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In This Issue

OR Construction Project Approved

Hudson Medical Office Building

Service Highlights

Meet our Family Advisory Council

 
A Message from
Bill Stephan, MD, Vice President, Medical Affairs


stephanbill

As you may know, Peter Davis announced his plans to retire last summer.  I would like to extend my gratitude to Peter Davis for his tireless and unwavering commitment to St. Joseph Hospital for the last 25 years.  Peter's contribution to this organization and community are immeasurable. I know you all join me in wishing Peter well as he embarks on his retirement. 
 
David Ross has already started working hard as our new President and Chief Executive Officer of St. Joseph Hospital. David is an accomplished healthcare leader who comes to St. Joseph Hospital from Barnes-Jewish St. Peters Hospital (BJSP), in St. Peters,  Missouri.  Please join me in giving a warm welcome to David.
 
Don't forget to stop by the June 8th Medical Staff Open House Event from 5:30-8:00pm in the hospital Atrium area. It will give everyone a chance to connect with your fellow colleagues, meet the new CEO and learn more about the ambulatory services offered at St. Joseph Hospital.
 
 
CathPCI Registry

The St. Joseph Hospital's Cardiovascular and Diabetes Center has been participating in the National Cardiovascular Data Registry (NCDR�)'s CathPCI Registry�.  
 
This registry of cardiac catheterization and PCI procedures gives us risk-adjusted, quarterly benchmark reports that help us compare our performance with volume-based peer groups and the overall national experience. The registry helps us identify any quality gaps and implement new processes to improve patient care. The first outcome report we received for 2009 was positive.
 
We will be adding this information to the quality section of our website
www.stjosephhospital.com over the summer for patients to view.   
 
 
New Provider Spotlight


dorson

Margaret Dorson, RN, APRN, Joins the Roger Dionne, MD, Senior Center at St. Joseph Hospital 
 
St. Joseph Hospital and the Roger Dionne, MD, Senior Center welcome Margaret Dorson, RN, APRN, to the Allied Health Staff.  Ms. Dorson is a graduate of the University of Massachusetts Lowell, Lowell, MA.
 
Ms. Dorson is a board certified gerontological nurse practitioner and adult nurse practitioner and has over 20 years of nursing experience. Her special interests include patients with dementia, in particular those with Alzheimer's Disease.
 
As the new Roger Dionne, MD, Senior Center Nurse Practitioner, Ms. Dorson will be working with current geritatric providers conducting physical assessments, providing nursing home and assisted living visits, and working with specialty clinics.
 
For more information about the Senior Center or to make an appointment with Ms. Dorson, please call the Roger Dionne, MD, Senior Center at St. Joseph Hospital at (603) 595.3722.
 



HelenTenneySmith

H. Tenney Smith, NCSP, AOGPE, Joins The Center for Neuropsychology, Learning, and Behavioral Medicine 
 
H. Tenney Smith, NCSP, AOGPE, is the newest staff memer to join The Center for Neuropsychology, Learning, and Behavioral Medicne at St. Joseph Hospital.  H. Tenney Smith is an experienced and dedicated literacy expert, special educator, school psychologist, and teacher-trainer. She has an enthusiastic and creative approach to engaging all learners and a strong belief in optimal and accessible learning for all. 
 
For more information about the Neuropsychology, Learning, and Behavioral Medicine at St. Joseph Hospital,  please call 603.598.3384.
 
Physician Champion Named


Gould

Congratulations to Peter Gould, DO.  Dr. Gould was recently named Physician Champion and works in the Emergency Department at St. Joseph Hospital.  
 
 
Cardiovascular and Diabetes Nutrition Clinic

As you may know, nutrition education can lower blood lipids by 15% and A1C by .25% to 2.9%.  Are your patients with diabetes, dyslipidemia and cardiovascular disease meeting their goals? Our nutrition experts at the Cardiovascular and Diabetes Center at St. Joseph Hospital can help! Patients may be referred to us to help manage high cholesterol, diabetes, high blood pressure, obesity and heart-related illnesses.
 
We work closely with you and your patient to create a meal plan that meets their lifestyle and health needs.
 
Referrals are required. Appointments can be made through Central Booking at (603) 598.3323.           
 
Andrea Hebert MS, RD, LD, CDE
Melanie Baker MS, RD, LD, CDE
Phone: (603) 595.3971
Fax: (603) 578.5023 
 
Save the Dates!


Calendar_blood drive

Medical Staff Open House - 
Tuesday, June 8, 2010, 5:30-8:00 p.m.  Come meet David Ross, St. Joseph Hospital's new President and CEO and visit our Ambulatory Services area. The reception will be held in the Atrium area at St. Joseph Hospital.  
 
Quarterly Medical Staff Meeting - Tuesday, June 15 - CME begins at 5:15 p.m. Guest Speaker: Palmer Jones, Executive Vice President, N.H. Medical Society. Dinner and meeting to follow at 6:30 p.m. (Carl Amelio Room).   
 
St. Joseph Hospital's Annual Golf Tournament -  Monday, July 19, 2010, Nashua Country Club. Please contact Di Lothrop, 603.882.3000, ext. 63052 for more information.  
 
Breast Cancer Advances and Updates, Friday, October 8, 2010, Crowne Plaza, 8:30 a.m. to 3:30 p.m.  Topics to include: Breast Cancer Navigation and Survivorship, Breast MRI, Breast Reconstruction, Genetic Testing/BRCA, Oncotype DX, Radiation Treatment Updates. 
CME's available - watch for your invitation in the mail!

 
 
Call for Articles

St. Joseph Hospital Medical Staff Newsletter is published by Medical Affairs. Please submit ideas, comments, and suggestions to Dr. William Stephan, Vice President, Medical Affairs at (603) 882.3000 ext. 67046, or e-mail [email protected]
 
Medical Staff
NEWSLETTER
Spring  2010

Communication - the Essential Ingredient for a Safe, Effective and Efficient Healthcare System


Communication is central to the provision of safe, high-quality medical care. However, the increasingly complex healthcare environment can complicate the communication process and hinder information exchanges that are necessary for optimum care.
 
Communication breakdown in healthcare can occur in various ways.  There can be communication failures during patient handoffs (e.g., transfer of responsibility for patients between caregivers, such as during a change of shift or on patient discharge from the hospital), between a patient's attending physician and consulting physician, between consultants or even between the physician and the patient. Patients and families expect that transfer of information among caregivers will be reliable. They expect the appropriate information to be transferred in a seamless and uninterrupted fashion. 
 
This spring the Medical Executive Committee and the Board of Directors modified the Rules and Regulations of the Medical Staff to emphasize the responsibility for consultants to communicate directly with follow up consultants when transferring care.  Also the referring physician's responsibility to document the date and time that consultants are contacted was clarified. 
 
An effort to ensure that the discharge form is faxed to the primary care physician at the time of discharge is also underway.  A recent review of this process, revealed that it is done more consistently on some units than on others. Repeat education and ongoing monitoring of performance is planned to increase our compliance with this important step at the time of transfer of care. 
 
Evidence suggests that the rate of readmissions is independent of length of stay or even completeness of the discharge process but is critically dependent on patients seeing their primary care provider within one to two weeks of hospital discharge to ensure that their clinical course is following the desired trajectory.   Some patients may need to be seen even sooner for "fine tuning" before returning to the emergency department and undergoing readmission.  We will be looking for a way to track outpatient follow-up and its relation to readmission over the next few months. This effort will be critically dependent on good communication between discharge and follow-up clinicians.
  
 
 

Patient Safety via AdminRx



RX vial_label

AdminRx uses bar coding that allows staff to electronically document how patients receive their medication. When your patients are admitted to the hospital, a bar coded ID band is placed on their wrist. Before your patient receives any medication that a physician orders, the nurse will scan the bar code on the patient's ID band. The medication pops up on a computer. A pharmacist then makes sure the patient is not allergic to the medication ordered and that it does not interact with other medications the patient is taking. The nurse will then receive the medication the patient needs. The nurse scans the patient's ID band and the medication package to make sure the dosages and prescription match. Once everything has been checked, the medication is then given. 
 
If you have any questions or concerns about AdminRx, please contact Aaron Thibodeau, Manager of Physician Applications at (603) 882-3000, ext. 63506 or e-mail [email protected].  
 
 

Meet Our Family Advisory Council




Family Advisory Council
The St. Joseph Hospital Family Advisory Council began in November of 2009. Our Family Advisory Council (FAC) serves as a formal mechanism for involving patients and families in policy and program decision making in the healthcare setting.

The purpose of the Family Advisory Council is:
  • To work together with St. Joseph Hospital and medical staff to promote family-centered care.
  • To collaborate with St. Joseph Hospital and medical staff in improving the quality of care provided to patients and their families in both inpatient and outpatient settings.
  • To improve patient and family satisfaction.
  • To offer input to St. Joseph Hospital leadership in planning and evaluating services, programs and policies.
  • To promote a positive relationship between St. Joseph Hospital and the community.
  • To contribute to the education of present and future healthcare providers.
The Family Advisory Council (FAC) meets once a month. Each month, various SJH staff members have attended the council meetings to educate the group on topics of interest. In January, we discussed system-wide Patient Education and FAC members agreed to participate on the SJH Patient Education Committee. In February, the leadership team from the Emergency Department, including Dr. James Martin, Medical Director, presented to the group. Initiatives to improve patient care and patient flow were discussed and the FAC members found this presentation very informative. In March, we looked at a presentation regarding Healthcare Reform and it's impact on our community as well as brainstorming ideas to enhance the upcoming promotion of the Hospitalist Program. 
 
More information on the Family Advisory Council and projects they are working on will be posted in upcoming months.
If you have questions about the Family Advisory Council, please contact Sheila Caron at (603) 882-3000 ext. 63208.
 
 

Ultrasound Guided Peripheral Nerve Blocks for Post-Operative Pain Control



Regional anesthesia including epidural and peripheral nerve blocks has been the mainstay of post operative pain control. Epidural has been very effective for orthopedic procedures such as total joint replacements. In the recent times, it has fallen out of favor due to widespread use of anticoagulants such as lovenox, coumadin, etc. for DVT prophylaxis.
 
Peripheral nerve blocks emerged as an effective and safer alternative to epidural. As part of multimodal technique involving long acting oral narcotic such as oxycontin started on the day of surgery and continued post-op, intra articular injection of morphine, ketorolac and bupivacaine, peripheral nerve block either one shot or continuous infusion has been most commonly used for pain control after total joint procedures here at St. Joseph Hospital.

Peripheral nerve block techniques have evolved over the years. In the beginning, anatomical landmark and paresthesia techniques were used. In my training years, which was until a few years ago, nerve stimulation techniques were most commonly used. Recently, ultrasound guided techniques have become the more widely used standard technique. The use of ultrasound for regional anesthesia is relatively new, however, interest in this application is growing rapidly. Ultrasound guided nerve blocks were first described as early as 1978, but it was not until the advent of advanced ultrasound technology in the 1990's that interest in this field grew.

Regional anesthetic techniques were historically associated with a reported failure rate of up to 20%, presumably because of incorrect needle and/or local anesthetic placement. Multiple trial-and-error attempts to locate the target nerve can lead to operator frustration, unwarranted patient pain, and time delay in the operating room, especially in patients with difficult anatomical landmarks.

Advantages of Ultrasound over nerve stimulation and paresthesia techniques include: 
  • Direct nerve localization and the surrounding structures including blood vessel, muscles, bones, etc.
  • Provides real-time imaging guidance during needle advancement allowing for purposeful needle movement and proper adjustments in direction and depth.
  • Direct visualization of local anesthetic spread around the nerve during injection.
  • Improves the quality of sensory block, the onset time, and the success rate compared to nerve stimulator techniques (as shown in some clinical studies).
  • Reduces the number of needle attempts for nerve localization, which decreases patient discomfort and improves satisfaction.
  • Reduces incidence of unintentional intravascular injection and therefore decreases the risk of serious complications such as seizures and cardiac arrhythmias.
  • Reduces unintentional intraneural injection and therefore avoids long term serious nerve injury.
  • It can be used even when a motor response cannot be found such as in trauma cases.
Imaging techniques have made huge progress in medicine. Regional anesthesia has a made a huge comeback with the advent of ultrasound. More peripheral nerve blocks are being done for orthopedic procedures than ever before. It has become popular in residency training programs as well as private practices and hospitals like St. Joseph.
 
Interscalene and supraclavicular blocks most commonly performed for upper extremity surgeries especially shoulder. Femoral and popliteal blocks are most commonly performed for lower extremity surgeries, most commonly knee (total knee replacement, ACL reconstruction, etc.) and ankle fractures. Use of ultrasound is increasing for treating other chronic pain conditions such as piriformis syndrome, ilio-inguinal neuropathy, etc.
 
Use of ultrasound has a learning curve. It can be challenging in obese patients. Fine adjustment of transducer probes can be difficult with conductive gel making it slippery to stabilize the probe on the patient.
 
But we are all excited about it...we are getting better everyday and this is great news for our patients!
 
Submitted by:  Dr. Madhankumar Sathymamoorthy
(Dr. Kumar)
Granite State Anesthesia (www.granitestatepain.com).
 
 


 OR Construction Project Approved!




On April 15, 2010, the New Hampshire Certificate of Need Board (CON) approved our Operating Services Renovation Project for the main hospital Operating Rooms and supporting services such as Prep/Recovery, PACU and the family waiting area.  Phase I of the project has already begun and includes completely new Heating, Ventilation and Air Conditioning (HVAC) for the Operating Room Suites and surrounding areas. As many of you may know, the original operating rooms were constructed in 1979 and the HVAC system currently in place is out-of-date and beyond its useful life. A state-of-the-art HVAC system is important to control room temperature, preserve sterility of the operating rooms and provide ultimate surgeon, staff and patient comfort. New, upgraded systems and equipment are essential to providing our patients with the highest quality care during their surgical experience. Location of the new system is critical to providing the best performance and patient experience and to insure this, the new unit will need to be located in close proximity to the main hospital operating rooms. The best location for this is the patio/porch located between 3 North and 3 South. Construction has already begun on the porch to accommodate the new unit. We anticipate the HVAC upgrade and installation to be complete by mid-July.
 
Updates will be included in future editions of the Medical Staff Newsletter and in the coming weeks, the Marketing Department will launch a newsletter for continued updates throughout the course of the project.
 
 


 Blood Bank Notes




bloodbank
Did you Know?
 
If you want to transfuse a patient or have blood on hand, the blood bank must have orders as follows:
 
"A Type and Screen with the numbers of units to be crossmatched for infusion (today or tomorrow) or to be kept on hold."
 
The blood bank sample is good for three days and expires at midnight on day three.
 
If blood must still be kept on hand, new orders and new sample must be requested.
  
Questions? Contact the Blood Bank at ext. 67210.
 
 
 


Hudson Medical Office Building - Good for the environment. Good for your health.




Hudson

The new Hudson Medical Office Building, is now open at 208 Robinson Road in Hudson. This environmentally-friendly building, with geothermal wells for heating and cooling, energy efficient systems and windows, and southern exposure, helps to take care of the environment while our providers take care of their patients. 
 
The two-story, 30,000 square foot medical building is the home to SJ Family Medical Center-Hudson, St. Joseph Rehabilitation Services, Laboratory and X-ray services, and Dartmouth-Hitchcock Hudson Family Practice. Additional office space is still available. Please contact Bob Demers, at (603)882-3000, ext. 67001 for more details. 
 
To learn more about the new Hudson Medical Office Building, please visit www.stjosephhospital.com.  

 


St. Joseph Hospital Partnering with Lifeline to Offer Peace of Mind to Patients 




LifelineLogo
St. Joseph Hospital Lifeline provides personal response services 24-hours a day, 365-days-a-year to patients in the Greater Nashua area. The service provides quick assistance whenever personal support is needed especially in a medical emergency.
 
Lifeline is a personal response service that gives patients immediate access to help whenever they need it. By simply pushing a lightweight, waterproof button that can be either worn around the neck or wrist, a subscriber is immediately connected to a highly trained monitor who has instant access to the caller's complete health history and will quickly link each subscriber to the care they need.
 
The new Lifeline with AutoAlert option also enables patients to push the pendant-style button for help at any time, but adds an added layer of protection by automatically placing a call for help. If a fall is detected and the wearer can't push the button because they are disoriented, immobilized, or unconscious. Lifeline is the ONLY medical alert service provider that integrates this capability into a pendant-style Help Button.
 
For additional information about Lifeline or Lifeline with AutoAlert, please call St. Joseph Hospital Lifeline at (866) 674.9900 ext.4333, or Michele Canto on the Senior Adult Mental Health Unit at St. Joseph Hospital at (603) 882.3000, ext. 66406.
 
 


Service Highlights: The Center for Neuropsychology, Learning, and Behavioral Medicine




The Center for Neuropsychology, Learning, and Behavioral Medicine at St. Joseph Hospital offers services in the following areas for children and adults:
  • Clinical Neuropsychology provides assessment, consultation, and treatment for patients with a head injury, stroke, dementia, memory disorders, epilepsy, multiple sclerosis, Parkinson's disease, ADHD, and learning and developmental disorders. 
  • The Learning Center provides assessment, tutoring, and individual and group educational therapy for dyslexia, dysgraphia, and other organizational and learning disabilities.
  • Behavioral Medicine offers consultation and treatment for medical illnesses that are affected by stress and other psychological factors, such as asthma, cardiac disease, diabetes, chronic pain, and cancer.
If you would like to know more about The Center for Neuropsychology, Learning, and Behavioral Medicine and how its services can assist your patients, please contact the Center's Director Ted Davis, Ph.D. at (603) 598-3384 or email [email protected].
 
St. Joseph Adult Day Health Center 
 
It is meaningful and important for older adults to have something to look forward to each day. Whether the member just needs social interaction or faces a chronic illness, Adult Day is there to help and provide care for a variety of conditions. This program is specifically designed to promote and enhance the social, physical and cognitive skills of members.
 
Through the innovative day program, members have time to socialize, enjoy scheduled entertainment, participate in activities, reminisce, and develop new interests. The goal is to enhance or maintain a level of independence, while members remain in the community and continue to be a vital part of family life.
 
Morning and afternoon snacks are served, along with nutritious hot lunches. Members receive on-site services such as personal care and social work services, among others, according to individual needs and physician's orders. The experienced team coordinates with members and their families to create an individualized care plan, whether they need care on a daily basis or one day a week.
 
Adults needing social or medical support in a supportive setting are eligible to join our program. Potential members undergo a nursing assessment prior to enrollment. However, members do not need a medical diagnosis to attend. Medicaid and private pay are accepted. 
 
If you have a patient who would benefit from the services at Adult Day, please call Melissa Ostlund, RN at (603) 598.2470.
 



2010-2011 Provider Directory




Provider Directory Cover_new
Thank you to all the providers who sent back updated information for our new provider directory. Our new directory arrived in April and has been distributed to your offices. Our online directory has been updated and remains the best resource for up-to-date information on all providers affiliated with St. Joseph Hospital.
 
Take a look at http://www.stjosephhospital.com/Provider-Search.  If you have not received your copy, or would desire additional copies, please contact Sheila Caron at 603.882.3000, ext. 63208 or by email at [email protected].