E-Newsletter for Heywood Healthcare Medical Staff
Message from the Athol Medical Staff President - Elizabeth M. Nottleson, MD
Dear Friends and Colleagues,
As you know, the new, beautiful addition to Athol Hospital is open and humming with activity. Many of my patients have remarked on the gorgeous space, but we know it is the special people inside that create the care and quality medicine that supports the community. I wanted to take this opportunity to introduce you to the providers inside the beautiful building.
Physician/Provider Wellness - Helen Heneghan, MD/CMO
Who Heals the Healer?
My patient wept as she delivered her baby, his 10 fingers and toes perfectly formed, waxy and unmoving. I wept along with her, tears coursing down my cheeks under my sterile mask, as she cradled her stillborn infant.
Physician Health Services
Reasons to Call, Refer, or Self Refer- PHS provides assistance with a wide variety of health conditions, as well as personal and professional situations. Reasons to refer yourself or a colleague, or to contact PHS for advice include:
Addictive behaviors involving money or technology
Alcohol And substance misuse
Attention, learning and organizational issues
Life challenges (financial, retirement, career)
Medical/physical concerns that may impact one's ability to practice medicine
Neurocognitive changes and memory loss
Occupational stress and burnout
Practicing medicine in our increasingly complex health care system
Psychiatric and mental health concerns
Relationship and family problems
Unexpected outcomes, medical errors or malpractice stress
Go to www.physicianhealth.org or call (781) 434-7404
Welcoming New Faces to Heywood Healthcare!
Vinod Mohan, MD, Infectious Disease
Dr. Mohan is Board Certified in Internal Medicine and has completed a fellowship at the University of Vermont in Infectious Disease. He is here Monday, Tuesday and Friday for inpatient consults. Beginning in December, he will be seeing patients in clinic on Tuesday afternoon. Dr. Mohan can be reached on his beeper (413) 365-1102 or (978) 630-6559 (for booking patients).
Patrick Hook, MD, Rheumatology
Dr. Hook is board certified in Internal Medicine and has completed a fellowship at Boston Medical Center in Rheumatology. Dr. Hook will be located in Suite 104 of the Medical Office Building seeing patients Monday through Thursday and will be available for inpatient consults. Dr. Hook can be reached at (978) 630-5011.
Brett Adam Ancowitz, MD, Gastroenterology
Dr. Ancowitz is board certified in internal medicine and has completed a fellowship in Gastroenterology at Brown University Medical School. He will be here full-time and located in Suite 104 of the Medical Office Building. Dr. Ancowitz can be reached at (978) 669-5522
Athol Hospital New Construction Updates
- Registration is now located in the main lobby and phlebotomy will move to the old cardiology wing. The renovations to that area should be completed in a few weeks.
The parking lot will have a first pass on the black top by November 15th unless there is inclement weather. Patients will be able to access this lot as soon as the curbing is installed and painting of the lines is complete. This new lot will provide 29 additional patient parking spaces, which includes 7 handicapped spaces, with easier access to the ED.
The Radiology suite is scheduled for completion by the end of December.
POOP- No, not that kind of poop. Still offensive, it could make you poop your own pants. “Pain Out Of Proportion to Exam” is something that we should all recognize as potentially serious. Mostly because nothing in the differential is good. In fact, they are all terrible, true emergencies!
Safe use of DOAC's- In recent years, there has been a sharp increase in the use of direct-acting oral anticoagulants (DOACs) for treatment of atrial fibrillation or VTE. DOACs include apixaban (Eliquis), edoxaban (Savaysa), Rivaroxaban (Xarelto), and dabigatran (Pradaxa). The ease of use (i.e. lack of monitoring) is one of the advantages of these newer medications. However, there are situations when the use of DOACs should be carefully evaluated or may be contraindicated, as outlined below.
Extreme body weight:
- Obesity: International Society on Thrombosis and Haemostasis (ISTH) recommends avoiding DOAC use in patients with a BMI > 40 or a weight of > 120kg.
- Underweight: (use with caution) Systemic exposure may be increased by 20 to 30 % in patients < 50 kg.
Pregnancy and breastfeeding: It is recommended to avoid use.
Moderate to severe hepatic impairment (Child-Pugh class B or C)- Use with extreme caution or avoid use.
Bariatric Surgery: Altered absorption - evaluate the risk vs. benefit of possible decreased drug absorption against the consideration of alternative anticoagulants. Efficacy may be decreased.
Renal Impairment /Elderly – The 2019 Beers Criteria lists them as medications that should be avoided or reduced with varying levels of kidney function.
Drug Interactions – Severe interactions occur with CYP3A4 inhibitors and inducers, as well as P-glycoprotein inhibitors and inducers, which may lead to bleeding or treatment failure.
Please see individual prescribing information for each medication for specific details, or contact a pharmacist at (978) 630-6238 if you have questions regarding these precautions.
The ELMER project is currently on schedule and moving right along. The standards build will be completed by the end of October; however, we have already begun the early phases of Implementation. Many of you may have seen activity as we started on site “assessments”. We had multiple assessment days scheduled in September to assess workflows.
There was an official kickoff with providers at the PAC (Physician Advisory Council) meeting on September 11th. There was a high-level slide show demo of key aspects of the ambulatory and acute/ED tools, highlights of next steps and a chance for PAC members to ask questions. The PAC has created and approved a problem list management policy. This will be important for how we all manage the patient problem list across the continuum. We had representation at the Meditech Physician/CIO forum by Carol Roosa, Sandi Wiltshire and Dr. Andrea Damour, which took place September 18-19. In November, select representatives will attend the Clinical Leadership Preparedness Program.
We are excited that we have so much provider engagement in this project as we know that is how we will be successful. As always, if you have any questions, please reach out to Haley Bogdasarian (978) 827-5167, Carol Roosa Ext. 6448 or Sandi Wiltshire Ext. 6112 for more information.
Infection Control- It's That Time of Year...
Flu Shots for Patients
We have begun assessing all hospitalized patients for a flu shot. Patients requesting shots will be vaccinated prior to discharge.
Employee/Provider Flu Shots
Flu shots are a bit delayed this year. Initially, Employee Health will provide flu shots for direct care staff and providers and then will provide flu shots to remaining staff members. This year the deadline to obtain your flu shot is December 6th.
If you obtain a flu shot elsewhere, please send verification to Employee Health. If you work elsewhere and are vaccinated here, consider taking a picture of your consent form so you can email it to yourself/other employer. If you have any questions, please feel free to contact Employee Health Ext. 6545.
Update on Heywood/Athol Policy of CT Coronary Calcium Scoring
CT coronary calcium scoring is an effective tool in helping booth the primary provider and specialist alike in selecting the proper patients for aggressive risk factor modification. Many of you attended or have reviewed my slides from the April 18, 2019 Heywood Grand Rounds on CT Coronary Calcium scoring and update on the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease.
Wondering why your asthma patients need repeat prednisone tapers? They usually need more than 5-10 days of therapy and frequently benefit from the addition of an inhaled steroid for 3-4 additional weeks! I recommend that you overlap the inhaled steroid with the last 2-3 days of oral prednisone. The goal is to reduce airway inflammation. Joseph Walek, MD
Please order "Celiac Disease Comprehensive Panel" blood test BEFORE starting gluten free diet (GFD). If the panel is abnormal, please call GI (for confirmatory endoscopy), before you commit to GFD, which has its own down sides. Phani Molakatalla, MD
Healthy men can have wide swings in testosterone levels, so a low testosterone should be confirmed on two or three measurements before diagnosing hypogonadism. Testosterone levels drop during the day and with food. Testosterone levels should be checked in the early morning, fasting. John Poremba, MD
A diagnosis of lupus should not be automatically associated with a positive ANA. Studies have shown that low-titer ANAs (1:40-1:80) are unlikely related to any rheumatic autoimmune conditions without concomitant symptoms. Patrick Hook, MD
Patients who are unable to walk on a treadmill with intermediate/higher pretest probability and/or with underlying left bundle branch block, should undergo Lexiscan SPECT. This test should not be used for younger, healthier patients with low pretest probability. Ben Prentiss, MD
Consider looking at prior chest CT's for underlying vascular calcifications. If there are calcifications to coronary vasculature or the aorta, patients should be started on a statin and an aspirin for secondary prevention. Aimee Cormier
What is considered an Advanced Directive? MOLST, DNR, Palliative Care, Healthcare Proxy, and Living Wills (personal directives)
How do we know the document is complete? Forms must be signed, dated and filled out completely where applicable.
What do you do with an Advanced Directive once it is complete? Upon arrival to the organization, if an Advanced Care Planning Document is completed or in hand, it will be faxed to Medical Records at the numbers below depending on the site of registration.
Athol Fax#: (978) 249-1136, Monday–Friday 7:00 am – 3:30 pm
Heywood Fax#: (978) 630-6152, Monday–Friday 7:00 am – 7:00 pm
Medical Records will scan the document into the EMR by the next business day.
Locations that the form could be scanned into or have been placed in the past:
- Advance Directives
- Healthcare Proxy
The Medical Ethics Committee
Both Athol and Heywood Hospitals have a Medical Ethics Committee. It is a multidisciplinary committee whose purpose is to act in an advisory role to assist healthcare professionals, patients, families and the community to facilitate ethical decision making.
Medical Staff Services Department
The majority of the Medical Staff policies have been reviewed and revised. Please access the Medical Staff Policy and Procedures page on the Intranet or contact the Medical Staff Services Department for a hard copy.
For credentialing purposes, please notify the Medical Staff Services Department if there have been any suits or claims against you alleging malpractice, negligence, failure to diagnose, etc., which have been pending, opened, or closed during the past ten (10) years.
Additionally, provide information as to any formal or written complaints that may have been filed against you with any state professional licensing board.
Bariatric Services Program
"Since joining Heywood in July 2019, Precision Surgical Specialists completed 15 bariatric surgeries in our perioperative suite. As most of you are already aware, a thriving bariatric program is highly valuable to our community. We are thrilled to work with Dr. Rebecca Shore, who is leading the charge to grow and enhance a weight loss program for our patients." --Rozanna Penney, CRNA MSNA, Vice President of Perioperative Services, Chief Certified Registered Nurse Anesthetist
We are excited about the opportunity to provide Bariatric Surgical care for the patients of the Gardner area and Heywood Hospital. Our team consists of Dr. Roy Shen, Dr. Daniel Campbell, Dr. David Lin, and myself.
Since our first case this summer, we have been increasingly impressed, not only with the surgical staff and Bariatric program members, but also the post-operative nursing and ancillary care.
If your patients suffer from obesity or have already had weight loss surgery, we would be happy to see them in consultation and discuss treatment or follow-up options. We have extensive experience and are invested in the metabolic side of bariatric surgery and the treatment of type 2 diabetes. We offer a full evaluation and support for the laparoscopic gastric bypass, laparoscopic sleeve gastrectomy and band patient. We look forward to building a great program and a strong collaborative with the entire hospital staff.
-Rebecca Shore, MD
Rebecca Shore, MD
Roy Shen, MD
Daniel Corey Campbell, MD
David Lin, MD
For more information please visit www.heywood.org/hmg
Upcoming Meetings and Events
Heywood Med Executive Meeting
December 4, 2019 - 11:45 am
Pierce Board Room, Heywood Hospital
Athol Med Executive Meeting
December 4, 2019 - 8:00 am
Hillis Board Room, Athol Hospital
Heywood Medical Staff Meeting
January 13, 2020 - 5:30 pm
Pierce Board Room, Heywood Hospital
Save the Date! Snowflake Celebration—Annual Heywood Holiday Party
Fun for employees, medical staff & volunteers!
Friday, December 13th
625 Betty Spring Road, Gardner
Cocktails - 5:30 pm
Dinner - 7 pm
Dancing, Photobooth & Entertainment - 8 pm
Medical Staff Rosters October 30, 2019