Posts (9)

Aug 17, 2015 · First-year residents rethink daily labs, improve patient care

Sometimes, it’s the simplest things that make the biggest differences in a patient’s care.

Fresh out of medical school at the University of North Dakota and weeks into his first year of residency, Joel Beachey, M.D., found himself contemplating a challenge from his attending physicians and chief residents: Just how frequently do hospital patients need certain blood tests?

Not as often as one might think.

Dr. Beachey and seven other residents – Drs. Urshila Durani, Elsie Mensah, Priya Joel Beachey, M.D.Vijayvargiya, Gaya Acharya, Kalie Kebed, Megha Prasad, and Matthew Thoendel – embarked on a quality improvement project to see if something as simple as talking through expectations could reduce two tests: Electrolyte panels and complete blood counts. Those tests are among those most commonly ordered, Beachey said.

“Dr. Beachey and the team looked at the literature and found close to 70 percent of lab tests done in the hospital on patients were unnecessary,” said Amy Oxentenko, M.D., director for the Internal Medicine Residency program.

The two tests – complete blood count and electrolyte panel – have important uses: Complete blood counts can help a physician assess whether a patient is fighting an infection or has internal bleeding. An electrolyte panel can help monitor for kidney function.

Having the tests may not change overall management of patients’ conditions. In some cases, it can harm patients, said Dr. John Ratelle, Internal Medicine, co-coordinator of the Quality Improvement curriculum during which Dr. Beachey and the team completed the project.

“We kind of assume if you’re in the hospital, you’ve got to have your blood drawn, right? That’s just something that needs to be done,” Dr. Ratelle said. “But maybe that’s not the case. Maybe things have been stable and it’s not really influencing day-to-day care.”

A number of factors play into physicians ordering the tests.

“A lot of it is lack of provider comfort and lack of knowledge what the cost of testing is,” Dr. Beachey said. “It’s also a lack of knowing what consultant expectations are for daily labs.”

Dr. Beachey and his team collaborated with other stakeholders across several departments and work areas. Based upon their analysis, they put together a short education session and then compared the number of the two tests ordered per patient for three days before the session and three days after the session. The number of tests ordered per patient per day dropped by 33 percent following the education session.

“We were kind of surprised that within that short period of time that we had that significant of a result,” Dr. Beachey said. “It really showed us that just a simple intervention, such as providing education and encouraging providers to think about their daily ordering, can make a really large difference.”

For Dr. Oxentenko, it highlighted the need for faculty to set clear expectations as well as a cultural shift in medicine.

“We need to give trainees permission to not order things. When I think back to when I was a resident, more was better. You felt that you were a better resident if you thought of everything and ordered all these laboratory tests while someone was in the hospital,” Dr. Oxentenko said. “The culture is completely different now.”

For Dr. Sara Bonnes, General Internal Medicine, the project demonstrates the power of small changes and the need to teach quality improvement methodology.

“It’s not necessarily the big things that make the greatest difference,” said Dr. Bonnes, co-coordinator of the Quality Improvement curriculum  in which Dr. Beachey and the team completed the project. “A lot of times, they like to focus on changing the electronic orders or other things. Sometimes, it’s just communication that is key.”

Dr. Bonnes said it’s important to share findings of quality improvement projects, both within and outside Mayo. In November, Dr. Beachey presented their findings at the Minnesota American College of Physicians meeting and won the quality improvement poster competition. In April, he was able to share their findings with a larger audience at the national American College of Physicians conference.

Dr. Beachey is interested in continuing the improvement efforts to see how the results might be sustained.

Watch Drs. Beachey, Bonnes, Oxentenko and Ratelle describe the project:

Jul 29, 2015 · Mayo Medical School takes on bold new initiatives to improve medical education

Mayo Medical School is at the forefront of a major transformation in medical education.

The school is expanding to Arizona and Florida to become one of the first national medical schools in the United States, offering a single curriculum across three campuses. In addition, Mayo will be among the first medical schools in the nation to offer a Science of Health Care Delivery curriculum, providing future physicians and researchers with innovative approaches to improve the quality and value of patient care.

The system of medical education has not changed much in 100 years. The first two years of medical school traditionally focus on the biological sciences, while the second two focus on the clinical sciences. But Mayo Medical School is expanding on that notion to include a “third science” of health care delivery, which will be integrated throughout the students’ four years.

Michele Halyard, M.D., interim dean of the Mayo Medical School

Michele Halyard, M.D., interim dean of the Mayo Medical School

“At Mayo Medical School, we are working to provide our students with the knowledge and skills to heal not only the patient, but the health care system as well,” said Michele Halyard, M.D., interim dean of the school.

Currently, Mayo Medical School receives nearly 5,000 applications each year for its 54 student slots. Expanding the medical school will nearly double the enrollment and allow the school to offer unparalleled medical education to 50 additional incoming students a year on the four-year Arizona campus, beginning in 2017. The total student body for the school will surpass 400 medical students by 2021.

Mayo Medical School is also launching a 2 + 2 program in 2016, allowing up to eight students each year who have completed their first two years of training on the Rochester, Minnesota, campus to complete their third and fourth year on the Florida campus. In addition, students in the M.D.-Ph.D. program will also have the opportunity to complete their Ph.D. training on the Florida campus.

The expansion of Mayo’s medical school and its unique collaborations with other health care organizations across its sites will offer students access to diverse patient populations across multiple care settings. In Florida, for example, which is known for its Transplant, Cancer and Neuroscience programs, students can expand their training by also doing rotations at neighboring health care organizations with high volumes of Medicaid or pediatric cases.

Mayo Medical School receives AMA grant to develop innovative curriculum

Mayo Medical School’s bold new advances in medical education and its dynamic, personalized learning environment set the bar high for medical education. The new Science of Health Care Delivery curriculum, which is being jointly developed with Arizona State University, is supported through an American Medical Association grant called Accelerating Change in Medical Education. Mayo—which was one of only 11 medical schools in the nation awarded the grant—will receive $1 million over five years to develop this transformative curriculum.

Mayo Medical School, the other 10 medical schools and the AMA will work through a consortium to rapidly spread innovations and best practices for innovative medical education. “The beauty of the consortium is that the schools are sharing their knowledge across the consortium, and hopefully we’ll share this unique focus to other medical schools across the country,” Dr. Halyard said.

The science of health care curriculum will have six domains:

  1. High-value care
  2. Population-centered care
  3. Teamwork
  4. Leadership
  5. Person-centered care
  6. Health policy, economics and technology

The curriculum will focus on modern-day lessons that are not traditionally taught during medical school but are critical for future physicians to be well-versed in. These issues might include spiraling health care costs; changing payment structures; new technology, such as electronic health records; medical simulations and team-based care; and caring for the whole patient, not simply treating the disease.

“Besides training students in the Mayo Model of care, we will help students become well-rounded and understand the complexities of the health care system and have the abilities to address those complexities,” Dr. Halyard said.

The curriculum will also have an additional component focusing on wellness and resiliency that has already been implemented at the Rochester campus. “At Mayo Medical School, we really take seriously the well-being of our students and want to help them be equipped to manage their own well-being,” Dr. Halyard said.

With the development of a national medical school and an innovative new curriculum, Mayo Medical School will continue to be a leader in the forefront of medical education.

Jul 21, 2015 · Mayo Clinic among top hospitals in U.S. News & World Report Honor Roll

Mayo Clinic today has been named one of the best hospitals nationwide by U.S. News and World Report. Mayo Clinic earned more No. 1 rankings in individual specialties than any other provider based on reputation, services and volumes, safety and clinical outcomes.

“This ranking underscores our long-standing commitment to provide the highest-quality care that best meets our patients’ needs,” says John Noseworthy, M.D., president and CEO, Mayo MSS_571426Clinic. “Mayo Clinic is fortunate to be ranked No. 1 in more specialties than any other hospital in the nation. We owe our success to staff members who dedicate themselves daily to this shared mission.”

Mayo Clinic was second overall on U.S. News & World
Report’s
 2015-2016 Best Hospitals list and earned a No. 1 ranking in eight specialties:

Read the full article on the Mayo Clinic News Network.

Jul 17, 2015 · Repairing mitochondrial disease

A multidisciplinary team has successfully eliminated fatal mitochondrial DNA mutations in stem cells from patients with mitochondrial diseases. The study is published in the journal Nature as a collaboration between some of the top research institutions and Mayo Clinic’s Center for Regenerative Medicine.

Mitochondrial diseases are a particular struggle for patients and their families as treatment options are limited, something made even more dire as many of those affected are children. Andre Terzic, M.D., Ph.D., director of Mayo Clinic’s Center

Andre Terzic, M.D., director, Mayo Clinic Center for Regenerative Medicine

Andre Terzic, M.D., director, Mayo Clinic Center for Regenerative Medicine

for Regenerative Medicine, explains: “These are life threatening conditions where standard care is limited to alleviating symptoms of disease. Our proof-of-concept study shows that functionally corrected stem cells can be generated from these patients, providing initial steps towards regenerative therapy for mitochondrial disease.”

Read the full post on the Center for Regenerative Medicine’s blog.

Jul 10, 2015 · Balancing quality and cost of care

Mayo Clinic CEO John Noseworthy, M.D. recently took part in an interview with the Wall Street Journal and joined MSNBC’s Morning Joe. He took both opportunities to talk about the trend toward forming contracts with large corporations for certain types of specialty care. MSS_0001253077

Mayo Clinic has had a relationship with Walmart for 18 years in which Walmart associates needing organ transplants are sent to one of the Mayo Clinic for evaluation and care. That relationship has expanded and now patients facing breast, colorectal and lung cancers are sent to Mayo Clinic for evaluation and treatment.

“If you are an employee at Wal-Mart and you unfortunately get one of these conditions, Wal-Mart will pay for an evaluation at Mayo Clinic, and all treatments and evaluations necessary including traveling to Mayo Clinic with a caretaker,” Dr. Noseworthy told the Wall Street Journal.

“It is an extraordinary benefit but it makes sense for Wal-Mart because the diagnosis will be accurate, the care will be as safe as it can be, and cutting-edge as it can be and the patient can get back to work. They’ve recognized that the avoided cost for complex care in a highly engineered system like Mayo saves them money,” he added.

These kinds of relationships likely will grow in health care.

“This is a trend. There are a number of groups that do this,” Dr. Noseworthy explained during the Morning Joe segment. “Complex health care is very expensive, and it’s important to get it right the first time.”

Watch an excerpt of the WSJ CEO Forum interview.

Watch the MSNBC Morning Joe segment.

Jul 9, 2015 · Multiple myeloma research and possible cures highlighted as Tom Brokaw writes about his experience

When a well-known person faces a serious medical situation, it brings attention to the illness and treatments.

This is what happened when legendary NBC News anchorman Tom Brokaw was Tom Brokawdiagnosed with multiple myeloma, a rare form of blood cancer, at the Mayo Clinic. He has since written about his experiences in an inspiring new book, “A Lucky Life Interrupted: A Memoir of Hope.”

Brokaw, a member of the Mayo Clinic Board of Trustees, had been suffering from persistent back pain. His doctor visits close to home didn’t yield any answers, so he eventually made an appointment when he was in Rochester to see a Mayo orthopedist and then his internist.

Brokaw’s case was particularly tricky as nothing was spotted during the initial exam. His internist, Dr. Andrew Majka, wanted to look a little deeper. He ordered blood tests because he was concerned Brokaw had a hematoma from two unexpected falls he’d had while fishing.

After examining the blood results, Dr. Majka and Dr. Morie Gertz, chair of internal medicine, confirmed the diagnosis of multiple myeloma. “In my 30 years of work on multiple myeloma, I have seen a 200 to 300 percent improvement in survival rates. It used to be uniformly fatal,” says Gertz.

The cause of multiple myeloma is unknown, but that is the subject of active research at Mayo, as are the searches for cures. Others who have suffered from the disease have included ABC News anchorman Frank Reynolds and Geraldine Ferraro, the first woman to run for U.S. vice president

“The future of patients who have been stricken with multiple myeloma is very, very positive. There are new drug trials that we are leading. There is rapid development of new diagnostic tools, brand new therapeutic classes of drugs and new biological agents. All of these can be combined to maximize outcomes and minimize any adverse effects and allow patients to lead a completely normal life,” says Gertz.

He says multiple myeloma will continue to be heavily researched, and Mayo will be an important partner in new treatments based on the understanding of the biology of the disease.

Brokaw writes that even before he became a Mayo trustee, he shared a “Midwestern pride” in the clinic as “one of the world’s greatest healthcare facilities, known for its expert, coordinated care and patient efficiency.

Brokaw ends the book with, “It is not enough to ‘rage, rage against the dying of the light.’ It is also a time to quietly savor the advantages of a lucky life and use them to fill every waking moment with emotional and intellectual pursuits worthy of the precious time we have. Life, what’s left. Bring it on.”

Watch a video of Morie Gertz, M.D., describe how Mayo Clinic is advancing diagnosis and treatment of multiple myeloma.

 

Jun 18, 2015 · Studying surgical outcomes to improve patient care

Dr. Charles H.  Mayo

Dr. Charles H. Mayo

For nearly 100 years, Mayo Clinic has been dedicated to evaluating surgical outcomes in order to improve patient care and reduce risks associated from surgery.

Dr. Charles H. Mayo said in 1930, “A surgical procedure should be planned so that the patient, with the least possible risk and loss of time, will receive the greatest benefit possible.”

This focus on improvement and better care continues today with the Surgical Care Improvement Project, which aims to evaluate the care of surgical patients at Mayo Clinic and determine the percentage who receive timely and effective care. The project focuses specifically on four types of surgical complications: surgical site infections, adverse cardiac events, deep vein thrombosis and postoperative pneumonia.

Mayo's continuous quality improvement efforts include a focus on reducing surgical site infections, adverse cardiac events, deep vein thrombosis and post-operative pneumonia.

Mayo’s continuous quality improvement efforts include a focus on reducing surgical site infections, adverse cardiac events, deep vein thrombosis and post-operative pneumonia.

As Dr. Mayo also said, “In the conquering of serious diseases by surgical measures, it is important that the operation itself be as free from mortality as possible.”

The work continues through the Surgical Outcomes Program, which was founded in 2005 within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. For example, Mayo’s research showed 96 percent of breast cancer patients needing lumpectomy avoid a second procedure within a month because a technique called frozen section analysis ensures surgeons remove cancerous tissues the first time.

Learn more about the program’s research findings and how they are improving patient care in this Mayo Clinic Advancing the Science blog post.

Jun 10, 2015 · 1,000 liver transplants and the future of health care

What’s in a milestone? For patients, perhaps everything.

In May, Mayo Clinic transplant surgeon Charles Rosen, M.D. completed his 1,000th liver transplant surgery.

Dr. Charles Rosen, Mayo Clinic transplant surgeon

Dr. Charles Rosen, Mayo Clinic transplant surgeon

Rosen is among a small handful of liver transplant surgeons to have reached that personal milestone. But Rosen would be the first to say that transplant surgery emulates Mayo Clinic’s model of collaborative, team-based medicine.

“This is hardly something a person does alone,” Rosen told the (Rochester, Minnesota) Post-Bulletin, adding that the surgery itself “takes four hands” in addition to a broad surgical support team and other medical professionals. Dr. Rosen thanked his transplant center colleagues, the organ procurement organization LifeSource, and “1,000 patients with real need.”

Mayo Clinic in Rochester performed 104 liver transplants in 2014 from both deceased and living donors, according to the United Network for Organ Sharing, the organization that governs organ donation. Since UNOS began keeping records in 1988, Mayo Clinic has performed 2,478 liver transplants. (Mayo Clinic in Rochester’s program began in 1985, with Mayo Clinic in Florida following in 1998 and Mayo Clinic in Arizona opening its program in 1999.) More than 6,000 liver transplants are performed each year throughout the United States, according to the American Liver Foundation.

Each transplant surgery represents a milestone for patients facing life-threatening illnesses such as Hepatitis C, cirrhosis of the liver and autoimmune disease that give patients the chances to enjoy the kinds of milestones many healthy people take for granted Nearly 90 percent of Mayo Clinic Rochester liver transplant patients survive three years after transplant, according to data from the Scientific Registry of Transplant Recipients. The national average is 81 percent. The percentages of patients receiving liver transplants at Mayo Clinic in Arizona and Mayo Clinic in Florida surviving three years post-transplant exceed national averages as well.

Dr. Charles Rosen is presented with a shirt commemorating his 1,000th liver transplant.

Dr. Charles Rosen is presented with a shirt commemorating his 1,000th liver transplant.

Research shows that centers that perform large volumes of transplant surgeries gain efficiencies and expertise that helps all patients receiving organ transplants fare better than those who receive transplants at medical centers with lower volumes. Mayo Clinic’s experience and continuous improvement in transplant medicine led to Walmart to choose Mayo Clinic as a Center of Excellence in 1996.

Sadly, there is a shortage of organs nationwide. Regenerative medicine holds the promise of creating bioartificial livers and patient-specific liver cell transplants to meet patients’ needs. For more than 50 years, Mayo Clinic has been at the leading edge of clinical and basic transplant research. Recently, Mayo Clinic researchers found livers donated after cardiac death were safe for use in patients fighting liver cancer.

With the exception of two positions briefly held elsewhere, Dr. Rosen, 55, has been on staff at Mayo Clinic since 1991.

“Dr. Rosen would be the first to tell you that liver transplant is a team sport,” Dr. Brooks Edwards, executive director of the transplant program, told the Post-Bulletin. “That said, Chuck Rosen is a singularly inspiring individual to watch. Every patient is an individual to him, and he cares for every patient like a member of his own family. He lives the Mayo creed, that the needs of the patient are the only needs to be considered. He’s first in to the office in the morning and the last one out at night.”

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