November 2007 - Kadlec Regional Medical Center

Novermber 2007
F
open MRI
or Tony Robinson, just the thought
of undergoing another magnetic
resonance imaging (MRI) exam was
enough to have him postpone it, even
if his doctors deemed it medically
necessary. The idea of going inside the
tube of the traditional MRI was not
something Robinson took lightly; he is
extremely claustrophobic and the confined
space of the MRI made undergoing the test
nearly impossible for him.
Volume 19, Issue 4
anewoption
manage going through an MRI. I’d
postpone it as long as I could and I
dreaded it,” he said.
Robinson hasn’t always been claustrophobic. In 1984, while serving with the
Special Forces in Honduras, Robinson’s
base was attacked and a bunker exploded.
He ended up under the rubble. Since that
time, he doesn’t even like to have a blanket
on top of him when he sleeps.
Recently, Robinson’s doctor was again
recommending an MRI. When he finally
called Kadlec’s Outpatient Imaging
Center to make an appointment for an
MRI he got some good news. Kadlec has
the region’s first 1.5 tesla open MRI which
produces high quality images without
the patient having to go into the traditional
MRI tube.
Yet through the years, Robinson has
faced brain surgery and three major back
surgeries which required MRI testing.
“Even when I was sedated I could barely
MRI is used by physicians to study
muscles, joints, organs, and even blood
vessels and is one of the most accurate
and noninvasive procedures available to
obtain images of the body. But for some,
getting an MRI can be a claustrophobic
experience. The prospect of lying in such
a tight, enclosed space for any length
of time can be uncomfortable and even
frightening. In a typical MRI machine,
the top and sides of the tube are only
eight to 10 inches from the patient’s body
and face. Once inside, the patient must
lie still during the exam, which can take
anywhere from 30 minutes to an hour. Kadlec has had an open MRI for some
time, but because it uses a low-field
magnet which doesn’t produce the same
high quality images as a traditional MRI,
its use is limited.
Continued, Page 2
Kadlec’s new open MRI produces
high quality images and offers
patients such as Tony Robinson
new options.
A higher le vel of c a re.
a new option . . . . . .
(Continued from Page 1) Now, Kadlec has
a new option for patients like Robinson.
“This new Siemens Espree High Field
open bore scanner is a 1.5 Tulsa, which is
what you see with most closed systems,”
said Deb Mapstead, Kadlec MRI supervisor.
As the name implies, the new MRI
technology is open on either side of the
patient, allowing for more space and
visibility. It features an opening of nearly
2.3 feet in diameter and almost one foot
of free space between a patient’s head
and the magnet. Approximately four
feet long, the magnet allows more than 60
percent of exams to be completed with the
patient’s head outside the tube, helping to
ease claustrophobia.
The new open MRI is also better suited
for larger patients who may have difficulty
fitting inside the traditional high-field
MRI or are over its weight limit. “Our
traditional MRI has a weight limit of
350 pounds while this open system can
accommodate patients weighing up to
550 pounds. We are able to offer MRI to
patients who otherwise would not be
able to undergo this important scan,”
said Mapstead.
Because it is so open, it is also ideal for
children who might be frightened by
a traditional MRI. “A parent can even
hold a child’s hand throughout the entire
scan,” said Mapstead.
“This MRI is a really, really good
complement to the imaging services at
Kadlec. It’s ideal for patients who are
larger or those who are claustrophobic,”
she said. “It produces such crisp, pretty
images which all patients deserve.”
givingorders
A
patient in Kadlec’s Emergency
Department tells the attending
physician that he is in a great deal of
discomfort and the doctor orders
appropriate medication to be administered to the patient. Just a few months
ago, getting that medication to the
patient could have taken from 30 to 60
minutes by the time the prescription
was handwritten, recorded, delivered
to the right people and administered.
Now, because of a new electronic
order system in Kadlec’s Emergency
Department, the time it takes for a
patient to receive that medication is
reduced to minutes.
Computerized provider order entry
(CPOE) allows physicians to write
orders on a wireless computer, which
then immediately transmits them for
delivery. With the new system, patient
care can be directed right from the
patient’s bedside.
“I’ve been really impressed with
the new system. The order is communicated directly; I don’t have to wait to
take that order to someone. I can order
an X-ray or a CT scan and as I walk
out the exam room, that department
has already called to say they are
ready for the patient,” said John
Matheson, MD, Emergency Department
medical director.
Kadlec is one of the first hospitals
anywhere to add this new capability to
its electronic health records system.
“It used to take 30 minutes to an hour
to get a pain medication processed from
the time the physician would write
the order, get it to the secretary and
then to the nurse. If there were a lot
of patients, orders could get really
stacked up. Now it’s instantaneous.
We can be at the bedside giving the
medication in 10 to 15 minutes,” said
Cindi Warburton, ED clinical educator.
It’s more than speed that makes this
an important advancement for patients.
There’s also a safety component.
“We need to do everything we can
to minimize errors in communications,
so the fewer times we have to relay
that information, the better off our
patients will be,” said Kadlec Emergency
physician, Ethan Bachrach, MD. “If
you just take handwriting out of the
equation, that’s an enormous improvement. All of these orders are electronic
or you check a box for a standard
lab. The need to read someone else’s
handwriting is
eliminated and
we minimize
the potential
for errors.”
For Robinson, the new open MRI is a
significant change. “It is 100 percent
better. The first time I saw it I knew I
could do this. It’s a lot smaller and my
whole body is not in it during testing.
I can see out the whole time and I can
even see my feet. This is good news
and I am really relieved that it is now
available,” he said.
For more information about the new open
MRI, call (509) 946-4611 extension 4930. n
Ethan Bachrach, MD works on the computerized provider order entry.
Dr. Matheson
agrees. “It
really does
take us a step
further. It
allows for more
efficient delivery of care and
really does
set us apart,”
he said. n
I
magine an interactive miniature city
designed specifically for children.
Its whimsical design includes traffic
lights, electronic walk signs, cross
walks, street signs, a real fire hydrant,
a fire station, bicycling simulators
and even a kid-sized hospital. And its
not just for fun — this tiny-sized city
would be designed specifically to teach
children about real traffic safety.
three to 12 and to create a dialog for
learning between an adult and a child.”
The project has been made possible
with the support of the community, said West. “Kadlec has
been on board since the
beginning and helped
to create the ‘hospital’
It’s not imaginary. It’s Cooper’s Corner,
a new facility at Columbia Center
created in memory of Cooper Jones,
the 13-year-old who was killed by an
inattentive driver during a 1997
sanctioned bike race in Spokane.
Cooper’s parents vowed to honor his
memory and to do so created the first
Cooper’s Corner in Spokane. Twice
the size of the original, the Tri-Cities
version will be the second site.
Families can tour the city on foot,
learning about pedestrian safety or by
Plasma car learning the rules of the
road. Another mode of transportation is
stationary bikes on a virtual bike tour
of the Tri Cities. This hands-on, interactive exhibit will teach young and
old about bicycle safety, the proper fit
of bike helmets, hand signals, general
rules of bicycle safety and the importance of bike maintenance.
Although small in size, Cooper’s
Corner is large enough for adults to
go through with children. In fact, said
Lynda Lou West, the project organizer
with the local Washington Traffic
Safety Commission, “Children must be
accompanied by an adult, and an adult
must be accompanied by a child. It’s
designed especially for children ages
Kadlec’s
Roger Casey
helps with the ‘hospital’
at Cooper’s Corner in
the Columbia Center Mall.
which includes the donation of a flat
screen TV-DVD that can be used
as a light box to show broken bones
and also to show safety videos,”
said West.
Watch for the opening of
Cooper’s Corner before
the Christmas holidays. n
B
reast cancer affects more women
than any other type of cancer except
skin cancer. Each year more than 180,000
American women learn they have breast
cancer. While the exact causes are not
known, it is known that factors such as
family history, age and race influence the
occurrence of breast cancer.
A new program at Kadlec Medical Center
is giving women who are at high risk for
breast cancer some measure of control
over the disease — even before they are
diagnosed with it. Kadlec’s High Risk
Breast Screening Program (HRBSP) is the
region’s only specialized program to help
identify and monitor women at high risk
for developing breast cancer. The 5-step
program combines knowledge, medical
skills and patient education with the best
surveillance and diagnostic methods to
help these women assess and act upon their
individual risk. Early identification of risk
allows a woman to create an appropriate
screening and management plan.
One challenge, according to Hall, is to
identify women who actually fall into the
high risk category. With a 1-in-8 lifetime
risk for every woman, it may be chance
alone that a woman may have a family
member who had breast cancer. In fact,
said Hall, most learn they are unlikely to
have a hereditary predisposition to breast
cancer. “Only 10 percent of all cancers,
including breast, are due to an underlying
hereditary cause,” she said. Patients with
a 10 percent or greater risk for a hereditary
breast cancer will receive information on
genetic testing
In the absence of a hereditary cancer
syndrome, some women are still at risk for
breast cancer based on personal and family history. Patients with a 20 to 25 percent
or greater lifetime risk for breast cancer
will receive information on the program.
The first step in the new program is a
formal risk assessment. Kadlec’s Sarah
Hall — the region’s only certified genetic
counselor — works with women to
evaluate personal and family history
risk factors.
Each year more than 180,000
American women learn they have
breast cancer.
bre
are you at hi
Scientists have identified BRCA1 and
BRCA2 as two genes that account for 85
percent of hereditary breast and ovarian
cancer cases. Women who have the
inherited BRCA have a lifetime risk for
breast cancer of up to 80 percent and are
appropriate candidates for increased
eastcancer?
igh risk for
surveillance, chemo prevention and
risk reducing surgery.
“Once we identify through assessment
who is at greater risk, it is up to the
woman to decide if she wants to pursue
increased surveillance and/or genetic
testing. It is a personal decision,” said
Hall. “Some will decide to have it; others
will not.”
Following a formal assessment, eligible
women may enroll in HRBSP. Through
the program these women will have their
medical imaging records flagged for
closer tracking.
The third step in the program is patient
education and support. Through HRBSP,
women receive educational material
about cancer, surveillance options, lifestyle modification information and access
to local and national support groups.
The fourth step is to create an individual
management plan. The women will have
an opportunity to consult with a radiologist,
a surgeon, an oncologist
or a gynecologist to
discuss appropriate
surveillance and
management.
Options may include beginning annual
mammograms prior to age 40 or adjunctive screening with breast magnetic
resonance imaging (MRI).
In 2007, a report by the American
Cancer Society recommended MRI as an
important supplement to mammograms
for high risk women. The MRI can detect
very small cancer in the breast and it is
particularly helpful in younger women
who may have dense breast tissue.
Kadlec offers the only breast MRI in
the region. “Breast MRI is an important
tool when used in coordination with the
high risk breast cancer screening program.
Routine mammography is an effective
method for women with average risk for
breast cancer; however, for women at
higher risk, mammography may not be
enough,” said Tri-Cities radiologist Julian
Kassner, MD.
Another new piece of equipment the Kadlec
Foundation recently purchased in support
of HRBSP is an MRI-compatible upgrade
kit which allows for biopsies using MRI
guidance. When an area of interest is
identified through the MRI and a biopsy
is recommended, the new equipment will
allow the procedure to be performed.
“It’s an important addition to our MRI
services and another example of the
Foundation supporting and improving
the quality of care offered at Kadlec,”
said Dr. Kassner.
The final step in HRBSP is patient tracking
and follow-up which creates a mechanism
for increased coordination of care among
various specialties.
“These are complex issues that require
expertise. There are implications for
every decision. That’s why we are here —
­to help women who are at a high risk for
breast cancer make decisions that are
right for them,” said Hall.
Dr. Kassner encourages providers who
wish to have more information about
the new HRBSP to contact him through
the Department of Radiology at
(509) 942-2221. n
Who can benefit from
genetic counseling?
Cancer genetic counseling is
helpful for individuals with a
personal or family history of:
n
n
n
n
early onset breast cancer
(less than 50 years of age) or
ovarian cancer at any age.
breast and ovarian cancer
in the same person.
male breast cancer.
multiple family members
with breast or ovarian cancer.
How do I find a
genetic counselor?
Kadlec has the region’s only fulltime, certified genetic counselor.
Call Sarah Hall at (509) 942-2821.
update
kadlec clinic
6
1
2
7
3
5
4
welcome
new physicians
ACTIVE
ACTIVE
ACTIVE
Brian Witte, DO
Devin Despain, DO
Ekta Khurana, MD
Anesthesia
Anesthesia
Pediatrics
888 Swift Blvd.
945 Goethals Drive, Suite 310
888 Swift Blvd.
Richland, WA 99352
Richland, WA 99352
Richland, WA 99352
(509) 946-4611
(509) 946-7332
(509) 946-4611
Michael Duey, MD
John Malone, MD
Anesthesia
Infectious Disease
COURTESY
888 Swift Blvd.
510 N. Colorado, Suite A
Richland, WA 99352
Kennewick, WA 99336
Saumyajit Datta, MD
(509) 946-4611
(509) 735-6689
Family Practice
John Fisher, MD
Shakti Matta, MD
4303 W. 27th Ave., #H
Anesthesia
Pediatrics
Kennewick, WA 99337
888 Swift Blvd.
712 Swift Blvd., Suite 4
(509) 783-4673
Richland, WA 99352
Richland, WA 99352
(509) 946-4611
(509) 946-8188
Adam Smith, DO
OB/GYN
Timothy Gormley Jr., MD
Clark Morres, MD
320 W. 10th Ave., Suite 102
Radiology
Emergency Medicine
Kennewick, WA 99336
888 Swift Blvd.
953 Stevens Drive, Suite C
(509) 585-5910
Richland, WA 99352
Richland, WA 99352
(509) 946-4611
(509) 943-5616
Carrie Rosenberg, MD
Rodney Graves, DPM
AFFILIATED
Anesthesia
Podiatry
888 Swift Blvd.
925 Stevens Drive, Suite 1B
S. Paul Herndon, MD
Richland, WA 99352
Richland, WA 99352
Pediatric Cardiology
(509) 946-4611
(509) 943-2325
4800 Sand Point Way NE
Seattle, WA 98105
Melvin Wahl Jr., MD
Markus Forsythe, MD
(206) 987-2000
Orthopedic Surgery
Emergency Medicine
875 Swift Blvd.
888 Swift Blvd.
Richland, WA 99352
Richland, WA 99352
(509) 946-1654
(509) 946-4611
Kadlec Medical Center continues to
serve the needs of the community with
the expanding Kadlec Clinic system.
Currently, Kadlec Clinic includes:
1
Associated Physicians for Women,
945 Goethals Drive, Suite 200,
Richland, (509) 943-0300.
2
Senior Clinic,
1050 Gilmore Street, Richland,
(509) 942-3135.
3
West Richland Family Practice,
4001 Kennedy Road, West Richland,
(509) 942-3130.
4
Kennewick Family Practice,
4309 W. 27th Place, Kennewick,
(509) 942-3120.
5
South Richland Family Practice,
560 W. Gage Blvd., Suite 203, Richland,
(509) 942-3150.
6
Pediatric Clinic in the Corrado
Building next to Kadlec hospital in
Richland, (509) 942-3160.
7
Coming in 2008, Pasco Family
Practice on Sandifur Parkway near
Broadmoor Mall.
PaceSetter is published by
Kadlec Medical Center
888 Swift Blvd. • Richland, WA 99352
(509) 946-4611 • www.kadlecmed.org
Kadlec Medical Center is proud
to serve the region as a
not-for-profit community hospital.
Mary Lynn Merriman, MLM Communications, editor; Sara Nelson Design,
Ltd., design and layout; Esprit Graphic
Communications, printing; Mark Roberts
Photography, Jim Hall, and Delt Clark,
photos.
PaceSetter Editorial Board members
are Delt Clark; Betty Uppington; Meg
Fallows; Julie Meek; Antoinette Burnside;
Anjan Sen, MD; Rozanne Tucker; Jim
Hall; Jeff Clark; Nan Domenici; Susan
Spohr and Roger Casey.
M
ethicillin-Resistant Staphylococcus Aureus. Just the name
sounds menacing.
But MRSA (mer-sa), as it is often called,
has moved from relative obscurity to
the front page in recent years as its
occurrence has skyrocketed.
In the past, “staph” infections were fairly
easy to treat with several antibiotics
especially methicillin. In fact, in 1974
only two percent of all staph infections
were resistant to methicillin. Today,
over 60 percent of staph infections are
MRSA. A recent edition of the New
England Journal of Medicine reported
that MRSA now accounts for more
than half of the skin infections treated
in U.S. emergency rooms.
Staphylococcus Aureus, or staph, is a
fairly common bacterium that can be
found on the skin and in the nose of
about one of every three people. When
the bacterium enters the body through
a cut or break in the skin, it can cause
a mild to serious infection. MRSA is
one strain of the staph bacterium that
is very resistant to antibiotics, which is
why MRSA is called a “superbug.”
“In our emergency department we
have seen an increasing number
super
bug
battling the
of patients with MRSA. They think they
have a spider or bug bite when in fact
they have a skin and soft tissue infection
that looks like a boil, abscess or inflammation. Once it is cultured it turns out
to be MRSA instead,” said Kadlec’s
infection control practitioner Fran
Petersen, RN, BSN, CIC.
These skin infections often occur in
otherwise healthy people and if not
treated in a timely fashion, MRSA can
lead to more serious infections. MRSA
is also no respecter of age, according
to Petersen. Patients coming to Kadlec
with a MRSA infection have ranged
from babies to the elderly.
MRSA has emerged as a problem because
of the overuse or inappropriate use of
antibiotics according to Petersen. “People
have a tendency to not complete the full
treatment of an antibiotic. This helps
foster resistant strains in an
organism,” she said.
Treatment of MRSA
ranges from outpatient to
inpatient care. “Severe
MRSA infections can
take a very long time to
treat; not just days, but
weeks,” said Petersen.
Kadlec follows Center
for Disease Control
guidelines and isolates
hospitalized
patients with
MRSA while
they are being
treated for infection or if they are
colonized with
this bacteria.
The good news is MRSA is preventable.
The main mode of transmission to other
people is by hands or by touching
objects that have been touched by a
person who has MRSA.
“Hand hygiene is very important. It is
important to wash your hands when
they are visibly soiled, before you eat,
before you prepare food, after contact
with body fluids, after changing diapers,
touching pets or using the restroom,”
said Petersen.
Avoid sharing personal items such as
towels, washcloths, razors and clothing.
Also keep wounds covered and don’t
touch them.
“We can pick up germs from many
sources, including doorknobs and
railings. However we pick them up,
we can transfer them to ourselves
or another person. That’s why hand
washing is so important,” said Petersen.
If you can’t wash your hands, use a
hand sanitizer. “They are very effective
in killing the bacteria when used
properly,” she said.
“Kadlec encourages its patients to ask
everyone who comes into contact with
them if they have washed their hands.
People can be shy about asking,
but we don’t want them to be. New
table tents in the patient rooms even
say ‘Please ask: Did you wash or sanitize
your hands.’ We also have alcohol
cleanser available throughout the
hospital for everyone’s use.
“MRSA can be very serious. Anytime
you have a bacterium that is resistant,
it is serious,” said Petersen. n
Giving
Thanks
This time of year,
we turn our hearts to thankfulness.
At K adlec Medical Center,
we thank you for trusting us
with your health care.
We wish you and yours good health
well into the future.