Patient Care

Yesterday marked a big day for Stanford and the local community: Ground was broken for the new Stanford Hospital & Clinics. As Ruth Schechter reports in our online story:

Scheduled to open to patients in 2018, the new building will optimize the hospital’s services and infrastructure, adding more beds, private rooms, state-of-the-art operating suites, expanded emergency services and the flexibility the hospital needs to adapt to advancing technologies and more streamlined services.

The new 824,000-square-foot hospital will increase patient capacity to 600 beds and feature 368 individual patient rooms, an enlarged level-1 trauma center and an emergency department nearly three times the size of the current capacity. Designed by the internationally recognized firm Rafael Viñoly Architects, the project will feature amenities intended to enhance both physical and emotional healing with the latest in medical, surgical and diagnostic technology. The new building will be connected to the current hospital by a bridge and tunnel.

The new hospital will feature individual patient rooms centered on health and well-being, with expansive windows that provide natural light and integrated accommodations for family members to visit and spend the night. Patient rooms will be modular, allowing them to accommodate any level of acuity. A roof garden setting will create a quiet retreat for patients and families, and landscaping will feature native and drought-tolerant plants. The building also incorporates the latest innovations in green technology to reduce the hospital’s environmental impact.

About 400 community members, donors, and administrators, including Amir Dan Rubin, the hospital’s president and CEO, and Lloyd Minor, MD, dean of the School of Medicine, were on hand late yesterday to watch as “shiny red shovels were put to ceremonial dirt.”

Previously: Growing up: The expansion of Lucile Packard Children’s Hospital, Hospital mock-ups help refine plans before construction begins and City of Palo Alto approves rebuilding and expansion of Stanford Hospital and Lucile Packard Children’s Hospital
Rendering of new hospital from Rafael Viñoly Architects

Blogger-physician Aaron Neinstein, MD, offers today a nice, brief reminder of how small things in health care can make such a big difference. Noting that he received a thick, comfortable cloth robe instead of the “humiliating, cold, and uncomfortable paper gown” at a recent dermatology appointment, he writes:

Small touches like this robe can make a dramatic difference in the patient experience. This does not mean that “luxury” can or should replace high-level medical care. However, thoughtful touches like this robe can enhance and augment high quality medical care to make it even better, and we should not ignore these opportunities to make our patients feel more comfortable.

For Stanford nurse Alicia Moreci, RN, the whiteboard has become more than just a place to write information about her patients. It’s also a blank canvas where she displays her now famous drawings in the hospital’s cardiac-monitoring unit. A segment on NBC Bay Area featured her drawings and Moreci explaining how her role as artist-in-residence in the cardiac-monitoring unit at Stanford Hospital & Clinics all began with a small drawing of the Loch Ness Monster.

Moreci creates a new drawing every week and, as reported in a past Inside Stanford Medicine story, her artwork has become so popular that other units have requested she decorate their whiteboards. She told my colleague, “My unit has been joking that it’s going to hire me out and use the proceeds to fund a party.”

Those of you who have ever waited for hours (or what feels like hours) in an emergency room might appreciate this statistic: In the last eight months, the median door-to-doctor time for patients visiting Stanford’s emergency department dropped from 45 minutes to 18. So what happened? Credit the implementation of two new programs, Team Triage and Fast Track, that were “designed to provide speedier, more efficient service” in the ED. The current issue of Stanford Medicine News has more details:

First came Team Triage, inaugurated a year ago. In the same area as the waiting room, big bronze-colored letters that spell “triage nurse” are affixed to a dividing wall, behind which patients are evaluated by a team of doctors, nurses and ED technicians. Apart from trauma patients brought in by ambulance to receive the highest-priority care, everyone who comes into the ED passes through the Team Triage area. Minor injuries are classified as 4 or 5, the most critical as 1. “Most patients are 3s,” said Patrice Callagy, RN, patient care manager in the ED. “They might have abdominal pain or broken bones.” Team Triage also allows for earlier diagnosis of time-sensitive conditions, such as stroke.

An analysis found that 40 percent of the hospital’s patients were sick enough to have been admitted through the ED. It also showed that 12 to 13 percent of the ED’s patients were 4s and 5s, who did not require hospitalization. Yet their relatively minor medical issues meant that they were waiting the longest, starting with how long it took for them to see a doctor.

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Enter Fast Track, a dedicated team composed of doctors, nurses and ED technicians whose job is to treat patients with less-severe health problems as rapidly as possible. “We treat you and let you get on with your life,” said [Grant Lipman, MD], Fast Track’s medical director. “You’re the least sick, so we’ll treat you the fastest.” The median length of stay for Fast Track patients is 65 minutes, well under the original goal of 90 minutes.

Previously: Decreasing demand on emergency department resources with “ankle hotline” and Windows ER?

Much has been written about the tragic events in Boston on Monday, but I have to draw attention to a New Yorker piece detailing how the doctors and nurses at area hospitals leapt into action to treat victims’ war-like injuries. Atul Gawande, MD, describes what happened at the hospitals that afternoon, and his take on why people there worked with such “grim efficiency”- and why, in turn, so many victims survived - is compelling:

…Something more significant occurred than professionals merely adhering to smart policies and procedures. What we saw unfold was the cultural legacy of the September 11th attacks and all that has followed in the decade-plus since. We are not innocents anymore.

Frustrated by inconclusive tests, strange symptoms and a lack of answers from their health-care providers, some patients have turned to the online community for answers about perplexing illnesses. And a new web-based tool, called CrowdMed, aims to make it even easier to diagnose medical mysteries. The New Scientist reports:

Anyone can join CrowdMed and analyze cases, regardless of their background or training. Participants are given points that they can then use to bet on the correct diagnosis from lists of suggestions. This creates a prediction market, with diagnoses falling and rising in value based on their popularity, like stocks in a stock market. Algorithms then calculate the probability that each diagnosis will be correct.

In 20 initial test cases, around 700 participants identified each of the mystery diseases as one of their top three suggestions.

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The goal is to help people who come down with any of around 7000 “rare diseases” as defined by health agencies in Europe and the US. In Europe alone, 30 million people have a rare disease, 40 per cent of whom either go undiagnosed or are misdiagnosed at some point.

As the popularity of using the Internet to answer health questions grows, it will be interesting to see how services such as CrowdMed, and search engines like FindZebra, even further redefine the doctor-patient relationship.

Previously: The importance of curation and communities when crowdsourcing clinical questions, New search engine designed to help physicians and the public in diagnosing rare diseases, Report shows 35 percent of U.S. adults turn to the Internet to diagnose a medical condition, Dr. Google: Threat or menace? and Patient self-diagnosis: From the browser to the exam room
Photo by Ryan Brooks

For young patients coming into the hospital several times a week for dialysis, balancing school work and the long hours spent getting treatment can be a challenge. So Lucile Packard Children’s Hospital hired a teacher to work exclusively with hemodialysis patients and help keep them up to date with classwork.

A recent Packard Children’s article offers a closer look at the program and instructor Katie Fennimore, a former elementary school teacher trained to work with children with special needs. To help kids make the most of their time, Fennimore uses a variety of tactics, including declaring the first hour of treatment a no-TV “power hour” and loading educational materials and apps onto iPads and computers at the dialysis center. Beyond keeping students focused on academics, she also helps make sure parents, school teachers, administrators, doctors and nurses are updated on patients’ medical status and needs. From the piece:

Lori Vargas is mother to 15-year-old dialysis patient Taylor Simpson, who was diagnosed with Goodpasture syndrome just over a year ago. Vargas said, “Katie is a huge help for us. She helps bridge the communication between us and the school when we need that extra support.”

In Fennimore’s role, knowing her dialysis students individually is key to helping their progress. Vargas added, “Katie knows, off the top of her head, everything that is currently going on in Taylor’s classes. She will also be attending Taylor’s [Individualized Education Plan] meeting via conference call to help us communicate with Taylor’s teachers and explain the importance of Taylor staying in school even though she has this illness.

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“Katie is a great motivator for Taylor while she’s here in dialysis to stay focused on her homework and grades,” said Vargas. “She rocks! We are grateful for all her help.”

Photo by Lucile Packard Children’s Hospital

Pediatric surgeons have been slow to adopt a technique that could keep their patients safer during a common but risky hospital procedure. But the Stanford scientist behind a new study of the procedure hopes his new research findings will provide the push they need to change their ways.

The procedure is insertion of a central venous catheter, a type of intravenous line that gives access to the largest vein in the body. It’s used when the a peripheral IV (the kind that goes in the patient’s hand or arm) is not appropriate - for instance, if a patient needs to receive a large volume of IV fluid, or needs a chemotherapy drug that could damage small veins. Inserting a central line requires poking a needle deep inside the body, into one of three major veins that feed to the very biggest vein, the vena cava. Once the needle is in the vein, it provides a pathway for threading in the catheter.

Since 2010, the American College of Surgeons has recommended that surgeons use ultrasound to see what they’re doing during this procedure. The new study provides fresh, kid-focused evidence that this is the right thing to do, as our press release on the research explains:

“Although it’s a common procedure and is sometimes perceived as benign, it’s not,” said Sanjeev Dutta, MD, senior author of the new study. “We found that, even in the hands of experienced pediatric surgeons, the use of ultrasound can mitigate the risk of complications when placing central lines.” Dutta is a pediatric surgeon at Packard Children’s and an associate professor of surgery at the School of Medicine. The research was published online today in the Journal of the American College of Surgeons.

In the study, when pediatric surgeons used ultrasound, they were able to successfully guide the needle safely into a vein 65 percent of the time on the first try, and 95 percent of the time within three tries. In contrast, when they used only anatomic landmarks to guide insertion, success rates were 45 percent on the first attempt and 74 percent after three attempts. Previous research has shown that needle placement into a vein for central line insertion is associated with few complications if it succeeds on the first try, but after three attempts, the risk of complications jumps sharply. Complications of a failed insertion can include bleeding in the chest cavity, lung puncture that causes air to be trapped in the chest cavity, puncture of the carotid artery and, rarely, fatal complications such as strokes

Past research has shown that telemedicine can help reduce health disparities between rural and urban areas and be as effective as in-office visits for diagnosing and treating dermatology conditions. Now findings recently published in JAMA Neurology suggest that “virtual” house calls for Parkinson’s patients provide clinical benefits comparable to seeing a physician in person.

In the small study, researchers at Johns Hopkins University and the University of Rochester Medical Center randomly selected patients with Parkinson’s disease to participate in three web-based conferencing sessions while the rest of the group visited a physician’s office over seven months. According to a university release:

At the end of the seven months, the researchers measured the patients’ perception of their quality of life and the level of care they were receiving. They found that the patients who received virtual house calls did as well as those who received in-person care.

The researchers also measure the economic value of allowing individuals to receive care in their own homes. They found that the average telemedicine visit lasted 53 minutes from beginning to end. In contrast, patients who received in-person care spent an average of 255 minutes per visit when factoring in the trip to and from the doctor’s office for a total of 100 miles and 3 hours of travel time over the seven months duration of the study.

Researchers commented on the significance of the findings saying they “demonstrate that quality specialized care can be effectively delivered to individuals in remote locations.” But, they also noted several barriers to telemedicine becoming widespread such as licensing and reimbursement requirements.

Previously: FCC allocates $400 million in funding to develop and expand telemedicine, Telemedicine takes root in the Midwest, How a Stanford dermatologist is using telemedicine to reach underserved populations in California and Can telemedicine work for dermatology patients?

Video games, which critics say promote sedentary behavior and can glamorize violence, are often associated with their negative health effects. But a piece on Discover magazine’s Crux blog offers an overview of scientific evidence suggesting that gaming could be helpful to a diverse range of patients, including people recovering from severe burns, teens battling cancer, and, according to a new findings, individuals diagnosed with dyslexia. According to the article:

…[A] relatively new branch of science is focusing on the therapeutic aspects of video games. This new generation of researchers who have grown up with video games are starting to use their unique mix of skills to look into the possibility of improving people’s lives through gaming.

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A study released today finds that video games can be therapeutic in what first seems like an unlikely context: treating dyslexia. Researchers tested the reading and attentional skills of kids with dyslexia before and after playing video games over the course of nine separate 80-minute sessions. They found that action video games, specifically, left the kids able to read faster and better able to focus their attention. In fact, those 12 total hours of video games play did just as much, or more, for reading skills than demanding traditional reading therapies.

Attention and reading skills probably go hand in hand, the researchers say. “Visual attention deficits are surprisingly way more predictive of future reading disorders than are language abilities at the prereading stage,” said study author Andrea Facoetti of the University of Padua in Italy. By improving visual attention, then, games can address this root cause of dyslexia.

Previously: O’Reilly Radar Q&A looks at how games can improve health, Can playing Tetris reduce flashbacks and aid in the treatment of PTSD?, Study shows gaming may be helpful in treating teen depression, Gaming for good: Video games designed to heal and Can video games improve memory, boost brain power?
Photo by Marco Arment