The Meaning of Care Magazine - Winter 2018

Winter 2018

A ‘Weightless’ Approach to One Heavy Diagnosis Page 8

President’s Letter With the hectic schedules many of us face these days, it can be easy to take the even the smallest of things for granted. A warm jacket on the first chilly day of fall, the burnt orange leaves sprouting from the trees and the first snowfall.

Since being diagnosed with spinal cord cancer in 2013, a diagnosis which has led to his current paralysis, Mike Lambert has learned to take nothing for granted and truly appreciates every day he has with his wife and two daughters.

While Mike struggles with movements on land, the warm water in our aquatic therapy pool provides him with the freedom to move and strengthen his once weak body. Thanks to the work of our physical therapists and our new aquatic therapy pool, Mike is making progress and recently powered himself up into a standing position — an achievement resulting in a few cheers and tears.

Steve Goeser

President and CEO Methodist Health System

Those who are facing a cancer diagnosis also take little for granted, as hearing “you have cancer” can be a life-altering experience. We are always exploring ways to better detect and treat cancer for our patients and their families. The sentinel lymph node mapping procedure now under clinical trial with our gynecologic oncologists is an excellent example of how we’re making a significant difference in the lives of those diagnosed with endometrial cancer.

Our community’s aging population can teach us a lot about appreciating life’s little moments. With 10,000 baby boomers reaching retirement age each day, providing quality health care for this population will be imperative in the years to come. To provide that specialized care, we recently implemented a new Geriatric Resource Nurse Program in our Emergency Department. This program is already making a difference in the lives of those who are trusting us with their care.

As we enter the holiday season, I encourage you to make time to appreciate those around you. We know you have many options for your health care needs and we are indeed grateful to everyone who allows us to deliver The Meaning of Care every day.

Sincerely,

s

ter d daugh wife an ancer is h h it oming c mbert w Mike La ation for overc v ti o a ne d y.

– his m again o g in lk a and w

Emerging Technology Page 4

A ‘Weightless’ Approach Page 8

Tackling Unique Challenges Page 12

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“This is very exciting for our community,” Baumert said. “For more than 130 years, families have trusted Methodist Jennie Edmundson from the birth of their child to a loved one’s last days and everything in between. We value that relationship and people’s trust in us. This project demonstrates our commitment to and investment in improved community health for generations to come.”

Methodist Jennie Edmundson Hospital Breaks Ground on $20 Million Project

Community leaders, health system executives, physicians and clinical staff gathered in September to celebrate the groundbreaking for the new medical office building on the Methodist Jennie Edmundson Hospital campus in Council Bluffs.

Steve Baumert, president and CEO of Methodist Jennie Edmundson Hospital, first announced the $20 million project in May.

The first floor of the medical office building will provide clinic space for approximately 15 Methodist Physicians Clinic primary care providers.

It will also include an imaging suite, as well as a new Urgent Care location with easy access and extended hours.

Another important aspect to the new building is a focus on women’s health care. Women’s services will be located on the second floor and feature up to six women’s health experts, as well as outreach clinic opportunities with Methodist Women’s Hospital maternalfetal medicine specialists.

“Methodist Health System is dedicated to extending our women’s services to a broader audience throughout western Iowa,” said Steve Goeser, president and CEO, Methodist Health System. “This will allow Methodist Jennie Edmundson to serve as the health system’s eastern

Groundbreaking ceremony at Methodist Jennie Edmundson Hospital

edge for women’s services, something we are extremely excited about.”

Construction of the medical office building is underway with completion anticipated by early 2020.

Methodist Hospital Achieves Fourth Magnet Recognition

Methodist Hospital recently attained Magnet recognition for the fourth time, a testament to its continued dedication to high-quality nursing practice.

The American Nurses Credentialing Center’s Magnet Recognition Program® distinguishes health care organizations that meet rigorous standards for nursing excellence.

The credential is the highest national honor for professional nursing practice.

In 2004, Methodist became the first hospital in Nebraska to earn Magnet status. Now it is the first Nebraska hospital to achieve the status four times. Worldwide, a select group of 477 health care organizations have achieved Magnet recognition. Of those, 45 have been designated as Magnet organizations four times.

“Our nurses are leaders in their field and are contributing to the advancement of the science and art of nursing,” said Teri Tipton Bruening, MSN, RN-BC, CNE, vice president for patient care administration and chief nursing officer for Methodist Hospital. “Because of their active engagement in research, evidence-based practice, innovation and policy, we achieve quality patient outcomes that exceed national benchmarks.”

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Emerging Technology and Clinical Trials HELP FIND AND FIGHT CANCER Story by Katina Granger

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David Crotzer, MD

There is a standard across all types of cancer: The earlier you find it, the easier it is to treat.

When it comes to cancer, the ability to pinpoint, isolate, destroy or remove dangerous cells is critical. It’s why our highly skilled teams of surgeons, radiologists, pathologists, oncologists An iridescent, green dye helps surgeons isolate and staff at Methodist Estabrook sentinel lymph nodes during the clinical trial.

Cancer Center work tirelessly to find and implement the latest cancer-fighting technologies. And when new ideas are born, potentially life-saving clinical trials help our teams lit up the monitors. The pulsing green dye, seen through forge new paths for cancer treatment. cameras that were aimed at the surgical field, looked like something out of a sci-fi film as two robotic arms snipped One such offering, the I-125 seed, is making surgery more away at the edges. comfortable and convenient for patients with the earliest signs of breast cancer. This tiny radioactive device is an “And that’s the right sentinel node,” David Crotzer, MD, alternative to current methods of finding the smallest announced from the controls of the DaVinci surgical cancer cells. robot. The gynecologic oncologist at Methodist Estabrook Cancer Center's Midwest GYN Oncology Clinic then Meanwhile, in the fight against endometrial cancer, removed the tissue for biopsy.

Methodist is leading the way with a clinical trial aiming to prove that a method for finding potentially cancerous It was just the first part of a procedure that would help lymph nodes is effective. In this case, a green dye may Vicki Brink beat cancer. light the way for surgical oncologists.

Something from a Movie

In the darkened Methodist Hospital operating room, all eyes were fixed on the video screens as an iridescent glow

“

If you take out that first sentinel lymph node and there is no evidence of cancer, there’s a greater chance all of the other lymph nodes are going to

“

be negative, too.

— Brent Tierney, MD

Out of the Blue

Vicki made an appointment with Methodist Physicians Clinic OB/GYN William Weidner, MD, after experiencing some unexplained bleeding. At 73 years old, the only times she had ever been in the hospital were to have her babies.

To say hearing the word “cancer” took her by surprise is somewhat of an understatement.

“It’s been a little bit of a whirlwind,” Vicki said.

Dr. Weidner delivered her a diagnosis of stage 1 endometrial cancer and referred her to Dr. Crotzer.

“It’s a real shock, but I’ve been blessed with good care and the right people every step of the way,” she added.

The Lymphatic Superhighway

As a specialist dedicated to the diagnosis and treatment of gynecologic cancers, Dr. Crotzer is no stranger to treating endometrial cancer like Vicki’s. In fact, he and his team are leading a clinical trial with the hope of solidifying a new standard of care. Their goal is to ensure doctors remove the cancer while helping the patient maintain a high quality of life. It all has to do with lymph nodes.

Lymph nodes are an important component of our body’s immune system, attacking and destroying germs

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Hugging Becky Childers, PA-C, a member of the care team at Methodist's Midwest GYN Oncology Clinic, Vicki Brink is thankful for the care she received.

throughout our body in a watery fluid called lymph. The nodes work as tiny filters, getting rid of the bad and replacing it with good.

But when it comes to cancer, this lymphatic network can also be a superhighway for disease to travel throughout the body.

Old Methods, New Ideas

While it’s important to remove potentially diseased nodes, cancer specialists like Dr. Crotzer are doing what they can to save healthy ones.

“The idea is you inject the dye close to where the tumor is, and it will find the very first lymph node in that organ system,” said Brent Tierney, MD, a gynecologic oncologist at Methodist Estabrook Cancer Center’s Midwest GYN Oncology Clinic. He is also one of the experts leading the clinical trial.

“The more lymph nodes you remove in relation to cancer, the more potential that women have for swelling and discomfort from lymphatic fluid collecting in their pelvis and legs,” Dr. Crotzer said. “We’re trying to make sure that patients who have nonaggressive cancers don’t undergo lymph node dissections if they don’t need them – minimizing unwanted side effects while also making sure that any affected lymph nodes are removed.”

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Sentinel lymph node mapping is a procedure in which an iridescent, green dye is injected near a tumor, with the intent of it being absorbed by nearby lymph nodes.

The first lymph nodes to be illuminated by the dye are known as sentinel lymph nodes – those that would be the first to carry and spread cancerous cells from a tumor.

“Sentinel lymph node mapping is established as the standard of care for breast cancer, and it's been that way for a number of years. It's

“

I’ve been blessed with good care and the right people every

“

step of the way.

— Vicki Brink

also the standard of care for melanoma,” Dr. Crotzer said.

“If you take that lymph node out, test it and find there's cancer in there, then there's probably a chance the cancer has already metastasized,” Dr. Tierney said. “If you take out that first sentinel lymph node and there is no evidence of cancer, there’s a greater chance all of the other lymph nodes are going to be negative, too.”

The Question of “Where” When it comes to endometrial cancer, the question hasn’t been whether sentinel lymph node mapping works – it’s researching how the lymphatic system works in that particular area of the body and whether mapping the nodes can actually pinpoint those that would be most affected by the disease.

“Sentinel node mapping was tricky for endometrial cancer because we were trying to figure out where you inject the dye,” Dr. Tierney said. “Should we inject it in the uterus on the tumor, or can we inject the cervix? What we have found is that we actually can just inject the cervix and have a pretty good idea if the sentinel node is negative, thus the other lymph nodes are more than likely going to be negative as well.”

The clinical trial now underway hopes to prove that injecting the dye into the cervix is the best place to start. Similar trials have been done at institutions such as the Mayo Clinic and the University of Indiana, and researchers have gained valuable information. This clinical trial will ultimately look at patients who undergo sentinel lymph node mapping and full lymph node dissections.

Richard Kutilek, MD; James Reilly, MD; and Tom Brennan led the charge to bring the I-125 seed to Methodist Estabrook Cancer Center's Breast Care Center.

Known as I-125, the seed is about the size of a piece of pencil lead. It’s implanted into a woman’s breast when there’s an abnormality that needs to be removed but is too difficult for a surgeon to locate.

“We use an ultrasound to find the cancer, guide a needle into it and then drop the seed in,” explained Richard Kutilek, MD, a radiologist and medical director for imaging at the Breast Care Center. “It’s a piece of cake.”

Today, nearly all endometrial cancer patients at Methodist – no matter their stage – have the option to join the trial and have their lymph nodes mapped.

The seed contains trace amounts of radioactive material – less than a drop of iodine – which the surgeon can then locate using a special detector. Finding and removing the seed means doctors find and remove the cancer.

Even with a nonaggressive stage 1 cancer, Vicki was eager to join the study.

A New Option

“I thought this would be a really good procedure and give me some reassurance that the lymph nodes don’t have any evidence of cancer,” she said. “I also know that I’m doing something to help other ladies who may be facing something like this.”

The Tiniest Seed

Another new procedure at Methodist Estabrook Cancer Center focuses on the comfort and care of breast cancer patients with the smallest signs of disease. A tiny “seed” is helping doctors pinpoint and remove areas of cancer too small to be seen or felt.

“It’s just another option that can be a little more convenient for the patient,” said James Reilly, MD, a surgical oncologist at Methodist Estabrook Cancer Center’s Breast Care Center. He spearheaded bringing the procedure to Methodist.

The I-125 is considered a safe alternative to a procedure doctors still use to locate cancerous cells.

“In cases where we don’t use the seed, a radiologist inserts a guide wire either with an ultrasound or mammogram,” Dr. Reilly said.

“That wire would then lead us to the lesion.

The only difference to the patient is that the woman would have a wire sticking out of her breast until the surgery, making her unable to leave the hospital between procedures.”

Using a guide wire instead of the seed means two procedures must be scheduled for the same day, which can be an obstacle.

“For patients, it’s a benefit because you can have the seed inserted a day or two before your surgery and can schedule it first thing in the morning,” Dr. Kutilek said. “You don’t have to wait for multiple departments to align their calendars so you can have a procedure you may be anxious about in the first place.

Plus, you don’t have a wire hanging out of your

breast while you’re waiting for surgery, so there’s a comfort aspect as well.”

It Takes a Village

From the provider standpoint, bringing the I-125 seed to Methodist was a collaboration between many teams – surgical oncology, radiology and nuclear medicine. Because of the radioactive material contained inside the seed, the implant must be tracked along its every move.

“We are the overseer of this tiny seed,” said Tom Brennan, service leader for imaging at Methodist Hospital. “It comes in the door, and we escort it to the Breast Care Center, where it is implanted in the patient. We then escort the seed from surgery to pathology once it is removed. After pathology takes the seed from the tissue, we bring it back home where we store it for two years before disposal. There are a lot of man-hours involved in governing these little seeds, but there is a huge patient benefit, and that makes it all worthwhile.”

Putting Patients First

Whether it’s through offering an alternative option or participating in a clinical trial, patient benefit is behind every technology and every treatment. It’s behind everything we do at Methodist. It means the world to us, and to patients like Vicki.

“I consider myself very lucky,” Vicki said.

“I’ve been blessed with the care I’ve received at Methodist.”

To watch the video, visit bestcaretoday.com

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Mike Lambert attempts muscle contractions with the help of Julie Jessen, PT, MPT.

A ‘Weightless’ Approach TO ONE HEAVY DIAGNOSIS Story by Jessica Gill

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He looks comfortable and confident as he’s wheeled onto an adjustable floor, then lowered into 96-degree water.

Mike Lambert, 38, hasn’t walked in years. But with little assistance, he’s able to stand up inside the Methodist aquatic therapy pool.

What landed him in the water began in 2013, when he started to experience some numbness in his thighs.

It was nothing. At least that’s what he thought. In fact, he has a family history of sciatica, so he chalked it up to that. Mike had bigger things on his mind, like becoming a father.

He and his wife were expecting their first child.

Mike Lambert was diagnosed with anaplastic ependymoma (spinal cord cancer) at 32.

“We were doing all the things. We were getting her room ready and stuff like that,” Mike said. “I remember my foot started catching on the carpet – my left foot would drop. I would stumble and trip over things.”

He finally decided to call his doctor. An MRI showed something much scarier than sciatica: lesions – too many to count – along his lower spine.

“I didn’t exactly know what that meant,” he said.

“Was this serious?”

It was. His doctor ordered him to return for more scans, citing a possible tumor. Research told Mike this was likely a brain tumor, and that he didn’t have much time left.

Mike remembers quite vividly what followed. He went in on a Monday for additional scans. On Tuesday, he received the good news that there was nothing found in his brain.

“That was a breath of fresh air,” he said.

While it wasn’t brain cancer, it was spinal cord cancer (anaplastic ependymoma). With his daughter now 2 months old, Mike began to weigh his treatment options.

In July 2013, Mike underwent surgery. The goal was for doctors to obtain a biopsy and

“debulk” as much as they could from around Mike’s spine. While there were some lesions left behind, they weren’t of much concern.

The surgery was successful. He received six weeks of proton radiation therapy on his brain and spine. By the end of the year, Mike was considered stable.

Another Uphill Battle

It wasn’t long before routine scans started to show growth around Mike’s spine. Mike began oral chemotherapy in 2015, then IV chemotherapy that summer – it worked, but only for a while. This meant another six weeks of proton radiation therapy – this time on his lumbar spine.

Doctors also recommended infusion therapy, in which tumor-starving medication is delivered into a vein. It stopped the growth of his cancer, but it also depleted his energy level. For 2 1/2 years, he continued with infusions. And for 2 1/2 years, he was incredibly weak.

The silver lining came in February 2018. Doctors had seen no growth in over two years and felt comfortable taking Mike off the treatment. He was once again stable, and his energy returned.

The Power of Positive Thinking

Mike is a realist, but it’s clear he’s never had a shortage of optimism. He’s got a lot of inner strength and three giant sources of motivation: his wife of nine years, Katie, and their two little girls – Izzie, 5, and Addie, 3.

“I want to take them camping,” the proud dad said. “I want to go on hikes with them.”

While he now has the energy to do such things, the cancer robbed him of his strength and feeling from the waist down. He’s now confined to a wheelchair.

“When you have this kind of paralysis,” Mike explained, “your leg is still there, but it just feels like it’s encased in cement. Like trying to move your toes in a tight shoe or something – you know you’re moving it in your mind, but it’s not actually moving.”

Doctors don’t know whether Mike will ever walk again.

“There’s nothing saying I can,” Mike admitted.

“But if there’s nothing saying I can’t, who’s to say I can’t? I want to at least try.”

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Diving In

Mike was referred to Madonna Klein, PT, MPT. She’s the clinical coordinator of outpatient therapy services at Methodist Hospital.

“Mike is a glass-half-full kind of guy,” Klein said.

“He has been given lemons, and he’s truly made lemonade.”

From the moment Klein met Mike, there was never a question that he was the perfect candidate for aquatic therapy.

“Not only does he not have to work against gravity,” Klein explained, “he gets assistance from the buoyancy when moving. So, even if he elicits a little muscle contraction, the water can take him the rest of the way.”

This is beneficial when Mike tries to mimic the motion of walking. But because his leg muscles have become so atrophied from disuse, they’re almost too buoyant for certain exercises and stretches.

That’s where tools like ankle weights come in.

They’re used to weigh his feet down when he needs to lengthen his legs and get a good hip flexor stretch, which is important after being in a wheelchair for so long and necessary for standing upright.

Other seemingly simple items like foam pool noodles, life preservers and small hand-held paddles are powerful resources when it comes to Mike’s efforts in the water.

One of his aquatic therapists, Julie Jessen, PT, MPT, believes that physically, the pool has been pivotal for Mike.

“It seems like every time he comes, he gains some range of motion,” Jessen said. “He gains a little bit of strength.”

She also feels it’s been critical to him mentally.

“Being able to come to the pool and do the things he can’t do on land improves his mood,” Jessen said. “It also improves his sense of independence.”

The Feeling of Progress

For Mike, it’s been nice to be able to float into certain positions and stretch areas that gravity normally doesn’t allow him to. But it’s during his land-based therapy with Klein that he has really noticed dramatic improvement.

Just weeks after his first aquatic therapy appointment, something amazing happened.

He still gets emotional when talking about it.

Klein was working with him in the gym – guiding him to contract his thigh and lift his leg off a bolster. They had attempted similar movements in the past.

After a couple of hard-fought tries, he succeeded. He kicked his leg off that bolster.

“The amount of improvement over just a couple weeks in the pool was astounding,” Mike said as he choked back tears.

“Like – emotionally astounding.

Because I hadn’t moved that way in so long!”

And during a more recent gym session, Mike was able to power himself up into a standing position as Klein locked out his knees.

Mike powers himself up into a standing position for the very first time, using Madonna Klein, PT, MPT, for support.

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“He has not been able to do that since he lost the use of his legs,” Klein said. “It’s just incredible.”

Not Just for Cancer Patients

Mike was the first patient inside the pool after it was dedicated in October 2017 in honor of Heather Roberts, who lost her battle with brain cancer in November 2016. The pool – also known as Heather’s Healing Pad – was funded in part by Leap-for-a-Cure, which was spearheaded by the Roberts Family to benefit the Omaha community with brain cancer awareness, education and treatment.

And while aquatic therapy has shown promising results in people suffering from cancer-related conditions, it doesn’t end there.

So many people are benefitting from this “weightlessness” in the water.

The Methodist aquatic therapy pool has helped orthopedic patients, stroke patients and patients like Anna Johnson, 34. She has spastic cerebral palsy.

“Basically, you feel trapped in your own body,” she said.

When Anna turned 30, she said, her body took a turn for the worse. She grew stiffer and weaker. Every move she made was challenging and exhausting.

When she walked into her first aquatic therapy session at Methodist – she immediately noticed the warm and welcoming atmosphere. That alone was healing, she said.

After just 22 sessions, Anna noticed a substantial difference – not only in how freely she could move, but how free she felt.

“When you can’t move the way you want to move – the way you know you can move, it’s frustrating,” she said. “I was really depressed.

Being in the water took that away. Especially when I saw the difference on land.”

Recently, Anna started land-based therapy, which has been very successful.

“There’s no way I could do what I’m doing if it wasn’t for Julie and that pool,” Anna said.

More Than Therapy, More Than a Goal

Anna’s story is similar to Mike’s. Both have unique conditions. Both have seen astonishing results. Both admit that what they found at Methodist has been unlike the rest of their care – it’s not one-size-fits-all. It’s individualized.

It’s strategic.

Further Enhancing Patient Experience

As if heated, state-of-the-art hydrotherapy wasn’t enough, a couple of upgrades are being implemented at Methodist HealthWest – home of the Methodist Aquatic Therapy Program.

Temperature

The pool’s consistent 96-degree pool temperature feels wonderful to the body and promotes healing. It’s essential for dilating blood vessels and increasing circulation. But getting out of the water – into a 75-degree room, for example – can be uncomfortable.

“When you get out of that warm, comfortable environment, and then you make your way into a normal room-temperature bathroom, that can feel really cold,” said Madonna Klein, PT, MPT. “We don’t want any part of this to seem uninviting for our patients.”

Anna Johnson was diagnosed with cerebral palsy at 13 months old.

“And I just don’t think you get that at other places,” Mike said.

Perhaps even more therapeutic than that patient-centered approach are those who provide it.

“

I never say never to patients. I want them to stay optimistic, because I’ve seen some incredible things as a physical therapist. I’ve seen people get to a place no one thought was possible, all because they never gave up.

“

— Madonna Klein, PT, MPT

“It’s not about the tools in the gym,” Mike said.

“It’s not about the great new table I get to sit on.

It’s about the people.”

If you ask Jessen and Klein, they’ll tell you they’re simply doing what they love – helping people reach their goals.

“Boy, would I love for Mike to be able to walk again,” Klein said. “To the point where he can actually walk his girls into their classrooms or walk them to school.”

Radiant heat panels are being installed in the bathrooms just outside of the pool area. This is meant to ease the transition on a patient’s body as he or she exits the pool – avoiding that “shock to the system” feeling that can result from an immediate change in temperature.

Accessibility

One must travel a long hallway on the lower level of HealthWest’s north side to get to an aquatic therapy session. Along that stretch of hallway, there have never been handrails for support and assistance. Depending on a patient’s needs or inabilities, that walk can be a challenge – not to mention, exhausting.

And she firmly believes it’s possible.

“It’s a trek,” Klein said. “And for someone who maybe can’t walk very easily, that’s a lot to ask.”

“I never say never to patients,” Klein added. “I want them to stay optimistic, because I’ve seen some incredible things as a physical therapist.

I’ve seen people get to a place no one thought was possible all because they never gave up.”

Medical grade handrails are being placed on both sides of the hallway so patients have something to hold onto. These will help prevent injury and assist with balance. They will also be beneficial in conserving a patient’s energy prior to therapy – ensuring his or her time in the pool is most productive.

Mike doesn’t plan on giving up. He’s determined to see the world from six feet high again. But if this journey has taught him anything, it’s to value every day – to do more with the time he’s given, with the people he loves.

“If I never walk again, fine,” Mike said. “I just want to be there for my kids. That’s pretty much it. And my wife and I – we’ve got plans. We’re not going to let this stop us. So, I choose to decide that I’m going to do it – that I’m going to live my life.”

Funding for these additional upgrades is being provided by the Roberts family and Leap-for-a-Cure in memory of Heather Roberts.

If you think you or a loved one could benefit from the Methodist Aquatic Therapy Program, ask your doctor about a referral. Like other types of physical therapy, aquatic therapy is covered by most insurance plans.

To watch the video, visit bestcaretoday.com

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Unique Challenges TACKLING

Story by Patrick Smith

Geriatric resource nurses Jessica Lock, BSN, RN-BC, left, and Terri Perry, BSN, RN

When Janet Hyde arrived at the Methodist Hospital Emergency Department, her pain level was at a 10.

The 76-year-old grandmother had broken her humerus that morning. Now she faced the possibility of surgery and short-term rehabilitation. But that wasn’t her biggest worry while talking to Emergency Department (ED) staff. As the primary caregiver for her

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husband, who has Alzheimer’s disease, she wondered who would care for him.

For Janet and her family, geriatric resource nurse Terri Perry, BSN, RN, became a port in the storm.

“She got so overwhelmed and emotional,” said Michelle Grothe, Janet’s daughter.

“Terri just held her hand and talked her through it. I was just so amazed by the compassion. She was telling her, ‘I know that your husband is a concern right now.

But right now we're more worried about you.’”

Older Patients Present Unique Challenge

An estimated 10,000 Americans turn 65 each day. Nationally, patients 65 and older account for about 15 percent of emergency room visits. At Methodist Hospital’s Emergency Department, that number is higher: 37 percent so far in 2018, averaging about 29 people a day.

Those patients frequently arrive for nonemergent reasons such as falls, pain and

weakness. And their unique needs present a challenge: How do you give them the care they need while connecting them with resources so they can prevent hospital admissions and ED visits? In Janet’s case, it meant treating her acute injury while giving the family options for her husband’s care.

“Perfect Opportunity” Takes Root

Methodist found inspiration 400 miles away at Northwestern Medicine in Illinois, where a program was using dedicated nurses to identify and address non-emergent issues.

“What a perfect opportunity to avoid some of these unnecessary hospital admissions if we can help these people on the front porch,” said Sue Rohlfs, MSN, MA, RN, who is Methodist Hospital’s service executive for patient care administration.

Not only could such a program address challenges seen in the ED, but it could fit into Methodist’s systemwide initiative to create solutions for the unique needs of older adults.

Methodist’s Geriatric Resource Nurse (GRN) program began taking shape in early 2016.

It began with one GRN seeing patients one day a week. Now Perry; Jessica Lock, BSN, RN-BC; and Nicole Hansen, BSN, RN-BC, rotate to provide coverage every weekday from 7 a.m. to 7 p.m. A fourth GRN is set to join the team soon.

“It takes a special person to fill the role,” said Alice Kindschuh, DNP, APRN-CNS, GCNSBC, director of doctoral studies at Nebraska Methodist College. Understanding how an ED works and having a love of working with seniors are crucial.

“These aren’t geriatric nurses working in the ED. These are emergency room nurses with geriatric education, and we did that really very consciously,” said Kindschuh, who helps oversee the program and works to provide nurses the education they need to become GRNs.

GRNs Shine Behind the Scenes

The decision to involve a GRN starts with a brief screening done in the course of an emergency nurse’s initial patient assessment. The screening involves a series of questions intended to get a feel for a

patient’s health and risks beyond the current visit. Depending on the answers, a GRN is alerted.

family “invaluable” information on home-health options in the event her recovery limited her ability to care for him.

In the Methodist Hospital ED this year, 55-60 percent of patients over 65 have been identified as people who could benefit from time with a GRN. On any given day, a GRN might personally visit with as many as six seniors with the greatest needs. While an emergency nurse focuses on treating patients’ symptoms, GRNs have the more time-consuming tasks of identifying the causes and other issues, then connecting patients and their families with the resources they need.

“My mom especially needed that,” Michelle said, “to know that there is help available.”

A sampling of what a GRN may do:

GRN Program “Helps Everybody”

• Partnering with social workers, who offer referrals and information on skilled nursing, home health, hospice, respite care and other resources • Calling physical therapists to the ED for on-site assessments • Referring patients to Methodist’s Balance and Fall Physical Therapy program and/or the Geriatric Evaluation and Management Clinic • Identifying needs tied to medication, depression, palliative care, Alzheimer’s disease and Parkinson’s disease • Scheduling follow-up appointments • Coordinating prescription delivery

“

It helps everybody.

Not just the patient, not just me, but

“

all of us.

— Joseph McCaslin, MD, Medical Director of the ED

“We talk about safety,” Perry said. “My big thing with people is, they'll say, ‘I’m fine at home.’ And I'll say, ‘I’m really glad. I want you to stay at home as long as you can.

I just want you safe.’”

During Janet’s stay, the focus was on her husband’s safety. Perry gave Janet and her

A GRN’s job doesn’t end when the patient leaves the ED. Within a few days, she calls the patient, asking how a follow-up appointment went, if a prescription was picked up or if there are any issues or questions.

“I can’t tell you the number of ED readmissions I have prevented over the phone, just by answering simple questions,” Lock said.

There’s wide consensus that the GRN program at Methodist has been a success.

Data on two of its initial goals – decreasing hospital admissions and preventable ED visits – are hard to pin down. But there’s plenty of evidence pointing to increased satisfaction among patients, nurses and providers.

“That’s why I’m a big proponent of it,” said Joseph McCaslin, MD, medical director of the Methodist Hospital Emergency Department.

“It helps everybody. Not just the patient, not just me, but all of us.”

What does the future hold? There are no firm plans for expansion at the moment, but “as the volumes grow, we’ll be right there waiting to grow,” Rohlfs said.

A Passion for the Job

Training and planning have been crucial to the GRN program’s success, but the most important component is the people who make it work. People like Perry and Lock, who combine top-notch nursing with a love for older adults.

“I just think they’re one of the strongest generations,” Perry said. “I get to meet a lot of neat people.”

Added Lock: “It’s a good blend of my skills, of loving the older population and loving the ED.” For patients and families, it’s another way they are touched by Methodist’s commitment to care.

“It was just a traumatic time for us,” Michelle said. “It was very comforting being taken care of like that.”

Winter 2018

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This year, 85 percent of Methodist employees participated in the Caring Campaign.

They CARE! Methodist employees send a strong message to the community:

They not only work at Methodist, they invest in its future.

Once a year, employees are invited to take part in the Caring Campaign, an effort in which they show their support by making donations to Methodist Hospital Foundation or United Way. This year, 85 percent of employees participated in the campaign – which is more than double the national average of around 33 percent. And it is a new record for Methodist.

“I have been donating to Caring Campaign for six years,” said Kelly Menousek, BSN, RN, CEN, an Emergency Department staff development nurse. “I have seen how my gift makes a difference, and it feels good to help others.”

Together, employees raised nearly $400,000 for various programs and projects.

Last year, employees contributed 25 percent of the funds needed to begin Methodist Mobile 3D Mammography –

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bestcare.org

a program that allows patients to receive 3D mammograms on the go.

“

This is an organization worth supporting.

— Brenda Franks

“

This year’s greatest need is the Methodist Hospital Emergency Department renovation and expansion project, which will double the amount of space and provide easier access, less waiting and more privacy.

“The employees see the needs firsthand and know they are real,” said Ryan Albrecht, MHA, director of practice operations at Methodist Physicians Clinic HealthWest Orthopedics. “The Emergency Department is an important resource for our entire community.”

“Who knows Methodist better than its own employees?” asked Brenda Franks, who works in the laboratory. “I hope that my support will show others in the community that this is an organization worth supporting.”

To learn more, please visit MethodistHospitalFoundation.org

methodisthospitalfoundation.org

The 1891 Society Named for the year in which Methodist Hospital was established, the 1891 Society recognizes the current giving of loyal donors who support the programs and projects of Methodist Hospital Foundation. We thank the following friends who made a gift between June 1 and Sept. 30, 2018.

Founders

Gifts & pledges $100,000 & greater Charles M. "Mike" Harper Robert D. Keckler

Leaders

Gifts & pledges $50,000 to $99,999 The Bridges Family

Guardians

Gifts & pledges $10,000 to $49,999 The Baer Foundation Gilbert M. & Martha H. Hitchcock Foundation John & Wende Kotouc Dr. & Mrs. Todd Lovgren Methodist Physicians Clinic Women's Center Craig Bassett, MD Paige Berryman, MD Julia Bishop, MD Jessica Bracken, MD Amanda Buskevicius, MD Mark Carlson, MD Sarah Gernhart, MD Lanette Guthmann, MD Rebecca Jacobi, MD Carolee Jones, MD Brian Karre, MD Brianne Kling, MD Thomas Martin, MD Mia Nagy, MD Darrick Peters, DO Allison Phillips, MD Antara Pothuloori, MD Megan Prickett, MD Aimee Probasco, DO Judith Scott, DO Tifany Somer-Shely, MD Rachel Swim, MD Christine Vo, MD William Weidner, MD Susan Westcott, MD Project Pink'd, Inc

Protectors

Gifts & pledges $5,000 to $9,999 American National Bank Cox Business Susan J. Dennis Sandy & Kate Dodge Bob & Susan Knapp Leslie Koenig, MD Marco, Inc Charles W. McLaughlin, III Midwest Gastrointestinal Associates, PC Tyron A. Alli, MD Alexander B. Bernal, MD Douglas E. Brouillette, MD John J. Cannella III, MD Jason J. Cisler, MD Rebecca A. Ehlers, MD Joshua T. Evans Sr, MD Helen O. Fasanya-Uptagraft, MD Benjamin S. Hall, MD Kimberly S. Harmon, MD Grant F. Hutchins, MD Kathryn E. Hutchins, MD William C. Livingston, DO Thomas R. McGinn, MD Matthew M. McMahon, MD John C. Mitchell II, MD Trevor J. Pearson, MD Kyle D. Rose, DO Edwin C. Schafer, MD Michael E. Schafer, MD Marc A. Scheer, DO Bradley J. Schroeder, MD Brian W. Ward, MD Omaha Lancers Hockey Foundation Omaha Storm Chasers Dr. John Park & Dr. Anna Trauernicht Perinatal Associates, PC Robert Bonebrake, MD Brendan D. Connealy, MD Joshua D. Dahlke, MD Neil Hamill, MD Todd Lovgren, MD Emily Patel, MD Andrew Robertson, MD Hemant Satpathy, MD Dr. & Mrs. Frederick C. Raiser Dr. & Mrs. Thomas J. Rankin Security National Bank of Omaha Sirius Computer Solutions

Friends

Gifts & pledges $1,000 to $4,999 Michael & Julie Ahrens American Contract Systems Dani & Marcus Anderson Baird Holm LLP

8701 WEST DODGE ROAD, SUITE 450 OMAHA, NE 68114 402-354-4825

Banyan Medical Systems Bishop Business Blackman & Associates, PC Kim Bland Ron & Connie Brasel Michael & Jennifer Campbell Jeffrey S. Carson, MD Cerner Corporation Alvin & Paula Chamberlain Dr. & Mrs. Andrew M. Coughlin Dr. C.C. & Mabel L. Criss Memorial Foundation Darmody Management Marcia DeRoin Roy & Gloria Dinsdale Downtown Rotary Club of Omaha Jim & Marge Eggers Tom Elser & Stephen Hug Todd & Cathy Engle Elaine V. Ford Jeff & Keri Francis Dianne L. Fuhs Steve & Brenda Goeser Dr. & Mrs. John A. Haggstrom Michael & Sharon Hansen Leone Harlan Dr. & Mrs. Herbert A. Hartman, Jr. HDR Healthcare IQ Leslie C. Hellbusch, MD Mary Lue Hicks Hillcrest Health Services Holland Basham Architects Ruth & Otis Huntley Ilene Kelly Kiewit Building Group Dan & Deb Lindstrom Sean McMahon & Tracy Madden-McMahon Cynde McCall Drs. Joseph & Debra McCaslin The McGowan Family MDWest One, PC Methodist Hospital Administration Methodist Jennie Edmundson Hospital Methodist Physicians Clinic Administration Methodist Shared Service Systems Laura Millemon, MD MMC Mechanical Contractors Nebraska Cancer Specialists Margaret Block, MD M. Salman Haroon, MD Ralph J. Hauke, MD Timothy K. Huyck, MD Robert M. Langdon, Jr., MD Kirsten M. Leu, MD John M. Longo, MD Nagendra Natarajan, MD Geetha Palaniappan, MD David A. Silverberg, MD

Yungpo Bernard Su, MD Stefano R. Tarantolo, MD Peter M. Townley, MD, Emeritus Nebraska Furniture Mart Nebraska Health Network Neonatal Care PC Khalid Awad, MD Brady Kerr, MD David Minderman, MD Chinyere Oarhe, MD Lynn O'Hanlon, MD Thomas Seidel, MD Chinyere I. Oarhe, MD Penny J. Olson Omaha Nephrology, PC Dr. & Mrs. Jeffrey A. Passer Passer Restorative Therapies Cyndy Peacock Pepsi Cola Bottling Company Pinnacle Bancorp Radiologic Center, Inc Lisa A. Bladt, MD Kevin M. Cawley, MD Paul S. Christy, MD Ryan A. Dvorak, MD David J. Hilger, MD Richard A. Kutilek, MD Ben A. Maertins, MD Kevin L. Nelson, MD Nick L. Nelson, MD Temple S. Rucker, MD Linda A. Sing, MD Max Stevens, MD Kristofer A. Vander Zwaag, MD Sue & Ron Rohlfs Rotella's Italian Bakery Connie Ryan Andrew J. Sass Dr. & Mrs. William A. Shiffermiller Lois Stebbins L. B. "Red" & Jann Thomas Melodee & Tommie Thompson The Vetter Foundation Jennifer D. Vogler Wakefield Community Schools Samuel Watson, MD Spencer & Michele Williamson Our friends who wish to remain anonymous.

Winter 2018

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Nonprofit U.S. Postage PAID Omaha, NE Permit No. 563

An Affiliate of Methodist Health System

8303 Dodge Street Omaha, NE 68114 Winter 2018 Volume 8 – Issue 3

The Meaning of Care magazine is published by Methodist Health System Marketing & Public Relations. Free subscriptions are available by emailing your request to bestcare@nmhs.org.

Senior Director of Marketing Director of Public Relations Writer/Associate Editor Writer/Associate Editor Writer/Associate Editor Photographer/Videographer Art Director/Photographer

Jenni Stoll Claudia Bohn Katina Granger Jessica Gill Patrick Smith Daniel Johnson Chris Thompson