Black Hills Doctor's Miraculous Journey from War-Torn Liberia Breaking Down Communication Barriers in the Office
Regional Health’s Dr Daniel Petereit. THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS
Parkston Makes a Bold Move for Workforce Housing
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MEDICINE I S A SCIENCE of UNCERTAINTY A N D AN ART of PROBABILITY.
” —William Osler
From Us to You
Staying in Touch with MED
ELCOME to another edition
of Midwest Medical Edition (MED) Magazine, the premier business publication for healthcare professionals in the South Dakota region. Whether you are new to our publication or a long-time reader, we are glad you are here and we invite you to submit article ideas, news, and feedback to us any time at info MidwestMedicalEdition.com. In this issue, we are proud to feature a wellknown name in cancer care in South Dakota. Regional Health radiation oncologist Dr. Dan Petereit’s work, particularly in health disparities, has led to a greater understanding of how to provide quality care that is more equitable, accessible, and effective throughout the region. If you have ever had difficulty communicating with a patient, you will want to read Mallory Earley’s article on communication barriers in healthcare. We also have photos from the American Heart Association’s big Go Red event in Sioux Falls, an interview with retiring Avera Health president Jon Porter, a look at the challenge of workforce housing in rural communities, and an exploration of the issue of women in clinical trials. As always, we have wrapped up all the news for you in News & Notes and compiled a list of current events in Learning Opportunities. Let us know if we missed anything! Our staff works hard to make MED the most relevant, helpful, interesting and regionallyfocused piece of mail in your mailbox. Let us know how we’re doing! Reach us any time at Info@MidwestMedicalEdition.com and check MidwestMedicalEdition.com often for news updates between issues. All the best! —Steff and Alex
PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota VICE PRESIDENT SALES & MARKETING Steffanie Steffanie Liston-Holtrop
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VO LU M E 9, N O. 2 ■ M A R C H 201 8
IN THIS ISSUE 10 | Go Red Event Unites Local Women in Fight Against Heart DIsease
20 | Prairie Lakes Brings Cutting Edge BPH Procedure to Watertown Urologist Chris Adducci, MD, says the newest system offers several advantages over other minimally invasive approaches.
22 | Expanding Cancer Care in Pierre Avera St. Mary's isn't waiting for the opening of the new cancer center to bring advanced new treatments to central South Dakota.
23 | Women and Clinical Trials Sanford researcher says it not just about equity—it's about the science.
LOOK FOR THIS SYMBOL throughout the magazine to indicate additional content on our website: Links are included for digital readers. Print readers can search the article title to find the indicated links.
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Prairie Lakes Healthcare System South Dakota Association of Healthcare Organizations (SDAHO) Dakota Lions Sight and Health
26 | Specialized, Complex Surgical Techniques Added to Heart Program at Omaha Children's
28 | Jon Porter on Avera, Retirement, and Soccer Avera Health's longtime President and CEO talks about the remarkable events during his tenure and his plans for the future.
29 | Workplace Violence in Healthcare More than 70 percent of all workplace violence happens in healthcare. Here's what can be done. ■ By Lori Berdahl
30 | What is the Most Critical Issue for Healthcare Providers in 2018?
REGULAR FEATURES 4 FROM US TO YOU 12 NEWS & NOTES 31 LEARNING OPPORTUNITIES
ON THE COVER
■ By Alex Strauss
During his distinguished career, radiation oncologist Dr. Daniel Petereit has helped bring advanced treatments to Black Hills patients, including some of the region's most underserved people.
6 | Barriers to Effective
Communication Quality care depends on quality communication. ■ By Brandy Boone
8 | Profile:
Meet Martin Digler, PA he Regional Health PA T escaped violence and poverty in Liberia to set up a new life in the Black Hills
24 | Workforce Housing is
“Mission Critical” for Rural Facility Parkston's hospital makes a bold move to attract new employees.
Barriers to Effective Communication BY MALLORY EARLEY
O ENSURE AN EFFECTIVE physician
LIMITED ENGLISH PROFICIENCY (LEP) PATIENTS
-patient relationship and provide quality
Another breakdown in communication can occur with
care, you must be able to communicate
LEP patients. Title VI of the Civil Rights Act prohibits
with your patients.
discrimination on the basis of race, color, or national
Federal law requires physicians to make reasonable
origin. Because of this Act, physicians are required to
accommodations for hard of hearing and Limited English
ensure that non-English speaking patients have equal
Proficiency (LEP) patients. If proper accommodations are
access to healthcare.2 You and your office staff need to
not afforded to these individuals, serious consequences,
take reasonable steps to make sure LEP patients have
including medical professional liability lawsuits, can
meaningful access to care.
Your options for communicating with LEP patients can include hiring bilingual staff if English is not the
HARD OF HEARING PATIENTS
dominant language in your area, using a telephone or
The Americans with Disabilities Act (ADA) strictly
video conferencing interpretation service, contracting
prohibits any discrimination against individuals who are
with companies to provide qualified interpreters who
hard of hearing in places of public accommodation.
will come to your office, or using a written translation
Under Title III of the Act, a physician’s office is defined as
a place of public accommodation.1 As such, it is required
Some patients ask their family or friends to translate
to make reasonable accommodations for hard of hearing
which can be helpful. However, it remains the physician’s
patients. Because the standard is reasonable accommo-
responsibility to ensure that the communication is
dation, there is not a bright-line rule which states what
accurate and effective. As with any patient, the doctor
each practice must do for each patient. Appropriate
must ensure accurate communication of any medical
accommodations will vary based on the circumstances
terminology. When using an interpreter, the physician
of each patient’s case and his or her needs.
should stress the importance of confidentiality and
Discuss communication preferences with hard of hearing patients in advance. Their options can include a
document in the medical record the type of interpretive services used. ❖
qualified interpreter on site, note taking, computer-aided transcription services, or devices such as telephone handset amplifiers and Telecommunications Devices for the Deaf (TDDs). If you have a large number of hard of hearing patients it may be effective to hire an interpreter.
Mallory Earley, JD, is a Senior Risk Resource Advisor at ProAssurance
Sources: 1. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990). 2. Civil Rights Act of 1964, Pub. L. 88-352, 78 Stat. 241 (1964). 3. Nielsen-Bohlman et al., Health Literacy: A Prescription to End Confusion, Institute of Medicine (Eds. National Academies Press 2004). 4. Ibid. 5. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC2912714/
❱ F ind how many Americans have ❱ L earn best practices for working limited ability to understand or act on health information
with minimally literate and non-compliant patients
Don’t lose sight of the value of local eye banks The gift of sight The restoration of an individual’s sight is one of the
in its most viable state for transplant. Dakota Lions
most meaningful, altruistic gifts a person can give.
Sight & Health also supplies tissue for important
Today over 68% of people living in North and South
research projects that the alternative model may
Dakota have registered as a donor and over 95%
not. And perhaps one of our most important services
of Americans support organ donation. They do this
is offering meaningful and ongoing support for the
care about their neighbors and
families of donors.
believe in the good their gift can do. What we lose if we lose local eye banks The importance of your local eye bank
The damage of turning cornea donations into big
For decades, all U.S.-based eye banks operated as local
non-proﬁt programs primarily focused
business will be wide reaching. Loss of the public’s
on serving a small geographic location. But recent
dramatically reduced tissue availability. The loss of
developments in the industry signal a departure from
tissue available to researchers may mean important
this model. Dakota Lions Sight & Health is concerned
medical discoveries are delayed or never happen.
about the devastating impact this could have on
donations and the ability of local eye banks to meet
eye banks and surgeons will be lost. Grieving and
the needs of their communities.
coping support for local donor families may be a need
belief that donations are a gift could result in
collaboration between local
that goes unfulﬁlled and may also lead to fewer Dakota Lions Sight & Health has been serving the
donors in the future.
Dakotas for over 25 years. Our focus is on our North and South Dakota communities and providing
We need your support
surgeons the tissue they need to help others. Dakota
Local, non-proﬁt eye banks are a vital link in providing
Lions Sight & Health is the only dedicated non-proﬁt
the best care to patients. Please let your local
actually located in the Dakotas. Because we recover,
hospitals know that you support Dakota Lions Sight &
prepare and deliver corneas locally, we provide tissue
Health and believe cornea donations should remain a
gift of sight.
[P R O F I L E]
Meet Martin Digler, PA
ARTIN DIGLER, a Physician Assistant at Regional Health Heart and Vascular Institute, is quick to call himself blessed. When he tells the harrowing story of his escape from the violence, disease, and poverty of
his West African homeland of Liberia to end up a family man, living freely and doing work he loves in the beautiful Black Hills, it is hard not to agree. In Liberia, where education beyond kindergarten is not free, where the average life expectancy is just 57, and where civil war
had been raging off and on since 1989, Digler managed to graduate from high school, even though it meant living in abusive foster homes and working without pay. He was helping at a hospital compound where he and his family had once sought refuge when he met Joel Swiesow, a Rapid City man who was there on a twoweek mission trip, in 1999. Swiesow and Digler struck up a friendship that eventually moved Swiesow to become Digler’s sponsor, arrange for his entry into the US, host him in his own home, and help him pursue a college education. “He sent me a letter at the end of that year and asked me to send my high school documents to him and he gave me some money to start college in Liberia,” recalls Digler. “At the end of the first semester, I got an email saying that I had been accepted at the School of Mines and Technology and needed to go to America to go to school.” “It was like a dream to me,” says Digler. “God just opened the doors for me.” But after a month of standing in line daily at the US embassy to get a visa, Digler had begun to lose hope of arriving in time to start school in September. An administrator at the hospital placed a satellite call to Digler’s US sponsor who contacted Senator Daschle’s office for help. A month later, Digler was living in the Swiesow’s basement in Rapid City while studying interdisciplinary science at the School of Mines. He had long had an interest in science and medicine,
Martin Digler (center) surrounded by colleagues on a visit to Phebe Hospital in Liberia.
Phebe Hospital where Digler met Swiesow in 1999
having spent time on the Phebe hospital campus and having lost several siblings to disease. Martin eventually transferred to SDSU where he majored in Biology and was later accepted into the Physician Assistant program at Long Island University in New York. After five years in the cardiology department of a Wisconsin hospital, he jumped at the chance to return to Rapid City with his wife and four small children in 2014. “I always loved the environment here and I like the outdoors,” says Digler. “Spending time in New York made me really appreciate living in the Midwest. Also, I wanted to come back here to be closer to family.” In addition to the
IT WAS LIKE A DREAM . . . GOD JUST OPENED THE DOORS FOR ME.
Sweisows, Digler also has a biological sister who lives in the area. Although he has come a long way, Martin has never forgotten his Liberian roots. He has been actively involved in starting, maintaining and raising money for a Liberian orphanage and school that helps children like himself get educated without the threat of abuse. Last Fall, he returned to Liberia to bring much needed medicines. “I am blessed to be working with great physicians and a great healthcare team,” he says “I gain so much knowledge from them and they are supportive of my dreams. They want to provide good healthcare for the people of Rapid City and also for the people of Liberia.” ❖
❱M eet some other international students who have chosen to practice in our region
MED's Steff Liston-Holtrop with survivor and presenter Lucy Henglefelt (center) and the Go Red Executive Leadership Team.
Unites Local Women in Fight Against Heart Disease More than 400 guests gathered at the Sioux Falls Convention Center on January 30th for the American Heart Association’s annual Go Red for Women Event. MED was proud to once again help sponsor and share the event this year and MED’s own Steffanie Liston-Holtrop was this year’s event chair, which featured a reception, silent auction, dinner and an evening program. Attendees heard from healthcare providers on ways to minimize their risk for cardiovascular diseases and stroke, were inspired by survivor stories, and had an opportunity contribute to the cause. The final numbers are still being tallied, but the goal for this year’s event was $150,000 which will be used to fund research and education around women and heart disease. According to the AHA, an estimated 80 percent of cardiac events may be prevented with education and lifestyle changes. A special thanks to Julie Prairie Photography for covering the event for MED. Event Chair Steffanie Liston-Holtrop
❱C heck out the website for all the (l to r) Dr. Kelly Steffen, Cynthia Stys, Dr. Tom Stys, Dr. Maria Stys, Steff Liston-Holtrop, Dr. Richard Clark, Dr. Orvar Jonsson
photos from the Go Red Event
Happenings around the region
News & Notes
South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska
Avera McKennan Hospital & University Health Center has opened a new Inpatient Rehabilitation Unit on the fifth floor of the Prairie Center, located on the main hospital campus in Sioux Falls. This project is part of $174 million in projects announced in April 2017 on the new Avera on Louise campus at 69th and Louise, as well as the main hospital campus. The unit is located in what was previously shell space in the Prairie Center, set aside for future use. The unit has 24 private, post-acute rooms which are located around the perimeter of the fifth floor, as well as increased space for rehab care.
AMY ELLIOTT Amy Elliott, MD and members of her research team have joined Avera Research Institute as the Center for Pediatrics and Community Research. Dr. Elliott has been a principal investigator on several National Institutes of Health (NIH) research projects including an initiative to reduce infant mortality in American Indian communities and the Safe Passage study examining environmental influences on child health outcomes. Dr. Elliott’s areas of scholarly interest include health disparities, population health, fetal alcohol spectrum, fetal and infant mortality, early childhood development, pediatric sleep disturbance, environmental exposures and maternal–child health. Dr. Elliott and her team are coming from Sanford Health. Avera Health has expanded its Careflight program to better serve rural residents and improve response times across the 72,000 square-mile region Avera Services. The expansion involves placing a fixed-wing aircraft in Pierre. A Careflight helicopter is currently based in Aberdeen as well as a fixed-wing plane and helicopter in Sioux Falls. The fixed wings can fly at higher speeds and greater distances. Ground ambulances take patients to and from the airport in support of the fixed-wing unit. Careflight was the first helicopter transport service in South Dakota.
Avera PACE has signed an agreement with The Innovation Institute. The Innovation Institute’s networking efforts will assist PACE partners. Avera PACE provides healthcare systems and providers with personal service and access to cost-effective contracts, bottom-line savings, and quality products from brand-name manufacturers.
BLACK HILLS MARK LONGACRE Regional Health has named Mark Longacre as President of the new Regional Health and Advanced Orthopedic and Sports Medicine Institute in Rapid City. Longacre has worked in the healthcare field for more than 25 years. He recently served as Executive Director of Orthopaedic and Neurosciences at Nebraska Medicine in Omaha, Nebraska. He also served as Chief Operating Officer of Nebraska Orthopaedic Hospital in Omaha for 12 years. The Advanced Orthopedic and Sports Medicine Institute is currently under construction with an expected opening in the Fall of 2018.
Regional Health Rapid City Hospital has been rated a four-star hospital by the Centers for Medicare & Medicaid Services (CMS), up from last year’s three stars. Regional Health Spearfish Hospital retained its four-star rating for this year, and Regional Health Sturgis Hospital was also rated four stars, its first-ever star rating from CMS. In the latest report, Rapid City Hospital was above the national average in three measures: readmission, efficient use of medical imaging and timeliness of care. Spearfish Hospital was above the national average in readmission, patient experience and timeliness of care.
HALIE ANDERSON Halie Anderson, MD, has joined Rapid City Medical Center practicing allergy, asthma and immunology. A native of Spearfish, Dr. Anderson attended USD Sanford School of Medicine and completed a pediatric residency at the University of Wisconsin-Madison where she also did her allergy and immunology fellowship. Dr. Anderson is certified to treat patients of all ages and is one of only five board-certified allergists currently practicing in the state of South Dakota. Regional Health Urgent Care North and Regional Health Urgent Care West, both in Rapid City are the first urgent care centers in South Dakota to earn the Accredited Urgent Care designation from the Urgent Care Association America. The designation is the highest level of distinction for urgent care centers.
SANFORD Sanford Health has increased its global presence in international health by extending its services to seven countries. This year, Sanford will enter New Zealand, Ireland, Vietnam, Costa Rica and South Africa and increase its presence in China and Ghana. This expansion follows last year’s acquisition of a minority stake in ISAR Klinikum, a hospital leader in stem cell therapies located in Munich, Germany. Sanford Health’s international health care arm, Sanford World Clinic, will now be in nine countries with more than 30 locations. US News and World Reports rated Sanford USD Medical Center the Number 1 hospital in South Dakota. The medical center is ranked high performing in all nine areas evaluated (colon cancer surgery, lung cancer surgery, COPD, heart failure, heart bypass surgery, aortic valve surgery, abdominal aortic aneurysm repair, knee replacement and hip replacement). Only 48 hospitals, or one percent, of those evaluated across the nation received such high honors.
ALICE NORDSTROM Sanford nurse, Alica Nordstrom, RN, was recently given a DAISY award for exceptional nursing Nordstrom works in Ortho/Neuro at Sanford USD Medical Center.
DISCOVER. INSPIRE. GROW.
Edith Sanford Breast Center Symposium Friday, April 20, 2018 JOIN US Edith Sanford Breast Center Symposium | Friday, April 20
Sanford Center, Dakota Room 2301 E. 60th St. N | Sioux Falls, SD
Learn from local and national breast cancer experts on topics such as survivorship, genomics, immunotherapy, staging guidelines, lymphedema and lymph node surgery, radiation oncology technology and scientific research in breast cancer at Sanford Health. To register, visit sanfordhealth.org keyword: Edith Symposium
• Happenings around the region
News & Notes
• Happenings around the region
News & Notes
SIOUXLAND DOUGLAS W. MARTIN
ERIN LICHTER Mercy Medical Center–Sioux City has appointed Erin Lichter as Director of Radiologic Services and Neurophysiology in November. Prior to joining Mercy, Lichter was an X-ray technologist for 10 years and an interventional radiology tech for 6 years. Lichter most recently worked as an instructor for the radiology program at Southeast Community College as well as a manager at an urgent care clinic in Lincoln, Nebraska.
GOKUL SUBHAS Gokul Subhas, MD, board certified colorectal surgeon, has joined UnityPoint Clinic General Surgery. Dr. Subhas received his Doctor of Medicine degree from Government Medical College in Nagpur, India. He completed his residency at Providence Hospital in Southfield, Michigan, and a colon and rectal surgery fellowship at Rutgers Robert Wood Johnson in New Brunswick, New Jersey. His expertise is in anorectal, colorectal, and general surgeries. Dr. Subhas previously practiced at Tri-State Specialists.
Alicia Held, MSN, Surgical Unit Nurse Manager, and Kari Kirchmeier, MSN, Clinical Nurse Educator at Mercy Medical Center, have earned RN-BC certification through the American Nurses Credential Center (ANCC). Held and Kirchmeier join the ranks of more than 27,500 nurses who have earned board certification in Medical-Surgical Nursing, the most popular designation offered by the ANCC. The certification attests to the achievement of specialty knowledge beyond basic nursing preparation and is evidence of clinical expertise and leadership in nursing practice in acute care settings for the adult patient population. The ANCC is a subsidiary of the American Nurses Association (ANA).
Douglas W. Martin, MD, FAADEP, FACOEM, FAAFP, Medical Director of UnityPoint Health-St. Luke’s Occupational Medicine, has been appointed to serve the American Academy of Family Physicians (AAFP) Commission on Education for a four-year term that began December 15, 2017. Martin received his degree from the University of Nebraska Medical Center in Omaha. He is certified in family medicine by the American Board of Family Medicine and is a certified Medical Review Officer and Aviation Medical Examiner.
PRADEEPA P. VIMALACHANDRAN Board certified family physician Pradeepa P. Vimalachandran, MD, MPH, has joined Oakland Mercy Medical Clinic in Oakland, Nebraska. A native of Toronto, Canada, Dr. Vimalachandran completed her residency at Creighton University Medical Center in Omaha. She received her undergraduate degree at the University of Toronto. She also studied at Argosy University in Chicago, Illinois and received her Doctorate of Medicine at All Saints University School of Medicine in Loubiere, Dominica. She also holds a Master of Public Health degree and is pursuing a graduate degree in Business Administration.
JENNIFER MILBY Jennifer Milby, FNP-C, has joined the Akron Mercy Medical Clinic. Milby received her nursing degrees at Briar Cliff University. Prior to joining Akron Mercy Medical Center, she was a healthcare provider at Mercy Singing Hills Family Medicine and Urgent Care, Curaquick Clinic, and Dunes Surgical Hospital. She also served as clinical nurse instructor at Iowa Central Community College. Milby is board certified in infection prevention and family practice.
SHANNON HOOS-THOMPSON Shannon Hoos-Thompson, MD, FACC, has joined UnityPoint Health-St. Luke’s Cardiology Services and Cardiovascular Associates (CVA). Dr. Hoos-Thompson received her Doctor of Medicine degree and completed her residency and her fellowship at Creighton University in Omaha. She is board certified in internal medicine and cardiology.
MARC BURRELL Marc Burrell, MD, joined the Mercy Medical Center Radiology team in January. He is fellowship-trained in Vascular and Interventional Radiology. Dr. Burrell utilizes imageguided catheters to perform minimally invasive therapies to treat conditions that formerly required extensive surgery. A native of Milwaukee, Wis, Dr. Burrell completed his education and began practicing in Texas. He completed his diagnostic radiology residency and fellowship in Vascular and Interventional Radiology at the University of Texas Southwestern Medical Center.
AMY BECKER Mercy Medical Center–Sioux City has named Amy Becker Clinical Educator of Medical/ Surgical Units. She holds a BA in history with an education minor and a BS in nursing from Briar Cliff University. Since moving to education, she volunteers with the Employee Activity Council and supports the Education and Informatics Committee of Nursing Council.
OTHER Wapiti Medical Staffing has announced the acquisition of Emergency Practice Associates (EPA) – a medical staffing agency located in Waterloo, Iowa. Wapiti Medical Staffing has twenty years’ experience connecting physicians and individuals in the medical field with healthcare facilities throughout the United State. Wapiti is based in Milbank, South Dakota, with additional offices in Huron, Rapid City, Salt Lake City, Utah, and Waterloo, Iowa.
See the website for the full-length version of each of these news articles
SUE SALTER Make-A-Wish South Dakota has named Sue Salter as its new president and CEO. Salter was chosen by the statewide Board of Directors following a search to replace Paul Krueger who has taken a role with Make-A-Wish America, the national organization. Salter has 15 years of municipal and non-profit management experience, combined with eight years of professional fundraising experience. She is a Certified Fundraising Executive (CFRE) and comes to Make-A-Wish from the Sanford Health Foundation where she has served as a major gifts officer since 2014.
North Central Heart
Friday, May 4, 2018 8 a.m. – 5 p.m. Sioux Falls Convention Center • Sioux Falls, S.D. Learn the latest trends in the diagnosis, technology and treatment of vascular disease during this daylong symposium. 17-HHSD-9257
Call 605-322-8950 for more information or go to Avera.org/conferences and click on Events and Live Courses to register.
4520 W. 69th St. • Sioux Falls, SD 57108 • AveraHeartHospital.org
• Happenings around the region
News & Notes
Dr. Daniel Petereit, MD, FASTRO
ANIEL PETEREIT, MD, a radiation oncologist with Regional Health John T. Vucurevich Cancer Care Institute in Rapid City, is one of those people who gets an idea and runs with it. Inspired by his father Frank Petereit, MD, a longtime radiologist in Sioux Falls who clamored his way out of a life of poverty, Petereit earned his medical degree at USD and did his residency in radiation
oncology at the University of Wisconsin. He did additional training in gynecologic oncology and head and neck cancer at MD Anderson Cancer Center. “I liked the multidisciplinary aspects of radiation oncology and appreciated
that it can be curative as well as palliative,” says Dr. Petereit, who says he also enjoys building relationships with patients as they go through treatment.
BY ALEX STRAUSS
“In some specialties, you don’t get as much of that.” Dr. Petereit spent 10 years training and teaching in the Department of Human Oncology at the University of Wisconsin-Madison where he led the radiation therapy portion of the gynecologic oncology service for 5 years. In 1999, he got an idea to return to his home state and bring what he calls “the culture of service and science in which I was immersed” to cancer care in the Black Hills region. “I viewed it as an opportunity to bring services to this part of the country that weren’t being offered,” says Petereit. “At the time, 20 to 30 percent of Black Hills cancer patients were being referred out for more complicated treatments like brachytherapy.” Petereit hit the ground running. Within his first two years, Regional Health’s first brachytherapy program was up and running. Shortly thereafter, Dr. Petereit returned to the University of Wisconsin with Regional Health administrators (Adil Ameer and Richard Haeder) to evaluate a new treatment called Tomotherapy – “an absolute game changer in the field of radiation oncology”, according to Petereit.
“Mastectomy rates were also very high in the Black hills at that time,” says Dr. Petereit. “If a woman wanted to avoid mastectomy, she was looking at 6 weeks of radiation.” But the new brachytherapy program could condense that time into just five days, making it much easier for patients who had to travel far from home. This was especially good news for American Indian women in the region, who live an average of 140 miles away from the cancer center. “A big part of the program was just gaining the trust of the tribal community,” says Petereit.
Dr. Petereit with breast cancer survivor Britney Brouillette. Photo courtesy Regional Health.
IMPACT ON OUTCOMES More than 4,000 American Indians have been enrolled in various clinical trials as a
Under Dr. Petereit’s guidance, Regional Health became the fourth
result of Walking Forward—the highest in
site in the world to implement the now familiar system which delivers
the nation for any program working with
image-guided IMRT (intensity modulated radiation therapy) with an
this population. Fifty papers on Walking
integrated CT scanner in order to achieve a more conformal dose of
Forward have been published in peer-
radiation while sparing the adjacent normal tissues.
reviewed journals and an analysis of the data suggests that American Indian cancer
patients with screen-detectable cancers are
The forward momentum continued into 2001 with the National Cancer
now presenting with earlier stages of disease
Institute’s announcement of new cancer disparity grants for community
and experiencing higher cure rates.
cancer centers gave Dr. Petereit another idea.
cessation project included 256 American
of-the-art cancer technologies and services and that had access to a
Indians in a randomized controlled trial using
population suffering from cancer disparities. Petereit recognized
nicotine replacement, counseling, and text
that Regional Health was a perfect fit. The following year, the John T.
messaging to mitigate the high rates of tobacco
Vucurevich Cancer Care Institute secured its first-ever NCI grant and
use (40% to 50%) and tobacco-induced cancers.
the Walking Forward program was born.
Twenty-five percent of participants were
“We had the technology in place and we had access to this underserved population,” says Dr. Petereit. “All the stars really aligned when NCI began issuing these grants.”
smoke free at six months. In 2015, administration of the Walking Forward program was moved to Avera Health
The NCI-funded cancer disparity project called Walking Forward
in Sioux Falls, where Dr. Petereit serves as
launched in 2002 with the aim of improving cancer treatment and
Director of Disparity Research at the Avera
outcomes among Northern Plains American Indians in the region.
Cancer Care Institute. He continues to live
American Indians tend to present with much more advanced cancers
in the Black Hills and practice at Regional
and have the worst cancer-specific survival rates of any racial/ethnic
minority group in the US.
Recently, a Walking Forward smoking
The grants were reserved for centers that were offering state-
In an Executive Summary of the 15-year-
Walking Forward offered a culturally tailored patient navigation
old program, Petereit wrote, “Overall, the
program designed to bring more American Indians into clinical trials.
absolute persistence of the Walking Forward
Community Research Representatives offered educational programs
team, particularly when barriers to address
encouraging screening and early detection and implemented surveys
these complex socio-economic issues
to identify barriers to access. Walking Forward also included trials
appeared difficult or insurmountable, has led
focused on improving participation by reducing treatment length with
to the program’s longevity and continued
advanced treatment technologies such as brachytherapy and IMRT.
LOOKING FORWARD New opportunities continue to present themselves. Last month, the Bristol-Myers Squibb Foundation approved a 3-year 1.6 million dollar grant for the next iteration of Walking Forward— Increasing Lung Cancer Screening for High Risk Smokers in a Frontier Population project—a low-dose CT screening project which will begin in May. In the future, the hope is that the lessons learned from Walking Forward can be applied to other indigenous populations with health disparities. Dr. Petereit is currently working with the International Cancer Expert Corps (ICEC), based in Washington, DC, to accomplish these goals. Meanwhile, he is the incoming president of the American Brachytherapy Society and continues to be excited about advancing cancer care in the Black Hills. In recent years, stereotactic radiation has made it possible to treat small lung tumors with minimal side effects and high cure rates. “This successful program is led by my partner Dr. Michael Swartz which will compliment the lung cancer screening project,” says Dr. Petereit. Regional also recently implemented MRI-guided brachytherapy for advanced cervical cancer, which may improve cervical cancer cure rates by 10 to 20 percent. Finally, in partnership with Avera,
Dr. Petereit wishes to thank his Walking Forward staff, Regional Health and Avera Health, his partners Drs. Eric Eastmo and Michael Swartz, his friend and colleague Dr. Norm Coleman at the NCI, the American Indian community, and his wife Jean and their four kids for their support.
Regional Health patients can now undergo genomic profiling to further customize their cancer treatment when appropriate. As he looks back at his progress and forward to his future, Dr. Petereit says he hopes he will not live out actor Graham Greene’s predictions when he said “Life is lived in the first 20 years. The remainder is just a reflection.” “Hopefully, there has been some progress but I am hoping there is still more progress to come,” says Dr. Petereit. ❖
[T E C HN O L O G Y]
Prairie Lakes Brings Cutting Edge BPH Procedure to Watertown
“THIS REPRESENTS THE LATEST
ATERTOWN AREA MEN
center like Watertown’s Mallard Pointe Surgical
suffering from symptoms such
Center. Patients go home the same day with a
as frequency, urgency, strain-
catheter, which comes out in three days.
ing, and irregular flow due to
says Dr. Adducci, who trained on the
now have a new minimally
procedure at Urology Specialists in
invasive option for relief closer
Sioux Falls, the only other center in
South Dakota that currently offers
Chris Adducci, MD, with
Prairie Lakes Urology recently
“Most men experience some
began offering transurethral
discomfort, frequency, and urgency
radiofrequency thermal therapy
for a few weeks. But gradually, the
with the Rezum system to qual-
tissue that was killed with the steam
BPH BUT IT IS
ified patients, many of whom
either want to get off medication
will resorb and open the channel. CHRIS ADDUCCI
By 10 to 12 weeks, they are as good as
ONE THAT IS
for BPH or avoid going on it.
“The technique is not new,” says Dr.
Adducci says Rezum can be used for a
Adducci. “He have had endoscopic ways of
wider range of patients than some other
opening up the area using heat. The difference
minimally invasive BPH treatments such as
with Rezum is that it is convected heat, rather
the UroLift implant system and causes less
than conducted heat. You are literally injecting
discomfort than transurethral microwave
steam into the prostate at nine-second inter-
thermotherapy (TUMT). Rezum does not cause
vals. So there is less discomfort than with
incontinence or erectile dysfunction and is
a procedure such as transurethral needle
approved for gland sizes less than 80 grams.
TOLERABLE” - CHRIS ADDUCCI -
“Our patients are tolerating this very well,”
benign prostatic hyperplasia
they are going to get.”
ablation (TUNA), which also takes a lot longer.”
“This represents the latest in-office proce-
With Rezum, the patient receives an aver-
dure for BPH but it is one that is very, very
age of six needle insertions (up to 15), each one
tolerable,” says Dr. Adducci. “It is great to be
lasting nine seconds. The procedure is done
able to offer this cutting edge treatment right
under local anesthesia, often at an outpatient
here in Watertown. This one is here to stay. ❖
Wife’s Brush with Breast Cancer Drives Rapid City Plastic Surgeon
LASTIC SURGEON HUNTER MOYER, MD, was
to twelve months through the course of multiple
already well established as an expert in breast
procedures. “The cancer may determine options
reconstruction in Atlanta, Georgia when his wife
somewhat and if a patient needs radiation, that may
was diagnosed with breast cancer at the age of just 35. “Even though I’d been in the field for awhile, it was a big
surprise to us when my wife was diagnosed,” says Moyer.
steer us in one direction or the other. Every patient is different and a lot depends on their individual situation and their desires.”
Because of her age, Moyer’s wife decided early on on to have
As Regional Health prepares to roll out a new
a double mastectomy. The early stage of the cancer made
Breast Center of Excellence, its first organ-specific
her an ideal candidate for a nipple-sparing procedure. “Because
institute, Dr. Moyer says he is looking forward
she already had breast implants, we just exchanged those implants for larger ones,” says Moyer. “She didn’t need radiation.” Moyer’s training at Emory University, which has a large breast reconstruction program, as well as his personal experi-
“We do a lot of different things in plastic surgery, but breast cancer reconstruction is the most rewarding.” - HUNTER MOYER-
to making breast reconstruction an even bigger part of his practice. “The first goal of this center is to improve patient outcomes through coordination of care, including meeting together, looking
ence, has made him especially passionate about this area
at the latest advancements, etc.,” says Dr. Moyer. “The
of plastic surgery. Last year, he brought that passion and
secondary goal is to make the cancer journey easier
expertise to Regional Health.
for patients and the third is to make it easier for refer-
“The first goal is to eradicate disease. But a lot of studies
ring physicians, so that they know that they are
and my personal experience has shown that the secondary
referring patients to a center that is going to provide
goal of restoring form can have a huge impact on how women
the top level of care.”
feel about themselves,” says Dr. Moyer. “We do a lot of different
The new Center of
things in plastic surgery, but breast cancer reconstruction
Excellence will feature a
is the most rewarding.”
Today’s breast cancer patient has many choices for
board as well as a single
preserving and restoring form, from breast conserving surgery
website, a single phone
to implants to new breasts built from the patient’s own tissue,
number, and a single
which can take more time in the OR but may deliver higher
patient navigator dedi-
long-term satisfaction. For bilateral mastectomy, Moyer often
cated to breast cancer.
recommends implants. For unilateral mastectomy, a breast
Moyer anticipates that
made from autologous tissue may make for an easier match.
the new center will
Moyer says a big part of his job is helping women make these
attract not only patients,
kinds of decisions.
but also dollars to fund
“Patients normally have all of these options available,” says Moyer, who often works with patients over three
breast cancer research at Regional. ❖
Dr. Moyer with his wife and children on top of Black Elk Peak in the Black Hills.
EXPANDING CANCER CARE IN PIERRE
HIS FALL, Avera will open
mastectomy over breast conserving
of early lung cancer in high risk
The Helmsley Center, home
surgery so that they don’t have to
to its sixth cancer institute,
between Avera St. Mary’s
place, we are very integrated with
Hospital and Avera Medical Group
Accelerator is still a few months
our main hospital in Sioux Falls,”
in Pierre. This $30 million dollar
away, the hospital is not waiting to
says Dr. Donepudi, who regularly
ACI will be an especially welcome
advance cancer care in Pierre. Avera
participates in tumor boards with
addition to central South Dakota,
St. Mary’s has provided 3D mammog-
Avera colleagues in Sioux Falls.
raphy for more than a year
easy access to a hospital
and this past fall added
that provides radiation
contrast enhanced digital
treatment, even though
CEDM uses a contrast
cause of death in five
agent in combination with
out of eight of Avera St.
mammography to make
Mary’s primary service
cancers that are not visible
“At least a third to a half of cancer
on standard mammo-
grams show up as enhanced areas.
“Even though we are a small place, we are very integrated with our main hospital in Sioux Falls.” - SREEKANTH DONEPUDI -
“Pretty much every patients I see here has a genomic consultation
patients need radiation therapy at
“This gives us even better infor-
with the genomic team in Sioux
some point during their cancer jour-
mation compared to a mammogram
Falls.” The integration means that
ney,” says Sreekanth Donepudi MD,
and can really help us determine who
cancer patients in Pierre can receive
MPH, a medical oncologist at Avera
needs a biopsy and who doesn’t,” says
the genetic counseling they need
St. Mary’s. Right now, those patients
without having to travel long
are travelling 150 miles or more to
In addition, Donepudi says the
access treatment that they cannot
hospital has standardized diagnos-
get in Pierre.
tic protocols for several cancers
already available in Pierre in the
“It is difficult to tell patients that
to ensure that patients across the
hospital’s former ICU, Dr. Donepudi
they have to go somewhere else for
Avera system receive the same
says The Helmsley Center will
six to eight weeks of treatment,” says
standard of care. That includes
improve the experience by offering
Donepudi. “Some women choose
low-does CT scans for the detection
it in a dedicated area. ❖
❱A ccess an interactive presentation on The Helmsley Center
“Even though we are a small
While the new Elekta Linear
❱W ant to see more? View the gallery of architectural drawings.
WOMEN AND CLINICAL TRIALS T
HE WOMEN’S MOVEMENT OF THE 1970 s
brought issues such as pay equity, birth control, and gender roles into the national spotlight. But it would be another 20 years before policies regarding women in drug trials would get a much-needed makeover. The
effort to bring women and ethnic minorities into clinical trials is ongoing. In 1977, the FDA specifically recommended against including women of childbearing age in Phase I and early Phase II drug trials. Lora Black, RN, MPH, Senior Director of Clinical Research at Sanford Research, says this broad policy was damaging, not just from an equity standpoint, but from a scientific standpoint. “It’s not just about equal representation,” says Black, who is also a clinical instructor with the USD Sanford School of Medicine. “Men and women differ at the cellular level. Women have different organs and different hormones. Sometimes even cycles can affect medications and dosages, etc.” A case in point is the insomnia drug zolpidem (Ambien). In 2013, new data suggested that women may metabolize the drug differently than men, potentially resulting in pronounced next-morning impairment at the recommended dose. In light of the new data, the FDA recommended that the zolpidem dose be cut in half for female patients. “Some drugs stay in the system longer if you have more body fat and women have more body fat than men,” says Black. “So body composition can also play a role.” Although the NIH established a policy recommending that researchers include women in studies in 1989, it was not until 1993 that Congress made it a law. Today, NIH will not fund any grant or support any project that does not agree to include a gender breakdown
in animal trials and report on the sex, race, and ethnicity of the people enrolled in clinical trials. “Different ethnic groups potentially have different DNA, which can affect how they are going to respond to medication,” says Black. “Those are things we can’t capture unless they are included in clinical trials.” Black says the challenge now is to make sure providers offer clinical trials to their eligible female and ethnic minority patients and to encourage patients to enroll. “It is a multifaceted education piece,” says Black. “We need folks to understand that, without engaged volunteers, we can’t move the science forward. We are always trying to find different ways to get that message out to patients, researchers, providers, and collaborators, such as device manufacturers.” “We want to make sure that, when we are designing clinical trials, we are designing them with differences in mind, so that we make sure we are answering the right
“IT’S NOT JUST ABOUT EQUAL REPRESENTATION. MEN AND WOMEN DIFFER AT THE CELLULAR LEVEL.” - LORI BLACK -
❱ F ind out more about the history of women in clinical research from the Office of Research on Women’s Health
❱ S ee why Sanford researchers received national recognition this fall
The new four-plex in Parkston means new hospital hires may not have to search far for housing
Workforce Housing is “Mission Critical” for Rural Facility
MANY TIMES, WE HAVE HAD
THE CHANCE TO HIRE SOMEONE, BUT COULDN'T
project in order to keep rents affordable,
ship position at a rural
and signed a five-year rental agreement
healthcare facility will
on two of the apartments to ensure that
tell you that recruitment
they would be occupied. The new building
is tough. Often, the higher level the
opened in October.
position, the longer it takes to fill and the harder it is to keep a person in it.
“Available housing that is decent and affordable is essential for a small health-
For Avera St. Benedict
care center like ours,” says
FIND A PLACE
Health Center in Parkston,
Blasius. “When we are fortu-
just filling CNA positions
nate enough to get someone
FOR THEM TO
at their nursing home is a
hired, many times that person
LIVE IN OUR
major challenge. Like a lot of
needs to live in the commu-
rural facilities, they cannot
nity because they have call
afford to miss out on a great
- RITA BLASIUS -
candidate because the com-
munity doesn’t have enough housing.
N YO N E I N a leader-
Association of Healthcare RITA BLASIUS
Organizations considers the
“Many times, we have had the chance
issue of workforce recruitment and
to hire someone, but couldn’t find a place
retention so important for medicine in
for them to live in our community,” says
the region, that they have established a
Avera St. Benedict President and CEO, Rita
website dedicated to supporting facilities
Blasius. So Avera St. Benedict, in partner-
like Avera St. Benedict in their efforts.
ship with Avera Health and the Parkston
Right now, the two rented apart-
Area Development Foundation, recently
ments are being used to house medical
decided on a bold move to address the
students in the FARM (Frontier And
Rural Medicine) program during their
They found a Mitchell developer
nine-month stay in Parkston. The other
willing to build a new four-plex apartment
two are home to people who are also
building in Parkston, helped fund the
working in town. Blasius says the new
Inside one of the newly-built apartments which opened in October.
WHY ARE HEALTHCARE POSITIONS
SO HARD TO FILL?
said there were either no applicants or an insufficient number of qualified applicants. felt they are unable to compete with other employer.
Source: South Dakota Healthcare Workforce Survey Report
housing isn’t just a ‘win’ for the
It is also a win for the developer,
a choice between two equal jobs and
health center, but for the entire
for whom the new building generated
communities, the housing may be the
community as new residents boost
so much interest, that he is already
deciding factor,” says Blasius. “We
the tax base and support economic
building a second one in Parkston.
just felt like it was mission-critical
“If a healthcare professional has
for us to support this project.” ❖
❱C onnect with SDAHO’s workforce website for more resources.
© 2017 MMIC Insurance, Inc.
Because your great care comes in all sizes. At MMIC, we make it our practice to protect your practice. That’s why we’ve built a responsive team of experts—to help you minimize clinical risks, stay current in the ever-changing health care industry, and keep your practice thriving. And, in the event of a claim, we’re here for you. Because you’re here for them—no matter the size of the challenge. Insurance & Risk Solutions | MMICGroup.com
Specialized, Complex Surgical Techniques Added to Heart Program at Children’s
to the lungs instead connect the
surgical procedures such as “unifocal-
lungs to the aorta, and the heart
ization” – a single procedure employed to
has a hole in the wall that sepa-
repair a defect known as tetralogy of
rates the lower chambers.
Fallot with pulmonary atresia and major aortopulmo-
With tetralogy of Fallot, not
nary collaterals – are being offered in a new program at
enough blood is able to reach
Children’s Hospital & Medical Center in Omaha.
the lungs to get oxygen, and
The Pulmonary Artery Rehabilitation program is being
oxygen-poor blood flows to the
developed by cardiothoracic surgeon Ali Ibrahimiye,
body. Infants and children who
MD, of Children’s Specialty Physicians who is also an
have tetralogy of Fallot have
assistant professor in the Department of Surgery at
episodes of cyanosis, a bluish
UNMC College of Medicine.
tint to the skin, lips and finger-
Unifocalization is a procedure created by Frank L. Hanley, MD, director of the Children’s Heart Center at the Lucile Packard Children’s Hospital at Stanford University. Dr. Ibrahimiye, who is board certified in General Surgery, Thoracic Surgery and Congenital Cardiac Surgery, completed a fellowship in Congenital Cardiac Surgery there, where he performed surgery alongside Dr. Hanley. “It is a very tiring, tedious, eight to ten-hour operation, and children can become very sick afterward,” Dr. Ibrahimiye says. “A surgeon has to do a lot of these operations
A SURGEON HAS TO DO A LOT OF THESE OPERATIONS TO LEARN HOW TO DO IT WELL AND BE COMFORTABLE PERFORMING IT.
level of oxygen in the blood leaving the heart. With the unifocalization procedure, the misdirected blood vessels are rerouted into a single vessel or the pulmonary artery, which is then attached to the right ventricle through a conduit called a homograft, to restore normal circulation from the lungs to the heart. After this step, the hole in the ventricle wall is repaired. The comprehensive care these patients receive at Children’s takes into account the variability from child to child. “Our heart team not only performs these complex surgeries,
- ALI IBRAHIMIYE -
to learn how to do it well and be
but also any additional procedures that may follow,” Dr. Ibrahimiye says. Dr. Ibrahimiye says the fact that
comfortable performing it. During my fellowship, we were
Children’s is a medium-sized program affords patients
doing one or two a week.”
and their families a higher level of personalization. “It
Not only has Dr. Ibrahimiye performed the unifocal-
allows our surgeons to not only operate, but to actively
ization operation many times, he has also written about
participate in our patients’ care,” he says. “I see my
it, documented it in videos, and presented about the sur-
patients twice a day. I round in the morning and round
gery at numerous conferences, including the Congenital
again before I go home. That is not always the case in
Heart Surgeons’ Society (CHSS) annual meeting in Chicago
in October 2017.
nails, due to the
Having such a program here in the middle of the
Tetralogy of Fallot with pulmonary atresia is an
country gives referring physicians a unique regional
extreme form of tetralogy characterized by absence of
option, Dr. Ibrahimiye says. “They do not need to send
flow from the right ventricle to the pulmonary arteries.
their patients to California to address this condition or
The defect actually involves four (tetralogy) heart defects:
many other pulmonary artery reconstruction issues,” he
a large ventricular septal defect (VSD), pulmonary
says. “That keeps patients and their families closer to
stenosis, right ventricular hypertrophy and an overriding
home, and saves them the expense and burden of moving
aorta. The blood vessels that should connect the heart
for what might be months of hospitalization and care.”
LIFE CAN CHANGE IN A HEART BEAT When it comes to medical matters of the heart, we know life can change in a heartbeat. At the Regional Health Heart and Vascular Institute, our team of specialists are here to provide high-quality, compassionate heart care.
When it comes to medical matters of the heart, we know life can change in a heartbeat. At the Regional Health Heart and Vascular Institute, our team of specialists are here to provide high-quality, compassionate heart care.
LIFE CAN CHANGE IN A HEARTBEAT
Heart and Vascular Institute 4150 5th Street | Rapid City, SD 57701 | 605-519-5433 regionalhealth.org/hvi
Compassion . Experience . Trust Â Â? Â? Â? Â? Â Â 605.334.1930 6301 S. Minnesota Ave., Suite 300 www.plasticsurgerysiouxfalls.com March 2018
[I N T E R V I E W]
Jon Porter on Avera, Retirement, and Soccer
HIS YEAR, AFTER MORE THAN FOUR decades at the helm of Avera Health, and on the brink of his 70th birthday, President and CEO Jon Porter will retire. Porter saw the health system through
tremendous growth and change, including the transition from traditional hospital/nursing-home focus to fully-integrated care continuum. In the late 1990s, Porter helped facilitate the process of uniting the Benedictine and Presentation health systems in the co-creation of Avera Health. We talked with him about his tenure and his plans.
MED: You have done and seen so much during your time at Avera. What accomplishment are you particularly proud of? JP: The fact that we were able to take
more intense investment in our core geography.
MED: Beyond the clinical advances, how do you see things changing for the better in the future?
these two disparate Catholic groups
JP: I have 8 grandkids between 6 and 19 years old and they all live
that had been engaged in their own
JP: We are now in all aspects of
in SIoux Falls, Pierre, and Rapid
separate ministries for 100 years and
healthcare under the auspices of the
City. I missed a lot of my own
bring them together. There is trauma
Avera Health ministry. And we are
kids growing up and I don’t want
in letting go of something that you
growing those services and the
to miss my grandkids. I don’t
have had for 100 years. At one time,
specialty nature of those services.
think I’m going to write a book,
they saw each other as competitors.
We recognize that it is frustrating to
or become a worldwide speaker or
To have them come together and
get bills from lots of different places.
a consultant. My wife and I may
share a vision of a system that could
We are moving to where it will be
travel some and I love to ride my
be stronger and bigger, that was
one singular medical record, one bill,
motorcycle. But, honestly, I see
one relationship. It will take a while,
myself at a lot of soccer games
but I think this is what people want.
and school plays!
MED: What do you think has been your biggest challenge?
MED: Are there things you are going to miss?
JP: Trying to figure out how to
MED: So what is next for you?
provide the highest possible quality
JP: Well, I’m not going to miss going
of care and still remain financially
to work every morning at 7, especially
viable. Part of that was right-sizing,
when it’s 17 below wind chill! But I am
being more intentional in focusing
going to miss people. The Sisters have
on our geographical footprint. The
given their entire lives to this health
Presentation Sisters had nursing
ministry, day in, day out. When you
homes in Montana and the
work with people like that and with
Benedictines had some in Colorado.
clinicians that are just so committed
So the orders had to go through a
to treating every patient physically
divestiture and and transfer of these
and holistically, you can’t help but
facilities so that we could make a
THE FACT THAT WE WERE ABLE TO TAKE THESE TWO DISPARATE CATHOLIC GROUPS AND BRING THEM TOGETHER . . . THAT WAS SIGNIFICANT.
- JON PORTER -
Workplace Violence in Healthcare BY LORI BERDAHL
CCORDING TO THE 2011 TO 2013
identify hazards and risk factors for violence. It is import-
Bureau of Labor Statistics data, US health-
ant to remember that the violent acts are perpetrated not
care workers suffered 15,000 to 20,000
only by patients, but also by distraught family members,
injuries each year related to workplace
visitors, and fellow workers.2
violence that required time away from work for treatment and recovery.
OSHA’s third key component for violence prevention
and 74% of all workplace violence injuries occurred in healthcare, on average this is four times greater than in private industry.2 And, the problem is likely much greater than these statistics suggest, considering they do not account for the assaults or threats that don’t lead to time away from work. Studies have also shown that violence in healthcare is remarkably underreported. 1 Contributing to these trends are
involves design and implementation
70% TO 74%
of control measures to respond to the identified risk factors. These may include engineering or administrative changes such as protecting nurses’ stations with enclosures or deep counters, improving lighting,
THE PERCENTAGE OF ALL WORKPLACE VIOLENCE THAT OCCURES IN HEALTHCARE
controlling public access to high-risk areas, ensuring adequate staffing, or installing panic buttons, which can quickly notify security of threats.2
SOUCE OSHA, 2016
The fourth key is thorough
caregivers’ perceptions that they
and repeated training so staff can
have a professional and ethical duty to “do no harm” to
recognize warning signs and can respond effectively and
patients, often putting their own safety and health at risk
confidently. Staff should be taught to watch for early signs
to help a patient.
of rising anxiety levels.
In their Guidelines for Preventing Workplace Violence
OSHA’s final key component for violence prevention
for Healthcare and Social Service Workers, OSHA outlines
is recordkeeping and program evaluation. Healthcare
5 key components to a comprehensive workplace violence
providers need to feel empowered to report any and all
threatening incidents. These should not be overlooked as
First, demonstrated commitment from management
simply “part of the job.” Supervisors need to listen to these
and active inclusion of front-line employees are equally
reports empathetically and ask follow up questions that
critical for success during each phase of the prevention
help to identify system vulnerabilities. A uniform violence
reporting system should be established with regular
Second, a thorough worksite analysis is needed to
review of reports.2
References: 1 O ccupational Safety and Health Administration. (2015). Preventing workplace violence: A road map for healthcare facilities. Occupational Safety and Health Administration Publication No. 3827. Retrieved from https://www.osha.gov/Publications/OSHA3827.pdf 2 Occupational Safety and Health Administration. (2016). Guidelines for preventing workplace violence for healthcare and social service workers. Occupational Safety and Health Administration Publication No. 3148-06R 2016. Retrieved from https://www.osha.gov/Publications/osha3148.pdf
Lori Berdahl, OTR/L, CEES, is an Ergonomics and Loss Control Specialist with RAS.
❱ S ee the warning signs of imminent violence
❱ F ind out what healthcare specialty areas are most susceptible to workplace violence
❱ L ink to the NIOSH interactive multimedia training module for nurses
[ T HE Q UE S T IO N]
What is the most critical issue facing healthcare providers in 2018? It depends on who you ask and what role they play in healthcare. We invited some of our recent interviewees to share their perspectives. HUNTER MOYER, MD, REGIONAL HEALTH
I would say the biggest challenge in 2018 is to avoid burnout. A physician’s day is filled less and less with caring for patients and more with the rigors of electronic records, health insurance policy demands, government regulations and hospital politics. These demands can take the focus off the doctor-patient relationship, which is the foundation of medical practice.
RITA BLASIUS, PRESIDENT & CEO, AVERA ST. BENEDICT HEALTH CENTER, PARKSTON
Workforce recruitment and retention! It is difficult to hire good people if they cannot find a place to live in the community. This is mission-critical for small, rural healthcare facilities like ours.
JON PORTER, PRESIDENT & CEO, AVERA HEALTH
Budgeting and workforce development. Fiscal ‘19 will be the third year in a row where our target has been to find $80 to $100 million in savings in order to stay viable. We are constantly looking for efficiencies, new services, etc. At the same time, we currently have about 1,100 job openings.
DAN PETEREIT, MD, REGIONAL HEALTH
Healthcare is so big and life balance is hard. Where do you even start? Email? EMR? Patients? Research? I think we all struggle to avoid burnout with all the different things pulling on our time.
ALLISON SUTTLE, MD, CHIEF MEDICAL OFFICER, SANFORD HEALTH
We’re trying to push for change and move but other payers may be moving at a different pace, with different agendas. It is hard to turn as the Titanic from the fee-for-service world with all the other players moving at the same time. It is essentially having to disassemble a wall that we built and build a brand new one.
Learning Opportunities MARCH 9
11th Annual Avera Brain & Spine Institute Conference: Stroke and Spine Update
23rd Annual North Central Heart Vascular Symposium
Location: Hilton Garden Inn
Information & registration:
8:00 am – 4:00 pm
Downtown, Sioux Falls Information & registration:
8:00 am – 5:00 pm
Location: Sioux Falls Convention Center email@example.com Phone: 605-322-8950
firstname.lastname@example.org Phone: 605-322-8950
APRIL 11 8:00 am – 4:00 pm 26th Annual Avera McKennan Trauma Symposium Location: Sioux Falls Convention Center Information & registration: email@example.com
MAY 9 44th Annual Perinatal Conference Location: UnityPoint Health–St. Luke’s Auditorium Phone: 712-279-3500
8:30 am – 4:00 pm
Avera Caring Professionals Conference
Location: Sioux Falls Convention Center
8:00 am – 5:00 pm Edith Sanford Breast Center Symposium
Information & registration: firstname.lastname@example.org Phone: 605-322-8950
Location: Sanford Center, Dakota Room Registration: Sanfordhealth.org, keyword: Edith Symposium
8:00 am – 4:00 pm
8:20 am – 4:30 pm Avera McKennan Diabetes Conference Location: Hilton Garden Inn Downtown Information & registration: email@example.com Phone: 605-322-8950
SAVE THE DATE
20th Annual Missouri Valley Symposium Location: ASHH Professional Offices Pavilion, Yankton, SD Information: YanktonMedicalClinic.com/MVS Phone: 605-665-6933
Sanford Sanford Sanford Center Center Center forfor Digestive for Digestive Digestive Health Health Health
Muslim Muslim Muslim Atiq, Atiq, MD Atiq, MD MD LeeLee Austin, Lee Austin, Austin, MDMD MD Brett Brett Baloun, Brett Baloun, Baloun, MDMD MD Gastroenterology Gastroenterology GastroenterologyGastroenterology Gastroenterology GastroenterologyGastroenterology Gastroenterology Gastroenterology
C. MD Mankongpaisarnrung, C. Mankongpaisarnrung, C. Mankongpaisarnrung, MD MD MD K. Kijsirichareanchai, K. Kijsirichareanchai, K. Kijsirichareanchai, MD MD Jorge Jorge Gilbert, Jorge Gilbert, Gilbert, MDMD MD Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology
NOT NOT NOTALL ALL ALL COLONOSCOPIES COLONOSCOPIES COLONOSCOPIES ARE ARE ARECREATED CREATED CREATED EQUAL. EQUAL. EQUAL. It’s It’s It’s true. true. true.
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Bhavesh Bhavesh Bhavesh Patel, Patel, Patel, MDMD MD Gastroenterology Gastroenterology Gastroenterology
Sanford Sanford Sanford Surgical Surgical Surgical Associates Associates Associates
The The The team team team you you you choose choose choose forfor your for your your colonoscopy colonoscopy colonoscopy does does does matter. matter. matter. Some Some Some are are are better better better atat ﬁnding at ﬁnding ﬁnding polyps polyps polyps than than than others others others during during during this this this important important important screening. screening. screening. Sanford Sanford Sanford Health Health Health is is the is the the only only only team team team inin in the the the region region region who who who is is nationally is nationally nationally recognized recognized recognized byby U.S. by U.S. U.S. News News News && World & World World Report Report Report forforfor excellence excellence excellence inin GIin GI procedures. GI procedures. procedures. Gain Gain Gain anan advantage an advantage advantage against against against colorectal colorectal colorectal cancer cancer cancer with with with our our our experts. experts. experts.
George George George Angelos, Angelos, Angelos, MDMD MD Paul Paul Bjordahl, Paul Bjordahl, Bjordahl, MDMD MDDennis Dennis Dennis Glatt, Glatt, MD Glatt, MD MD Colorectal Colorectal Colorectal Surgery Surgery SurgeryGeneral General General Surgery Surgery Surgery General General General Surgery Surgery Surgery
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019029-00218 019029-00218 019029-00218 Rev.Rev. 2/18 Rev. 2/182/18
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