Last year we began focusing on social media as another great tool to distribute information directly to our community.  The response has been terrific.

And, as reported in Friday’s Triangle Business Journal in an article entitled Social Media Grows in the Triangle, WakeMed is one of the most active users of social media among local private companies in our area.  We look forward to continuing to grow our presence online and welcome any suggestions and feedback via Twitter, Facebook or this blog.

Thanks for helping us get to the top of the heap.

The News & Observer featured a front-page story today about the renewed emphasis on preventing concussions in professional sports like the NHL.  Dr. John Wooten, a pediatric neurologist with Raleigh Neurology, is focused on helping young athletes recover from concussions at the WakeMed Concussion Clinic.  The clinic helps determine when it is safe for a student athlete to return to the playing field and the classroom following a concussion.

From the National Football League to North Carolina high schools, there’s a growing awareness of the potentially serious damage that concussions can cause athletes.  The NFL has adopted guidelines that require athletes to be cleared by independent doctors before they can return to the football field and the NHL is studying the issue this week.  A similar policy has been in place at North Carolina high schools since last year.

 And the need is real, in 2008, according to the Thompson Emergency Department Database, 1,318 Wake County patients ages 0 to 17 were seen and discharged from emergency departments with a diagnosis of concussion or closed head injury.  Additionally, The Center for Disease Control estimates that 1.6-3.8 million recreation-related concussions occur each year in the United States and 5 to13 percent of these injuries result in an emergency department visit. 

Returning to the playing field – or even the classroom – after a concussion too soon can provide stress that prevents the brain from healing properly.  It also puts athletes at risk of Second Impact Syndrome, a second injury to the brain before it is fully healed that causes swelling of the brain.  It is a serious condition that has resulted in the death of two North Carolina high school football players.

 The WakeMed Concussion Clinic, is one of the only dedicated clinics in the nation that provides students with the same level of care that many professional athletes receive.  The clinic puts students through a series of tests to evaluate their balance and cognitive skills, including a computer test that requires you to recognize and recall a series of shapes, words and objects.  It is the same advanced test that is used by the NFL, NHL and Major League Baseball to evaluate the cognitive skills of professional athletes.

 To learn more about concussions, click here.  Also, watch media coverage on WRAL and WTVD about the WakeMed Concussion Clinic.

Amar Patel is manager of the WakeMed Medical Simulation Center.

Yesterday WakeMed Simulation Center staff and Air Mobile crew hosted a drill in Sampson County where EMS responders practiced diagnosing a STEMI (heart attack) and calling for air support. 

The purpose of the drill is to ensure that first responders in Sampson County can diagnose a STEMI quickly and are able to get patients the care they need as quickly as possible. Research shows that the faster a heart attack patient gets to the cath lab where an intervention is performed to open the blocked artery, the better their chances are for survival and the better their quality of life will be after the event.  The more time the heart muscle is deprived of oxygen due to a blocked artery, the more permanent damage will occur.  

The article published in the Sampson Independent today sums up the drill and has some great pictures of the simulator being loaded into WakeMed Air Mobile.

Patients in Sampson County can be proud of their emergency response teams. Total time from STEMI to patient arrival by air transport to the WakeMed cath lab was 1 hour 18 minutes.  Pretty impressive!

Stan Taylor, Vice President of Corporate Planning

The Cary News included a story yesterday quoting me and profiling two Holly Springs residents on their desire to have a hospital built in their town.  Every community wants a hospital for convenience, choice, access, and yes, competition throughout the region.  But it is not feasible for every community in an urban county like Wake to have a $100,000,000 hospital every few miles.

A community hospital generally needs at least 80 to 120 beds in order to attract the physician specialists and clinical staff necessary to ensure a wide breadth of services. Specialty hospitals, like the 60-bed women’s hospital WakeMed is planning to build in North Raleigh, or a cancer hospital, or even a hospital specializing in surgery, can thrive with fewer beds because of its single focus. 

However, a non-specialty, community hospital with fewer than 80-beds typically serves as a referral source. In other words, if a patient presents to the emergency department with a serious ailment for which they need inpatient care, chances are very likely they will be immediately transferred to a tertiary care center with more specialties and services.

There are many areas of our county where it takes more than 9 miles to get to a hospital. In fact, most communities in Wake County are at least that distance from a hospital, including some areas within Raleigh – a city that has 3 hospitals.

But, the question of the allocation of health care resources never has had an easy answer.  The challenge for state regulators is to strike a balance so all citizens of North Carolina have access to facilities and services that provide high quality, affordable health care - without unnecessary duplication and overlapping services in an area.  An exact recipe makes for a strong health care community where all citizens are served.

WRAL is airing a story this evening that will feature an interview with Dr. Atkinson explaining health care charges.  Here is some background on how this story came about.

At a recent Raleigh Chamber meeting, WRAL’s new General Manager Steve Hammel asked Dr. Atkinson to help him understand the charges he incurred after having surgery at another local hospital.  Dr. Atkinson explained how health care charges are calculated. Steve was impressed by the answer and thought the community would like to hear about it as well.   Dr. Atkinson agreed to an interview and was promptly contacted by reporter Bruce Mildwurf.

WakeMed prides itself on being transparent and always welcomes the opportunity to answer questions health care consumers have.  But, we also know that this is a very complex issue that likely cannot be fully explained in less than two minutes, so we thought we would share some additional thoughts on this blog in advance of the story airing. 

The easiest way to explain what goes into the charge for a medication or medical device is to walk you through what it takes for something as simple as getting an aspirin prescribed and delivered to the patient.  This likely requires more resources than you may think.

The doctor has to order an aspirin, the nurse inputs the order, the pharmacy tech fills it, the pharmacist checks it and then the nurse delivers it to the patient.  The charge for all of these individual staff and the technology it takes to fill the order are rolled into the $1 WakeMed charges for an aspirin.  It would be very easy to sensationalize the fact that an aspirin costs $1 in the hospital and only $.07 or less at Costco, but this would not be a fair comparison. 

A statement itemizing charges is also not a good representation of what a hospital actually is paid for performing a procedure.  Additionally, Medicare ruled long ago that you could not have a separate line item for nursing care or other required support like kitchen staff, housekeepers, laundry staff, janitorial staff, medical records, IT, doctors, lab personnel, human resources, reception, clerical staff, transcription, billing and coding staff, insurance verification, switchboard operators and the administrators required to ensure that everything runs as smoothly as possible. Not to mention the costs of state-of-the-art medical technology, food, telephone, TV, electricity, linens, pillows, mattresses, beds, cleaning supplies, etc.  All of these costs get rolled into the medication, supplies, and procedures listed on a charge statement.

The system is not perfect. In fact it has many flaws that need to be addressed, but for a hospital to survive and meet its mission of caring for all, it must learn to work within the system.  Hopefully, in the near future, we will all see some substantive changes in the way lives are covered and how the medical miracles of today are funded.

Update March 3 9:55 am: Missed the story last night, catch it here.  In a short period of time, Bruce did a nice job explaining many of the issues.

Today more winter weather is predicted to affect the Triangle area. And, although the sun is starting to come up a little earlier and stay out a little later these storms and cold winter are likely putting a damper on your moods.  Dr. Jeffrey Childers, a WakeMed psychiatrist,  shares information about seasonal depression, what to do to get yourself out of the doldrums and when you should think about seeking medical help. 

If you find yourself in a temporary funk during the winter months, you are not alone.  Millions of Americans experience seasonal depression – or Seasonal Affective Disorder – year after year.  It is a type of depression caused in part by the shorter days and lack of daylight that accompanies winter. 

While many people experience some form of the “winter blues,” it can become a serious issue if it consistently interferes with your ability to function.  Like with other forms of depression, you should seek treatment if seasonal depression causes you to become less productive, skip work, withdraw from friends and family, and experience a lack of energy that prevents you from functioning normally.

Seasonal Affective Disorder affects both children and adults and can lead to more serious types of depression, including bi-polar disorder.  The good news: it can be treated effectively with a mixture of therapy and medication.  Increased exposure to daylight can help, too.  Dr. Childers encourages those with seasonal depression to take advantage of bright sunny days and spend time outdoors.  In severe cases, patients may undergo a special type of light therapy to counteract the lack of exposure to daylight. 

The next time you find yourself struggling through a dark winter day, now you will know why.  Get out in the sun and try to shake those winter blues.  But if it becomes a prolonged situation that begins to affect your life, talk to your doctor about Seasonal Affective Disorder.

At WakeMed  heart health awareness is not just a priority during February (American Heart Month).  So, even though it is March, we felt that you would still benefit from hearing from a cardiologist or two about how they stay heart healthy.  These profiles were also included in our most recent issue of Heart to Heart.

Dr. John Sinden

Dr. John Sinden’s Prescription for Heart Health

Raleigh Cardiology Associates

Heart to Heart: What helps you focus on fitness?

Dr. Sinden: Setting goals is important and helps make the work of fitness more focused. Having a purpose is also a great motivator. My son, who goes to Boston College, has run in the Boston Marathon a couple of times, and my wife and I have gone up to see him. We learned about the Dana-Farber Marathon Challenge team runners by watching these committed folks run in the marathon. A Raleigh friend has also run with the team.

My son encouraged me that I could run with the team even though I couldn’t time-qualify for the race. I went to the Dana-Farber Cancer Institute’s Marathon Challenge team Web site, applied for the team and was accepted to run in the marathon in April. Now, I have a goal — to run the marathon. And, I have a purpose — to raise funds for the Dana-Farber Cancer Institute’s efforts to help scientists continue to achieve better cure rates among patients. My goal is $6,075. These are strong motivators for me. But I believe that routine daily exercise is important, and certainly one does not have to run a marathon to attain his or her fitness goals.

Matters of the Heart

Please note too that we added another Matters of the Heart event being held on March 11 at the WakeMed Heart Center Conference Center.  Dr. John Sinden of Raleigh Cardiology and Dr. Brent Myers, medical director, Wake County EMS, will cover the basics of chest pain, from the warning signs and early diagnosis and treatement to activation of the 9-1-1 emergency system.   Space is still available. Visit this web site to register.

Enhanced features, better ergonomics and quicker operating times characterize the new da Vinci Si Surgical System that came to the Raleigh Campus this January.  It replaces an older model of the da Vinci Surgical System that was used by physicians of Wake Specialty Physicians – Urology and OBGYN for the past five years.  The replacement makes the Raleigh Campus one of five hospitals in the state, and the only hospital in the Triangle area, to own and operate this advanced surgical robot.

The da Vinci Si offers surgeons 3-D visualization during laparoscopic surgeries, along with greatly enhanced dextarity, precision and control. Its state-of-the-art technology allows for smaller incisions, less bleeding, and an easier reach under vessels and organs.  Using the da Vinci, surgeons can offer a minimally invasive option for complex surgical procedures. Surgeons operate the robot by sitting at a console and directing every maneuver that its mechanical arms make. 

When comparing the da Vinci Si to the older model da Vinci, several enhancements allow for greater efficiency in the operating room (OR). Its features are more streamlined so that time is saved during set-up.  The added picture-in-picture viewing capability allows a surgeon to easily view a patient’s films during surgery. The robot also includes HD viewing, toughscreen technology, the opportunity to connect with tools that use alternative energy sources, a more ergonomic surgeon console, and the ability to save console settings so the operator can quickly reach his or her comfort level.

This video, taken during a training session demonstrates the agility of the instruments and the ability to work in small spaces.   In the video, Cary Zeipekkis with Intuitive Surgical Systems, explains the benefits of using the da Vinci for transoral surgery.

Robin Carver, RN

Robin Carver, RN, serves as WakeMed’s director of infection control.

According to the North Carolina Division of Public Health (NCDPH), there has been a recent increase in gastrointestinal illness across the state due to norovirus. Highly contagious, this virus can infect someone who ingests only 10 particles of virus.  That is smaller than the head of a pin.  For example, it usually takes about 100,000 colonies of a bacteria to quantify an infection. 

Norovirus begins suddenly and causes nausea, vomiting, diarrhea and stomach cramping. Sometimes, people may also feel tired and experience a low fever, chills, headache and muscle aches. It is contracted in areas of close contact, most commonly in long-term care facilities, schools and restaurants, especially those with buffets. This has commonly been referred to as the “cruise-ship” virus. The NCDPH warns that norovirus is spread by direct person-to-person contact or the ingestion of fecally contaminated food or water.

Protection is relatively easy, but you must be diligent. Strict hand washing with warm water and soap remains the number one way to avoid norovirus. Alcohol-based hand sanitizers are not effective. Wash your hands frequently with soap and warm water, especially after using the restroom and before eating.  It is also important to note that norovirus is not killed with regular household cleaners.  A solution of bleach and water is the best defense.  More information on norovirus can be found on the NCDPH Web site.

Update March 1, 1:00 pm:  In case you missed it, Robin Carver did an interview with NBC 17 on Friday all about Norovirus.