, Dr. Kevin Bowers was one of the first to use the technology. “The robot provides an element of control and an increased level of accuracy estimated at two to three times that of the traditional procedure. Getting the precise alignment can be the key to the longevity of the procedure. The robot’s biggest advantage is this level of accuracy.” Biz
three responsible for Oro Valley Hospital’s Total Joint Program. She said, “From the patient’s perspective, they understand not only the surgical aspect of what’s going to happen, but learn the importance of exercise and breathing, for example, which helps them recover more quickly. Our goal is to empower them to be an active partner in their care, helping them to get home faster.” This focus on patient engagement sends a powerful message to patients, challenging them to take responsibility for their health. Data – including length of stay, infection rate and discharge rate – is tracked by the hospitals and indicates how they perform against national standards. The results are astounding. Total knee and hip replacement patients at NMC and OVH stay an average of two days in the hospital – compared to the national average of three days. NMC has an 81 percent discharge rate of two days for total knee patients, compared to the national average of 25 percent. For total hip replacement patients, it’s even higher – 98 percent – compared to the national average of 22 percent. These are 2012 statistics, the most recent available. Sotelo and team attribute these impressive statistics to patient empowerment. “Patients want to get better and get back to their active lifestyle. We give them the tools to get them there,” Sotelo said. When it comes to spine and neck surgery, the buzz word is minimally invasive surgery – or MIS. “MIS is a muscle-sparing procedure. continued on page 154 >>> www.BizTucson.com
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BizHEALTHCARE continued from page 152 That means surgeons don’t cut into the muscle but rather separate the muscle vertically to access the spine,” said Mandy Gessler, a registered nurse with NMC, who serves as the center’s spine navigator. Longer incisions that cut through the muscle used to be the norm in traditional spine surgery. The MIS approach uses smaller incisions to help reduce damage to surrounding tissue, lower risk of infection, reduce bleeding and pain and help patients heal faster. Spine surgery patients follow the same protocol as joint patients – class, handbooks and pre-procedural screening. Patients are also encouraged to call Sotelo with questions before or after
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surgery, and she provides her email and direct phone number in the handbooks and during class. Teamwork is also attributed to the program’s success. That team includes Sotelo, along with the surgeons, dedicated operating room teams, physical and occupational therapists, hospitalists and the patient’s primary care physician. Sotelo said Northwest’s spine team is “collaboration at its best for the benefit of the patient.” The team, including surgeons, meets monthly to review outcomes and best practices. The goal is to continually evolve the program to give patients the best possible experience. “It’s about giving our patients a one-
of-a-kind experience that gives them their lives back. We decide as a team on how to treat each case. We bring that experience of care so that patients can maximize their recovery,” Sotelo said. As of December 2014 Northwest Medical Center is the only hospital in Arizona that has national certification for hip, knee and spine surgeries from The Joint Commission. It is also a designated Blue Distinction Center for hip, knee and spine surgery. Oro Valley Hospital received national certification from The Joint Commission for its total knee and total hip replacement programs in 2013. Oro Valley Hospital does not offer spine surgery.
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Patients want to get better and get back to their active lifestyle. We give them the tools to get them there.
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– Mary Sotelo Total Joint and Spine Coordinator Northwest Medical Center
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Intensive Wound Care Saves Lives
First in Tucson to Offer Laparoscopic Weight-Loss Surgery
By Mary Minor Davis For most people who are injured or recovering from surgery, wounds heal without incident. Yet for 2 percent of the nation’s population, non-healing wounds can be life-threatening.
By Mary Minor Davis Obesity affects between 28 to 32 percent of the population, according to recent data published by the United States Centers for Disease Control and Prevention. If the trend continues, 46 percent of Americans will be obese by 2018. Annual healthcare costs for the obese average $1,429 more per patient than people of normal body weight, according to the CDC. Dr. Patrick Chiasson and Dr. Stephen Burpee are working to address this epidemic as independent members of the medical staff practicing bariatric surgery at Northwest Medical Center. Across the country over the past 10 years, bariatric surgery has surged. While the initial goal was to reduce obesity, Burpee said weight-loss surgery also alleviates many of the subsequent underlying diseases that occur as a result of obesity – especially diabetes. It may also reduce the risk of stroke, coronary disease, cardiovascular disease, even death. NMC was the first to bring laparoscopic weight-loss surgery to Tucson. The surgeons said, “We have performed more than 2,000 surgeries since 2003.” In 2009, NMC was the first program in Tucson to be certified by a national program that sets industry standards for surgical weight loss. Today NMC’s surgical weight loss program is accredited by the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program. Burpee credits the NMC bariatric program with having a strong team approach – beginning with patient education, including classes, to walk patients through their options, all the way through post-operative care. Bariatric surgery has evolved dramatically since the 1960s, Burpee said. 156 BizTucson
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Surgeons removed part of the stomach to treat ulcers, which were a severe condition before medication was developed to alleviate their severity. It was soon learned that patients lost weight as a result of the procedure. Since then, the introduction of minimally invasive laparoscopic procedures “changed the paradigm of bariatrics completely” because it typically led to safer surgeries and faster recovery with reduced risk of complications, Burpee said. Only 1 percent of the people who qualify for bariatric surgery actually end up getting it, he said. There simply are not enough resources in the industry to accommodate the need. “The biggest detractor is the cost. It’s a great treatment on an individual basis. It’s not practical on a population basis. Doing surgery on all of the people who need it is not economically viable.” Burpee said about 70 percent of patients keep off the weight and see reduced health risks. Lifestyle changes, behavior, diet and exercise all play into long-term success. Yet studies also show that it’s not just about “calories in/calories out” anymore. “We used to think weight loss occurred because the stomach was made smaller – but now we are learning that there are a lot of other chemical systems in place that support weight loss. The surgery affects hormonal systems that control body weight and metabolism. Much of our metabolism is out of our control no matter how much exercise or calorie restrictions we put in place.” Burpee encourages people to learn whether weight loss surgery is right for them. The center offers free seminars that outline the various procedures and potential outcomes. “The better educated people are, the better the results.”
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In fact, chronic wound care has become a significant healthcare cost – with an estimated $50 billion spent on treatment, according to a study published in 2012. By 2009, Northwest Medical Center had already recognized this growing challenge in patient care and opened the Wound Care Center, setting quality benchmarks comparable to some 600 successful wound centers in the United States. The center specializes in the treatment of a variety of wounds – including diabetic, arterial and pressure ulcers; chronic venous stasis disease (which can lead to blood clots); soft tissue infection; osteomyelitis (bone infection); skin tears or lacerations; radiation burns from cancer treatment; and non-healing surgical or other traumatic wounds. Nationally, the average healing time is about 15 weeks with a 66 percent success rate where the wound is entirely healed. The Wound Care Center at Northwest beats that consistently – with 90 percent of patients becoming wound free within 45-50 days. Dr. Scott M. Bolhack is medical director of the center. He said proper wound care is essential to prevent amputation and save lives. Diabetic patients are at especially high risk of amputation. “The statistics around even having a single toe removed are really horrifying,” Bolhack said. National studies show that any type of amputation can significantly shorten the patient’s lifespan. Vikki Hensley, a registered nurse and certified wound care specialist, is clinical director of the Wound Care Center. She said the team’s mission is to “determine what’s causing the wounds, then apply the best treatment protocols to enhance the healing.”
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Getting Back in the Game Sports, exercise, fitness – once you’re hooked, there’s no stopping you. Unless, of course, you get hurt. Whether a minor injury or something more serious, it’s important to ensure your injury heals properly so you can get back to the activity you love. That’s why Northwest Healthcare recently launched a Sports Medicine program caring for athletes and physically active people of all ages. The program brings together a multidisciplinary team – including orthopedics, orthopedic surgery, neuromusculoskeletal medicine, osteopathic manipulative medicine, sports medicine, physical therapy and family medicine. By incorporating a broad range of specialties, this program individualizes treatments for the patient, helping patients recover from sports-related injuries as quickly and safely as possible. Though many athletes may see their primary care physician when an injury occurs, a physician trained in sports medicine has additional nonsurgical training in fracture management, concussion management, sprains and strains, joint injections and other sports-related treatments. The sports medicine team has partnered with local high schools to help them better manage athletes with concussions. During football preseason, student athletes receive a baseline test using a specialized computer program, which provides physicians with reference points should a concussion be suspected throughout the season. Dr. Troy Taduran, a sports medicine physician with Northwest’s Sports Medicine program, said concussion management is extremely important because of the potentially devastating consequences. If not managed correct158 BizTucson
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The Challenges of Aging
ly, concussion can lead to major problems – including Chronic Traumatic Encephalopathy, a permanent and degenerative condition occurring from multiple impacts to the head, and Second Impact Syndrome, which is brain swelling that occurs from impact to the head of someone who has not fully recovered from concussion. “It is vital athletes receive appropriate and expedited concussion management. Sometimes symptoms of concussion are obvious, while other times they are less apparent. The sooner we can diagnose and begin treatment, the sooner they can recover and get back in the game,” said Taduran. Taduran, along with Dr. William Prickett, orthopedic surgeon and medical director of the program, and Dr. Christopher Houdek, orthopedic surgeon, attended high school football games to provide instant attention and treatment should an athlete need it for concussion or other sports-related injury. Beacause Tucson is a mecca for runners, triathletes, cyclists, tennis players, golfers and a host of other sports, the program is expanding in 2015 to serve athletes and sports enthusiasts of all ages. Taduran said his goal is to treat active adults and return them to their desired activity as safely and quickly as possible. “We promote active lifestyles and do everything we can to facilitate that,” he added. Northwest is set to open its new Sports Medicine clinic in the second quarter of 2015, which will include onsite imaging services, physical therapy, performance testing and nutritional services for sports medicine patients.
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The aging process presents challenges that can be overwhelming. Sometimes these challenges cause symptoms that affect an individual’s ability to carry out basic life activities and roles. When this happens, many don’t know how to cope. The 17-bed Senior Behavioral Health Unit at Oro Valley Hospital offers a specialized program for patients ages 55 and older to deal with and manage these symptoms. It is a voluntary program for those who decide they need help. Whether it’s coping with stress, grief or addictive behaviors, the behavioral health team, led by Medical Director and Psychiatrist Dr. Vicki Berkus, works with patients to help empower them to be healthy and maintain balance as they age – and return them to their life and family. Mental health resources for the elderly are few and far between in Pima County. This specialized program for seniors is an important resource for the community. “The elderly are more susceptible to every aspect of mental illness. They don’t have the defense systems, whether physiological or medical, to handle the effects of a mental illness that younger people have,” Berkus said. Berkus challenges the referring person – whether a parent, spouse or doctor – to ask “what about this person has changed that requires an acute care setting?” It can be a change in cognition, behavior, memory or even eating habits, she said, with no other discernable medical reason. Patients are admitted to the unit by a doctor or through the emergency room. The average length of stay is two weeks with follow-up outpatient therapy once the patient has left the hospital. The goal is to provide the tools to help them cope with the challenges of aging.
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Improving Occupational Health Outcomes By Mary Minor Davis
Treating Sleep Disorders
Managing occupational health issues is a complex business. That’s why more companies are seeking third-party sources to help manage regulatory compliance and costs.
By Mary Minor Davis There is nothing more rewarding than a good night’s sleep – waking with a clear mind and an energetic body to start the day. Unfortunately, nearly 40 million Americans suffer from some sort of sleep disorder that robs them of that well-rested feeling. The Sleep Center at Oro Valley Hospital helps patients overcome the obstacles to achieving a good night’s rest. Dr. Elias Kakish said that finding solutions to sleep deprivation isn’t just about feeling rested – it’s also about preventing other health risks that arise from loss of sleep. Sleep disorders can affect anyone, though they are more often seen in people with increasing obesity or who are aging. Once referred to the sleep center, Kakish said, patients are scheduled for a sleep study designed to assess abnormalities in their sleep patterns – ranging from brainwave activity to loss of oxygen, irregular cardiac rhythms and even seizures. The most common sleep disorder is obstructive sleep apnea. This condition results when the flow of air pauses or decreases during breathing while asleep because the airway is floppy, has been narrowed or blocked. A pause in breathing is called an apnea episode. A decrease in airflow during breathing is 160 BizTucson
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called a hypopnea episode. An episode occurs if breathing is affected for at least 10 seconds. If a patient has more than five episodes per hour, they are diagnosed with sleep apnea. Five to 15 episodes is considered mild and more than 30 is considered severe. “Even mild sleep apnea is significant enough to require treatment,” Kakish said. Sleep apnea has been linked to increased risk of stroke, heart attack, high blood pressure, coronary artery disease, depression and memory loss. The center also studies insomnia, narcolepsy and restless leg syndrome. More than half of those who suffer from a sleep disorder go undiagnosed, Kakish said. That’s why the hospital works to educate the public about the importance of treating sleep issues and what to look for to determine if you should have a study done. “Among the symptoms that can indicate a sleep disorder are snoring, excessive daytime sleepiness, loss of energy, irritability, mood or behavior changes, morning headaches, inability to concentrate and workplace mishaps or accidents,” he said. “It’s important to discuss these issues with your physician. Sleep deprivation can be a life-threatening condition. You should take care of your sleep.”
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The demand for this expertise led Northwest Healthcare to launch its Occupational Medicine program just over a year ago. Led by Troy Overholt, a registered nurse, this program focuses on injury management for on-the-job injuries. It also provides routine drug screening, lab testing, blood pressure checks and health fairs. “The key is that employers want to partner with skilled personnel in the area of occupational medicine because workers compensation premiums can come with a pretty significant cost, depending on the employer’s history,” Overholt said. “Employers have a financial interest in keeping employees healthy.” Private-sector employers spend an average of $30.11 per hour worked on employee compensation. Just over 8 percent of that is for legally required benefits, such as workers compensation, according to the U.S. Department of Labor Bureau of Labor Statistics. The No. 1 work injury complaint is back pain. Overholt said his team can work with Northwest’s joint and spine programs to help identify the cause and treat or eliminate the problem. “One injury can cost an employer thousands of dollars,” Overholt said. “We can help bring closure to some of these recurring injuries, resulting in better outcomes for all.”
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