President’s Message

Posted on Apr 2, 2020 in President's Message, Uncategorized | 0 comments

Dear Colleagues,

We are at the forefront of a monumental challenge in the fight against COVID-19. This global pandemic has ripped apart the norms by which we practice medicine, threatens to sicken us as we care for those affected, and will undoubtedly alter forever the nature of our social fabric.

It is with that understanding that I feel ever more committed to my community – my neighbors, my colleagues, and my patients. Every day I go to work, I reassure myself that my training and experience have prepared me for this. Our senior administrative leaders have been working tirelessly with our physicians to plan and execute a strategy for dealing with the pandemic. We are expanding our clinical footprint, re-purposing existing spaces, flexing staff to meet the demands.

Is it enough?

Reading and watching the news is profoundly sobering. New York has a growth and death curve for the disease that surpasses the tragedy occurring in Italy and Spain. Is California only a week or two behind? Did the shelter in place order enacted by our counties and our state do enough to “flatten the curve” locally?  There are more questions than answers.

Let me acknowledge all the fears and anxieties that you face, because I have them too. I worry about getting sick, and exposing my family to disease. I worry about my colleagues who are older and with medical conditions that put them at greater risk. These are my friends. My greatest comfort and expectation is knowing that in these extraordinary times, we physicians will act extraordinarily.  Already I have received pledges of support from physicians in the community, physicians returning to bolster the ranks, and offers from other specialties to fill in wherever they are needed.

 We must also be mindful to care for ourselves in all of this. Get some sleep. Go for a run. Read your kid a story. Catch up on Game of Thrones. Get in touch with friends through FaceTime. In such difficult times, it is often the little things that will get us by.

If those little things are not enough, our EAP for physicians is going live on April 1. This is a resource that can help you with free counseling, referrals for pet care/child care etc.

Call 800-477-2258 or email eap@sutterhealth.org

You can also reach out to peer support @ peeroutreachabsmc@gmail.com

Attached is also a list of resources from the Palo Alto Medical Foundation, some of them dealing specifically with coronavirus.

Well-Being Checklist

Posted on Apr 2, 2020 in Uncategorized, Wellness Committee | 0 comments

We are all struggling to deal with this unprecedented outbreak.  I wanted to share with you a Well-Being Checklist  I created with the guidance of colleagues at Berkeley’s Greater Good Science Center and a longer reflection on how we might deal with this stressful time.

1. When in doubt take few deep breaths and slow down
2. Appreciate our teamwork
3. Find beauty in those we care for
4. Let your compassion flow 
5. Look for the gifts that life offers
6. Take stock of the people in your life and check in on them often
7. Hug those you can
8. Get outside and smell the roses
9. Move your body and get some sleep

Stress, Anxiety and Well-Being in the Time of Covid-19

1. Let’s keep the existential threat in perspective.  Let’s go to the big question that crosses all of our minds.  Am I going to die? We are use to the idea of pathogens surrounding us, but this threat is on a different level and rising death tolls and worried families makes it feels a lot worse.  Doctors describe feeling “radioactive” and are making up their wills. It is important to look at the data and not the news stories of deaths without a denominator or circumstances of the infections (no PPE) . First of all, we are now taking universal precautions – all masks all the time now. If we take a high number of 10% healthcare worker infection rate ( it was much lower in Hong Kong without universal precautions) and a high death rate from infection of 5%, the chances of dying from COVID-19 is 1/200.  If the numbers are 5% infection rate and 2% mortality, the chances of dying from it is 1/1000.  If I got on the bus to Cache Creek knowing my chances of winning was 199/200, I would feel pretty good about it.  Something to keep in mind when your brain, like my mine, starts spinning out of control in moments of worry. 

1. Anxious, Stressed? Of course, we have good reason to be! Anxiety can have this negative connotation of repetitive thought patterns and wasted energy, but when we have to process an unprecedented event and ever-changing data, anxiety is an appropriate response.  There is a lot we need to learn and there is new information daily!  It takes time absorb it and then process it.  However, we can slip from productive processing to unproductive ruminating pretty easily. Self awareness can help us see the addictive nature of the computer and social media. When this happens, it is time to change the channel and utilize our social support systems to move our thoughts away from the news.  We also need think about mindfulness and other self-care tools.

3. The answer?  It starts with the breath.  The best way to quiet our minds through the breath. A single deep breath will decrease sympathetic tone.  And if you take a few, focusing on the breathing as you do so, you can begin to calm the mind as well as the body.  This is basis for most mindfulness practices.  Research has shown that those who do even brief but regular breathing meditation get back to a calmer nervous system faster after a stressor than those who don’t.  Part of this is just learning to pay attention to our bodies and thus notice and let go of the tensions that build up.  

It is inevitable while working these days to have a mind racing with ruminations about lack of PPE and insufficient testing and worries about what is next.  For me sometimes this happens to the point that I am not paying as much attention to what is actually happening right now, right in front of me.  And that is how errors with doffing and donning happen.  Even just a single deep breath helps! Practice makes it better; I have found that my 5 minutes of meditation most days – a  practice of being in the present moment – allows me, at least for a moment, to stop the fretting and see more clearly what I need to do right now. With a sense of calm, I then carry on. 

4. “Never waste a good crisis!” I am not sure who said this first, but crises can lead to change.  For many of us, well-being practices have gone from feeling like a luxury we don’t have time for to anecessity.  So take this opportunity to start a practice which will benefit you a lifetime.

For those interested in a breathing or meditation practice.The headspace meditation app https://www.headspace.com/ is free to physicians for the rest of the year.  I like  https://insighttimer.com/ and it is always free.

There are other easier well-being practices like gratitude, connecting with friends and looking for the wonder and beauty in our lives. There are many easy tools to develop these types of practices at the Greater Good Science In Action site https://ggia.berkeley.edu/.  

5. Gratitude in the time of COVID.

People who study gratitude talk about the idea of hedonic adaptation – you get use to stuff going well so you take it for granted.  Well, nothing like a pandemic to make you realize how good things have been. Now I am saying thank you to those who grow the food, make the toilet paper, pick up the trash and make it so the internet and lights go on every time I push the button.  I am sure we all are taking stock of the important relationships in our lives and in so doing, feeling gratitude for them as they grow.  And at work, we all appreciate the support we give one another and the incredible leadership we have.  So be sure to deliberately count your blessings everyday!  We do “three good things” at the dinner table to share good things that have happened.

6. “A Paradise Built in Hell”. 

In her fantastic book, San Francisco based writer Rebecca Solnit describes how disasters often allow people to be their best selves: to act with generosity, and selflessness, to make community, to find courage, and to act with purpose that can elude them in the day to day when we are lost in the routine and more focused on ourselves. If we take a break from the grim statistics on Twitter, we can find much of this inspiring behavior on social media:

Here is a card passed out to  help neighbors in need

Here, People singing with their neighbors in Spain:

Some of the love is directed toward healthcare providers like the people of Madrid cheering for healthcare workers:

The tension at work can make it hard to see, but we can see the heroic work of everyone at the med center – from the nurses who continue to provide the gentle loving touches our patients need, to EVS who is diligently killing the bad guys, to the leadership teams that has expanded the med center’s capacity and changed workflows practically overnight! 

7. The Science of Happiness: Concern for others ->Meaning ->  Purpose-> Service-> Happiness.  We all need time on the beach with a margarita (or a corona?!) in our hand, but the research compiled by my colleagues at the Greater Good at Berkeley come up with a  surprising at is in line with religious traditions: concern for others is the key to a meaningful life and a sense of overall happiness with one’s life.  The research suggests that finding meaning and acting with purpose are the keys to happiness. We intuitively know it having chosen this work, but we often fail to appreciate it. Now is time to take this in: We are dedicated to serving the most vulnerable members of our community.  We save lives everyday. 

Despite our concerns, we understand we are privileged to be part of the solution to this crisis. Taking care of our community is what we do.    We open our hearts to strangers and treat them like family. We live with purpose.  Keeping that in mind may be the best thing we can do for ourselves in the time of COVID. Now is a time to feel pride in our work and to live life with a real sense of meaning.  

If we take care of each other and learn to take better care of ourselves, we can will find deep satisfaction in our work and our lives even as we confront this pandemic. 

Happiness = love+ fun+meaning and purpose!

8.  Famous last words: Fear of things getting out of control has rightfully driving much of the anxiety.  Thankfully, the infection curve remains relatively flat and we have only a week until of social distancing should kick in. We appear to be ahead of the curve in terms of preparation in the East Bay.  We have learned from the mistakes of others and  we have had valuable time to prepare.  Everyone from the state, local government, big Sutter and especially our local leadership has done an amazing job. We need more PPE, clarification of new work-flows, more capacity, more vents, a palliative/ fever unit and guidelines for palliating those at extreme risk –  all of which are happening now.  With these steps in place, our great team of hospitalists will be safe along with the rest of the med center staff.  Importantly, our community will get the care it deserves, too. Of course, we are not there yet, but I think we can have a certain degree of confidence that we will be pretty well prepared when things inevitably heat up.  

Thanks for being great teammates and all you do for our community!
Leif Hass, MD

Sutter Health Community Connect

Posted on Apr 2, 2020 in Uncategorized | 0 comments

Congratulations to all of our physicians who’ve had patients donate to ABSMC in their honor. What you do everyday really does make a difference in our patient’s lives!

Posted on Apr 2, 2020 in Announcements | 0 comments

2019 Community Acquired Pneumonia Update

Posted on Apr 2, 2020 in Announcements | 0 comments

2019 Community Acquired Pneumonia Update

By:  Yuumi Miyazawa and Cory Schlobohm – Department of Pharmacy

In October of 2019 the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) updated the community acquired pneumonia guidelines.1 This update in 2019 is the first time the guidelines have been updated since 2007.

Some of the key changes:

  • No anaerobic coverage recommended for aspiration pneumonia unless there is an empyema or abscess
  • Stronger evidence in favor of Beta-lactam + macrolide combination instead of Beta-lactam + fluoroquinolone combination
  • Steroids not recommended for routine use (can still be utilized for Asthma/COPD exacerbations)
  • Procalcitonin not recommended to guide initial antibiotic therapy, though may be helpful to monitor
  • Obtain sputum and blood cultures for severe disease or those being given MRSA or P. aeruginosa coverage
  • Withhold MRSA coverage when MRSA nasal swab is negative, especially non-severe CAP

“Severe disease” defined as Septic shock, mechanical ventilation or ≥ 3 of the following:

  • Hypotension
  • Multilobar infiltrates
  • Hypothermia (<36)
  • Leukopenia (WBC <4K)
  • Thrombocytopenia (PLT <100K)
  • RR ≥ 30 breaths/min
  • PaO2/FiO2 ratio ≤ 250
  • BUN ≥ 20 mg/dL
  • Confusion/disorientation

If non-severe disease and no history of P. aeruginosa or MRSA: Ceftriaxone + Azithromycin (consider doxycycline instead of azithromycin if QTc is prolonged)

If respiratory isolation of MRSA in last year: Add Vancomycin.

If respiratory isolation of P. aeruginosa in last year: Switch ceftriaxone to Cefepime or Zosyn.

If severe disease and patient was hospitalized and received IV antibiotics within last 90 days: Azithromycin + Vancomycin + Cefepime or Zosyn.

Fluroquinolones should be reserved for patients with severe allergies to beta-lactams.

Lastly, the guidelines recommend treating for a minimum of 5 days. If confirmed P. aeruginosa or MRSA for a minimum of 7 days and longer if delayed clinical response or lung abscess/empyema. The duration should be based on achievement of clinical response.

  1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Am J Respir Crit Care Med 2019; 200(7) e45-67.

New Physicians Memo

Posted on Apr 2, 2020 in New Physicians, Uncategorized | 0 comments

S U M M I T   M E D I C A L   S T A F F   O F F I C E

M E M O R A N D U M

DATE:           April 1, 2020

TO:                 Distribution List

FROM:           Leanna Hudson
Medical Staff Services

SUBJECT:    New Physicians

The following new physicians have been granted privileges. To review privilege list please go to the Intranet: Department/Medical Staff/ Summit/ Physician Privileges. Please contact the Medical Staff office if you have any question.

David C. Carrington, MD
105 North Bascom Ave., Ste.101B
San Jose, CA 95128
(408) 918-0405
Neurology

Max L. Cohen, MD
East Bay Regional
411 30th St.
Oakland, CA 94609-3310
(510) 541-0689
Pulmonary Diseases

Christin B. Destefano, MD
Epic-Care
1480 64th St., Ste 100
Emeryville, CA 94608-2038
(510) 629-6682
Hematology/Oncology

Adam C. Janik, MD
20101 Lake Chabot Rd., Fl. 4, Rm. 2738
Castro Valley, CA 94546-5305
(510) 727-3147
Hospice and Palliative Care Medicine

Ernest N. Lo, MD
Epic Care
400 Taylor Blvd Ste 201
Pleasant Hill, CA 94523-2163
(925) 687-2570
Hematology/Oncology

President’s Message

Posted on Mar 3, 2020 in President's Message | 0 comments

Hello!

My name is Jeff Chen, your new chief of staff. I am an emergency physician by training and have been working at ABSMC for the past 14 years. I am excited to represent all of your concerns over the next two years.

Before going further, I would like to recognize Dr. Jill Kacher Cobb for her incredible leadership, energy, and vision these past two years, and for the remarkable efforts she has made to further physician wellness and engage with our hospital administration to work towards our common goals.

My journey into medicine started of course as a patient. As a young man, I had embarked upon many perilous activities that invariably landed me in the emergency department for treatment. I was always thankful for the care that I received and felt the innate vulnerability that one feels when ill or suffering. It is this intrinsic human-ness that lends to our ability to care for others, that we have been or certainly most will be in that place. As patients, we have implicit trust in our doctors, and yet that faith that the care will be safe, personal, and accessible is not one that is easily achieved.

We practice in difficult times. Our patients expect and deserve the best that we can give. We are constantly asked to do more with less time. Distractions abound. Innovations in technology encourage more time in front of a screen instead of a face. Market forces, legislative mandates, and the changing demographics of our community threaten to curb our ability to practice.

At the heart of it all, the connections we make with our patients, those moments in which we remember that we too are patients, is what makes our care truly special.

Tip of the month:
Practicing safe medicine requires that we be cognizant of the possibility of error. Before critical tasks, whether procedurally based or cognitive:

Stop
Think
Act
Review

Congratulations to the ABSMC Mitral Valve program, which earned the Society of Thoracic Surgery 3 star (out of 3 stars) rating for 2016-2019, of which only 4 out of 133 programs in the state received 3 stars! This was due to the combined efforts of our excellent thoracic surgeons, cardiologists, anesthesiologists, and ancillary staff. Kudos!

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

How to Place a Nutritional Insulin Order

Posted on Mar 3, 2020 in Announcements | 0 comments

Patient Reunion Shines a Light on Importance of Coordinated Stroke Care

Posted on Mar 3, 2020 in Announcements | 0 comments

Safe Care Event

Posted on Mar 3, 2020 in Announcements | 0 comments

Safe Care Event

In July of 2019, a patient encountered an event that could have led to a serious safety event. Mary, 62 years old, came to the ED for a large right pleural effusion and a right chest tube was inserted. She had a known history of recurrent cholangitis due to hepatic stones and required hepatectomy (Dec 2015) to clear the bilateral intrahepatic ducts. A CT of her abdomen indicated a collection of posterior hepatic fluid and a CT guided hepatic drain was placed in IR.

The majority of the pleural effusion had drained but areas of loculation remained. Mary declined surgical decortication and consented to a trial of TPA/Dornase instilled into the right chest tube. During the sixth dose of TPA/Dornase, administered by the intensivist, the TPA/Dornase was accidently instilled in to the hepatic drain. Minutes after the incorrect drain was determined, the medication was aspirated back and 70cc of bloody fluid was collected. She endured significant pain and pressure in the region. Mary would be monitored for bleeding and worsening anemia. The following day, Mary receive a unit of PRBC.

Mary remained stable over the next few days and eventually her chest tube was discontinued. A follow- up CT indicated an increase size of perihepatic fluid collection. The hepatic drain remained in place after discharge and will have a follow-up CT in one week. She was discharged 5 days after the event.

Recommendations:

  • IR and Nursing to label two or more drainage lines in the same region.
  • MD iInitiate Universal Protocol and Time Out process for TPA administration
  • Initiate the Sutter Safety T.R.A.C.E.R. mnemonic with new line connection or line connect

Trace existing line from the source to site
Reading existing line labels
Affix labels if/where required
Connecting compatible lines without forcing or adapting
Examining the new connection
Retracing and confirm source to site

Patrick Acebo, RN and Yenny Johnson, RN