In October 2016, Amy Laarman, Clinical Nurse OR, nominated Autumn Chihak, Main Operating Room Clinical Nurse, for a Daisy Award. The nomination reads:
Over the course of two weeks, Autumn cared for a young trauma patient who experienced multiple surgeries for her injuries. The patient had multiple fractures in her torso and extremities and had also head and facial injuries. During this time, the patient was critically ill and unaware of her condition.
When Autumn reviewed the chart for this visit to the OR, she learned the patient was starting to become more alert and was in a lot of pain. Due to the patient’s critical condition and severe pain, hygiene activities had been minimal. Noting the patient’s progress and the young age of the patient, Autumn knew the patient would be very concerned about her appearance when she became fully alert.
Autumn discussed providing a bath and shampoo to the patient with the anesthesiologist and surgeon while the patient was under anesthesia before bringing the patient back to the OR. They formulated a plan to do this efficiently, gathering supplies and equipment. Autumn’s orientee helped by obtaining a comb and other supplies and by assisting with the process. The surgeon removed staples and redressed old wounds after Autumn bathed the patient.
Autumn’s focus went beyond surgical intervention for this patient and provided excellent nursing care that encompassed the patient’s whole self. Thank you, Autumn.
On Tuesday, December 20, when many of us may have been scrambling to prepare for the holiday, Jessica Wertsch and her mother, Joni Hallberg — a surgical technologist at Mercy Health Saint Mary’s — visited Mercy Health Lacks Cancer Center bearing 18 Thirty-One® bags filled with cheerful gifts for cancer patients.
As a Thirty-One bag consultant, Wertsch wanted “to give back to the community and to honor a close family friend Dr. Marilee Mead, a hand and plastic surgeon at Mercy Health Saint Mary’s and a cancer patient at Lack Cancer Center.”
The gift bags were given to patients in Dr. Mead’s honor right before Christmas.
Dr. Mead is battling cancer and appreciates the power of surprises that comfort. “The windows in the chemo center let in a lot of lovely natural light, but when you’re undergoing treatment, it’s easy to feel cold, and the contents of these bags will help patients stay warm and pass the time in comfort. I’m honored that Jessica put together all of these gift bags for patients.”
Joined by Dr. Mead, the trio set out to surprise and delight patients who were in the chemo center. They went from patient to patient, allowing them to choose the bag that best fit their personality. Patients were surprised and deeply touched.
“These gifts are really nice, they really lift up the spirits when you’re going through your chemo,” said patient Carol Raap. “We really appreciate it.”
Patient Brenda DeVries agreed. “This is just wonderful. I can use all of this. It made my day! It is greatly appreciated.”
Friends and family members donated the goodies inside the bags, which included hats, blankets, gloves, puzzle books, hand sanitizer and gift cards to The Shoppe.
After distributing the bags, Wertsch expressed her delight: “The smiles on the patients’ faces made it worthwhile. If I was able to do this in one week’s time, I wonder what I could do for people next year by planning ahead.”
By Brooke Wiles, Medical Dosimetrist – Mercy Health Muskegon Johnson Family Cancer Center
A diagnosis of cancer changes everything — especially when it concerns a child.
My 8-month-old son, Alexander (Zander), was diagnosed with Acute Lymphoblastic Leukemia on June 12, 2015. My husband James and I were devastated.
For the next five months, Zander lived on the oncology floor of a West Michigan children’s hospital. My husband and I were determined to have one of us at the hospital with Zander at all times…but we couldn’t imagine how we were going to continue to work, care for our precious 3-year-old daughter, and also be there for our son. James and I were overwhelmed.
We decided that my husband would leave his job immediately, and I would continue to work full-time for Mercy Health at the Johnson Family Cancer Center as a medical dosimetrist.
Enter my Mercy Health family. My colleagues immediately sprang into action to support our family in a variety of ways. Some colleagues donated money to help us with expenses. Others gave me their PTO days so that I could take a break from work, spend time with Zander, and also maintain some semblance of normalcy in our home life.
I can’t describe the level of ongoing emotional and practical support our family received from my coworkers. Their generous spirit helped me to get through the toughest time in my life.
In the months that followed Zander’s diagnosis, there were many doctors’ visits, blood transfusions, fevers and ER visits. Throughout it all, my work family listened to me, gently explained the procedures my son was undergoing, and helped me to deal with the profound emotions that accompany a diagnosis of childhood cancer.
My work family even made it possible for my husband and I to get away for one evening just to relax! I have never worked with people who have been so caring, selfless and compassionate. Our family is blessed to know that my Mercy Health colleagues have our backs.
Today Zander is about six months away from completing his chemo treatment. He is in remission, and is healthy enough to be in daycare, which has allowed James to return to work full time. We are deeply grateful for the excellent care we have received in West Michigan.
Please know that you are our second family who will always hold a special place in our hearts. Thank you, colleagues, for truly living the Mercy Health mission.
With so many unknowns, a trip to an emergency department (ED) tends to raise anxiety for patients: What’s wrong with me? Is my condition serious? Will I require tests? Will it be painful? Will I be admitted? How long will I be there?
The good news is that since January 2016, the EDs on the Mercy and Hackley Campuses have operationalized an approach to triage that helps to answer those patient questions more quickly and reduce door-to-discharge metrics for low-acuity patients. It’s called the Vertical Unit within the ED, and it is transforming care with significant results.
Of course, triage has always occurred in the ED, but this new approach assesses quickly which patients will require fewer resources and then places them on a faster track of care than that of the traditional ED patient, without compromising quality of care.
“We’ve had iterations of fast track for years,” said Frank Duncan, III, MD, FACEP, Medical Director of the Emergency Department on the Mercy Campus. “With the help of the Process Excellence team, we’ve redefined what ‘fast track’ means, determined inclusion and exclusion criteria, and better streamlined the process.”
During peak volume times, from 11 a.m. to 11p.m., the Vertical Unit is in operation, and a triage nurse is stationed at the ED entrance. This nurse sees and speaks with patients as soon as they arrive. This “first assessment” is an important part of the process.
Josh Hulbert, RN, is the lead triage nurse in the ED on the Mercy Campus. “I’m the gatekeeper. I’ll ask patients as they arrive, ‘What can I help you with today?’ or ‘Why are you here today?’ without violating their privacy,” said Hulbert. As the first person to interact with patients, Hulbert can do a brief observational assessment to ensure that people receive the best care.
After the triage nurse has greeted and sent patients to registration, a secondary assessment or triage takes place with other ED nurses, who take vitals and make the final determination about which track is best for the patient — traditional or vertical.
Not All ED Patients Are Equal
An example: An 80-year-old woman who presents with abdominal pain will likely require an extensive workup that could include bloodwork and an X-ray, CAT scan or ultrasound (more resources). A 17-year-old with a sprained ankle might need an X-ray and a splint (a candidate for the Vertical Unit). What happens next makes the difference.
The teen with ankle pain will be brought into a Vertical Unit patient room that has a comfortable chair rather than a bed [see photo]. The patient will literally be sitting (or vertical) while a staff member has a HIPAA-compliant conversation, takes a confidential history and conducts an exam.
In contrast, a “traditional patient,” will be assigned to a room with a bed, and the patient will lie down — be horizontal — and remain there until the best course of action is determined.
The vertical patient may then be sent to a secondary waiting room [see photo] or be sent to X-ray. After an X-ray, the patient could return to the waiting room or might be returned to another Vertical Unit patient room for a conversation with a provider and a splint, if necessary.
“The Vertical Unit is designed to keep people upright and moving to help expedite their discharge from the ED. As the patient, you might have to move more, but you are released more quickly,” said Duncan.
Caring for More Patients More Quickly
What began as a pilot program (September 2015–January 2016) quickly turned into a best practice, based on immediate results. Combining Fast Track with the Vertical Unit improved significant metrics three months after go-live:
Reduction in Fast Track Door-Doctor Median Times (8.5-minute reduction)
Reduction in Overall Door-Discharge Median Times (20-minute reduction)
Reduction in Fast Track Door-Discharge Median Times (24.5-minute reduction)
Perhaps Duncan says it best: “Our focus has always been the patient. If I’m a patient and have a simple problem, I want to be in and out as quickly as I can. We all are busy people and have other things we’d rather be doing than be in the ED. Anything we can do to provide appropriate and efficient care is my goal.”
To learn about similar innovations in the ED at Mercy Health Saint Mary’s, click here.
In 2015, 15 percent of the time the Emergency Department (ED) at Mercy Health Saint Mary’s was trying to care for more than 200 patients per day. Earlier this year, the number of such high-volume days, wait times, and patients who left without being seen (the LWBSs) increased significantly. Something had to change.
In early 2016 the statistics were staggering:
High-volume days: 34 percent, more than double of 2015’s, to at least twice a week
Median length of stay: 171 minutes, or nearly three hours
On high-volume days, the median number of people who left without being examined (LWBS) because of long wait times: 12
Mark Figurski, MD; Cindy Ballast, RN; and Lori Laviolette, APP, (pictured left) were just a few of the ED staff who were concerned about these numbers. They noticed that holdups occurred as patients waited for the provider or as rooms lay vacant until cleaned. “High-volume days are especially overwhelming and efficiencies suffer,” Figurski said. “There’s a lot of wasted time just trying to clean rooms.”
Together these colleagues considered a bold option: Why put all patients in a room with a bed? What if some patients stayed seated (vertical) in a room, and providers went to them?
In December 2015, members of the ED held an extensive two-day model cell event to work out the details of what is now called the Vertical Patient experiment, which they implemented in April 2016. Everyone in the ED was represented: Registration, nurses, physicians, Patient Care Assistants and security — and everyone had a voice in the planning process.
The Vertical Patient Model has succeeded even beyond the ED’s goals. By the end of April, its effectiveness was clear:
Median length of stay for vertical patients before experiment: 119 minutes
Median length of stay for vertical patients after experiment: 57 minutes — 52 percent decrease!
What’s more, patients have responded positively to this new approach. “People ask if we have comment cards that they can fill out,” said Laviolette. “They’re so happy to get the care they wanted so quickly.” Ballast added: “I’ve gotten more hugs since April in the vertical patient center than in the entire five years I’ve worked in the ED.”
The Vertical Patient Model
Not everyone who comes to the ED needs to lie in a bed. The Vertical Patient Model identifies patients with less severe symptoms — such as a rash, a sprain or insect bites — and slots them into the vertical patient track instead.
When entering the ED, patients register as usual and go through triage, where it is determined if they will be assigned to the vertical patient track. Unlike the rest of the ED, the vertical patient bay has a separate waiting area and two smaller rooms for patients who stay seated the entire time. The separate waiting area is used for vertical patients if they need to go for labs, X-rays, etc, so that the rooms themselves stay open for the next patient.
Figurski described the Vertical Patient model as parallel work between provider and nurse. In the rest of the ED, providers and nurses see patients separately to keep up with the high numbers, and there can be a delay between their visits on busy days.
In the vertical patient bays, provider and nurse see the patient at the same time. “We don’t have to take time to communicate what happened in the room,” Ballast said. “The nurse knows the care plan because he or she is there as the provider explains it.”
Efficiencies make the difference. Patients sit in chairs in the vertical patient rooms, so less time is spent cleaning. Because providers and nurses care for patients simultaneously, the result is less time in the ED for patients.
Laviolette contrasted the new approach with the days before the vertical patient option: “The patients being seen in the two vertical rooms in less than an hour used to tie up nine rooms for over two hours.” With those nine rooms open for more acute patients who need them and vertical patients being seen and discharged in less than an hour, the entire ED decompresses.
The median length of stay also goes down for all patients. “The other day, providers in the vertical patient bay cared for 36 patients between noon and 6:30 p.m.,” Ballast said. “That means 36 other patients that the rest of the ED can get to faster.”
Patients aren’t the only ones benefiting from the Vertical Patient Model’s effects. Figurski, Laviolette and Ballast reported that colleagues working in the ED are much happier and more motivated since the experiment started.
“The whole department has taken ownership of patients and their length of stay,” Laviolette said. Figurski and Ballast quickly concurred. “There’s huge staff buy-in,” said Figurski. “Everybody is so invested in seeing length of stay go down.”
Currently, the vertical patient bays operate on Monday through Wednesday from noon to 8:00 p.m. The ED hopes to expand vertical patient hours to seven days a week.
“The vertical patient method is efficient,” Figurski said. “It helps with those huge patient loads and with patient satisfaction.”
To learn about similar innovations in the EDs in Muskegon, click here.
The October 2016 DAISY Award winner is Sarah DePhillips, RN, BSN from ICU at the Mercy Campus, Muskegon.
“Sarah always goes above and beyond, doing the little things that make patients feel better. On August 21 a patient wanted her hair cut. Sarah stayed after her shift giving the patient a haircut. The patient was grateful and felt much better. This is only one example…she always does little things like this…giving pedicures, making special “spritzers” for patients and whatever else to make patients feel like a human being and not just another patient.”
Sarah was honored with a surprise ceremony on her unit in front of her family, leaders and peers. To nominate a well -deserving nurse, please complete the nomination form located on the Mercy Health Muskegon Intranet.
The November 2016 Friends of Nursing Award winner is Charles Winslow, MD, Neonatologist and Program Lead for Muskegon’s Special Care Nursery Services. Dr. Winslow was nominated by Deb Perry-Philo, RN, Director of Women’s & Children’s Services.
Deb writes: “Dr. Winslow’s engagement in, and dedication to, the development of this service has went above and beyond whatever would have been imagined. Following the delivery of a critical infant from a critically-ill mom (who ended up in the ICU and later passed), Dr. Winslow regularly visited the mom’s ICU room, sitting with her and giving her updates on the baby. The extent of awareness this mom had of these conversations is unknown but this compassion was appreciated and meaningful to us and the patient’s family. Dr. Winslow also took (secure) pictures of the baby, who had been transferred to Saint Mary’s in Grand Rapids, to bring back and show the family as they could not easily get to Grand Rapids with a critically-ill family member in Muskegon. This is but one example of the care, compassion and dedication Dr. Winslow has exemplified.”
Dr. Winslow was honored with a surprise celebration on North 2 at Hackley amongst his nursing peers. To nominate a well-deserving colleague, please complete the Friends of Nursing nomination form located on the Mercy Health Muskegon intranet.
Pictured Sitting, Left to Right: Breena Cutter, Dr. Charles Winslow, Deb Perry-Philo;
Pictured Standing, Left to Right: Shelby Klinger, Kurney Withem, Kim Burrow, Martha Jonassen, Geralyn Kroll.
Mercy Health Saint Mary’s and Mary Free Bed Rehabilitation Hospital hosted a joint first-responder training session for our local EMS providers on Tuesday evening, November 29. Participants — including U.S. Army medics, area EMS and members of the Grand Rapids Police Department — received valuable insight and immediate intervention tools they can use in a trauma situation. Thank you to all who joined us for this free event!
It’s not often that a cancer patient claims to feel elated after a diagnosis of lung cancer followed by surgery. But Roy Taylor credits his early intervention and excellent prognosis to the low-dose CT Lung Screening program at Mercy Health Lacks Cancer Center and to his outstanding Mercy Health surgeon.
A smoker since age 18, Roy first became aware of Mercy Health’s low-dose CT Lung Screening while reading TheGrand Rapids Press in 2014. He already had COPD and was wondering if it would be worth it to get the affordable scan to give him peace of mind.
Because Taylor met several criteria1 — including the fact that he had quit smoking at age 58 — he qualified for the affordable cost of just $100 per lung screening, which was not covered by his private insurance at that time, but are covered now. Ron’s third and fourth scans were covered by Medicare. Taylor’s primary care physician made the referral to Mercy Health.
So in 2014, when he was 64, he made an appointment for his first scan, which showed no signs of cancer. A year later, his second scan also came back negative. In 2016 his third scan indicated he had a small growth in the middle lobe of his right lung. He was scared and was aware that “the long-term prognosis for lung cancer is not good.”
Enter Dr. Bruce Shabahang, medical director of Thoracic Surgery. His advice for Taylor was to return in six months for another scan to see if there were any changes. His fourth scan showed significant changes.
“My first thought,” said Taylor, “was to go get this right now and not wait.” Looking back he is glad that he followed Shabahang’s advice.
“Our standard protocol is to wait and see if there is a change and then pursue it further if necessary,” said Dr. Shabahang. Surgery followed in July 2016 that involved removing Taylor’s middle lobe, along with several lymph nodes.
Dr. Shabahang spoke with Roy and his wife Sue for a long time after the surgery. “He is a really caring guy who spent a lot of time with me, and the care I received at the hospital was great,” said Taylor. The surgeon told the couple that there was no apparent presence of disease following surgery and at that time Taylor’s cancer was completely resected, which are “pretty powerful words.” For the Taylors and their surgeon, “that was a really good day.”
Roy and Sue recall even more good news: “Dr. Shabahang was elated when he was able to tell us that, based on my stage of cancer, I would not require radiation or chemotherapy.”
Taylor’s advice to former smokers is this: “If it weren’t for that Mercy Health program, I’d be walking around with lung cancer and not know it until symptoms appeared, when it would probably be too late.”
“Since the program began in 2013, we have 1,000 people in our program, and 32 patients have been diagnosed with lung cancer,” said Mary May, oncology nurse at Mercy Health Lacks Cancer Center. We’re happy to report that the majority of those 32 patients have been diagnosed early.”
Between the COPD and the surgery, Taylor has lost about 15 percent of his lung capacity, but he isn’t complaining. “I owe my life to that program. Now I’ll be around to have fun with my grandkids.”
1Eligible patients must meet the following criteria:
Be between the ages of 55 to 77.
Have a smoking history of at least 30 pack years (one pack a day for 30 years or two packs a day for 15 years.)
Be a current smoker or one who quit smoking within the last 15 years.