June 2018 by MED- (Midwest Medical Edition)

Regional Recognized for Maternity Care Tips for Presenting Like a Pro

JUNE

SD’s New Rules for Handling a Data Breach

VOL. 9 NO. 4

2018

PRAIRIE LAKES HEALTHCARE SYSTEM Portrait of a Top 20 Rural Hospital

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THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

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A likely impossibility

is always

preferable to an

unconvincing possibility.

”

— ARISTOTLE

From Us to You

Staying in Touch with MED

ELCOME TO the June issue of

MED! Whether you are a clinician, an administrator, or some other healthcare stakeholder in our three-state region, we trust you’ll find news and information in these pages to enhance and support your life and business. In this issue, we shine a spotlight on a flagship independent rural hospital. Prairie Lakes Healthcare System was recently named a Top 20 hospital. But, as you’ll see in our cover feature, this dynamic institution is not resting on its laurels, but continues to grow and expand both its campus and its services. Also with exclusive interviews, and new technology, you’ll also find helpful information in this issue on

Steffanie Liston-Holtrop

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota VICE PRESIDENT SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER Julie Prairie Photography WEB DESIGN Locable

Alex Strauss

• the legal ramifications of South Dakota’s new data breach reporting law • initiatives aimed at improving communication between radiologists and other specialists • advice for de-escalating workplace violence and • presenting like a pro. Remember, MED is now regularly posting new news on our website. If you are not already on the VIP list to receive news updates (and early access to each issue) right in your Inbox, be sure to sign up at MidwestMedicalEdition.com. All the best! —Steff and Alex

DIGITAL MEDIA DIRECTOR Alyssa McGinnis CONTRIBUTING WRITERS Anne Geske

Theresa Parish STAFF WRITERS Liz Boyd Caroline Chenault John Knies

CONTACT INFORMATION Steffanie Liston-Holtrop VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com WEBSITE MidwestMedicalEdition.com MAILING ADDRESS PO Box 90646, Sioux Falls, SD 57109

OUT AND ABOUT At the South Dakota Medical Group Management Association meeting, April 26.

With Dr. Dan Heinemann and Arthritis Foundation Executive Director Darci Hustrulid at the April kickoff breakfast for the Arthritis Foundation’s April 20th Gala.

MED Magazine is produced eight times a year by Midwest Medical Edition, LLC, which owns the rights to all content. Every effort is made to ensure accuracy, however Midwest Medical Edition, LLC, cannot be held responsibly for consequences resulting from errors or omissions. Reproduction or use of the contents of this magazine is prohibited. Copyright 2018 Midwest Medical Edition, LLC.

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6| ACS ‘Magic of Hope’ Event Raises $142,000 See photos from the April gala to support cancer prevention, detection and research

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8| No Longer Lost in Translation Improved radiology reporting aims to reduce diagnostic and follow-up system errors

This Fall, MED is going all digital! NOW is the time to get on the email list to make sure you never miss an issue. Look for the signup link on the front page of our website. Love the print version? No problem! You can subscribe to keep receiving it. More information is coming soon.

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■ By Anne Geske

11| Interview: Sioux Falls Pediatrician Benson Hsu, MD Newly-named Bush Fellow discusses the future of data sharing in public health 20| Violence Prevention in Healthcare: Human Beings are Sensory Beings ■ By Theresa Parish

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22| Technology: Advanced Treatment for Autoimmune Disorders Now Available in Rapid City TPE service returns to the Black Hills thanks to creative thinking and cooperation 24| Minimizing Surgical Side Effects with Sentinel Node Biopsy New technique means many area gynecologic cancer patients may avoid complications of lymph node dissection 26| Lung Cancer Trial Opened Door for New Research Opportunities Why Sanford is having an easier time getting national research opportunities 27| Sioux Falls VA Highlighted for Equitable Healthcare

ON THE COVER

PRAIRIE LAKES HEALTHCARE SYSTEM 16 PAGE

PORTRAIT OF A TOP 20 RURAL HOSPITAL ■ By Alex Strauss

While the population of Watertown, South Dakota has remained more-or-less steady for 20 years, the town’s independent hospital has continued to grow and expand, adding both square footage and services at a rate rarely seen in a rural facility. How has Prairie Lakes Healthcare System done it? We spoke with some top leaders and providers to find out.

10 | South Dakota Enacts Data

Breach Notification Law

25 | Regional Health Rapid City

Hospital Recognized for Maternity Care

REGULAR FEATURES

How the hospital keeps its c-section rates well below the national average

4 FROM US TO YOU 12 N EWS & NOTES You early summer roundup of news around the region.

30 T HE QUESTION: WHAT IS YOUR TOP VACATION DESTINATION?

■ By Thomas Johnson

28 | Nervous Speaker?

Here’s How to Present Like the Pro You Are

■ By Alex Strauss

On the cover: Prairie Lakes Urologist Jeffrey Smith, MD, President and CEO Jill Fuller, Urologist Chris Adducci, MD, and Dot McAreavey, PT, Director of Rehabilitation Services, stand in the unfinished Prairie Lakes Specialty Clinic, which is on track to open this Fall. Photo courtesy Prairie Lakes.

(l to r) Thomas Asfeldt, Karen Asfeldt, Dr. Heather Karu, Dammika Karu, Steff

ACS ‘Magic of Hope’

Event Raises

$142,000

HE AMERICAN CANCER SOCIETY’S annual “Magic of Hope Benefit” held on April 21 in Sioux Falls raised more than $142,000 dollars for programs that support cancer prevention, detection, research, and advocacy.

MED was proud to help sponsor the evening and to meet so

many of our readers at the event, which included entertainment from Main Stage Ballet and The Unnotables band, casino-style gaming, hors d’oeuvres, and a silent auction. Congratulations to ACS for a successful event! ❖

WEB EXTRA

❱ S ee more photos from the event on our website. (l to r) Steff, Ryan Bohy and his wife, Dr. Kimberlee Tams.

(l to r) Kris Gaster, Dr. Wade Dosch, Dr. Mary Meierhenry, Steff

(l to r) Jessica Johnson, Kurt Johnson (behind Jessica) Dr. George Angelos, Dr. Brad Coots, Carmen Coots MidwestMedicalEdition.com

June 2018

No Longer Lost in Translation

Improved radiology reporting aims to reduce diagnostic and follow-up system errors BY ANNE GESKE

ETTING THE DIAGNOSIS RIGHT—what could be more important in assessing a patient’s symptoms? Imaging tests such as X-rays, CT scans, MRIs, ultrasounds and mammograms are essential tests within the diagnostic toolbox. So, it follows

that any communication between the radiologists interpreting these exams and the clinicians who order them is essential. And yet, it’s not so simple.

THE COMMUNICATION CHALLENGE Radiology is a complex specialty, and radiologists use their own intricate language, which must

“

then be translated, so to speak, into a clear and comprehensible interpretation—even for the

COMMUNICATION

for error is significant. In fact, MMIC found that the misinterpretation of tests and results,

BETWEEN

including radiologist-to-clinician communication, is a contributing factor in 27 percent of

highly trained medical professionals who order them. Given that communication between radiologists and clinicians usually takes place within

GIVEN THAT

written reports and the electronic health record (EHR)—not in person or via phone—the potential

RADIOLOGISTS AND CLINICIANS USUALLY TAKES PLACE WITHIN

malpractice allegations.1 More effective communication between radiologists and ordering clinicians may have made a difference in these cases.

THE REFERENCE PROCESS In 2015, the American College of Radiology (ACR) supported a process radiologists could use

WRITTEN

when communicating to referring clinicians through the radiology report: The radiology report

REPORTS

should include a standard management recommendation suggesting next steps for evaluation

AND THE

and a reference supporting that recommendation.2

ELECTRONIC HEALTH RECORD (EHR)—NOT IN PERSON OR VIA PHONE —THE POTENTIAL FOR ERROR IS SIGNIFICANT.

”

Sue A. Crook, MD, FACR, is a radiologist with Suburban Radiologic Consultants (SRC) in Bloomington, Minnesota, whose staff works with large Twin Cities health systems that have been rolling out the “reference process,” as it’s referred to in short, since 2015. “We help clinicians know what the next step is, if they’re unaware of it,” says Dr. Crook. “Following the impression of our report, we suggest further follow-up—such as another imaging test or a recommendation for a specialist—and what the evidence-based reference is for that.” The reference process is a way for radiologists to uniformly use consensus guidelines in their recommendations.

REDUCING HUMAN ERROR Without such a process, the referring clinician interprets the complex terminology in the radiologist report and makes their own determination for next steps. And because clinicians are human, perceptions and second-guessing may come into play. Radiologists have sometimes had to work to overcome perceptions by striking a balance between what might be seen as over-diagnosing, which is making sure results aren’t dismissed that point to further work-up, and under-diagnosing, in which more serious issues might fall through the cracks. “In the past, there have been lawsuits where a radiologist interpreted results correctly,” Dr. Crook explains, “but the referring physician thinks the radiologist overcalled it and decides to dismiss the issue. With this new process, I can say in my report, ‘I’m worried this patient may have cancer. We need to do the next test, and here is the evidence-based reference.’” The reference process helps ensure that patients who need further evaluation get it. This relatively new patient-safety process may soon become a common best practice. Its

MidwestMedicalEdition.com

implementation is recognized as a cutting-edge way to ensure that communication between radiologists and busy clinicians doesn’t fail. “Along with physicians, we have PAs and NPs referring patients to us,” Dr. Crook says. “They’re busy, and when they see the management recommendation, it kind of pops out to them. It’s something they can look at and pay attention to make sure that they understand the report, the words used and why those words are important.”

CULTURE SHIFT In Dr. Crook’s experience, healthcare culture is becoming more collaborative. More radiology groups are using management guidelines to prevent diagnostic error, prevent follow-up system failures and improve communication with clinicians. As medicine gets more complicated, medical professionals are realizing they can’t do it all. “That’s why you look to the expert in that area,” Dr. Crook says. “As we get more collaborative, physicians are happy for the help—they’re more accepting of it. Healthcare is becoming more patient-centered and more of a team effort.” ❖ References 1. Brink, 2017 Spring Issue. http://bit.ly/2AUyler Accessed December 4, 2017. 2. American College of Radiology. ACR supports collaboration to reduce medical diagnostic errors. http://bit.ly/2nuV8YS Published September 22, 2015. Accessed December 7, 2017

23RD ANNUAL

HOT HARLEY

NIGHTS JULY 12-14 HOTHARLEYNIGHTS.COM

FEATURING... NATIONAL ACT

SAWYER

Anne Geske is Managing Editor of Brink magazine, which is published by Constellation, a partnership of mutual liability insurers, including MMIC.

WEB EXTRA

BROWN TO BENEFIT

❱ F or more tips on reducing system errors, see the full version of this article on our website

June 2018

South Dakota Enacts Data Breach Notification Law BY THOMAS JOHNSON

FFEC TIVE J U LY 1 , HE ALTHCARE

There is a “risk of harm” exception in the new

providers, business associates, and other

law which provides that if the breached entity

businesses maintaining patient informa-

“reasonably determines that the breach will not

tion in South Dakota, will have a new law

likely result in harm to the affected person”, noti-

with which to adhere.

fications do not need to be issued. The law is

In the 2018 legislative session, South

substantially similar to data breach notification

Dakota’s legislature passed–and its governor

laws from other states, but it does contain some

signed–South Dakota’s first data breach notifica-

unique provisions. This includes a mandatory

tion law. Prior to the new law, South Dakota was

reporting obligation to credit reporting agencies,

one of only two states without a state law require-

which is something that does not expressly appear

ment to notify individuals in the event of a data

in HIPAA’s regulations.

breach. The law’s enactment signals the continu-

Interestingly, there is some question whether

ing emphasis in federal and state law, and

the new law creates a private cause of action for

regulatory environments, on protecting individ-

damages in violation of the new law. The law’s text

ual’s personal information.

does not create such a private cause of action. How-

Under the new law, which will be codified

ever, the law incorporates South Dakota’s Deceptive

in South Dakota’s trade regulation statutes,

Trade Practices Act, which expressly authorizes a

“Personal Information” and “Protected Informa-

civil cause of action. The Attorney General is also

tion” are broadly defined to include a wide array

authorized to prosecute violations of the law,

of personally identifiable information.

carrying penalties up to $10,000 per day for each

Categories of personal or protected information include a person’s first and last name combined with the following: • social security number; • driver’s license number or other government ID; • account number with access code/routing number; • health information as defined under HIPAA; and •e mployee ID in combination with an access code or biometric data.

violation. The new law exempts information holders that are subject to HIPAA and its regulations, as long as those information holders comply with HIPAA’s requirements. Nonetheless, stakeholders in the healthcare industry should take note of South Dakota’s new data breach regime. It may have incidental effects on their data security practices, including their notification obligations. From an enforcement perspective, it remains to be seen whether or not individuals can now expressly pursue private causes of action for certain data breaches in South Dakota. ❖

Generally, the law requires “information holders” to notify South Dakota residents of any “breach of system security” involving “personal or protected information,” within 60 days of discovery. The law also requires notice to the

Tommy Johnson is a corporate and healthcare lawyer at Boyce Law Firm in Sioux Falls.

Attorney General in data breaches involving greater than 250 residents.

MidwestMedicalEdition.com

[ INTERVIEW ]

Pediatrician and Bush Fellow Benson Hsu, MD

IOUX FALLS PEDIATRICIAN and Chief Medical Analytics Officer Benson Hsu, MD, of Sanford Health, is one of 24 people chosen from a pool of 751 applicants to receive a 2018 Bush Fellowship. The Bush Fellowship provides up to $100,000 over 12 to 24 months to support

fellows in developing “leadership skills and attributes”. MED caught up with Dr. Hsu to find out how he plans to use this special opportunity.

MED: What drew you to apply for the Bush Fellowship?

cohorts of leaders and community

BH: I was asked to lead enterprise

activists and begin collecting and

data analytics at Sanford. They

combining multiple data sets. I hope

wanted a central place to hold the

BH: In the pediatric ICU, I’m

to demonstrate the benefits of

data and one language for managing

fortunate to be able to care for some

combining population health data

it. This is where the seeds of my

extremely ill children. But I always

and encourage more sharing of this

idea for the Bush Fellowship came

have this lingering thought in my

data as a prevention strategy.

from. We want to figure out how sharing that data in a protected way

mind: Is there something we could have done to keep this child from needing care in the first place? My mind goes to immunization, nutrition, seatbelts, etc. And I

might be able to optimize the health MED: How does your recent article of the community. ❖ in the Harvard Business Review relate to the fellowship? MEDAd2018_RAS_Layout 1 3/22/2018 3:25 PM Page 1

wondered, are there better ways to identify at-risk kids earlier?

MED: Your original intent was to pursue more education with this money, but you’ve changed your mind. Why?

Applying a Human Factors and Occupational Health Philosophy to Risk Management.

BH: When I was selected as a finalist, I spoke with a Bush Foundation member who said, ‘You have had a lot of schooling. What else could you do to grow as a leader?’ I realized that I needed to take myself out of my comfort zone. I decided instead to reach out to

WEB EXTRA

Highly Trained Team of Specialists with Expertise in: Human Factors Engineering & Ergonomics Government Compliance and Regulation Industrial Hygiene Industrial Safety Occupational Therapy Psychology

❱R ead the Harvard Business Review article “Making Better Use of Health Care Data”, co-authored by Dr. Hsu and Emily Griese.

❱ L earn more about eligibility

Workers’ Compensation. It’s what we do. It’s who we are.

RASCompanies.com

for the Bush Fellowship

June 2018

Happenings around the region

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska

AVERA

BLACK HILLS

Avera eCARE, including telemedicine and monitoring services for ICU, Emergency, Pharmacy, Senior Care, Correctional Health, Specialty Clinic, Behavioral Health, Hospitalist and School Health, is celebrating 25 years in operation. Avera began telemedicine with a pilot project in 1993, connecting specialists in Sioux Falls to rural community partner facilities. In 2004, Avera expanded its telemedicine offerings to include eCARE ICU, its first 24-hour, on-demand service. Today, the system extends specialty care from its eHelm “virtual health center” in Sioux Falls to 400+ sites in 17 states. In its history, it has served over 1.4 million patients and saved an estimated $200 million in healthcare costs and millions of miles of travel for both physicians and patients.

Regional Health and Mitchell Technical Institute (MTI) have combined their Radiologic Technology education programs into a single program that allows students to complete clinical studies on both sides of the state and earn an associate’s degree from MTI in as little as 21 months. Demand for Radiological Technicians is increasing. MTI has a 98 to 99 percent job placement rate within six months of graduation. The cost of the MTI program is less than $23,000 for tuition, fees, books and uniforms. “Regional Health is proud to partner with a forward-thinking school like MTI. Our students will be well-trained and ready to start their careers in less than 2 years,” said Jamie Madden, Senior Director of Medical Imaging at Regional Health. Rapid City Medical Center will soon offer Platelet Rich Plasma (PRP) treatments for facial and vaginal rejuvenation. The in-office procedure uses components of patient’s own blood to naturally promote the production of collagen and growth factors to the treated area. The treatment has been shown to improve skin texture, thickness and tone and reduce the appearance of fine lines and wrinkles without the use of synthetic fillers. When used for hair loss, it has been shown to increase density of the hair by 30 to 40 percent and to stimulate regrowth. For gynecologic patients, PRP is injected into symptomatic areas to restore suppleness and increase lubrication and arousal.

SANFORD

The genomic medicine program at Sanford Health is expanding to Ireland through collaboration with the Hermitage Medical Clinic in Ireland. Physicians from Ireland will open a clinical initiative that explores how genomic profiling of tumors might help improve treatment options for patients with advanced or rare forms of cancer. The initiative represents the introduction of genomic testing in Ireland as a tool for deciding on cancer treatment.The initiative is modeled after Sanford Health’s GEMMA and COMPASS studies. The agreement with Ireland was part of a larger announcement where Sanford World Clinic also expanded into New Zealand, Vietnam, Costa Rica and South Africa. Sanford already has clinics in Ghana and China and owns a minority stake in a clinic in Munich, Germany.

Leaders form Sanford Health recently spoke about the Lorraine Cross award and other innovations at a conference at the Vatican. The conference, “Unite to Cure: The Fourth International Vatican Conference – How Science, Technology and 21st Century Medicine Will Impact Culture and Society,” brings together leaders in healthcare, science and research from around the world as part of the Cura Foundation conference, which is held every other year in Rome. This is the second time Sanford Health has presented at the invite-only event.

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A scientific advisory board has convened to narrow down the possible winners for the $1 million Lorraine Cross Award from Sanford Health. The prize will be given for the first time in December to recognize excellence in life-changing treatments, medical innovations and research. The award, which will be given every other year, is one of the top five most lucrative of its kind. Candidates for the award are chosen through nominations from the public and a computer algorithm that sifts through medical publications in search of great discoveries. The first step in choosing a winner is for the scientific panel to narrow down the candidates and make a recommendation.

June 2018

The Food and Drug Administration recently approved two new clinical trials involving adipose-derived stem cells at Sanford Health. Sanford now has four FDA-approved clinical trials involving adipose-derived stem cells, with a fifth pending, including a pivotal rotator cuff study, a facet joint study, a wrist osteoarthritis study, and a study for non-healing leg wounds. Sanford Health had the first FDA-approved adipose-derived stem cell trial in the United States in 2016, with its first rotator cuff study. Data will be reviewed and study reports will be completed for that trial by the end of the summer.

Neonatal Nurse Practitioner Mallary Van Tol (left) and Labor and Delivery RN Jolene Hooyer (right) are the latest Sanford nurses to be recognized with DAISY awards for exceptional nursing. Van Tol’s nomination says she “always makes time to sit down with families in the NICU to answer their questions and calm their fears”. Hooyer was described as calm, encouraging, patient, and friendly.

SIOUXLAND The Nylen Cancer Center in Sioux City is now offering TrueBeam, an advanced image-guided radiation therapy system. TrueBeam’s sophisticated software and respiratory tracking system confirms the exact location of the tumor or area to be treated, track its movement while breathing and protect nearby organs and healthy tissue from unnecessary radiation.The TrueBeam system rotates around the body to deliver radiation therapy from nearly any angle. The treatment beam can be aimed at a tumor anywhere in the body from multiple angles to hit the target in a complete three-dimensional manner. TrueBeam’s treatment beam can be delivered with submillimeter accuracy and varying intensity.

MidwestMedicalEdition.com

• Happenings around the region

News & Notes

Happenings around the region

JEFF LAMOREUX Mercy Medical Center-Sioux City has announced the appointment of Jeffrey Lamoreux as director of facilities. Lamoreux is a graduate of South Dakota State University where he received a Bachelor of Science in Electronics Engineering Technology with a minor in business. He has been serving in an interim role of facilities director since January of 2018. Prior to this, Lamoreux served as Mercy’s continuous improvement specialist.

JD WELANDER General Surgeon, Dr. JD Welander has joined Midlands Clinic in Dakota Dunes. Dr. Welander received his Doctorate at Creighton University School of Medicine and completed his residency at the Iowa Methodist Hospital. In addition to his education, he has published research in the Journal of Trauma and Acute Care Surgery. He is offering a full range of the latest general surgery services including, but not limited to, breast cancer surgery, colorectal surgery, gallbladder surgery, hernia surgery, laparoscopic surgery, minimally invasive surgery, robotic surgery, and trauma surgery.

WEB EXTRA

FADI RZOUQ Gastroenterologist and Advanced Endoscopist Fadi Rzouq, MD, has joined Midlands Clinic in Dakota Dunes. Dr. Rzouq received his MD from the University of Jordan and completed his residency at the University of Washington School of Medicine. He completed both his gastroenterology fellowship and an advanced endoscopy fellowship at the University of Kansas School of Medicine and is board certified in internal medicine and gastroenterology. Dr. Rzouq is qualified to treat Barrett’s esophagus, pancreas diseases and biliary systems using Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound. He also subspecializes in hepatology and performs therapeutic endoscopy.

OTHER The Department of Veterans Affairs (VA) Sioux Falls Health Care System hosted its first ever baby shower for Veterans who are new parents and Veterans and their significant others who are parents-to-be in early May. New parents and parents-to-be had dinner and an opportunity to meet other Veteran parents and parents-to-be, learn about topics of interest to new parents, play games, hear a speaker, and take home a new baby kit. Sioux Falls is one of 60 sites across the country to participate in the nationwide baby shower.

IAN ALVERSON Ian Alverson, PharmD, was named the 2018 Preceptor of the Year award by the South Dakota State University College of Pharmacy and Allied Health Professions in Brookings. Alverson is a 2012 graduate of the pharmacy program at SDSU and is currently employed at Madison Regional Health System and is a board certified pharmacotherapy specialist. Preceptors provide practical experience and training for students typically in their fourth year of pharmacy school, preparing them for their future careers. Alverson has served as preceptor for the past 5 years and has supervised over 30 pharmacy students in a clinical setting at various levels.

PAT RONAN Pat Ronan, PhD, Research Scientist and Associate Professor of Psychiatry and Neuroscience, Sanford USD School of Medicine, and his colleagues published an article in the March 2018 edition of Alcohol and Alcoholism titled Central Administration of Cyclosporine A Decreases Ethanol Drinking. This study, performed at the Sioux Falls VA Medical Center, demonstrated that immunosuppressants act in the brain to significantly decrease binge-like alcohol consumption in mice. In the past few years numerous lines of converging evidence have implicated brain immune mechanisms in alcoholism. This is the first study to show that directly targeting a specific protein in a neuroinflammatory pathway is sufficient to stop excessive alcohol drinking in an animal model. This study opens the path to discovering new therapies for alcoholism.

ASHLESHA KAUSHIK Ashlesha Kaushik, MD, has joined UnityPoint Clinic Pediatric Infectious Disease – Sergeant Bluff. Dr. Kaushik received her MD from Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India. She completed her residency in Pediatrics at St. Joseph’s Regional Medical Center (Mount Sinai School of Medicine of New York University), and a fellowship in Pediatric Infectious Diseases at the University of Texas Southwestern, Children’s Medical Center in Dallas. Dr. Kaushik is certified by the American Board of Pediatrics: Pediatrics; American Board of Pediatrics: Pediatric Infectious Diseases; and Healthcare Epidemiology, Infection Control and Antimicrobial Stewardship: Society of Healthcare Epidemiology of America (SHEA).

❱ F ind the full version of each of these news items online 14

MidwestMedicalEdition.com

ANNA BAHNSON Anna Bahnson, a Pillar Three student in the University of South Dakota Sanford School of Medicine, is a 2018 recipient of the Excellence in Public Health Award, presented by the US Public Health Service. Bahnson was recognized for her research and education project about skin cancer risks associated with working in agriculture, and the importance of educating cosmetologists to identify skin cancer symptoms on their clients. Bahnson’s project, titled “Skin Cancer Education in the Rural Salon” is designed to help educate cosmetologists in rural South Dakota about skin cancer lesions. Midwest ENT in Sioux Falls is among the first practices in the US to offer the SINUVA sinus implant. SINUVA was recently approved by the FDA to treat nasal polyps in adults who have had previous ethmoid sinus surgery (ESS). SINUVA is a non-surgical option that can be placed during a routine physician office visit and is clinically proven to reduce nasal congestion and polyps by opening the sinus and delivering anti-inflammatory medicine to treat nasal polyps. Orthopedic Nurse Carole Schultz, LPN, has received the 2018 Award for Nursing Excellence at Yankton Medical Clinic, PC. Nominations are submitted by the nursing staff and reviewed by a randomly selected award committee. Schulte has been a nurse for 40 years and has worked at Yankton Medical Clinic for 24 years. This is the third year for the award. Yankton Medical Clinic oncologist/ hematologist Dr. Mary Lee Villanueva has been recertified as a diplomate of the American Board of Internal Medicine in oncology. Dr. Villanueva is also board certified in internal medicine, hematology and is a clinical associate professor at the USD Sanford School of Medicine. The 2018 Dr. Theodore H Sattler/ Yankton Medical Clinic, PC, $1000 scholarship has been awarded to a student from Yankton High School. Recipient Javier Lopez plan to study medicine at Stanford University. The scholarship program has been in place for 22 years. High schools with the clinic’s service area are eligible to participate.

MANDY ROUNSEVILLE-NORGAARD Audiologist Mandy Rounseville-Norgaard, AuD, a Sioux Falls native who has experienced hearing loss herself, has just opened her new private practice, Sioux Falls Audiology Associates. Dr. Rounseville-Norgaard is a native of Sioux Falls and a graduate of the University of South Dakota and Missouri State University. She earned her doctorate degree at the University of Florida. In addition to practicing audiology at the Sioux Falls VA Medical Center, Dr. Rounseville-Norgaard’s experience includes private practice; ear, nose & throat; and education.

Beef As a First Food STARTING STRONG FOR OPTIMAL GROWTH Beef contains 10 essential nutrients including protein, zinc and iron, to fuel a child’s early growth and development.1 With its bundle of nutrients, beef as a complementary first food is associated with normal physical growth in infants.2 VITAL NUTRIENTS FOR A BUDDING BRAIN Infants and toddlers need protein, iron and zinc – all nutrients that can be found in beef – to support brain health and optimal cognitive development.3 NURTURING IMMUNITY Zinc and iron play an important role in an infant’s developing immune system.4 Introduction of foods that are a good dietary source of iron and zinc, like beef, early in life supports the growth of healthful bacteria in the gut, which may help to enhance immune function.5, 6 1. U.S. Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Release 28 (Slightly revised). Version Current: May 2016. Internet: http://www.ars.usda.gov/ba/bhnrc/ndl 2. Tang M, Krebs NF. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. Am J Clin Nutr 2014;100:1322-8. 3. Nyaradi A, et al. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Front Hum Neurosci 2013;7:97. 4. Chandra RK. Nutrition and the immune system from birth to old age. Eur J Clin Nutr 2002;56:S73-6. 5. Palmer C, et al. Development of the human infant intestinal microbiota. PLoS Biol 2007;5:e177. 6. Krebs NF, et al. Effects of different complementary feeding regimens on iron status and enteric microbiota in breastfed infants. J Pediatr 2013;163:416-23.

Visit BeefResearch.org for more research on Beef’s Role as a Complementary Food.

16-25752-SD-BeefFirstFood-Ad.indd 1

June 2018

Susan G. Komen Great Plains is introducing a new Treatment Assistance Program for individuals in Nebraska and South Dakota to help eligible breast cancer patients cover costs associated with treatment. The programs are among ten new community programs that received a total of more than $400,000 to provide medically underserved patients with breast health education, breast cancer screenings, and various types of support over the next year. The programs were selected for funding through a competitive application and independent review process.

4/25/2018 2:54:48 PM

• Happenings around the region

News & Notes

Prairie Lakes Health Portrait of a Top 20 Rural Hospital

BY ALEX STRAUSS

HIS SPRING, PRAIRIE LAKES HEALTHCARE SYSTEM IN WATERTOWN, South Dakota, a town of 22,000, was named among the Top 20 Rural Community Hospitals in the nation by iVantage Health Analytics. Prairie Lakes was the only independent hospital in our region to make the list, which was based on eight indices including inpatient and outpatient market share, quality, outcomes, patient perspectives, costs, charge and financial stability.

How has this small-town health system, which now includes a cancer center, a surgical center, and

dialysis units, managed to achieve this level of success, continually expand its size and services, and remain independent while the population of Watertown has held steady? President and CEO Jill Fuller says it started more than 15 years ago with an intentional decision by the hospital board. At that time, Prairie Lakes employed only one specialty physician—a radiation oncologist. “Our board made a strategic decision in 2003 when I was Chief Nursing Officer that we were going to better serve the 90,000 people in our 10-county service area by expanding our services,” says Fuller, who took the helm of the organization in 2009. “We are 100 miles away from Sioux Falls. Some of our people are 100 or 150 miles away from specialty services. So we knew they needed better access.”

Architect's rendering of Prairie Lakes Healthcare System with the new Prairie Lakes Specialty Clinic addition

October 2017

“ IT WAS SO ‘OUT-OF-THE-BOX’ TO IMAGINE THAT WE COULD START AN INT 16

Fuller says the decision to expand

and small organizations in South

services, along with a commitment

Dakota and beyond, and continue to

to a) maintain a substantial financial

expand its campus and technology—

cushion, b) diversify to keep up with

all without the financial intervention

changes in healthcare utilization, and

of another health system.

c) establish good relationships with

“We knew that a lot of people

critical access hospitals (including

were going out ot town for the kinds

helping them keep certain services

of services we now offer here, but it

in their own towns) set Prairie Lakes

was so ‘out-of-the-box’ to imagine

on its current course.

that we could start, for instance, an

It is a course that has allowed this

interventional cardiology program

81-bed hospital to now offer nine

in Watertown, South Dakota,” says

specialty service lines (including

Fuller. “The startup costs alone were

specialties like nephrology and inter-

huge.”

ventional cardiology that are often

As the hospital’s latest expansion,

unheard-of in small communities),

a $32 million dollar, 68,000 square

employ 23 physicians, maintain 21

foot specialty clinic, nears comple-

outreach clinics, collaborate with big

tion, it is clear that the gamble has

Photo courtesy Prairie Lakes.

care System

Jeffrey Smith, MD, CEO Jill Fuller, Dot McAreavey, PT, and Chris Adducci, MD.

TERVENTIONAL CARDIOLOGY PROGRAM IN WATERTOWN, SOUTH DAKOTA. ” 17

Architect's rendering of a corridor in the new Prairie Lakes Specialty Clinic which opens this fall.

paid off. “When I came here in 2000, our total patient revenue was 33 million,” says Fuller. “Today we are at 100 million. That came through adding services. Without doing that, we would have been on a totally different path.”

ATTRACTING QUALITY PROVIDERS While many rural healthcare facilities struggle to fill positions, Prairie Lakes has managed to excel in this area, too.

cath lab equipment, phototherapy for

input during the planning stages. “It

Fuller says many physicians, espe-

dermatology, a therapy pool, and a

was great to be able to work with

cially those in the latter part of their

new minimally option for benign

administration and the architects to

careers, appreciate the slower pace of

prostatic hyperplasia called Rezum.

determine exactly what was going

life in this rural community, the

“You don’t have to go seven layers

to be best for our needs,” says Smith.

natural beauty of the area, and the

up the chain if you want to get some-

“I have never done anything like that

warmth and friendliness of patients

thing done,” says Adducci, who helped

before.”

here. The hospital’s financial stability

bring Rezum to Watertown. “With

and its independent status are, for

Rezum, I said ‘here’s what I think we

many, the icing on the cake.

need’ and we were able to get it up

Urologist Chris Adducci, MD, one

and going quickly. Communication

of two urologists in town, says he was

has never been a problem here. If you

on the brink of burnout when he left

want to say something to Jill, you can

his multi-specialty clinic in Bismarck

just walk down there and talk to her.

nine years ago to join Prairie Lakes.

They are very responsive.”

He was attracted not only to the

SERVICES AT PLHS • CARDIOLOGY • DERMATOLOGY • ENT • GENERAL SURGERY • H OSPICE & HOME CARE

• P T & REHABILITATION • NEPHROLOGY • PULMONOLOGY • UROLOGY • WOUND CARE

promise of a higher quality of life for

INVITING INPUT

himself, but also to the high quality

That responsiveness and the oppor-

Along with dermatology, the

of care the hospital was providing, as

tunity to help guide innovation were

two-story Prairie Lakes Specialty

evidenced by its multiple service lines

also big draws for California native

Clinic will also house cardiology,

and top-of-the-line equipment.

Jeffrey Smith, MD, the only dermatol-

general surgery, nephrology, pulm-

“I don’t think many people under-

ogist for 100 miles around Watertown.

onolog y and urolog y. Physical

stand how unique this is,” says Dr.

Before he joined Prairie Lakes two

therapy, occupational therapy,

Adducci. “Any town this size would

years ago, Watertown hadn’t had a

speech therapy and Glacial Lakes

love to have this many service lines

full-time dermatologist for at least a

Orthopaedics will now be together

available on the ground. But it is a

decade.

on one floor in the new building and

difficult thing to carry off. Starting a

“I really liked that the hospital is

a new helipad on the roof will pro-

service line is a gamble. You have to

small and independent because there

vide direct access to the radiology

tool up and hope that the bodies are

is so much room for autonomy,” says

department and Emergency Room

there to make it successful. They have

Smith, who also provides monthly

below in the adjacent building.

managed to figure out a way to attract

outreach services in Milbank. “We

“Things have been growing here

physicians who are good at what they

are in the business of taking care of

like crazy and this facility is being

do and not grind them into the dirt.”

people and we put our priorities where

built with a view toward continued

Not only has Prairie Lakes been

they need to be. I feel like I am able to

growth,” says Smith, who will be able

innovative in finding alternatives to

make choices that are in the patients’

to offer phototherapy services in the

round-the-clock call—even for solo

interests without anyone breathing

new building. “Prairie Lakes has a lot

specialty providers like Adducci—but

down my neck.”

of foresight. They have really helped

they have demonstrated both the abil-

Dr. Smith’s clinic will relocate to

our clinic get up to par, including an

ity and the willingness to invest in

the new building when it opens this

EMR system which enables us to be

new technology. A few of the upgrades

Fall. Smith says the hospital not only

very efficient. They are setting it up

at Prairie Lakes this year include new

welcomed but invited his direct

for long-term success.”

MidwestMedicalEdition.com

“ I FEEL LIKE I AM ABLE

TO MAKE CHOICES THAT ARE IN THE PATIENTS’ INTERESTS WITHOUT ANYONE BREATHING DOWN MY NECK. ”

INNOVATION AND COLLABORATION For Physical Therapist Dot McAreavey, Director of Rehab and Wound Care Services, the hydrotherapy pool in the Specialty Clinic is another example of Prairie Lakes’ commitment to invest wisely in the right technology. The new pool, with a treadmill floor that can be raised or lowered to adjust resistance, is expected to pay off big for pain patients—a special focus for her department.

YOUR HEALTH IT LEGAL TEAM

“The thing I really appreciate about Prairie Lakes is that they allow employees, from directors all the way down the chain, to be innovative,” says McAreavey, who has been with the organization

Tommy Johnson has extensive experience

since 2004. “You can say, ‘I have a patient who has

advising his clients on all matters relating

this problem. We don’t have an option for them. What can we do?’ We are able to think outside the

to health information privacy and security.

box without having to go through quite so much

From EMR contracting to HIPAA breach

red tape. We are more fluid in how we move, which is more productive and better for patients.” McAreavey gives a lot of the credit to collabo-

investigations, Tommy and the Boyce Law Firm can help you safeguard your data.

ration, both within and outside of the organization. As an example, she cites last summer’s joint replacement education program that was run through Prairie Lakes to support Glacial Lakes

Data Privacy and Security • Health IT

Orthopedic patients. Prairie Lakes’ partnership with Lake Area Technical Institute for physical therapy education is another example. “These kinds of partnerships are fun and keep you thinking and staying innovative and creative,” says McAreavey. “That’s important in a small town where your patients are your friends and neighbors. PT is always personal, but it’s even more so here.” CEO Fuller says collaboration has also been pivotal for Prairie Lakes Healthcare as a whole. “Collaboration and partnership is an essential part of our success,” she says. “We collaborate with Sanford and Avera and even providers in Minne-

Tommy Johnson (605) 731-0215

apolis. We are able to pick and choose, which is to our advantage. I have also visited every hospital in our services area. This is really what population health should be about, where we all work

(605) 336-2424 • www.boycelaw.com 300 S. Main Ave, Sioux Falls, SD 57104

collaboratively. That is a novel concept.” ❖

June 2018

VIOLENCE PREVENTION in HEALTHCARE SENSORY BEINGS HUMAN BEINGS are

BY THERESA PARISH

ANY HEALTHCARE AND SOCIAL SERVICE AGENCIES look for ways to prevent injuries to their employees. Injury prevention training to reduce needle sticks, strain injuries, and falls are very common. However, a trend toward violence in the workplace has led to an increase in employee train-

ings to help contain this threat. Healthcare workers, who are very comfortable in their workplace, sometimes forget that

a hospital or clinic can be a very stressful place to the general population. A visitor may associate the hospital with a traumatic event such as the death of a family member, a childhood experience, or even their own mortality. They may feel the staff are keeping something from them, making them wait too long, or don’t care about them, and may react by lashing out. There are some populations that may even need more understanding due to their issues with a sensory processing disorder. As an occupational therapist who specializes in sensory processing and working with individuals with intellectual and developmental disabilities, I see a need for training to increase awareness of the sensory needs of these populations, especially since they often unintentionally injure caregivers. The need for training is increased when considering the high probability that healthcare and social service workers will come into contact with a patient or visitor who suffers from one of these issues.

“HEALTHCARE WORKERS . . . SOMETIMES FORGET THAT A HOSPITAL OR CLINIC CAN BE A VERY STRESSFUL PLACE TO THE GENERAL POPULATION.” 20

MidwestMedicalEdition.com

These individuals may have issues

issues, such as autism, but can also occur

with transitions to new places, people,

in anyone under stress or a perceived

or tasks. Different smells, sights, and

stress.

noises can increase the perception of a

We are all human beings, therefore

threat in their world and initiate the fight-

we are all sensory beings. Taking steps

REFERENCES 1 Dressner, M. (2017). Hospital workers: An assessment of occupational injuries and illnesses. Monthly Labor Review. https://doi.org/10.21916/ mlr.2017.17.

flight response. This response releases

to train staff on what sensory processing

hormones from the sympathetic nervous

is; how it affects each and every one of

system, especially adrenaline, and sends

us, especially in times of stress; and

a signal to the body for them to fight or

implementing protocols in the workplace

flee. In a hospital or clinic setting, this

to increase empathy and decrease envi-

can quickly become a combative or vio-

ronmental stressors can lead to decreased

lent situation.

incidences of some violent behaviors. â?&#x2013;

Knowing how to de-escalate is very

The Arc. (2011). Introduction to intellectual disability. Retrieved from https://www.thearc.org/ sslpage.aspx?pid=2448

important; however, with some sensory processing disorders, aggressive behaviors happen out-of-the-blue, with no

Anxiety and Depression Association of America. (n.d.). Facts and statistics. Retrieved from https://adaa.org/ about-adaa/press-room/ facts-statistics.

warning, and no time to de-escalate. When an individual is in the fight-flight response, de-escalation is often not an option as the â&#x20AC;&#x153;survival brainâ&#x20AC;? has taken over. This response can occur not only in someone known sensory processing

WEB EXTRA

Occupational 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/OSHA382.pdf

Theresa Parish is an occupational therapist. She is an Ergonomics and Loss Control Specialist/Sensory Processing Specialist with RAS.

5 Alzheimerâ&#x20AC;&#x2122;s Association (2018). Alzheimerâ&#x20AC;&#x2122;s disease facts and figures [Video File]. Retrieved from https://alz.org/index.asp.

â?ą L earn how violence prevention can start at the reception desk.

â?ą F ind out how many hospital

â?ąH ow common are developmental

injuries are the result of violence. (The answer may surprise you)

and intellectual disabilities?

Compassion . Experience . Trust Â Â? Â? Â? Â? Â Â 605.334.1930 6301 S. Minnesota Ave., Suite 300 www.plasticsurgerysiouxfalls.com June 2018

[ T E C HN O L O G Y ]

Advanced Treatment for Autoimmune Disorders Now Available in Rapid City

”

IN THE PAST, SOMETIMES PEOPLE WOULD DECIDE NOT TO HAVE THE TREATMENT OR TO TAKE THE HIGH DOSE IMMUNOSUPPRESSION OVER HAVING TO TRAVEL ALL THE WAY TO SIOUX FALLS.

“

TECHNIQUE THAT CAN

the high dose immunosuppression over

help stave off the ravages of

having to travel all the way to Sioux Falls,”

certain autoimmune disor-

says Dr. Okundaye. “Often, they then come

ders by cleansing the blood

back with a bad infection because of the

of immunoglobulins and antibodies is now available to patients in the Black Hills.

While TPE by itself is usually not a per-

Regional Health Rapid City Hospital is

manent solution to the overproduction of

now offering therapeutic plasma exchange

destructive antibodies, Dr. Okundaye says

(TPE), also known as plasmaphersesis, as a

cleansing the blood in this way can tame a

sort of stop-gap treatment for patients with

flare-up, reduce the level of immunosuppres-

autoimmune conditions such as lupus, Guil-

sion needed (and the associated side effects,

lain-Barré, Goodpasture syndrome, and

including infection), and give patients a faster

myasthenia gravis.

response to therapy. How intensive the TPE

“The majority of these conditions are caused by immunoglobulins and antibodies

regimen needs to be depends on the underlying condition.

in the plasma that are attacking the body,”

“In cases like myasthenia gravis, you

says nephrologist Ebima Okundaye, MD, who

want to do it more frequently,” says Dr. Okun-

was instrumental in bringing the new treat-

daye. “If they are doing well, you may

ment to Regional Health Rapid City Hospital.

decrease it to once a month or even once

“We can treat them by combining a treatment

every three months. You may or may not

like TPE to remove them with immunosup-

bring it back in.”

pressive therapy to stop their production.”

“Partnership has driven a lot of good, cost

During the 2 to 3 hour TPE procedure, the

effective approaches at our hospital,” says

patient’s blood plasma is removed and

Patient Services Director Marcia Taylor.

replaced with a substitute. Through a collab-

“These were machines that we already had

oration with the ICU, which already had four

and our nurses were already families with,

of the machines needed for TPE and was

so we were able to implement this quickly.”

using them for continual renal replacement

Taylor says TPE is offered on the outpa-

therapy, oncologists and nephrologists have

tient side of the hospital’s oncology unit,

been able to prevent patients from having to

where the environment is more relaxed and

go to Sioux Falls for this procedure.

patients can have family with them. ❖

“In the past, sometimes people would decide not to have the treatment or to take [Below] Patient Care Services Director Marcia Taylor, ICU Director Angie Mills, and Dr. Ebima Okundaye with the Prismaflex system used to provide TPE treatment.

immunosuppression.”

MAKE YOUR COMEBACK Weâ&#x20AC;&#x2122;ll get you back on the field, regardless of your game.

Regional Health Orthopedics and Sports Medicine: Orthopedic Surgery, Podiatry, Physical Medicine and Rehabilitation, Regenerative Medicine, Concussion Management, Sports Medicine, Physical Therapy

Locations in Rapid City and Spearfish 2805 5th Street | Rapid City, SD | 605-519-5757 2479 East Colorado Boulevard | Spearfish, SD | 605-578-0055

June 2018

Minimizing Surgical Side Effects with Sentinel Node Biopsy By Alex Strauss

URGICAL TREATMENT of endometrial and cervix cancers has traditionally involved the removal of lymph nodes throughout the pelvis (as well as aortic lymph nodes in the case of endometrial cancer), along with hysterectomy. While removing these lymph nodes can provide important diagnostic and staging information, gynecologic oncologist Luis Rojas, MD, says it also has serious drawbacks for patients.

“For many surgeons, it has been a point of pride, how many lymph nodes you were able to

remove,” says Dr. Rojas. “But we have been ignoring the fact that the removal of lymph nodes from these three regions has translated into potential harm, side effects, complications, and quality of life issues for many patients.” The rate of lymphedema after pelvic node dissection is around 47 percent. These patients often need extensive physical therapy and may be consigned to a lifetime of pressure garments and pneumatic devices. To reduce these complications and give patients a better post-surgical quality of life, Dr. Rojas now dissects only the first set of lymph nodes into which the uterus is draining (sentinel nodes) in most endometrial and cervix cancer patients. This involves “mapping” the lymphatics by injecting a fluorescent dye into the cervix and using robotic equipment with near-infrared visualization software to identify, remove, and analyze just the sentinel nodes. “We know that the sentinel nodes are the nodes with the

“ THE IDEA IS, IF YOU IDENTIFY THOSE [SENTINEL] NODES AND REMOVE THEM, YOU DON’T NEED TO REMOVE THE REST TO GET THE INFORMATION YOU NEED.”

highest likelihood of having metastatic disease,” says Dr. Rojas. “The idea is, if you identify those nodes and remove them, you don’t need to remove the rest to get the information you need. The technology is not perfect, but it has about a 98 percent sensitivity and specificity, so it is very accurate.” Once the sentinel nodes are removed, pathologists process them differently, too, using more cuts and special dye, which increases the chance of finding cancer cells, if they are there. In the first 20 “test cases” done at Avera, during which both the sentinel nodes and the rest of the region’s lymph nodes were removed, analysis of the sentinel nodes was 100 percent accurate in predicting the presence of metastatic cells in other nodes. The technique is so accurate—when done in centers like Avera with high enough volume—that the Society for Gynecologic Oncology issued a white paper in 2017 recommending it as the standard of care for most patients with endometrial or cervix cancers. Dr. Rojas estimates that 90 percent of his endometrial cancer surgeries are now done this way. He plans to present on the topic at Avera’s fall cancer symposium. ❖

WEB EXTRA

❱

Curious to know what lymphatic mapping looks like? See it on the website.

MidwestMedicalEdition.com

REGIONAL HEALTH RAPID CITY HOSPITAL RECOGNIZED FOR MATERNITY CARE

EGIONAL HEALTH RAPID

Centers for Disease Control statistics.

City Hospital’s efforts to

In the third and fourth quarters of

reduce caesarean sections

2016, Regional Health Rapid City

and early elective deliveries

Hospital was number one in the

and keep more babies out of the

country in this area.

NICU has earned it the Blue Dis-

“When I saw those numbers, I

tinction designation for maternity

went running to Shanon and said,

care from Wellmark Blue Cross Blue

‘What are you doing? This is amaz-

Shield.

ing!’,” says Carole Bunk,

“Interdisciplinary care

Vice President of Managed

is really the key to quality,”

Care. “It’s especially signifi-

says Shanon Waldner, RN,

cant because we get all the

Director of Women and

cases in the region. We don’t

Children’s Services at the

just get the easy cases or

hospital. “We have an amazing group of providers

the low risk cases. So the job CAROLE BUNK

we are doing in this area is phenomenal.”

that have collaborated over the last 7 years over what

“A lot of other organiza-

quality looks like and what

tions are in communities

is evidence-based.”

that cater to a lower risk

In 2012, this team

population,” points out Lori

developed an “Induction of

Wightman, Chief Nursing

Labor” guideline that mir-

Officer at Regional Health.

rored the American College of Obstetrics and Gynecol-

Wightman says the hospiSHANON WALDNER

tal’s impressive statistics

ogy recommendations to

with such a diverse patient

avoid elective deliveries

population demonstrates

prior to 39 weeks gestation,

the high level of care pro-

the point at which newborn

viders in the hospital’s

lungs are likely to be fully

five-state rural region can

developed and mothers are

expect when they refer their

less likely to have a com-

patients to Regional.

plication that leads to a c-section. Their

efforts

LORI WIGHTMAN

benef it

Annual caesarean rate Nationally

to achieve the same exceptional outcomes.”

interdisciplinary collabora-

Nationwide, BCBS companies have

resulted in annual overall cesarean

tion,” says Wightman. “All of our

recognized more than 1,000 hospitals

rates between 20-22% for each of the

professionals have had to come

as Blue Distinction Centers for mater-

last five years. (Blue Distinction looks

together to agree on best practice

nity care. Hospitals are assessed using

for a rate of less than 27% among first

guidelines and to move forward in

a combination of quality data supplied

time deliveries.) Nationally, cesarean

the same direction to produce these

by the hospitals and cost measures

rates average 31.9% based on 2016

outcomes. I hope this will set the tone

derived from medical claims. ❖

WEB EXTRA

have

the

20-22% 31.9% for other specialty areas as we strive

“I think this also illustrates

Annual caesarean rate at Regional

❱ F ind a complete list of Blue Distinction facilities

June 2018

❱ S ee why Rapid City Hospital was also recognized by CMS this year

[ RESE ARCH ]

Lung Cancer Trial Opened Door for New Research Opportunities “WE COULDN’T GET TRIALS LIKE THIS IN THE PAST. IT TOOK MANY DISCUSSIONS AND LOTS OF SAYING ‘HEY, YOU REALLY NEED TO THINK ABOUT US AS A SITE."

HE RECENTLY completed

is now being recommended as the new

trial on the immunother-

standard of care for certain kinds of lung

apy drug pembrolizumab

cancer patients.

(Keytruda)

Sanford

But the implications of the trial may

Health had important implications for

be even bigger and farther-reaching for

non-small cell lung cancer patients in

Sanford itself. Sanford was the only

the region. Thanks to Sanford’s involve-

non-university institution chosen for the

ment, patients with an illness that is

national study of the chemotherapy/

often fatal within a year, had access to

immunotherapy combination, a fact that

a promising new treatment long before

Powell says has helped put it on the

they might otherwise have even heard

national research “radar” at a new level.

about it.

“It took a lot of time and a lot of work,”

“If you look at when we opened this

says Powell. “I have been here for five

trial to when this treatment became avail-

years now and we couldn’t get trials like

able, our patients had access to it more

this in the past. It was like, ‘Who are you

than two years before it was available to

guys?’ It took many discussions and lots

the general public,” says oncologist and

of saying ‘Hey, you really need to think

researcher Steven Powell, MD, lead inves-

about us as a site.’ Our physician team has

tigator of the KEYNOTE trial at Sanford.

been motivated to bring better options

As a result of the trial, the combination

here and Sanford has put the infrastruc-

of chemotherapy and pembrolizumab

ture in place.” Powell estimates that 12 to 15 lung cancer patients were enrolled in the confirmatory Keytruda trial in Fargo and Sioux Falls. The treatment combination worked so well that patients across the region and nationwide can now access it through the accelerated approval pathway. “The only way people are going to get access to the newest, best treatments is to get access to clinical trials,” says Dr. Powell. “Now we can run any National Cancer Institute trials, we get to pick from pharmaceutical trials, and some of the universities are even contacting us. With new treatments, people are living years instead of months and it is great to be able to offer cutting-edge trials to our patients.” ❖

WEB EXTRA

❱

Read the results of the latest KEYNOTE trial

MidwestMedicalEdition.com

Sioux Falls VA Highlighted for Equitable Healthcare

HE SIOUX FALLS VA Health

visitation for same-sex partners and

to both LGBT veterans and staff and

Care System was recently

parents, and LGBT health education

is designed to make sure both feel

recognized, again, as a Leader

for key staff members.

supported and understood.

in LGBT Healthcare Equality

Primary care social worker

“When I first started down this

by the Human Rights Campaign

Tammy Reiff has been a champion

road four years ago, the challenge

(HRC) Foundation, the educational

for the LGBT movement in the VA

was just having the conversation,”

arm of the country’s largest lesbian,

and spearheads the Health Equality

says Reiff. “People want to be sensi-

gay, bisexual and transgender (LGBT)

Index as Special Interest Program

tive and not say something that

civil rights organization.

Manager.

would offend. But the conversation

“This is larger than people think.

is still essential. Because, if you are

It is not just about having policies in

a provider, a person who has transi-

“ THIS IS LARGER THAN PEOPLE THINK. IT IS NOT JUST ABOUT HAVING POLICIES IN PLACE THAT SAY WE’RE LGBT" FRIENDLY."

place that say we’re LGBT friendly,”

tioned from female to male may still

says Reiff. “It is actually educating

have breasts and a uterus. So that

our staff, visitors, and veterans to say

person still has to have their annual

this is how we prove it. We want all

exams. Same with a male to female

of our veterans to know that they are

transition.”

The Health Care System received

included in our care. Anyone can

Reiff’s work has brought her into

top marks for its commitment to

write a policy but our director has

contact with a number of LGBT vet-

equitable, inclusive care for LGBT

been incredibly supportive of educat-

erans, including a local transgender

patients and their families, who can

ing our staff in LGBT specific care.”

woman whose family rejected her.

face significant challenges in securing adequate healthcare.

With that aim, the VA will have

“She kind of came to the point

booths at pride festivals this

where the VA was her safe place,”

The VA is the only healthcare

months in Sioux Falls and Sioux

says Reiff. “That was confirmation to

facility in South Dakota to receive the

City, specifically inviting LGBT vet-

me that we are doing something

honor, which is awarded to facilities

erans to sign up for care. Reiff has

right. I am very invested in what we

that meet key criteria for equitable

visited VA Community Based Out-

do to support our country’s heroes

care, including nondiscrimination

patient Clinics across the area to

fully. The distrust that many of them

policies for LGBT patients and

initiate conversation around LGBT

have in our military is very real. We

employees, a guarantee of equal

issues and language. The HEI extends

need to do better.” ❖

June 2018

Nervous Speaker?

Here’s How to Present Like the Pro You Are

BY ALEX STRAUSS

Many physicians would prefer passing a small kidney stone to presenting a paper —JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

F THE ABOVE QUOTE describes

are presenting your own research, addressing

you, you can take comfort in the

your Kiwanis club, or proposing a toast at the

fact that you’re not alone. Why

office Christmas party, it means that someone

does speaking to a group of peers

out there considers you an expert. Don’t give

evoke such universal dread in so many

them reason to doubt it by revealing your ner-

people? It may have to do with many people’s

vousness or making apologies. Remember, in

deep-seated discomfort with being the center

many cases your audience has no idea what

of attention. Or it may simply be a lack of

they don’t know. Most crowds will be unlikely

experience. Rather than dwell on the why,

even to notice if you lose your place or miss a

let’s look instead at what can be done about it.

point. Just soldier on as the expert they have

First, take heart. There are hundreds of

come to hear.

stories of people who have overcome debilitating shyness, speech impediments and

USE ACRONYMS

various other problems to become not just

If you are worried about being able to remember

adequate, but extraordinary speakers. (Helen

your speaking points, acronyms are a favorite

Keller comes to mind) You, with your educa-

tool of professional speakers. Arrange the first

tion, brains, and desire to improve certainly

letters of your main speaking points (there

can, too.

should not be more than 3 to 5) into a word – even a nonsense word – and keep that word

BE THE EXPERT

in your head, or on your notes, as you move

If you have been invited to speak, whether you

through your points. Knowing you can always

MidwestMedicalEdition.com

28th Annual Missouri Valley Symposium July 20, 2018 - 8 a.m. to 4:30 p.m. Yankton, S.D. Register today: www.yanktonmedicalclinic.com/MVS Field experts present on a variety of relevant topics to today’s provider. Including: • • • •

smoking cessations diabetes management pharmocogentics suicide prevention

• e-cigarettes • risk management • and others

call that word to mind will help

CONSIDER USING PROPS

ensure that you don’t ‘draw a blank’

If you are one of those people who is

PRACTICE, PRACTICE, PRACTICE

when the spotlight is on you.

unsure what to do with your hands

To feel as confident as possible

when you are speaking (and, no, grip-

in a stressful situation, organize,

ACT THE PART

ping the lectern is not the answer),

simplify and practice your presen-

Even speakers who don’t get espe-

a prop can help. It does not neces-

tation. Many professional coaches

cially nervous can be guilty of poor

sarily have to be a prop that is related

recommend taping yourself in

presentation skills simply because

to the topic of your speech, although

order to get an audience member’s

they fail to be intentional. Poor pos-

that can often enhance a presenta-

perception. Be well familiar with

ture, hands in pockets, failure to

tion. Even a fountain pen, clipboard,

the information and the order in

make eye contact with members of

or the handheld remote you are using

which you plan to present it, but

the audience, and speaking too qui-

to advance your slide presentation,

avoid memorizing or reading, which

etly or too quickly can all be major

can instill confidence by giving you

can look stilted.

distractions and draw your audi-

something to hold on to and can help

Finally, smile! Your job as a

ence’s attention away from your

hand movements come more natu-

speaker is to put your audience at

information.

rally as you speak.

ease so that they can absorb what

A tall but relaxed stance, a clear,

If you do use a projected presen-

you have to say. A warm and pleas-

measured speaking voice, and appro-

tation such as a PowerPoint, take

ant demeanor makes them more

priate hand gestures all help to build

advice from civility consultant Sue

open to you and to your information

rapport with your audience and hold

Jacques and keep the slides “mini-

and is more likely to illicit apprecia-

their attention. If this doesn’t feel

mal in quantity, maximum in font

tive nods and attentive looks that,

natural to you, try this mental trick:

size, and memorable in nature”.

in turn, will boost your own confi-

Simply ‘act’ the way you imagine a

When you want to share more

dence. Everybody wins! ❖

professional speaker should act! Your

detailed or complex data, use hand-

audience won’t know the difference.

outs instead.

June 2018

[ T HE Q UE S T IO N ]

What is you favorite vacation destination? Warmer weather and the more relaxed pace of summer makes it a favorite time for many families to hit the road and experience new places. We asked some recent MED interviewees where they most love—or want—to get away from it all.

“Really anywhere with my wife and son. Recently, we've enjoyed everything from hiking in Glacier to rides at Tokyo Disney and driving the countryside of Tuscany.”

“So far, I think Copenhagen, Denmark has been my favorite place. The people were mellow and it was beautiful. But one place I would really love to go to is Rome.”

BENSON HSU

LORI WIGHTMAN

“ My favorite vacation is when our family joins us at our home in the Black Hills. I enjoy the peace and tranquility of... hiking with our dogs, riding our horses, and spending time in the yard.”

“Any ski resort!”

EBIMA OKUNDAYE

CATHERINE HAJEK

“My favorite vacation destination is wherever my friends are— especially in Italy!” MARCIA TAYLOR

SHANON WALDNER

“ My favorite destination is right here in the Black Hills. I love when I get to spend time here on a ‘staycation’ just enjoying the beauty of the our own forests and lakes.”

“ My favorite place in the entire world is my cabin at Lake Sakakawea [North Dakota]. I have been all over the world but . . . that is my Superman’s fortress of solitude!” CHRIS ADDUCCI

MidwestMedicalEdition.com

June, July

Upcoming Events JUNE 7 - 8

JUNE 22

JUNE 29

Avera Orthopedics and Sports Medicine Symposium

DLSH 20th Annual “Gifts of Sight & Health” Golf Tournament

Edgewood Senior Living 4-Person Golf Scramble

Location: Best Western Ramkota,

Location: Prairie Green Golf Course,

Location: Lenkota Golf Course,

Sioux Falls

Lennox, SD

Information & registration:

Registration: dakotasight.org/event/

Information: 605-367-9570,

averacontinuingeducation@avera.org

golf-tournament

edgewoodseniorliving.com

JUNE 22 – 23

JULY 20

3:30 pm Thurs / 4:15 pm Friday

1:00 pm

10:00 am

605-322-8950

JUNE 21

7:00 am – 4:30 pm, 7:00 am – 12:30 pm

12:00 pm – 1:00 pm Sanford Imagenetics Lecture Series

8:00 am – 4:00 pm 20th Annual Missouri Valley Symposium

Location: Schroeder Auditorium,

40th Annual Sanford Black Hills Pediatric Symposium

Sanford USD Medical Center

Location: The Lodge at Deadwood

Offices Pavilion, Yankton, SD

Information & registration:

Information:

sanfordhealth.org/classes-and-events

childrens.sanfordhealth.org,

YanktonMedicalClinic.com/MVS

keyword: Black Hills

605-665-6933

SAVE THE DATE:

Location: ASHH Professional

OCTOBER 17

UnityPoint Health - St. Luke's 34th Annual Cardiology Conference

Location: Delta Hotel, South Sioux City Riverfront

Because you help them get back on their feet, every day. 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, every day. Insurance & Risk Solutions | MMICGroup.com

sanfordImagenetics.org sanfordImagenetics.org

Unlocking the blueprint Unl of you. the You are unique. No one else is quite like you. And it’s your DNA that created the blueprint for who you are. Now with a unique genetic screen, Sanford Health doctors have the power to take that blueprint to build a care plan for patients. You are unique. No one else is quite like you. Andunique. it’s your DNA created the You are No onethat else is quite like Together, they can make blueprint foryour who DNA you are. you. And it’s that created the

a plan for theirforpatients’ blueprint who you are. health including finding Now with a unique genetic screen, more effective medications and better Sanford doctors have the power Now withHealth a unique genetic screen, to take that blueprint to have build a care understanding their risk for diseases. Sanford Health doctors the power plan forthat patients. to take blueprint to build a care plan for patients. Together, they can personalized make a plan for It’s more their patients’ health including finding Together, they can make for and every day.a plan more effective medications andfinding better their patients’ health including understanding their risk for diseases. more effective medications and better

care for today

understanding their risk for diseases. Seepersonalized what your It’s more carepatients’ for today and every day. It’s more personalized carehealth. for today mean for their and every day. See what your patients’ blueprint can mean for their health. blueprint can See what your patients’ mean for their health.

019039-00869 019039-00869 5/18 019039-00869 5/18

5/18

blueprint can

of y

Unlocking Unlocking the blueprint the blueprint of you. of you.

June 2018

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