President’s Message

Posted on Dec 1, 2021 in President's Message | 0 comments

I hope everyone had a restful Thanksgiving. I was working most of the week through the holiday and weekend, so I sent my family down to LA to be with grandparents. I figured they would have more fun there rather than dealing with my usual work-related fatigue and grumbling.

The emergency department was humming with activity. Thanksgiving and the days before and after will bring an interesting mix of patients, those with nowhere else to be, those who have held out on acute issues to be with family and friends, only to have those problems escalate to the more serious, and those who have perhaps overindulged and are paying the price.

I had finished taking care of a patient, with an uncomplicated diagnosis and treatment plan, and she took the time to say to me, “thank you for all you do.” I felt heartened, thanked her for being such a nice patient, and in the spirit of things, catalogued some of the things that I should be thankful for.

I have a job – it’s not easy, but there a plenty of folks out there who are supremely dissatisfied with their jobs and have left the workforce altogether.

I have my family – they are all doing well, bar the occasional mishaps and whining (especially from the four-legged variety) and are mostly in good spirits.

I have my health – sure, my hair is getting gray, my midsection is flabbier, I think I’m shrinking in height, but all in all, not too many serious medical issues (that I’m aware of).

I have great friends and coworkers – doctors and nurses can be a tempestuous bunch, but I am continually impressed how hard everybody works to help each other and do the right thing for patients.

I have relative financial security –I still owe mortgage to the bank, but I am dutifully saving for retirement and my kids’ higher education. I live simply – aside from a sordid collection of bicycles. All the things I need (even if they are not all the things that I want) I can pay for.

These are a few of things that I am thankful for, and I encourage you to think along these lines during the holidays. Many of our patients are not so lucky.

Omicron is coming.  This particular variant is notable for having multiple mutations within the spike protein that may evade our current vaccines. Already, Pfizer, Johnson and Johnson, Moderna are signaling that they will likely be developing new vaccines to address the latest variant.  Last month, I was hopeful that we were through the worst of it, that we would soon be in the endemic phase of this COVID nightmare, but perhaps that was too wishful. Europe is going through its fourth major wave of infections, lockdowns are once again being imposed. Global vaccine equity is the key here – while most developed countries have vaccinated 50-70% of their population, the African continent has only vaccinated 7% of the population. Complacency in adequately vaccinating developing countries has fostered an environment rich for mutation.

With that somber note, I wish you all a peaceful winter holiday. Take stock of everything that you are thankful for, and spread some gratitude to your colleagues and patients.

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

Reflections on 2020, Aspirations for 2021 – With a Science of Well Being Lens

Posted on Dec 1, 2021 in Wellness Committee | 0 comments

Reflections on 2020, Aspirations for 2021 – With a Science of Well Being Lens

I was feeling the weight of 2020 last week when I went to Ms. K, a patient who has had a particularly rough year.  “This is the year I lost my leg in the spring, and now, I am losing this battle with lung cancer all on top of Covid-19,” she said, “but I learned something this year, too.  I learned we all need each other, and we all need love”.  As she said this her eyes brightened and the heaviness that pervaded the room lifted and I felt a warmth in my chest.

“Yes, you are right, Ms. K,” I said, “We have learned some important things this year.”

“2020 = a dumpster fire” “2020 = world turned upside down”.  Taking my cue from Ms. K, I have been trying to see it rather as a world revealed. A world where we have a newfound appreciation for relationships and community.  A world much more fragile then we had understood it to be.  A world that needs our tender attention.

We may understand these things, but how do we move forward when so much tough stuff is still weighing us down?  Leaning on the research in social and cognitive sciences, I try to remain optimistic. It is in our DNA to care about the person in front of us and our community.   What we need now are cognitive nudges first to foster our own wellbeing and then our relationships with others.

Here are some ideas that people have embraced in 2020 that we can all explore moving forward in 2021.

Humility: We were humbled by the virus scientifically and socially by our threatened institutions.  And as it turns out, being humbled can be a good thing. There is a rich body of research to suggest that humility first makes us question our assumptions; then often this leads to listening to other people’s ideas and a less “self-focused” outlook.  Gratitude and a greater sense of connection with others follow. Humility is a good first step in self-compassion which can be very helpful in dealing with personal setbacks. 

Research has demonstrated that humility can be cultivated.  As clinicians to whom people look for answers, humility typically is not something we spend time developing. Given that we have all had a good taste of it in 2020, now is a good time to truly work at incorporating humility into our way of being.  And it starts with quieting our inner voices, deeply listening and letting go of some of our assumptions.

Compassion: Across the world Covid-19 wrought tremendous suffering and everyone felt the pull of compassion which is defined as sensing suffering and moving to address it.  Witnessing the compassion on social media moved us all weather this was images of people visiting isolated neighbors or the cheering of health care workers.  Those of us lucky enough be providing health care, we were inspired by our colleagues moving toward danger to express their compassion.

As providers, compassion is foundational in how we move through our world and should be our greatest source of inspiration and energy.  But what I call “the healthcare compassion paradox” can easily get in the way of the natural flow of compassion.  In order to feel compassion, one must witness the suffering of another.  All too often, we rush to the diagnosis and the treatment and miss this crucial step in generating compassion. Take a moment to open your heart and quiet your mind when you first see your patient; their story will inevitably provoke compassion that will sustain you through the encounter and give you energy going into the next.

Awe: Awe is the feeling we get in the presence of something vast or beautiful that challenges our understanding of the world. It is something we depend on the keep life fresh and in 2020, those vacations to “awesome” places like New York or the Grand Canyon didn’t happen, and this contributed the flat feeling we all experienced. Awe makes us feel more alive, but importantly, it also makes us more humble, generous and less self-centered.

This year researchers from UC Berkeley and UCSF demonstrated that awe can be cultivated, and we don’t need to travel the world to find it. A group of seniors were randomized to go on a brisk exercise walk or a walk where they were told to move more slowly but look carefully at their surroundings with a wonderous, aesthetic eye. Those on the “awe walk” reported a greater increase in wellbeing than the exercise group.   So, if we are looking for awe, we can find it nearby if we take the time to look for it.   People can be a great source of awe, too. With some attention, we can find awe in the beauty of our patients’ struggles; this can be another way our work can energize and inspire us.

Here is the link on how to do the awe walk yourself.  https://ggia.berkeley.edu/practice/awe_walk

Purpose: A decade of research confirms that a meaningful life or life well lived has plenty of joy, but more important is living with purpose.  While we are all a little joy deficient now, 2020 certainly made up for it with opportunities to live with purpose.  Purpose is an abiding intention to achieve a long-term goal that is personally meaningful and makes a positive mark on the world. Wearing a mask, staying home in the spring and over the holidays, seeing our patients despite the risks: this is living with purpose. We are leaders who daily work to promote the health of our patients and community. Never has the importance of this work been clearer.

But living with purpose requires stating our purpose.  As with compassion, purpose is so built in our work that we can easily fail to appreciate it.   I have made friends with a former patient and every week he texts me, “Have a beautiful day on purpose!” After each text, I feel energized and approach my work with a more open heart.  We all need reminders like this.

Love:  As we know now, about the only bright side of2020 is our greater sense of our shared humanity and with that, a greater sense of concern for others and need for connection.  This is an opportunity we shouldn’t miss to build upon.  To promote the health of patients and communities, we need to take the next step to make sure we all learn from this insight. We must use our platform in our communities and exam rooms to promote what people now intuit – that an open-hearted, connected world is a healthier one. We need to talk about love.

I am not talking about romantic love but love as defined by Barbara Fredrickson: a moment-to-moment experience of warm, mutual caring that we feel with any person – even strangers – in everyday interactions.  What she also calls more dully “shared positivity” creates a mutual sense of wellbeing. According to her research, our brains are wired to look for this love and if we have this mindset, we can see the world as a source of expanding connectedness and wellbeing.  As healthcare providers, by talking about the health benefits of love and encouraging them to “spread the love” we can promote the health our patients and communities.

Each day I saw Ms. K in the hospital, we had amazing, pithy little conversation.  When she was feeling stronger and ready to go home, she said. “Thank you, Dr. Hass for all you have done, and I’m glad you are almost through your 2020.”

“Well, we have all suffered, but we have become a little wiser as a result” I replied. Then I took her hand, gently rubbed her back and looked into her eyes for a moment.  We both teared up as I said, “Along with medical care, I will try to make sure everyone leaves our med center with a little love, too!”

Leif Hass, MD
Wellness Chair – Summit Campus

Immediate Post-Op Note Timing: MUST be done AFTER incision closure/procedure end

Posted on Dec 1, 2021 in Health Information Management | 0 comments

ABSMC Patient Experience

Posted on Dec 1, 2021 in News from Administration | 0 comments

New Physicians

Posted on Dec 1, 2021 in New Physicians | 0 comments

Sutter Community Connect

Posted on Dec 1, 2021 in EHR Updates | 0 comments

President’s Message

Posted on Nov 1, 2021 in President's Message | 0 comments

I recently watched an interview with Dr. Robert Wachter, chair of Medicine at UCSF, regarding his view of the trajectory of the COVID pandemic. He indicated that we have likely switched from a pandemic phase to an endemic one, where COVID will always be present to some degree. It got me thinking a lot about my own behaviors in the current state.

We have seen our internal numbers of cases going down, as well as those across the Sutter system. But they are not gone. Small blips here and there, with no great surges, the numbers of inpatients appeared to have stabilized, at least in the Bay region.

I have been living a pandemic lifestyle for the past year and a half. No dining in restaurants, no movies, no gym, no airplane flights. Of course, these have been personal choices based on the particular risk profile I live in – of constant exposure through work, of having school age children with no vaccine options (soon to change this coming week!), and of having parents with age and comorbidities being risk factors for serious illness or death.

But as the world learned from the influenza pandemic of 1918, life must go on. It took nearly two years for society to get back to some sense of normal, but it was one in which flu became common and seasonally came back to cause illness and death. This required, when it became available, a yearly flu shot to mitigate its effects. This is where I see us within the context of COVID.

Recently, my wife and I got our boosters, and we feel safer already. I have begun to loosen the reins a bit, making my first journey into the climbing gym (where one must show proof of vaccination to enter, and masks are required regardless) since this whole thing started. Just as in medicine, there is always a calculus of risk that goes into decision making, and some things I have withheld for too long.

The pandemic has accelerated certain technical innovations in healthcare such as telemedicine, which used the restrictions on in person interactions as a catalyst for growth and maturation. It will likely continue to grow. Virtual meetings are the standard now, and more people work remotely as part of their daily ritual. Just how much of what we once knew is going to come back, and do we even want to go back there? Perhaps the pandemic has made some things better? I know many others who are even less tolerant of risk than I am, and they keep waiting for the pandemic to be over, but… the coronavirus is unfortunately here to stay.  It’s endemic now. Over time, our collective immunity should strengthen, and we can only hope for the day when coronavirus is just a common cold again.

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

Massive Transfusion Protocol (MTP)

Posted on Nov 1, 2021 in Clinical Documentation | 0 comments

The Summit campus will go live with Massive Transfusion Protocol (MTP) procedures at ~9AM on 11/10/21.  Below is a brief overview of the MTP process versus orders for uncrossmatched emergency release RBC’s and STAT crossmatched RBC’s.  Educational information can also be found at the Massive Blood Transfusion Education Site: https://sutterhealth.sharepoint.com/sites/ABSMCMBTPROTOCOL

When to use an MTP: 

  • Transfusion of greater than 5 units of RBC in 1 hour
  • Loss or anticipated loss of 1 blood volume within 24 hrs or 50% of blood volume in 3 hrs
  • Bleeding rate  ≥ 150 mL/minute

Activate MTP by calling the Blood Bank (x6563), then place MTP order in Epic

When an MTP is ordered:

  • The blood bank staff stops working on all other orders
  • Prepares packages of blood/blood components per chart below, until MTP is deactivated
Package #Blood Components included
14 RBCs, UNXM or XM, Type O or Type compatible1 Plateletpheresis
24 RBCs, UNXM or XM, Type O or Type compatible4 Plasma (Type AB, A, or Type compatible)2 pre-pooled Cryo (or 10 single Cryo)
34 RBCs, UNXM or XM, Type O or Type compatible4 Plasma (Type AB, A, or Type compatible)1 Plateletpheresis
 Continue with Package 2, 3, 2…….

                **UNXM = Uncrossmatched, XM = Crossmatched

  • Benefits of MTP packages:
    • More timely availability of blood/blood products
    • Maintains 1:1 RBC:Plasma ratio for adequate coagulation
  • Do NOT deviate from established MTP packages à may not get desired benefits noted above; causes confusion for Blood Bank staff (non-standard workflow, question if MTP is needed)
  • Must bring patient ID label to Blood Bank to pick up products
  • Call Blood Bank to deactivate MTP when physician determines MTP can be halted, to minimize wastage of thawed plasma/cryo. 

For Urgent non-MTP blood release:  Call Blood Bank

  • If only UNXM PRBCs are needed, do not activate MTP.  Call Blood Bank to request emergency released UNXM PRBCs and place order for Emergency Blood.  PRBC units will be available just as quickly as those ordered as part of an MTP.
  • If XM PRBCs are needed, order STAT T&C.  Depending on the blood bank testing already done (and the antibody screen is negative), units will be available as follows:
Testing doneUnits available
T&S and ABO recheck~ 15 minutes
T&S only~ 20 minutes after ABO recheck sample received in blood bank
No testing~ 1 hour

Placing an Order for MTP in Epic

1.  Access the Blood Navigator.  You may need to look under More.

2. At the top of the Blood Navigator, check Massive Transfusion and click Open Order Sets

Sutter Hospitals Earn Recognition for Specialty Excellence

Posted on Nov 1, 2021 in Announcements | 0 comments

Sutter Launches New, Improved Method to Test for Heart Attack

Posted on Nov 1, 2021 in Announcements | 0 comments