To view or download a PDF version of the August/September 2015 CCON Stat, click here.

To view the Archives, click here.

On Tuesday, August 25th, several CCON students stopped by open lab to brush up on their nursing skills for the fall semester. Students helped a patient, Mr. Harvey, with his recovery. Thanks to the students, Mr. Harvey is now discharged and doing well. He is on his way to the "Midwest Checker Championship" in Toledo, Ohio. 

This was a great opportunity for students to have a refresher before they start clinicals in a few short weeks. 

A big thank you to Professor Deb Bartoshevich for putting everything together and to Professors Barb Brenzel and Beth Stay for volunteering their time to help out.

The stroke programs at Columbia St. Mary's Hospital Milwaukee and Ozaukee were both recently recognized by the American Heart Association/American Stroke Association and U.S. News and World Report.

Both Columbia St. Mary's Hospital Milwaukee and Ozaukee received “Get With The Guidelines – Stroke Silver Plus Quality Achievement Award” for implementing specific quality improvement measures outlined by the American Heart Association/American Stroke Association for the treatment of stroke patients. Additionally, Columbia St. Mary's Hospital Milwaukee was named to the “Target: Stroke Honor Roll.”

“Get With The Guidelines – Stroke” helps hospital teams provide the most up-to-date, research-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Columbia St. Mary’s earned the Silver Plus award by having 85 percent or higher adherence on all applicable achievement measures and at least 75 percent or higher adherence with five or more select quality measures in stroke for 12 consecutive months. These measures include aggressive use of medications and risk-reduction therapies aimed at reducing death and disability and improving the lives of stroke patients.         
The “Target: Stroke Honor Roll” recognizes current “Get With The Guidelines – Stroke” accredited hospitals who also had 50 percent or higher achievement of door-to-needle times within 60 minutes in applicable stroke patients for at least one calendar quarter.

“We are pleased to recognize Columbia St. Mary’s for their commitment and dedication to stroke care,” said Deepak L. Bhatt, M.D., M.P.H., national chairman of the “Get With The Guidelines” steering committee and Executive Director of Interventional Cardiovascular Programs at Brigham and Women's Hospital and Professor of Medicine at Harvard Medical School. “Studies have shown that hospitals that consistently follow “Get With The Guidelines” quality improvement measures can reduce patients’ length of stays and 30-day readmission rates and reduce disparity gaps in care.”

“Get With The Guidelines – Stroke” also helps Columbia St. Mary’s staff implement prevention measures, which include educating stroke patients to manage their risk factors and to be aware of warning signs for stroke, and ensuring they take their medications properly.

According to the American Heart Association/American Stroke Association, stroke is the number four cause of death and a leading cause of adult disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

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About Get With The Guidelines
Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 4 million patients since 2001. For more information, visit heart.org/quality or heart.org/myhealthcare.

About Columbia St. Mary’s
Columbia St. Mary's comprises four hospitals, Columbia St. Mary's Hospital Milwaukee (including the Women’s Hospital), Columbia St. Mary’s Hospital Ozaukee, Sacred Heart Rehabilitation Institute and a partnership with the Orthopaedic Hospital of Wisconsin. In addition, there are 62 primary care clinics, the Columbia College of Nursing, and an affiliation with Madison Medical Affiliates. The system serves Milwaukee, Ozaukee, Washington and Sheboygan counties, with more than 165 years of service. Columbia St. Mary’s is transforming healthcare through its leading cardiovascular services, robotic surgery, Trilogy cancer technology, Bariatric Services, Orthopaedic Surgery, Spine Center, Milwaukee Institute of Minimally Invasive Surgery, Heitz Radiation Oncology Center, Regional Burn Center, Van Dyke Haebler Center for Women’s Imaging, Multiple Sclerosis Clinic, Wound Healing Centers, accredited chest pain centers, certified primary stroke centers, Wisconsin Chiari Center, and full women’s health services including the Heart Secrets Program. Columbia St. Mary's and its sponsor organizations, Ascension Health and Columbia Health System, share a mission to make a positive difference in the health status and lives of individuals in the community with a special concern for those who are vulnerable. For more information, visit columbia-stmarys.org.

About Ascension
Ascension (ascension.org) is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world’s largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all persons with special attention to those who are struggling the most. In FY2015, Ascension provided $2 billion in care of persons living in poverty and other community benefit programs. More than 150,000 associates and 35,000 affiliated providers serve in 1,900 sites of care – including 131 hospitals and more than 30 senior care facilities – in 24 states and the District of Columbia. In addition to healthcare delivery, Ascension subsidiaries provide a variety of services and solutions including physician practice management, venture capital investing, treasury management, biomedical engineering, clinical care management, information services, risk management, and contracting through Ascension’s own group purchasing organization.

In recognition of National Chiari Awareness Month, Dr. Dan Heffez, Medical Director of Columbia St. Mary’s Wisconsin Chiari Center, was on TMJ4’s "The Morning Blend" discussing the often misdiagnosed and misunderstood condition.

Click image to enlarge.

Columbia St. Mary’s is the #1 rated hospital in southeastern Wisconsin (and #2 in the state) for high quality and low cost according to HCTrends’ 2015 Health System Quality & Resource Efficiency Study. Click HERE to view the full report.

This report is the first analysis in Wisconsin to measure system-wide quality and resource efficiency by incorporating both hospital and medical group measures. Measuring resource efficiency provides a meaningful comparison of how healthcare is delivered. When combined with a quality index, it provides a better indication of value.

The HCTrends health system resource efficiency analysis is based on a standard cost-per-episode methodology that measures the relative utilization of medical services provided to treat a specific episode of care. This approach helps to identify the frequency and types of medical services each health system provides to treat a particular episode and how that treatment protocol compares to other health systems.

HCTrends is the premier forum for market-oriented health care solutions in the Milwaukee area. They produce regular newsletters and reports examining trends and solutions to healthcare and employee benefits challenges.

Question: What is a Chiari malformation? And how do I know if I have one?

By Dr. Dan Heffez, Neurosurgery and Medical Director, Columbia St. Mary’s Wisconsin Chiari Center

Often misdiagnosed and misunderstood, Chiari malformation is a relatively rare structural abnormality at the base of the skull that affects the brain and spinal cord. While not life-threatening, it can cause a wide range of debilitating symptoms.

Patients often suffer from Chairi malformation for years without ever receiving an official diagnosis. I have treated patients who have been living with headache, pain, dizziness and a host of other symptoms sometimes for decades. They may have seen countless doctors who were unable to provide any long-term relief. Often, the diagnosis just goes unrecognized. That's where the Wisconsin Chiari Center comes in.

Many describe Chiari malformation as an abnormality of the brain, but that is not accurate. The brain is entirely normal. The malformation involves the base of the skull, which is too small to accommodate the lower portion of the brain. As a result, the lower part of the cerebellum, called the tonsil, protrudes into the upper spinal column. This results in compression of the brain stem and spinal cord, and an interference with the circulation of the spinal fluid.

What makes Chiari malformation so difficult to properly diagnose is the wide range of vague symptoms that affect so many different parts of the body. Also, despite the fact the Chiari malformation is present at birth, symptoms typically don’t appear until early adulthood.

The most common symptom is chronic, unexplained headaches, often described as intense pressure that begins at the back of the head and radiates behind the eyes. Chiari headaches can easily be confused with migraines, which further delays diagnosis.

Other symptoms include neck pain that radiates down the spine and across the shoulders, dizziness/vertigo, vague pains throughout the body, impaired balance/clumsiness, chronic nausea, foggy thinking, poor memory and concentration, frequent or urgent urination, irritable bowel syndrome, auditory symptoms (such as ringing in the ears, decrease in the ability to hear or sensitivity to sounds), difficulty swallowing, hoarseness and visual symptoms (including double vision, sensitivity to lights and blind spots). If you are suffering from any combination of the above symptoms, I recommend you talk to your doctor about the possibility of Chiari malformation.

The diagnostic process begins with a complete medical history followed by a detailed neurological examination. An MRI scan is the best diagnostic tool for detecting Chiari malformation. This test provides us with detailed anatomical information regarding the structures at the base of the brain and allows us to determine if the brain stem is being compressed.

If it is determined you have a Chiari malformation, there are several treatment options. Some people with a Chiari malformation experience no symptoms – in these cases no treatment is required. Some symptoms of Chiari malformation such as headache and dizziness may be effectively treated by medication. Medication alone, however, will not correct the root cause of the symptoms: the brain stem compression. As a rule, when the Chiari malformation causes symptoms that seriously impair the patient’s quality of life, surgery should be considered.

The goal of surgery for Chiari malformation is to make more room for the brain. A surgeon will remove a small section of bone at the back of the skull and spine. A patch of tissue is then sewn into the lining of the brain that expands the space and relieves compression of the brain stem and spinal cord. Most people who have had decompression surgery report immediate relief of many symptoms, and once surgery is performed the problem does not recur.

If your life has been challenged by a host of mysterious symptoms without any clear cause, you may be suffering from a Chiari malformation. The Wisconsin Chiari Center might just be able to help.

Dr. Dan Heffez is a neurosurgeon and medical director of Columbia St. Mary’s Wisconsin Chiari Center. For more information, call 414-585-1078.

This article appeared in the Thursday, September 10, issue of The Ozaukee News Graphic.

Dr. Peter Slocum, Urology, was on PBS’ “Black Nouveau” discussing prostate cancer causes, risks and treatment.

Ahead of the Susan G. Komen Race for the Cure on Sunday, September 27, CBS58 featured the great work being done by CSM’s Mobile 3D Mammography Center.  

Columbia St. Mary’s Cancer Center Milwaukee was recently named to Becker’s Hospital Review’s list of “100 Hospitals and Health Systems with Great Oncology Programs 2015.”

From Becker’s: “The hospitals and health systems included on this list lead the way in care for patients with cancer. These organizations have received recognition for their clinical outcomes, multidisciplinary care teams, clinical expertise and oncology research. They are also influential in cancer education and prevention efforts.”

Columbia St. Mary’s Cancer Center Milwaukee was recognized for its recent Outstanding Achievement Award from the American College of Surgeons Commission on Cancer.

Additionally, Becker’s says, “The center emphasizes a multidisciplinary approach to cancer care with an aim to treat patients' bodies, minds and spirits. To this end, the center is staffed with nurse navigators, offers genetics screening and counseling and integrative medicine options and is equipped with a healing garden to promote stress reduction and reduce the need for medications. The center is also accredited by the National Accreditation Program for Breast Centers and the American College of Radiology.”

Click HERE to see the full list.

Question: What is a multi-disciplinary clinic and how does it affect cancer care?

By Dr. Alysandra Lal, Surgeon and Medical Director, Columbia St. Mary’s Breast Cancer Program

Like most things in life, when it comes to breast cancer care, communication is vital. Poor communication among specialists, departments and the patient can cause confusion about the diagnosis and treatment plan, leading to delay of care.

That’s why at Columbia St. Mary’s, we decided to treat breast cancer differently.

A multidisciplinary clinic is a care model based on a disease process rather than a specialty clinic. Columbia St. Mary’s breast cancer multidisciplinary clinic offers a patient who is newly diagnosed with breast cancer a single opportunity to meet with all the providers who will participate in her care – one day, one time, one appointment. For the patient, that means that after one day of consultations, she has a good sense of her treatment plan and the providers who will be caring for her.

The strength of the clinic actually occurs hours before the patient arrives, though. Twice a week at Columbia St. Mary’s, the entire cancer care team holds a multidisciplinary conference in which we discuss all the patients who are newly diagnosed with breast cancer. Before the conference takes place, one of our nurse navigators – the heart of the program – will have already reached out to the patient, learning about them personally and inquiring about their health history.

The conference begins with an introduction by the nurse navigators. Then, a breast radiologist reviews the mammograms, ultrasounds and other pertinent imaging, and a pathologist shows the patient’s biopsy slides and any other relevant pathology. The surgeon, medical oncologist and radiation oncologist who will be caring for the patient will then present their treatment plan recommendations, which are examined and tempered by the rest of the team. We have a genetic counselor, a psychologist, research study coordinators, occupational therapists, a plastic surgeon, GYN and/or internal medicine physicians, and often members of women’s imaging and radiation therapy departments also in attendance.

This conference ensures that when the clinical team meets the patient, we all have the same information, have vetted our opinions and are offering the highest standard of care.

After the conference, each provider who will be involved in an individual patient’s care meets with the patient and her family one after another in our multidisciplinary clinic. This allows the patient to understand each element of her complex treatment plan from the expert in that field. The important themes of her diagnosis are repeated by each provider, which helps increase understanding.

Furthermore, by meeting with each provider, the anxiety of the unknown can be put aside and the treatment plan is quickly put into action. Patients express highest satisfaction with this clinic style that respects their time and the complexity of their care.

Our multidisciplinary conferences and clinics have helped Columbia St. Mary’s become innovators in our field. We received a grant from the Columbia St. Mary’s Foundation for occupational therapists to meet with patients for whom lymph node sampling is recommended prior to surgery to obtain baseline arm measurements that we hope will lead to earlier diagnosis and treatment of lymphedema, or arm swelling. We have a project in conjunction with our cardiac rehabilitation program that offers exercise programs to patients during chemotherapy, and we have developed more support groups for patients at all stages of breast cancer treatment as a result of patient needs identified in our multidisciplinary clinic.

There is also a large body of literature that shows the effectiveness of this team approach to cancer care. It helps guide accurate diagnoses, increases adherence to treatment guidelines and improves the overall quality of treatment. Multidisciplinary conferences have also been shown to reduce treatment variation and waiting prior to implementation of care, which increases patient satisfaction.

Such conferences have now become a standard for recognition in many national cancer care organizations. In fact, our conferences and clinics have recently led Columbia St. Mary’s Cancer Centers to receive the Outstanding Achievement Award from the American College of Surgeons Commission on Cancer and our inclusion in the Becker’s Hospital Review list of “100 Hospitals and Health Systems with Great Oncology Programs 2015.”

At Columbia St. Mary’s, we are very proud of our multidisciplinary breast cancer conferences and clinics and we believe that it is this type of integrated care that make us the regional leader in breast cancer care.

Dr. Alysandra Lal is a surgeon and medical director of the Columbia St. Mary’s Breast Cancer Program. For more information, contact 877-259-9358.

This article appeared in the Thursday, October 8, issue of The Ozaukee News Graphic.

To view or download a PDF version of the October 2015 CCON Stat, click here.

To view the Archives, click here.

Dr. Erica Berg, Radiology, was on TMJ4’s “The Morning Blend” discussing the importance of regular mammograms and the benefits of 3D mammography, which CSM offers at all of our breast imaging locations.