The Right Route to Recovery

The Right Route to Recovery

The Right Route to Recovery

All stroke rehabilitation is the same, right? Wrong. Here’s why.

A stroke doesn’t just come and go. The repercussions of the event can stay with a person both mentally and physically for a lifetime. Each year, roughly 800,000 Americans experience a stroke, and many of those must then begin the recovery process.

Darryl Kaelin, MD

“Stroke is one of the most common causes for disability in America and is certainly a leading reason for needing rehab,” said Darryl Kaelin, MD, medical director at Frazier Rehab Institute, part of KentuckyOne Health and associate professor of the division of physical medicine and rehabilitation at the University of Louisville. “After a stroke, survivors can lose a lot of physical and mental function and must work to get back what they can. That’s where rehab comes in.”

In or Out?

The primary mission of all rehabilitation facilities is to help patients improve their quality of life by working on:

  • Skills such as walking, talking and eating
  • Physical strength and flexibility
  • Living an independent lifestyle

“Stroke patients must carefully consider where they will seek rehab,” Dr. Kaelin said. “Not all hospitals and clinics offer the same services.”

Recently the American Stroke Association recommended stroke survivors utilize acute, inpatient rehab instead of skilled nursing facilities. This decision was based on several studies that revealed numerous advantages to inpatient rehabilitation programs compared with those in skilled nursing facilities.

Some of the most notable benefits of inpatient rehabilitation include:

  • Daily visits from a rehab doctor
  • Longer therapy sessions
  • Higher nurse-to-patient ratios

These added benefits can lead to quicker recovery times as well as longer life expectancy for those who participate in acute inpatient rehab.

This article originally appeared in the Fall 2016 edition of One Health Magazine. Want more health and rehabilitation news like this? Subscribe to One Health Magazine and receive the latest news straight to your inbox.

The Ten P’s: Tips for a Good Doctor Visit

Tips for a Good Doctor Visit

No matter how well-trained, motivated and compassionate your doctor is, you might not be getting as much out of your health visits as you can. The good news is that there are several things you can do to make the most of your office appointments.

Here are some helpful tips from a doctor about what you can do make your time together as meaningful as possible.

1. Prepare

Make sure you know the correct date, time and location of your appointment. If you have not been to that location before, look it up so you know where you’re going. Make sure to bring your identification, insurance card, and a list of your current medicines and allergies. If you are seeing a specialist, know the name of your primary care provider so the specialist can send a letter summarizing the visit. If the doctor might need to examine you, wear clothes that are easy to take off and put on.

2. Paperwork

If you are seeing a doctor for the first time, you might be told to expect new patient paperwork in the mail. Look for it. If you do not receive it, call the office. People in the office might be able to email it to you. Then fill it out. Do not try to decide what you think the doctor needs to know and withhold information. Humor the doctor by filling it out accurately and completely. Office personnel are accustomed to seeing information presented in a certain way, and may need to follow a sequence for computer entry of information.

3. Person

Consider bringing another person with you to your appointment to act as another set of eyes and ears. On the other hand if you have young, active children consider leaving them with a sitter so you can focus on your visit.

4. Punctual

Often you will be told both an appointment time and an arrival time. Take traffic and unfamiliar surroundings into consideration when planning travel time. You may have to sign more forms after you arrive, so if you arrive just before your appointment time you will be behind. If you are flustered because you are late, you will not be thinking clearly when it is your turn to see the doctor.

5. Play

It’s not fair and it shouldn’t be this way, but at times you will have to wait. Bring a book or another diversion to occupy yourself while you wait. You will be in a better mood when it’s your turn to see the doctor.

6. Phone

Your health demands focus. Turn off your phone when the doctor or nurse is in the room.

7. Purpose

This is one of the most important points. Think about the reason for your visit, and tell the doctor or nurse practitioner within the first few minutes. Do not tell a story to explain the background or build dramatic effect; these can come out with further discussion. Get right to the point. For example, “I am here to discuss my blood pressure medicine. My blood pressure has been high, and I am having strange sensations. I wonder whether they might be side effects of the medicine.”

8. Participate

Be there mentally and take part in your visit. Your doctor or nurse practitioner is making decisions based on your responses to questions, so answer questions as best you can. Do not say what you think they want to hear. For example if your physician prescribes a medication but you do not take it, say so. Or if your doctor explains the results of a test and asks whether you understand, do not say yes if you do not.

9. Pen and paper

If you do not have a scribe to help you, bring something to make notes about the topics you discussed. You might even ask the doctor to review what you wrote to ensure it is accurate. Keep your notes in a binder or notebook, and bring it with you to every appointment.

10. Plan

This is very important. Make sure you understand the plan before the visit ends. For example you might say, “So I am going to stop taking Toprol, and start Diovan. I am going to come back in 6 weeks for blood work and a recheck. Is that right?” You both should be clear about what should happen next.

Being an advocate for your own healthcare does not mean you have to be suspicious or confrontational, but it does require some thought. It will help you to think about your appointment before, during and after the visit. You will learn more about your health, be more satisfied with your experience, and position yourself for a longer, happier life.

Remember your P’s!


Dr. David LipskiDavid Lipski, MD

Dr. David Lipski practices venous and lymphatic medicine at KentuckyOne Health Vein Care Associates.

Expanding Transplant Care

Expanding Transplant Care Thanks to $5.3 Million in Funding

Trager Transplant Center

One of the leading providers of organ transplantation in the country has a new home.

The Trager Transplant Center in downtown Louisville provides world-class transplantation services to Kentucky and the surrounding states. Overwhelming success in such a short time has taken the center from Jewish Hospital to the newly renovated third floor of the Frazier Rehab Institute — a space nearly twice the size.

The Trager Center is recognized as being one of the first in Kentucky to perform adult heart, pancreas and liver transplants. It’s also capable of implanting the latest technology — such as the ventricular assist device — to act as a transplant alternative.

The Trager Transplant Center ribbon cutting ceremony

Pictured: Leslie Buddeke Smart CFRE, division vice president, development; Kelly McMasters MD, chairman of the U of L department of surgery; Mark Slaughter MD, executive director of cardiovascular services for the KentuckyOne Health Louisville Market, chair of the department of cardiovascular and thoracic surgery at the University of Louisville; Amy Trager; Jean Trager; Steve Trager; Michael Trager and Andrew Trager.

“We’ve certainly established a reputation in the region for high-quality care and incredible patient experiences,” said Joe Gilene, market president for the KentuckyOne Health downtown Louisville campus. “Many years of exceptional work, support from the Foundation and a generous gift from Jean and Bernard Trager in honor of their children and grandchildren have allowed us to expand our space to meet the rising demand.”

With the first procedure completed on Aug. 1, the new venue has already revealed numerous benefits, including:

  • Increased volume, thanks to expanding from six to 16 exam rooms
  • More comfort for patients and their families within a brighter area
  • Improved communication with four new consultation rooms
  • Updated education rooms to help answer patient questions and concerns
  • Additional space for on-site administrative and physician offices

“Our volume has greatly increased even from just two years ago,” said David Lewis, director of transplant services at KentuckyOne Health. “The new space allows us to take in more patients and, ultimately, save more lives.”

This article originally appeared in the Fall 2016 edition of One Health Magazine

Six Steps to Beat the Blahs

Six Steps to Beat the Blahs
There are ways to overcome cloudy, gloomy days.

“The wintertime and holidays can be difficult for many people suffering from depression or grieving the loss of a loved one,” said Kelly Gillooly, MEd, LCADC, director of behavioral health outreach at Our Lady of Peace (OLOP), part of KentuckyOne Health. “For those who struggle with depression during the holiday months, it’s important to not dwell on what the holidays are supposed to be like or how you’re supposed to feel.”

 

One Foot Forward

 

  1. Accept help from others — whether it’s with cooking, shopping or decorating.
  2. Avoid alcohol and other substances used to self-medicate.
  3. Don’t put too much pressure on yourself to have the perfect holiday.
  4. Find someone you can turn to when you’re feeling stressed.
  5. Get some exercise. Physical activity can help relieve depression.
  6. Give yourself permission to grieve if you’re struggling with the loss of a loved one.

“If you’re feeling down or overwhelmed, don’t be afraid or embarrassed to ask for help. Everyone needs support from time to time in their lives,” Gillooly said.

 

Need help finding peace and hope during the holidays or colder months?

 

Please do not hesitate to call — day or night — Our Lady of Peace’s Assessment and Referral Center. Our Lady of Peace is open 24/7 and offers assessments at no charge.

This article originally appeared in the Fall 2016 edition of One Health Magazine. Want more behavioral health information like this? Subscribe to One Health Magazine to hear from experts.

 

A Quicker, Better ER

Emergency Care

A Quicker Better ER

Providing better care when you need it most

The emergency room (ER) can be an extremely busy place. The Centers for Disease Control and Prevention found that there are 136.3 million emergency department visits each year in the United States, with the south having one of the highest population-based visit rates. With such high volume, patients can easily feel lost or forgotten in the crowd.

“At the end of the day, all patients really care about is getting quality care within a reasonable time frame,” said Michael Waterman, division director, performance excellence at KentuckyOne Health. “While we were having some successes, we knew we could improve and that our patients deserved better.”

A look at the ER data from all KentuckyOne Health facilities revealed opportunities to improve care and enhance the patient experience. One of the most telling numbers came from the “left without being seen” (LWBS) rates – a number that represents patients who leave the ER before getting help due to long waits.

“The worst kind of care is no care at all,” Waterman said. “Our LWBS rates showed that people from our communities were coming in and leaving before we could get to them. That wasn’t acceptable, and we knew there had to be a better way.”

Reducing Wait Times

In  February 2016, the first KentuckyOne Health facility, Sts. Mary & Elizabeth Hospital, began its ER redesign with $9 million from the Jewish Hospital and St. Mary’s Foundation. The process started by bringing in consultants who had worked with more than 200 ERs across North America.

“We saw where there were certain holes in our processes that provided us with opportunities for improvement,” Waterman said. “We just needed a tried-and-true template to get us moving in the right direction.”

After seeing improved outcomes within the Sts. Mary & Elizabeth Hospital ER, the decision was made in March to begin redesigning the ER in each KentuckyOne Health facility. Every ER went through a four-day process to initiate the transformation.

Day 1: Analysis

The hospital supplied a multidisciplinary team to analyze the current state of their ER. They reviewed what was done well, what could be improved upon and future goals.

Then, the department went through a “lean” process, where the team examined their current procedures and pointed out any step that didn’t add any value or contribute to meeting patients’ needs.

“When we sent the teams to review their own processes, it quickly became apparent that many of the steps, such as asking people for their information multiple times, were adding no value,” Waterman said. “By cutting this waste, we could drastically reduce the time necessary to see patients, treat them and send them on their way.”

Day 2: Redesign

The redesign process was modeled after the Sts. Mary & Elizabeth Hospital ER. However, each site modified the original plan to make it better match their setup. These modifications came from feedback from every member of the department. At Jewish Hospital and Sts. Mary & Elizabeth Hospital, Jewish Hospital and Sts. Mary’s Foundation provided funding for expansions and remodeling.

“All team members were involved with tweaking the processes to match their site,” said Jennifer Nolan, president, Sts. Mary & Elizabeth Hospital and Our Lady of Peace. “this wasn’t something that was being done to them by some outside force. It was an opportunity to control their own future as a department.”

Days 3 & 4: Testing

Once the redesigned process was created, the hospital teams tested it. Modifications were made as needed and then the entire process was tested again.

“A great part of this process is we collected data in real time,” Nolan said. “So we could immediately see if our goals were being met and then make process changes, if necessary.”

In the Future

The results of this four-day process across the entire system have been promising.

“Based on some preliminary data, we can see patients’ experiences are improving,” Waterman said. “Regarding LWBS, we have seen a range of results with reduction from 15 to 63 percents. The time from when a patient arrives to seeing a provider [physician or nurse practitioner] has decreased 38 percent on average across all our locations. The length of stay is also down by an average of 17 percents, and in some locations, it’s been reduced more than 30 percent.”

Regardless of how things are going, the ER teams meet every day to discuss the previous day’s performance and ideas of how to continuously improve.

“The future only looks brighter for our ERs,” Waterman said. “We allowed those in the department to make the process their own and put structures in place to provide them help and suggestions when they need it.”

This article originally appeared in the Fall 2016 edition of One Health Magazine. For the latest news on KentuckyOne Health, visit our News Center and read more about our 30-minute ER pledge.

 

Flipping the Health Care Switch

Flipping the Health Care Switch
The transition from high school to college isn’t the only change teens need to make as they enter adulthood.

Between the ages of 18 and 21, most young adults make the switch from their pediatrician to a primary care physician who focuses on adult care.

Ben Rambicure, MD, family medicine physician at KentuckyOne Health Primary Care Associates, recommends families start looking for a new provider early so everyone is prepared.

A 3-step Process

Age 12

Teach preteens how to discuss their health care. Adolescents should be familiar with their personal and family history, as well as any medications they take on a daily basis.

Age 17

Start the search for your teen’s adult primary care physician and help your teen understand health insurance coverage.

Ages 18-21

Make an appointment with the internal or family medicine physician for your teen.

“At this point, teenagers can call their pediatricians and say, ‘I’m scheduled to see this provider on this date at this time,’ and arrange for their medical records to be transferred,” Dr. Rambicure said. “Because everyone is on the same page regarding medical history, screenings, vaccinations and lab work, teens can expect a smooth transition.”

This article originally appeared in the Fall 2016 edition of One Health Magazine. Subscribe to One Health Magazine to learn more about Primary Care information from local experts.

The Rundown on Reviewing Your Insurance Plan

Read The Rundown on Reviewing Your Insurance Plan

The Rundown on Reviewing Your Insurance Plan
The new year is here – it’s time to get a handle on your insurance plan and understand what’s covered.

“The turn of the new year marks a good time to review your current coverage and available options,” said Sherrie Troutman, benefits manager at KentuckyOne Health. “Participants need to ensure they understand the specifics of their particular health plan.”

Troutman offers a few practices for maximizing your plan in 2017 and helping you select your 2018 coverage:

  • Boost your overall health by staying up to date with recommended immunizations and screenings. “Talk with your doctor or primary care provider about which screenings and immunizations you should get,” Troutman said. “Many recommended screenings and immunizations – like routine childhood immunizations, the flu shot, mammograms and Pap tests for women, and osteoporosis screenings for older adults – are typically covered in full by your insurance company.”
  • Understand the specific in-network and out-of-network coverage benefits of your plan. Using in-network providers leaves you with a smaller out-of-pocket cost.
  • Know your out-of-pocket balance. Look up the details of your plan to find out what your out-of-pocket limit is and what is remaining. You will not maximize your benefits until your deductible, out-of-pocket maximum and other plan requirements are met.
  • Keep track of the number of visits with your doctor you have in 2017 aside form annual wellness checkups and other preventive services. This can help you decide whether a traditional plan or high-deductible plan will better suit your future health care needs.
  • Take charge of your health and well-being by scheduling an annual wellness visit, or checkup, as well as other preventive screenings with your primary care provider each year. “These visits are the cornerstone of preventive care and are covered 100 percent,” Troutman said. “Preventive screenings are crucial for finding health problems before symptoms begin, when most conditions are easiest to treat.”

And, finally, don’t forget to investigate health and wellness programs and incentives offered through your workplace.

“Employee Assistance Plans provide a wealth of information and assistance, such as face-to-face counseling, legal and financial services, and online resources, to help manage stress and work-life balance as well as improve both mental and physical health,” Troutman said.

This article originally appeared in the Winter 2017 edition of One Health Magazine. Want more health and wellness information like this? Subscribe to One Health Magazine to hear from experts on how to take control of your health. 

Meet Our Physicians

In each edition of One Health, we will introduce you to some of the physicians who provide care at KentuckyOne Health. In this issue, meet two of the many KentuckyOne Health primary care providers.

Meet Dr. Alvarado

Ralph Alvarado, MD, FACP, primary care physician with KentuckyOne Health Primary Care Associates in Winchester, attended Loma Linda University School of Medicine in San Bernardino, California. Dr. Alvarado then completed the University of Kentucky’s combined residency in pediatrics and internal medicine, so he and his family have called Kentucky home for many years.

As a primary care physician, Dr. Alvarado works with patients to ensure they receive the preventive services they need.

“I have always felt KentuckyOne Health was an organization I could trust,” Dr. Alvarado said. “It has impressed me that even at a high level, the system’s goals always come back to the mission of providing more care for patients within the Commonwealth and reaching out to those who are underserved.”

To make an appointment with Dr. Alvarado or another KentuckyOne Health primary care physician in Lexington and Central/Eastern Kentucky, call 888.570.8092

Meet Dr. Waldridge

A native of Kentucky, Ron Waldridge II, MD, family medicine physician with KentuckyOne Health Primary Care Associates in Shelbyville, is a second-generation family physician.

“Because of my father’s love of medicine and the joy I saw him have with his career, I was inspired to pursue the same path,” Dr. Waldridge said. “In medical school, I realized family medicine fit the bill for me best. A lot of it is about relationships with families, and that’s what I enjoy — getting to know people and advising them about their health care needs.”

Dr. Waldridge graduated from the University of Louisville School of Medicine before completing a residency in family medicine at Carolinas Medical Center in Charlotte, North Carolina.

To make an appointment with Dr. Waldridge or another KentuckyOne Health primary care physician in the Louisville area, call 888.570.8091.

Breaking Records, Setting Trends

Stroke care

“We have an aging population with high risk for stroke and other significant neurological conditions,” said David M. Blake, MD, neurologist, president of the medical staff and stroke director for Saint Joseph Hospital. “We welcome the opportunity to care for these patients and are excited to improve stroke care for patients and families throughout central Kentucky.”

The neurology team at Saint Joseph Hospital is committed to improving quality of life for patients living with neurological illnesses, such as epilepsy, Parkinson’s Disease and multiple sclerosis. With expert neurosurgeons on-call 24/7, Saint Joseph Hospital is well-equipped to respond to emergencies that involve a damaged brain or spinal cord.

Timing is Everything

Additionally, Saint Joseph Hospital offers prevention and acute treatment of stroke, the fifth highest cause of death in Kentucky, according to the American Stroke Association. Utilizing a clot-busting medication called tissue plasminogen activator (tPA), Saint Joseph Hospital physicians work quickly to restore blood flow to the brain in patients presenting with stroke. The goal of tPA is to dissolve the clot of blood blocking an artery and to re-establish blood flow that delivers glucose and oxygen to brain tissue.

Saint Joseph Hospital exceeds expectations from the American Stroke Association in terms of door-to-treatment times. Utilizing a computed tomography (CT) scanner, the team at Saint Joseph Hospital can quickly determine when tPA is needed and how to respond to situations when it is not.

“Our goal is to administer tPA to ischemic stroke patients within the first hour of arrival to the hospital,” said Kristin Howard, BSN, RN, stroke program coordinator with Saint Joseph Hospital. “The sooner we can treat the core of the problem, the more likely we can restore brain function.”

If you have questions about stroke or other neurological illnesses, connect with the Saint Joseph Hospital neurological team at KentuckyOneHealth.org/sjhstrokecare

Choose Your Door: Convenient Access to High-Quality Health Care

Choose your door

More access points than any other health system.

Whether you’re sick or simply coming in for a well visit, your primary care provider should be your first stop. With primary care offices throughout Louisville, Lexington and Central/Eastern Kentucky, there is likely a KentuckyOne Health primary care office near you.

Anywhere Care

Whether it’s a holiday or after the office is closed, illnesses don’t always keep the most convenient hours. When you can’t see your primary care provider, Anywhere Care is a great alternative. Through secure video chat or phone consultation, you will consult with a board-certified doctor or nurse practitioner who can provide a diagnosis and treatment (including prescriptions, when appropriate).

Emergency Care

During a true medical emergency, finding a qualified medical team close to home can be a lifesaver. KentuckyOne Health operates 15 locations across the Commonwealth that are available 24 hours a day, seven days a week, to treat life-threatening illnesses or injuries.

Express Care

In and around Louisville, Express Care locations partner with Walgreens to provide coordinated and expanded health care services. With high-quality, convenient and affordable treatments just around the corner, you don’t have to wait to see a physician.

Urgent Care

Sprains, strains, infections or stitches — these mild to moderate conditions can be treated on a walk-in basis at KentuckyOne Health’s Urgent Care locations. No appointment necessary, Urgent Care is designed to get you in, out and on with your life.

Workplace Care

Health matters at work, too. KentuckyOne Health supports more than 2,500 local and regional businesses with services that include access to the KentuckyOne Health network of physicians and services, on-site wellness screenings, group health reports and wellness presentations.

To learn more about primary care and other services at KentuckyOne Health, visit ChooseYourDoor.org. For those in Louisville and the surrounding counties, call 888.570.8091. For those in Lexington and Central/Eastern Kentucky, call 888.570.8092.