THURSDAY, AUGUST 30, 2012 • THE BULLETIN
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Tapping engineers, families for hospital safety Wrong • Foundation launches a 10-year, $500M project to design better safety systems By Lauran Neergaard The Associated Press
WASHINGTON — Head of the hospital bed raised? Check. Patient’s teeth brushed? Check. Those simple but often overlooked steps can help protect some of the most critically ill patients — those on ventilators — from developing deadly pneumonia. And if they knew about them, family members could ensure the steps weren’t forgotten. Hospitals are rife with infections and opportunities for medical mistakes. Now, a nearly $9 million project at Johns Hopkins University aims to combine engineering with the power of patients and their families to prevent some of the most common threats. The idea: Design patient safety to be more like a car’s dashboard, which automatically signals drivers when the oil needs changing or if
a passenger forgot to buckle up, or like the countdown systems that make sure no step is missed when a satellite is launched. Today, safe, quality care largely depends on individual health workers remembering hundreds of steps without good ways to tell if they forget one, said Hopkins’ patient safety expert Dr. Peter Pronovost. Getting it right takes what he calls “almost heroic efforts.” And too often, the people best able to spot early warning signs — patients and their families — are treated as passive bystanders rather than encouraged to participate in their care, he said. “Who knows better than the family?” asked Dr. George BoLinn of the Gordon and Betty Moore Foundation’s new Patient Care Program. The foundation, created by Intel co-founder Gordon Moore, announced Tuesday
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that it is funding the Hopkins work as the first step in a planned 10-year, $500 million effort to improve patient safety and family engagement in hospitals around the country. Separately, the Institute of Medicine has signed on to help, partnering with the National Academy of Engineering, to bring together top experts on how to design safety systems.
‘Part of the team’ Sometimes the failure to merely discuss treatment with patients or their families causes the harm. Consider Nicole James, a commercial property manager in Elkridge, Md., who undergoes frequent overnight hospital stays to treat the intense pain of sickle cell anemia. One such visit turned into a miserable two-week stay when the ER doctor added a powerful antibiotic to James’ usual pain treatment without telling her first — a drug that worsened her sickle cell crisis. It turned out the doctor had spotted a shadow on James’ lung X-ray that he thought
Darin Durham, emergency services director at St. Charles Bend, demonstrates how the new portable defibrillator gives audible directions on how to operate the unit in his office recently. Money from the St. Charles Foundation bought three new portable defibrillators to use on remote trails during organized athletic events.
Continued from F1 Deschutes County Sheriff’s deputies ran more than four miles to reach him with a portable defibrillator. But that was unnecessary, Carsten said. Tufts was closer to a different parking area, but paramedics didn’t know exactly where he was or the most direct way to reach him, Carsten said. “I don’t want to take away from the idea that everyone tried very hard and did their best. It wasn’t because they had to run four miles. It’s because they didn’t know how to get there,” she said. “There needs to be better information and reaction time.” “If we had an AED sooner, he might have survived, but we don’t know that for sure,” said Dr. Michael Widmer, a cardiologist with Heart Center Cardiology. AEDs are automated external defibrillators, portable electronic devices that diagnose arrhythmias, or disturbances, in a person’s heartbeat. The defibrillators can send a dose of electric energy to resynchronize a rhythm. CPR can support blood circulation, but a defibrillator could have helped determine if it was an arrhythmia and whether an electric shock would have helped, Widmer said.
Photos by Ryan Brennecke The Bulletin
Filling a gap Most races don’t have emergency medical technicians on standby. This is not unique to Bend. Outside Magazine published an article on this topic earlier this year; it reported that doctors and paramedics across the nation are hesitant to volunteer because they fear medical malpractice lawsuits. Ultimately, it’s the competitors who may pay the price. In Oregon, those who volunteer medical assistance are covered under the Good Samaritan Act, a law meant to protect medically trained people from legal liability if they offer free medical care within their level of training, according to Widmer and Darin Durham, director of emergency services for St. Charles Bend and chapter president of the Central Oregon Emergency Nurses Association. “Liability scares a lot of people,” Durham said. “Everyone is afraid they’ll get sued.” In many cases, including Tufts’, when someone goes down in an event, another race participant helps. The emergency room doctor and cardiac nurse who stopped to try to save Tufts were not obligated to provide that service, Durham said. However, once someone identifies themselves as a doctor or a nurse, they’re obligated to care for the person until another qualified professional takes over. In any case, Tufts’ death pushed into gear a lingering discussion about a lack of medical personnel at events, Durham said. Almost immediately, the Central Oregon Emergency Nurses Association, St. Charles Cardiovascular Services, the St. Charles Foundation and FootZone race orga-
Submitted photo
Billy Tufts, the 40-year-old who died of a heart attack in the Dirty Half trail race, and his fiancee, Staci Carsten, 30.
nizers, who were in charge of the Dirty Half, discussed how to prevent another fatality on the trail. The St. Charles Foundation provided money to buy three new portable AEDs, which cost about $2,000 each. Durham’s department is purchasing some radios because cellphones don’t always work in these forested, far-off locations. Almost a dozen nurses from the nurses association have signed up to volunteer at these types of events, namely, ones in places that emergency vehicles can’t quickly access. Medical personnel are coordinating with various event organizers to determine which upcoming events need what number of volunteers and where they should be stationed on various routes. “We want to be first responders in minutes,” said
Durham. Most frequently, Durham expects the volunteers will provide superficial first aid when runners scrape their skin or turn their ankles, or when mountain bikers crash and break a bone. But when it is more life-threatening than that, they will be especially glad to be within reach. “Cardiac is not the most probable (incident), but it is the most devastating,” said Karen Doolan, St. Charles’ manager of cardiovascular services. “If we do this for three years and save one person, it’s worth it.”
was pneumonia but that she could have told him, and her regular physician confirmed, really was old scar tissue. “I know what’s normal for me,” said James, 37, who now insists that relatives drive past closer hospitals for Hopkins, where her doctor practices, no matter how late at night or intense her pain. Because the doctors know her, “I am not just somebody lying on the table. I am part of the team.” Tens of thousands of preventable deaths occur in U.S. hospitals every year. Numerous programs are under way to improve patient safety. Among them is the government’s Partnership for Patients, funded by $1 billion from the new health care law, that is helping hospitals adopt proven safety strategies. Hopkins’ Pronovost led the creation of one of the most well-known — a simple checklist that ensures hospital workers follow steps that lower the risk of deadly bloodstream infections from common IV catheters. That checklist now
is being used in ICUs nationwide, and the government reported last year that those infections have plummeted by 60 percent as a result. But catheter infections are just one of a dozen serious hospital-caused harms that threaten ICU patients, Pronovost said. Rather than fighting them one at a time, his new project will target multiple ICU threats simultaneously — from ventilator-associated pneumonia to deadly blood clots — without relying on old-fashioned paper checklists and with more family involvement. Already, Hopkins has introduced a “family involvement menu” of care items. “We believe that you know the person that we are caring for far better than we do,” the menu reads. Ultimately, Pronovost envisions an iPad-like device that allows both health workers and family members to see at a glance which of dozens of required daily care steps have been performed and which still need to be.
said. “That’s a healthier population. That’s why it catches people off-guard. You can look healthy and still have heart disease.” Studies have shown that 81 percent of runners who died in an event had experienced prior symptoms. Widmer said even athletes in their 30s and 40s are at risk for developing atherosclerosis, the buildup of cholesterol plaque in heart arteries. There are two kinds of plaque: obstructive and nonobstructive, Widmer said. Obstructive plaque slowly closes off the coronary arteries, which supply blood to the heart. People with this condition often experience chest pain or shortness of breath during physical exertion, when their heart rate and blood pressure goes up but the obstruction limits how much blood can bring nutrients and oxygen to the heart. The other type of plaque is nonobstructive. It creates a thin crust over the gooey cholesterol and fat cells. Meanwhile, inflammation eats away at this crust so it gets weak and can rupture, allowing “all the junk on the inside of the plaque to seep out into the blood stream,” Widmer said. This can create a clot and a heart attack in a person with no previous symptoms. “People who are athletic and have good blood pressure and cholesterol are less likely to develop plaque and less likely to develop heart problems. But low risk doesn’t mean no risk,” he said. “Exercise is overall very good for the heart, and that’s why we encourage everyone to do it.”
Prevention Participants who register for events such as the Dirty Half must sign waivers that say they are aware of the risks, that they’re fit enough to participate and that they release race organizers of any responsibility for their health. As part of this new effort to prevent another death, Doolan
and Widmer want to add some advice on such waivers as well as on event websites, “and not in small print,” Widmer said, that “if you’re experiencing these symptoms, do not run this race.” Chest pain or discomfort during exertion is a sure sign to stop, Widmer said. Other red flags that everyone should watch for: an unusual shortness of breath, feeling dizzy, lightheadedness, fatigue, passing out. Doolan added that some symptoms are atypical. “I’ve had people say it was back pain, not chest pain. In women it’s even more atypical,” Doolan said. It could be pain in the jaw or shoulder, for example.
Tufts’ legacy “(Billy Tufts) was a fit 40year-old who had a heart condition…. He was active, an avid mountain biker,” said Carsten, who is now trying to reconfigure her future without the man she planned to marry. The company Tufts was working for donated some money to the Central Oregon Trail Alliance, a nonprofit, volunteer mountain biking group, Carsten said. She is brainstorming with COTA other programs that could help athletes off the beaten track who are in trouble, even if it’s just with dehydration. She envisions a volunteer bike patrol on certain foot or bike races. She said she knows that event planners do their best and that there’s a lot to do. But there’s always something else that could be done, she said. “We’re all kicking into gear. Nothing gets done until something horrible happens. If that’s what this does, makes it safer for everyone in the future, that’s more than I could ask for,” she said. “I’m thankful that people try to make things better.” — Reporter: 541-383-0304, aaurand@bendbulletin.com
bacteria in mouth can take heavy toll on health By Drs. Kay Judge and Maxine Barish-Wreden McClatchy Newspapers
Your mouth is the gateway to your body, and can affect the health of the rest of your body. Did you know that more than 6 billion bacteria are present inside the mouth? In essence, you have more bacteria in your mouth than the Earth’s human population! Most of the bacteria in the mouth are harmless, but the wrong bacteria in your mouth can led to tooth decay, gingivitis, heart disease and kidney disease. Specific bacteria, including Streptococcus mutans, are responsible for tooth decay. In addition, researchers from the Royal College of Surgeons published a study in March showing that there may be oral bacteria that are responsible for accelerating heart disease. Their research showed that Streptococcus gordonii can produce a molecule on its surface that enables it to mimic the human protein fibrinogen, which is a blood-clotting factor. This activates platelets — the blood cells that are involved in clotting — and causes them to clump inside blood vessels. Platelet clumping can result in growths on the heart valves (endocarditis) or blood vessel inflammation that can block blood supply to the heart or brain. Here are some key facts about oral bacteria you may want to know, to keep your mouth healthy: • Your oral bacteria shift with age and health. The microenvironment of the oral cavity changes with age, the eruption or loss of teeth, and the presence of periodontal disease. Systemic changes, such as pregnancy or drug intake, also alter the number and proportion of flora. These changes are due to changes in the flow, amount and composition of salivary fluid and in the levels and activity of defense components such as immunoglobulins and cytokines in the saliva. Taking probiotics may help keep the bacterial balance in your body. • Sugar promotes growth of bacteria and plaque. Bacteria consume sugar from food residue in the mouth and excrete lactic acid, which becomes part of the plaque layer. Foods to avoid include soda, fruit juice, caramels and candy. Drink plenty of water between meals instead of soda to rinse out food debris and remove bacteria, and eat crunchy vegetables that are nature’s natural flossers (e.g. celery). • Bad oral health is linked to an increased risk of heart disease. Here is a surprising statistic: The relative risk of cardiovascular disease is doubled in people with periodontal disease. • Smoking is a risk factor for periodontal disease. Yet one more reason to quit smoking.
Athletes and heart attacks It’s rare for runners or cyclists have heart attacks during athletic events, Widmer said. “But the thing about Central Oregon is, we have so many athletes and so many events and races and so forth, as opposed to other parts of the state or country, we have a higher concentration of potential risk,” he said. Across the country, the rate of deaths from myocardial infarction — heart attacks — in athletic events is probably between one out of 1,000 and one in 20,000, he estimated. But in Central Oregon, it’s probably higher than the norm because we have more events, more participants and probably more middle-age participants, he said. It’s especially shocking when an athlete dies of a heart attack. But athletes are more likely to ignore symptoms, Doolan said. “Denial is huge. ‘It can’t be me. It’s heartburn,’ ” Doolan
We would like to announce that Dr. Eric Shreve has joined our team.
WELCOME Dr. Eric Shreve
Dr Shreve grew up in Cincinnati. After completing his undergraduate degree at Wabash College in Indiana, he completed his Medical Degree at University of Cincinnati. He performed a general surgery internship at University of Louisville and then finished his Urology Residency at University of Cincinnati. While at the University of Iowa, he trained in a fellowship program for reconstructive urologic surgery. He has specialized training in DaVinci robotic surgery as well as prosthetics and incontinence.
For appointments call 541-382-6447
Dr Shreve is currently seeing patients in Bend and Redmond.