Join Cox for 21st annual Baby Affair

Whether you’re planning a pregnancy, already expecting, or a brand-new parent – or even a new or expecting grandparent – the 2009 CoxHealth Special Delivery Baby Affair is for you!

Come and go as you like, and enjoy this special event designed with all things baby and parenting in mind. The event is 9 a.m. - 2 p.m., Saturday, March 7 at the Outpatient Center entrance of Cox South.

Participants can take advantage of a full day of activities including seminars on breastfeeding, relaxation during childbirth, infant massage, the popular Fatherhood: Basic Training class and more.

There will be a maternity fashion show, door prizes throughout the day and tours of the CoxHealth Special Delivery Suites and Mother/Baby Unit.

Convenient parking for the Baby Affair is provided near the Outpatient Center entrance (southwest side of Cox South, 3801 S. National).

For a complete schedule of events or for more information, call The Women’s Center at 269-LADY, or visit www.coxhealth.com.

Onsite CPR training provided by CoxHealth

CoxHealth is designated by the American Heart Association as an Emergency Cardiovascular Community Training Center. That means church groups, scout troops, civic organizations, fitness club employees – any group of at least six or more – can have CPR classes taught onsite at their location by one of our AHA certified instructors.

Onsite CPR classes range from general public certifications to health care provider courses for licensing purposes and include: adult, child and infant CPR, automatic external defibrillator training, choking relief and two-man CPR. Classes are provided throughout the area.

A generous grant from the CoxHealth Foundation helps offset the cost of certain classes. For more information, course prices or to schedule onsite CPR training, call 269-4117.

Walmart clinic expands care options

This month, CoxHealth is partnering with the nation’s largest retailer to offer a new level of accessibility and convenience with the opening of The Clinic at Walmart.

The retail clinic opened March 2 in the Walmart Supercenter located at 3315 S. Campbell in Springfield. The clinic, which is Walmart’s first in-store clinic in Missouri, is staffed by a nurse practitioner and specializes in fast, affordable access to basic health care for immediate, mild conditions, including sore throats, sinus infections, upper respiratory infections, earaches and bladder infections. No appointments are necessary and evening and weekend hours will allow added flexibility and access to care.

“By joining with Wal-Mart to operate The Clinic at Walmart, CoxHealth is one step closer to ensuring the health and wellness of our community,” says CoxHealth CEO Robert Bezanson. “Our Joint Commission accreditation demonstrates our commitment to providing the highest-quality care. Our clinic is staffed with licensed health care providers for extended hours – including weekends – so families can receive care without a long wait. We hope the clinic will also help ease the burden on our emergency rooms, by providing people with minor illnesses and ailments with another convenient, reliable treatment option.”

Cox officials say the clinic is key to expanding health care access in the Springfield area and changing the way care is delivered. The location inside Walmart will allow busy families to make a quick stop with no appointment and receive care without scheduling a doctor’s appointment or taking time off from work.

“It’s a very progressive idea and the clinic will be a point of access for our system that will offer convenience and affordability,” says Dr. Kerry Randolph, medical director of Regional Services. “The delivery of health care is in transition and we have to look at novel ways to get care to the public.”

Leaders at Cox also say the time is right for a retail clinic, especially given the economic environment. By providing a way to access treatment inside a popular retailer like Walmart, the clinic brings affordable care directly to those who need it.

“In times like this when the economy is struggling, people are having a harder time accessing care,” says Steve Edwards, CoxHealth’s senior vice president. “The new clinic is very affordable and most importantly it’s going to help us further our mission at a time when we’re worried about people accessing care. I’m excited about it – I was excited about it years ago when we started planning, but now there’s a profound calling to do this.”

The addition of the clinic also presents a new way for CoxHealth to reach new patients and be positioned for future growth.

“While it’s important to watch our spending, it’s still key to grow new business and be poised to increase market share when the economy rebounds,” Edwards says. “We’re holding off on some important positions elsewhere in the system and people may wonder why we’re going ahead with projects like the clinic. The answer is: because of growth. And this is growth that’s consistent with our mission.”

Plans for the clinic have been under way for the last few years, since Cox submitted its first proposal in December 2006.

“This has been three years in the making,” says David Taylor, vice president of Regional Services. “We’re excited it’s here and ideally we could see growing this throughout the region.”

Wal-Mart has 28 in-store clinics in seven states and officials say partnering with an organization like Cox has substantial benefits for everyone involved.

“Because CoxHealth is a well known and respected health care provider in the community, our customers will benefit from the convenience of prompt, professional care from an organization that they know and trust,” says Alicia Ledlie, Wal-Mart’s senior director of health business development.

“What a time to be a partner with Wal-Mart,” Edwards says. “When retailers across the country are seeing drops in business, Wal-Mart’s customers are turning to them now more than ever because Walmart has a very good value proposition. They offer high quality products at an affordable price and it’s a great partnership for us.”

Note: The term “Wal-Mart” refers to the corporate entity. “Walmart” refers to the brand name of the company’s U.S. operations. - ed.

Free injury and trauma prevention programs, car seat checks available to public

CoxHealth is a Level II trauma center dedicated to injury prevention for all ages. That’s why we offer free community education programs on injury and trauma prevention, and free car seat safety checks.

The programs, provided by the CoxHealth Trauma Services department, are taught by trauma nurse clinician Jami Blackwell. Blackwell’s background includes years as an ER and flight nurse. “Education like this really goes a long way toward helping individuals avoid needing a trip to the ER or a doctor visit,” says Blackwell. “I can say from experience, a little safety up front can make a big difference later on.”

Injury and trauma programs are available to civic organizations, church groups, scouts and schools of any size, and are appropriate for any age group. Any group wanting to learn more about reducing injury risk can request a program. Topics include: bike, ATV, seatbelt, water, fire, driving and home safety, and fall prevention. People interested in trauma and safety prevention can e-mail injuryprevention@coxhealth.com, or call 269-0919.

Many injuries to children are a result of improperly installed car seats. Fortunately, taking a few minutes with a certified car seat installation technician who can determine if the equipment is being used correctly can prevent these injuries. People interested in free car seat safety checks can e-mail carseats@coxhealth.com, or call 269-0919.

Cox College leaves tuition rates unchanged to help students in tough economic climate

The Cox College Board of Trustees recently voted to leave tuition and fees unchanged for the 2009-2010 academic year. “We made the decision in light of the current economy and the tightening of credit for students,” says Dr. Anne Brett, Cox College president. “To balance our budget we are tightening our belts where ever possible to continue to put students first,” she says.

Because costs continue to rise, but income from tuition and fees will remain the same, the college is taking steps now to prepare. “We are scrutinizing employee travel, we’ve put hiring for some open positions on hold, and we’re asking everyone to think twice about purchases to make sure they are critical,” Dr. Brett says. College leadership will continue to evaluate expenditures throughout the school year and make any necessary adjustments to the budget to ensure the mission of the college is not affected.

Precautions are key to preventing work-related injuries

Is your job a pain in the neck? How about your shoulders or knees? Some of the ways employees bend, lift and move at work can lead to injuries. According to Risk Management, those work-related injuries result in millions of dollars paid annually by CoxHealth for worker’s compensation claims.

An initiative is underway to make the work environment at Cox safer by reducing work-related injuries. Jolene Palmquist is the director of the work injury program in Rehabilitation Services. She is evaluating all job descriptions in the system to determine if they accurately reflect the physical demands required of the position.

First, Palmquist conducts a job analysis. She recently observed employees in Sterile Processing as they worked in the various areas. She was looking for those tasks that increase the potential for injury.

“We have a limit on what we should be lifting,” says Russ Gilbert, SPD educator, “but you can injure yourself bending over to pick up even a lightweight object if you aren’t doing it the right way. Injuries affect the employee and the entire department when someone can’t return to their job,” says Gilbert.

Palmquist then makes recommendations to the department to improve the ergonomics, suggesting adjustments to shelving and work surfaces so employees don’t have to reach too high or bend too low. Employees are also educated about the proper techniques of lifting, pushing, pulling and carrying.

Palmquist returned to Sterile Processing to instruct employees on stretching movements they can perform before and during each shift (above). The stretching and conditioning can prevent injuries by toning muscles and improving flexibility, with an added benefit of relieving stress.

“The program is customized for each department,” says Palmquist. “Staff can do the stretching and conditioning at home and at work to keep the blood flowing to the muscles that support the joints in our bodies. Exercises that keep that tissue healthy can counteract the effects of awkward positions, heavy lifting and repetitive movements at work.”

Saved seconds count in heart care

Speed can save lives in health care, especially in the treatment of heart attack victims. Rapid response means blocked arteries are opened faster, blood flow is restored to the heart and more muscle tissue is saved. Delay can mean lives lost.

Experts at Cox involved in all aspects of care for acute heart attack patients have collaborated to drastically reduce the time it takes to get a patient through the hospital doors to the preferred treatment of angioplasty in the cardiac catheterization lab. Their effort to improve the so-called door-to-balloon core quality measurement has resulted in dramatically lower response times and more lives being saved.

The national standard for door-to-balloon is 90 minutes or less. The latest data from the second quarter of 2008 and validated by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission, show CoxHealth with an average door-to-balloon time of 57 minutes. In that quarter, the fastest time for an individual case was 28 minutes. Numbers like these put Cox in the top 10 percent of the state and among the best hospitals in the nation for the treatment of emergency cardiac patients.

“I’ve been amazed at the lower door-to-balloon times,” says cardiologist Dr. James Ceaser. “I thought we would have to wait until we had the new emergency room, more space and more staff to make improvements to our times. But everyone has done an absolutely wonderful job. We all should be proud.”

The system of care responsible for the falling door-to-balloon rates at Cox today began to take shape more than two years ago. The American Heart Association and the American College of Cardiology had recommended changing the 120-minute national standard, which Cox was meeting, to the current 90 minutes or less. Since door-to-balloon is evidence-based medicine, research showed better patient outcomes with faster treatment. At Cox, the race was on.

Employees in the Pre-Hospital, Emergency and Cardiology departments formed a committee to analyze the complex process involved in identifying, transporting and treating patients with acute myocardial infarction (MI), a sudden and intense heart attack that occurs when blood flow to an artery of the heart is blocked.

The MI throughput committee identified several ways to create a more coordinated system, such as increasing interdepartmental communication, improving technology, and expanding ongoing education and feedback. The team focused on every step in the chain of care that could be sapping precious time and developed strategies that shaved seconds and minutes from the process.

Some of the changes that produced a more coordinated response to acute MI patients include: earlier activation of the Cath Lab; an overhaul of the education of paramedics in the use and interpretation of 12-lead EKG to detect acute MI and training for all Emergency department staff to perform EKGs instead of only hospital EKG technicians.

“Communication has helped with little things that can eat up precious time,” says LaDonna Smith, RN, a 20-year veteran of the Cath Lab. “Each department was doing its work in isolation and not thinking about what was happening before or after the patient got to them and left. When we started communicating our needs, the process really began to speed up.”

And the clock begins ticking as soon as the call for help comes into Central Dispatch at Cox North.

Emergency Medical Services dispatchers like Ron Litle usually work in a state of alertness but when a caller is complaining of symptoms like chest pain and shortness of breath, the situation is heightened even further.

“Pre-Hospital has made this a priority. Hair stands up on their neck if they think somebody is having an MI in the field,” says John Archer, Cox South Emergency department director. “They know they’re part of a group trying to get our times down to compete nationally.”

EMS operations manager Mike Dawson says the ability of Central Dispatch to “auto launch” or activate Cox Air Care based on caller information cuts response times. But the most significant factor is better education for paramedics in the detection with electrocardiogram (EKG) of an acute MI.

Using 12-lead EKGs, paramedics determine if a specific area of the EKG is elevated, which indicates the severity of damage to the heart. This is known as ST-elevation.
EMS medical director and ER physician Dr. Matthew Brandt developed an aggressive educational program that requires Cox paramedics to spend four non-consecutive 8-hour days each quarter training on 12-lead EKG use and interpretation, and the detection of ST-elevation-MI or STEMI.

“Last year, I took ten EKGs at random and asked our paramedics to determine if they showed the presence of a STEMI or not,” says Dr. Brandt. “Then, I showed the same EKGs to our ER physicians. The results were nearly identical.”

Dr. Brandt says the proven competency of paramedics in the recognition of STEMI has improved trust with emergency room physicians. Trust has also improved between ER physicians and cardiologists. At one time, after the ER physician confirmed a STEMI with the EKG, the cardiologist reviewed the EKG before the Cath Lab was activated.

“When the paramedics call us now and say we’re ten minutes out with an ST-elevated MI, we activate the Cath Lab team and the cardiologists right then. Think of the time that saves,” says Dr. Brandt.

The ED has taken that step even further by allowing the communications nurse who receives the call from EMS to activate the Cath Lab. That activation sets off a series of events that now happen simultaneously and with the same urgency as trauma and stroke.

The Cath Lab team responds from home or in house to set up the lab which can take up to 30 minutes. ER staff begins preparations. Once the patient comes through the door, three nurses, one technician, the ER doctor and a registration staff member surround the patient. Basic medications and an IV are started, blood is drawn, another EKG and chest X-ray are performed, and the patient is registered. In about 10-15 minutes, the patient is ready to head to the fourth floor Cath Lab.

“The ER team, the nurses, medics, the techs, everybody takes it as a challenge on how fast we can have that patient ready,” says Archer. “The Cath Lab team calls us as soon as they hit the building instead of waiting until they finish setting up the lab. Ten minutes later, we’re rolling with the patient.”

All ER staff were trained to perform the additional EKG required in the emergency room. Previously, only EKG technicians from Cardiology could perform the test after traveling to the ER from wherever they happened to be in the hospital. Changes throughout the process began to add up to time savings.

Cath Lab director Alan Kettelkamp says adding a night team Monday-Thursday improves times and provides a better continuum of care, since the Cath Lab is now staffed 24-hours from Monday morning through Friday evening.

“The patient comes in terrified that something horrible is happening to them,” says Kettelkamp. “Because of the hard work of everyone in the entire process, we’re able to get a balloon in the artery, and open it up. Blood is restored to the heart, the patient improves instantly, and we know that we pulled this patient out of a very bad situation.”

The process doesn’t end there. Details of the patient’s outcome loop back to all of the people involved in the care of STEMI patients with the help of real time feedback by the Quality Resource department.

“Communication is the biggest thing I do,” says Chris Schulze, Cardiovascular Services performance indicator facilitator. “We share data about standards and provide feedback on how we’re doing case by case and month by month. The boots on the ground figure out how to get it done more efficiently.”

And the MI Throughput committee continues to review protocols to find more ways to deliver even faster, more effective treatment for STEMI patients in the future.
“We are constantly looking for barriers and knocking them down,” says Archer.

“I believe that we removed our biggest obstacles to success through face-to-face and heart-to-heart communication,” says Becky Watts, administrative director of Cardiovascular Services.

“Until our experts had the opportunity to understand the demands and processes of each other’s departments, we were not successful in truly working together as a team.”

Trainer presented with ‘Best of 417’ award

Trainer Jack Misiorowski was surprised at the Meyer Center this morning by a visit from the staff of 417 Magazine, who came by to present his Best Personal Trainer award in person.

417 Magazine recently honored CoxHealth Fitness Centers and two trainers in their annual “Best of 417” issue. CoxHealth Fitness Centers won the title of “best gym” while Misiorowski was recognized as the best trainer and trainer Adam Grube was named as a runner-up. The 417 staff spent the morning Thursday delivering awards to recipients throughout the area.

417 general manager Joan Whitaker (above, left) presented the award to Misiorowski, who was quick to share the accolades with the more than 50 clients he trains.

“It’s not my success, it’s the people who come in every day and do the work,” he says. “I just try to give people the tools and their motivation to improve their quality of life. It’s a great job.”

Technology lights the night for Air Care

When Air Care makes a late-night flight across the darkness of the rural Ozarks, a new technology is helping pilots and crew have a clear view of the terrain below.

In January, Air Care added three sets of night-vision goggles to the arsenal of tools crews use to reach patients across the region. Air Care is now among the first flight teams in Missouri to adopt the technology.

“We have some dark holes in some of the rural counties surrounding Springfield,” says Susan Crum, director of Air Care. “This helps pilots visualize changes in terrain, trees and the obstacles near a landing site.”

The assistance from night-vision goggles is key to Air Care’s most important goal: safety for patients and crews.

“This may save a crew and it may save an aircraft,” Crum says.

Flight crews spent two days training on the new technology in December, and by January, all nighttime flights were assisted by night vision. For pilots and crews, the goggles are revealing surprising details in what is usually an inky blackness below. As they fly routes they’ve traveled hundreds of times before, they’re able to see back yards and bodies of water in places that were black before.

“Everything is flooded with light – once you see it, it’s kinda scary we did without goggles for all these years,” says flight paramedic Frank Perez. In darkness at midnight, the shadow of the helicopter is visible on the ground below. “And that was on a moonless night – a little moonlight is like daylight with these.”

Those details mean enhanced safety for the crew, whether they’re in flight or landing at a remote site.

Crum says the technology doesn’t change the weather decisions the crew makes, but the goggles enhance what searchlights can do and make night flying safer.

The technology has seen military use for decades and is now being recognized as an important safety feature for medical flight teams. Air Methods, the Denver company Air Care contracts with, has set a goal of having all of their helicopters equipped with night vision within two years. Air Care’s helicopter was designed to be night vision ready with special instrument and interior lighting that doesn’t interfere with the goggles. Ongoing military conflicts, however, have reduced the supply of goggles available for non-military applications.

The goggles amplify ambient light, including light beyond the spectrum of what the naked eye can see, to create a detailed image in the greenish hue familiar to most of us from televised war footage. The images are projected on tiny screens that sit inches from the user’s eyes.

The field of vision is about the same as that of a pair of binoculars and depth perception is minimal. The view, though, is unquestionably impressive. From the helipad at Cox South, one can easily read street signs and see far-away buildings normally shrouded in darkness. Even in spots that are completely dark, such as the back of the helicopter, the goggles make everything visible.

Crew members say no demonstration compares to flying through the night sky with the goggles flipped down.

“Just the contrast, the detail and the clarity are amazing,” says flight nurse Jim Lawrence. “You think you can see stars normally, but with the naked eye we’re seeing a tenth or even less of what’s out there.

“It’s like a sunset; a description or a picture of it isn’t adequate. You really have to experience it.”

Surgeon picks up family's hockey habit

What comes to mind when you think about hockey? Sarah Palin, recent hockey mom of note? Or Canada, where it’s the national sport? Maybe.

But what about doctors – orthopedic surgeons, actually? You probably don’t think about that. At least not like this ...

Dr. Judith Smith, an orthopedic surgeon at Ferrell-Duncan Clinic, has been playing hockey for two years now.

It all started a couple of Christmases ago when “Santa,” a.k.a. her husband Zeke Fairbank, gave her a pair of hockey skates with bright pink laces.

He and the couple’s children have played hockey for years, and were determined to get Dr. Smith in on the action, too.

“When I opened the skates, the kids were excited – jumping up and down and saying ‘Mom’s going to play hockey with us! Mom’s going to play hockey with us!’ and I thought ‘uh-oh.’ But really, how could I say ‘no’ to that?” she says.

Dr. Smith, her husband (who is also team captain) and 12 others play on the Ferrell-Duncan Clinic Skulls team at the Mediacom Ice Park in downtown Springfield. They play nearly every week – the ice park offers fall, spring and summer adult leagues.

The Skulls play in Division C, which Dr. Smith describes as the “least professional” league. But that doesn’t matter to her.

“It’s a lot of fun,” she says. “Really, anyone who has an interest in the sport can join a team and play.”

In addition to league play, the ice park offers practices and skill-building sessions such as Stick and Puck and Drop-In Hockey, which Dr. Smith says are great for people who are interested in hockey and would like to learn more. The center even offers equipment rental for those who aren’t ready to commit to the expense.

Players on the team sometimes come and go, but the Skulls have pulled together to become winners – the team won the fall 2007 league championship. And Dr. Smith says her hockey skills are constantly improving.

Her favorite part of the sport? “Scoring!” she says.

“I scored my first goal ever in October. It was great – they gave me the game puck as congratulations.”