Special section northwest healthcare 2015

SPECIAL REPORT 2015 THE REGION’S BUSINESS MAGAZINE

Northwest Healthcare

Expands Through Greater Tucson

Northwest Medical Center and Oro Valley Hospital

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By Dan Sorenson

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Two hospitals in northwest Tucson have steadily expanded their medical facilities and capabilities over the past five years and now serve patients throughout the metro area and as far away as Sierra Vista.

In addition to the flagship hospitals – North-west Medical Center and Oro Valley Hospital – this growing healthcare network now has six urgent care centers, including one in Green Valley, as well as physician offices and other facilities. Next up is the area’s first freestanding emergency department – a $7.2 million facili-ty to be built in Vail. Construction is scheduled to begin in February.

“We have been serving more than just north-west Tucson for many years. This is anoth-er example of our commitment to expand healthcare in the greater metropolitan area,”

2 Hospitals

6 Urgent Care Centers

+1 Freestanding ER

Coming Soon

Healthcare Closer to

Home

By Donna Kreutz

Northwest Medical Center and Oro Valley Hospital are the hospitals in an ever-expanding community health system that now includes satellite urgent care centers dotting the metro area, along with physician offices and other facilities to serve patients throughout Southern Arizona.

These flagship hospitals are the anchors of a network that is expanding to bring healthcare to the places where people work and live – including east and west sides and Green Valley. The next expansion will be a freestanding emergency center in Vail.

This healthcare network has steadily expanded the scope of specialty services that meet rigor-ous national standards – ranging from chest pain and cardiac care to strokes, joint replacement, breast health, spine care and bariatric surgery. Also offered are a freestanding women’s center, special-care nursery, pediatric emergency care and in-patient rehabilitation services. New pro-grams include sports medicine, senior behavioral health and oc-cupational medicine.

This is comprehensive con-temporary healthcare designed to meet the specific needs of the greater Tucson community.

Plus Nationally Accredited Specialized

Care


Jae L. DaleCEO

Oro Valley Hospital

Kevin StocktonCEO

Northwest Medical Center

NorthwestHealthcare

Expands to Serve Greater Tucson

BizHEALTHCARE


continued from page 136said Kevin Stockton, CEO of Northwest Medical Center.

“Both Northwest Medical Center and Oro Valley Hospital have patients that come from areas as far south as Sierra Vista,” said Jae L. Dale, CEO of Oro Valley Hospital. They also come from Pinal County.

“It’s becoming more of a destination, a real magnet. They’ll bypass a couple of hospitals to come to us. We’re not just serving the northwest community. We have stronger and stronger connec-tions to the outlying areas.” Dale said that’s particularly true for elective sur-gery. “They may have a neighbor that had a good experience.” For example, “we have one of the strongest or-thopedic programs in town.”

Patients do have choices, particularly if they’re already making the trip to Tucson from out of town, Stockton added. “It’s word-of-mouth marketing. Of-ten they talk among their friends and they’ll talk to the physician who goes to the hospi-tal where they want to go. If they need some kind of procedure, they’ll see what Oro Valley or Northwest Medical has done to el-evate the services in certain specialties.”

In the ever more consumer-oriented healthcare market, both Northwest Medical Center and Oro Valley Hospital have set out to attract patients by estab-lishing what are known as “centers of excellence” in several specialties over the past eight years.

Northwest Medical Center, formerly Northwest Hospital, is now 30 years old. The 300-bed facility has been steadily adding national accreditations – for bariatric surgery and joint replacement as well as centers for heart failure, chest pain, stroke, spine surgery and breast imaging, including the first 3D mam-mography in Tucson. The campus, at 6200 N. La Cholla Blvd., also includes a freestanding women’s center with labor and delivery, and a special-care nursery for babies born 28 weeks and above.

Oro Valley Hospital, at 1551 E. Tan-gerine Road, celebrated its 10th anniver-sary on Jan. 12. It has a growing campus of its own, including an adjacent medical building with offices for 65 physicians. The 146-bed hospital continues to grow in services and recognition – including an 18-bed Level IV trauma certifica-tion and pediatric-prepared emergency department, a 17-bed senior behavioral health unit, a certified total joint pro-gram, sleep center and accreditations for chest pain and stroke.

Perhaps the single most telling statis-tic defining the scope of the Northwest Healthcare network is this number –

2,600. “We have 2,600 em-

ployees in our health system,” Stockton said – and that’s only count-ing regular employees at the two hospitals, staff at other facilities on those campuses and that growing network of urgent care centers.

What Stockton calls “the team” goes beyond those 2,600 employees to include physicians who have privileges at the hospitals, volun-teers and emergency service providers. Northwest Medical Center is the adminis-trative base hospital for several EMS and fire agencies who provide

service to the community.While Northwest Medical Center and

Oro Valley Hospital are the key hospitals in the healthcare system, the network ex-pands into – and even beyond – the sur-rounding community. Those six urgent care centers span from the northwest to the Catalina foothills, to the westside on Silverbell Road near Speedway Bou-levard and to the Duval Mine Road in Green Valley.

Maintaining quality in a network of that size, both in terms of the number of highly specialized professionals and mul-tiple physical locations, requires borrow-ing approaches used in other industries. Stockton said, “We have initiated some lean management principles, working with frontline staff to identify barriers to

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Northwest Medical Center plans to build the first freestanding emer-gency department in greater Tucson. Ground will be broken in February for the $7.2 million facility in Vail. Con-struction should be completed by late 2015.

The Northwest Emergency Center at Vail will offer emergency medical care 24 hours a day, seven days a week. Board-certified or board-eligible emer-gency physicians, registered nurses and other patient care providers will staff the center. More than 30 new jobs will be created to serve patients at the new center, including registered nurses and staff for lab, imaging, ad-mitting and environmental services.

Kevin Stockton, CEO of Northwest Medical Center, said this new facility “will provide faster access to emer-gency care for people living in the Rita Ranch and Vail areas.” The facil-ity will have 12 private patient rooms and be equipped with radiology and lab services.

This center will treat patients with ill-nesses and injuries that require a higher level of care than what is avail-able through urgent care facilities, he said.

The emergency center will be built in the Houghton Town Center at the in-tersection of Houghton and Old Vail Roads. The developer of the Hough-ton Town Center is Diamond Ventures.

“Southeast Tucson is growing rapidly, so providing services like emergency care is an important part of our stra-tegic plan for this community center,” said Shannon Murphy, director of sales and marketing for Diamond Ventures.

Dr. Jim Hassen is medical director of the emergency department at North-west Medical Center. He said, “Our team of emergency physicians is look-ing forward to being part of this excit-ing new venture. This facility will be a first in Tucson. We look forward to offering high-quality emergency care at a location convenient for residents in the southeast area of the metro region.”

Area’s FirstFreestanding

Emergency Center

“We’re trying to get the carein the places

people live and work – so that patients seek

out care before theyget into theemergency

room.”– Kevin Stockton, CEONorthwest Medical Center

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http://OroValleyHospital.com


them doing their jobs.” The goal “is to provide the best and quickest care to the patients. It’s multidisciplinary, not just in nursing but pharmacy, transportation, and other clinical areas that impact our patients.”

Maintaining quality while attaining efficiency to control costs requires extending systems outside the hospitals, ac-cording to Stockton and Dale.

“The trend in healthcare is that hospital systems are be-coming more and more integrated with community-based systems,” Dale said. In their case, that means working with local EMS providers from Northwest Fire, Golder Ranch Fire District, Rural Metro and other local emergency ser-vices agencies. “It’s a real collaborative effort to go beyond the walls of the hospital.”

He said as part of a national trend, some EMS provid-ers actually partner with their local hospital and “go out to a discharged patient’s home and do a healthcare check. That provides continuity.” Oro Valley Hospital piloted such a program in Fall 2014.

Some of this reaching outside the hospital takes novel forms. For instance, Northwest Healthcare runs what these administrators refer to as “black-and-blue clinics” during high school football season. That seasonal weekend readi-ness deals with injuries from Friday night high school foot-ball games – and to address an emerging national trend – concussion management.

“And we’re expanding to the adult community,” Stockton said. Northwest Healthcare’s Sports Medicine program will care for adult athletes, too. He said there’s a new attitude about that group. “They’re not sick – they’re injured,” he said of weekend warriors, runners, triathletes and other adult athletes. The modern medical answer to an injured amateur and older athletes is no longer to just to tell them “to stop doing that.”

Northwest’s Occupational Medicine services also may bring people from outside into the network. Occupational medicine services – treatment of on-the-job injuries, pre- employment drug tests and physicals – are offered at three of its urgent care centers. Those services are offered at the Continental Reserve Urgent Care on Silverbell Road, Ran-cho Urgent Care in Rancho Vistoso and Northwest Urgent Care near Green Valley.

As with other healthcare services, “we’re making occu-pational medicine much more accessible,” Dale said. “It’s part of the same urgent care centers we already have. It’s one-stop convenience.”

And the growth spurt is far from over, most notably with the freestanding Vail emergency center, set to open in late 2015.

“We will continue to expand. We own 57 acres up in Marana near Tangerine Road and Interstate 10. We’ll be looking to build on that and in other parts of Southern Ari-zona,” Dale said.

Stockton added, “We’ll be opening a QuickMed walk-in clinic in the first quarter of 2015 on Valencia Road for the southwest markets. We’re looking at ways to provide more access to care.

“We’re trying to get the care to the places people live and work – so that they seek out care before they get into the emergency rooms,” Stockton said.

BizHEALTHCAREcontinued from page 138

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Oro Valley Hospital

By the Numbers• Salaries, Wages and Benefits – $173.7 million• Taxes Paid – $19.3 million• Uncompensated Care – $54.9 million

Northwest Healthcare also provides a variety of free services to the community including:• Periodic cholesterol screenings• Periodic flu shot clinics• Periodic sports physicals• Pregnancy testing • Annual stroke screening• Monthly health education seminars

Source: Northwest Healthcare, 2013


1. Northwest Medical Center 6200 N. La Cholla Blvd.

1a. The Women’s Center at Northwest 1920 W. Rudasill Road

2. Northwest Urgent Care at Orange Grove 3870 W. River Road

3. Continental Reserve Urgent Care 8333 N. Silverbell Road

4. Oro Valley Hospital 1551 E. Tangerine Road Oro Valley

5. Rancho Vistoso Urgent Care 13101 N. Oracle Road

6. La Paloma Urgent Care & Physician Offices 4001 E. Sunrise Drive

7. Northwest Urgent Care at Duval Mine Road 1295 W. Duval Mine Road

8. Northwest Urgent Care at Speedway 1370 N. Silverbell Road

9. Lazos de Familia 344 W. Ajo Way

10. Healthy Beginnings 333 W. Fort Lowell Road, Suite 120

11. Northwest Emergency Center at Vail Houghton and Old Vail Roads

opening in late 2015

12. QuickMed Walk-In Clinic 3000 W. Valencia Road future expansion

13. Marana – 57 acres near Tangerine Road and Interstate 10 future expansion

Northwest Urgent Care now includes six urgent care centers staffed with on-site physicians and registered nurses. Appointments are not necessary and patients are seen on a walk-in basis. The growing network spans the metro area from the northwest to the foothills to Green Valley.

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In today’s environment, navigating the healthcare system is hard work. Patients have a choice of where they receive care – but how do they choose?

Northwest Medical Center and Oro Val-ley Hospital strive to make the choice simple by staying focused on delivering high-quali-ty care every step of the way.

Combined, the hospitals are home to 12 national accreditations, sometimes referred to as “Centers of Excellence.” A steadily in-creasing number of the hospitals’ specialty areas have been certified for meeting high national standards – and their ongoing per-formance is continually monitored to make sure that level of performance is maintained.

The certifications, which are offered in many medical specialties, do not come eas-ily, say Registered Nurses Kay Stubbs and Julie Hunt, the chief nursing officers at Northwest Medical Center and Oro Valley Hospital respectively.

If these certifications could be compared to a standardized quality system in another line of work, it would probably be the rig-orous ISO – International Organization for Standardization – certifications for engi-neering and precision manufacturing. They involve the kind of scrutiny and standard-ized qualification of systems by outside au-ditors that give staffers from the operating room to the executive offices headaches and sleepless nights.

Delivering quality care is all about details, process, training, best practices and ongo-ing patient communication before, during and after the hospital stay. Stubbs and Hunt agree that national certifications and other evolving practices and standards at their hospitals “absolutely make a difference” to patients and the care they receive.

One way the hospitals are focusing on the patient experience is through education. For instance, patients scheduled for a knee or hip replacement are encouraged to take

a class at the hospital a week or more be-fore coming in for the actual surgery. And patients love the classes.

Patient education handbooks were piloted at Northwest Medical Center with bariatric surgery, and now extend to robotic, cardiac, and joint and spine surgeries. Each patient receives a handbook that prepares them in every possible way. Stroke and chest pain patients also receive educational handbooks to guide them through managing their con-ditions and recovery processes. Oro Valley Hospital provides patient education hand-books to their stroke, total joint and chest pain patients as well.

“Patients like that because then they know what to expect before, during and af-ter and they’re better prepared when they go home,” Stubbs said. And, it helps im-prove outcomes. “It’s empowering patients to maximize their recovery in collaboration with their medical team,” she added.

The upgrading of specialized care at both hospitals is a continuing process. “Every area that has a center-of-excellence capabil-ity is something that we want to look at – because it does make sure your processes are evidence-based, current and exceptional,” Stubbs said.

Oro Valley has upgraded its Emergency Department with a designation as a Level IV Trauma Center from the Arizona De-partment of Health Services. Hunt said the Oro Valley Hospital ER is also accredited for pediatrics through the Arizona Chapter of the American Academy of Pediatrics. This means the staff and physicians have re-ceived specialized training and are equipped to handle pediatric patients, which she said is relatively unique for a small hospital.

Another crucial area that improves both the patient experience and outcomes is com-munication – and that has changed dramati-cally.


Focus on Excellenceat Every Level

Rigorous National Certifications Set Standards By Dan Sorenson

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Julie HuntChief Nursing Officer

Oro Valley Hospital

Kay StubbsChief Nursing Officer


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continued from page 142“It’s really evolved,” Stubbs said.

“We encourage family members to par-ticipate. We have the patient’s care plan on a white board in the room. Both Northwest and Oro Valley hospitals have communication boards in every room – and that’s really to communi-cate with the family. Your wife can’t be with you the entire time you’re in the hospital, usually. She comes in and we have your care plan for the day on the board. So she knows what’s planned for you and who your nurse is. We know when the next pain medication is due. We know if you have been given any new medications. It’s all on the white board today, so your family is aware. And we know how to contact them.”

“Even the handoff at shift change is at bedside – so the patient can listen to the report that the nurses are giving to each other,” Hunt said.

“The outcomes are better for patients when they know what we’re going to do, what side effects of drugs to look out for,” Stubbs said. “If you’re part of the care team, if you know about possible complications, you’re going to speak up.”

She said this communication is part of the commitment to providing qual-ity care – an approach where “each patient is ensured to receive the same level of care – so there are certain steps along the way that have to be measured and met as the patient advances to be-ing discharged. It’s a really strong pro-gram.”

And there is follow-up after dis-charge, Hunt said. There is “discharge planning to make sure that patients get to the right setting, either at home with outpatient therapy if that’s appropriate, or to a rehab center if they meet crite-ria, or to some sort of assisted support if necessary.”

Hunt said, “We do discharge phone calls on all of our inpatients – so some-one in the hospital contacts them after they go home to make sure they un-derstood their discharge instructions. At either facility, two to four days after discharge, they get a phone call to see if they have any questions about dis-charge instructions. That’s how we try to ensure their recovery continues after they leave the hospital.”

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Northwest Medical Center• Bariatric Surgery Accreditation from the Metabolic and Bariatric Surgery

Accreditation and Quality Improvement Program.

• Breast Imaging Center of Excellence by the American College of Radiol-ogy.

• Chest Pain Center Accreditation recognized by the Society of Cardiovas-cular Patient Care. The protocol-driven approach to heart care allows the medical team to reduce time to treatment during the critical first stages of a heart attack.

• Heart Failure Accreditation by the Society of Cardiovascular Patient Care. The hospital’s protocol-driven and systematic approach to patient manage-ment allows physicians to reduce time to treatment, and to risk-stratify pa-tients to decrease their length of stay. One of Northwest’s unique answers to meet the needs of these patients is through its Heart Failure Clinic, which helps patients manage their condition, improve quality of life and slow the progression of the disease.

• Primary Stroke Center Gold Seal Designation by The Joint Commission as a Primary Stroke Center. Accredited stroke centers have demonstrated expertise in the early assessment, rapid diagnosis and treatment of stroke emergencies. The “brain attack” team collaborates with local emergency medical services to provide patients with quick access to advanced diag-nostic and treatment technology.

• Spine Surgery Gold Seal Disease-Specific Care certification by The Joint Commission.

• Total Knee and Total Hip Replacement Gold Seal Disease-Specific Care certification by The Joint Commission.

Oro Valley Hospital• Southern Arizona Emergency Medical Services, Level IV Trauma Center

• Chest Pain Center Accreditation recognized by the Society of Cardiovas-cular Patient Care. The protocol-driven approach to heart care allows the medical team to reduce time to treatment during the critical first stages of a heart attack.

• Primary Stroke Center Gold Seal Designation by The Joint Commission as a Primary Stroke Center. The “brain attack” team collaborates with local emergency medical services to provide patients with quick access to ad-vanced diagnostic and treatment technology.

• Top Performer on Key Quality Measures (Heart Attack, Heart Failure, Pneumonia and Surgical Care), 2011 and 2013,The Joint Commission

• Niche Certified ER means the hospital is more “user-friendly” for senior patients. The mattresses are thicker, oversized amplified pillow speakers make it easier to hear the TV, larger clocks make it easier to see what time it is.

• Total Knee and Total Hip Replacement Gold Seal Disease-Specific Care certification by The Joint Commission

• Pediatric-Prepared Emergency Care by the Arizona Chapter of the Ameri-can Academy of Pediatrics

National Accreditations

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When it comes to surgery, bigger is not always better. In fact, large incisions and long hospital stays are just two of the downsides of traditional, open sur-geries – and most patients would agree they would prefer neither.

Today patients have new options. Innovation has evolved and many sur-geons have adopted the philosophy “less is more” by utilizing robotic-assist-ed surgery techniques – with potential patient benefits such as less blood loss, less pain and less time in the hospital.

These benefits are apparent to many of the surgeons at Northwest Medical Center. They are committed to robotic technology and it shows. The hospital has attracted some pretty heavy hitters to its surgical ranks, allowing it to offer a comprehensive robotic-assisted surgery program.

With two dedicated robotic operating rooms, NMC has 23 surgeons on staff performing robotic-assisted surgery for general surgery – including gall bladder

and colorectal procedures, as well as gynecologic oncology, gynecology and, most recently, cardiac.

NMC is also the first hospital in Tuc-son – and the second in the state – to upgrade its robotic surgery platform to an ergonomic system that allows for multi-quadrant surgeries where the in-struments must be able to reach from the pelvis to the chest. The result is less time under anesthesia for patients com-pared to the previous robotic surgery platform. The newer system also pro-vides greater magnification of the sur-gical area and better access to some of the hardest areas to reach in the body.

Robotic-assisted surgery utilizes com-puterized technology that is operated by surgeons. It is the next evolution in minimally invasive surgery, said Dr. Sanjay Ramakumar, a urologist and in-dependent member of the medical staff at NMC.

This advancement allows surgeons to make smaller incisions and precisely

access areas within the body that pre-viously have been difficult to reach or would cause greater trauma to internal organs during surgery. For the patient, using robotics tools typically reduces pain, the risk of bleeding and other complications, and time spent in the hospital. “This results in better patient outcomes,” he said.

Ramakumar brought robotic-assisted surgeries to Tucson in 2005 when he performed the first procedure. “To date I have performed more than 630 pros-tatectomies,” Ramakumar said.

“Well-done surgery gives you good results” no matter what tools you use, he said. “When you have a good surgeon who is adept at using the technology of the robotic-assisted instruments, you have the best of both worlds,” he said. “The more technically complicated the surgery, the better the robotic-assisted surgery option is for the procedure.”

Dr. Robert Poston specializes in the use of robotics technology for cardio-

NMC Leads in Robotic-Assisted Surgery

By Mary Minor Davis

Dr. Robert PostonCardiothoracic Surgery

Dr. Megan NelsonGeneral Surgery

Dr. Sanjay RamakumarUrology

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vascular surgery. “Since 2006, I’ve per-formed more than 800 cardiac proce-dures using robotics,” Poston said.

“I’ve seen patients recover as much as two times more quickly than those who choose the more traditional procedure where the sternum is cracked open,” Poston said.

Dr. Megan Nelson was in the final two years of her residency in Michigan when she was introduced to robotic-assisted surgery. Although she knew the robot was a mainstream option for uro-logical and gynecological procedures, she had never considered the robot for general surgery. At NMC, she was men-tored by Ramakumar and now uses the tool for certain types of gallbladder re-moval, colorectal surgery and for ingui-nal, abdominal or hiatal hernias.

“I was excited by how much more I could see with the robot,” she said. “That was an a-ha moment for me. It’s such beautiful technology that you are able to do exactly what you want to

do without compromising any of your techniques.”

Poston said he’s seeing more patients who want to know about the robotics

option – because they are more educat-ed about the types of procedures that can be done, and they know they may recover more quickly and with less risk.

“We’ve gone away from the Marcus Welby days where patients will just listen to their doctor and do what is recommended,” Poston said. “Patients know what they want – and they want the least amount of trauma and less time in recovery. They want to get back to doing the activities they love. Smaller incisions are what they want.”

Brenda Franks, a retired school bus driver, lived with gallbladder issues for nearly five years before making the sur-gery decision.

Franks said the robotic-assisted pro-cedure was one option presented to her, but she wanted to research it to find out more. After briefly looking into the procedure online, she met with Nelson who was so “kind, compassionate and caring,” she said.

“Dr. Nelson took the time to educate me on the procedure and the expected outcome, using language I could under-stand,” Franks said.

“The more technically

complicated thesurgery, the betterthe robotic-assisted surgery option is for the procedure.”– Dr. Sanjay Ramakumar, Urologist

NMC Leads in Robotic-Assisted Surgery

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Two Dedicated Operating Rooms



After hearing the difference between the traditional open procedure and the more simplified robotic-assisted ap-proach, she chose to go with the less invasive procedure.

“She went through the belly button – an incision of a half-inch or so,” Franks said. “I found it remarkable. I don’t have any complaints.” Franks spent one night in the hospital and she said her recovery was “cut and dried.”

“I would encourage anybody to use this procedure,” she said. “If the sur-geon has the skill and you live in an area that has the technology, why wouldn’t you take advantage of that?”

Nelson said that while the learning curve to operate the robot can be “chal-lenging,” once surgeons are comfort-able with the equipment, the surgery time is comparable to many traditional and laparoscopic procedures.

Ramakumar agrees. “Once you have the experience with the machine, op-erating times are the same. “Balance comes from speed and precision,” he said.

Ramakumar said 90 percent of his patients go home the next day, com-

pared to traditional open-surgery pro-cedures where patients are hospitalized for two or three days or longer. “One-third of the hospital time is reduced – those are huge numbers,” he said.

Some in the medical profession criti-cize the cost of robotic-assisted surgery.

“What is often not included in those cost reports is time and money saved in extended hospital stays,” Ramakumar said. “Longer return-to-work time, the cost of complications that come from higher risks of blood loss, longer heal-ing time for open surgeries – none of these considerations are included in most cost analyses.”

NMC has two of the nine robotics systems in use in Pima County. Rama-kumar said it’s not enough to just offer robotic-assisted procedures. Hospitals must have a program in place that in-corporates three important elements – hospital commitment, surgeon commit-ment and a dedicated operating-room team that is familiar with the robotics system and can support the surgeon.

NMC has all of these elements – and that is attractive to surgeons such as Poston and Nelson.

“I was very impressed with how the OR team has embraced robotics,” Poston said. “NMC is being innovative and that is seen in the depth and the breadth of the program. I’ve been at some of the top hospitals in the country and I can tell you the team here is the best I’ve ever had.”

Poston said hospitals that look at making critical quality improvements and that are bringing innovative tech-niques forward are “what make good hospitals these days. It’s a good transi-tion into the future of healthcare. NMC has an infrastructure for innovation.”

Currently, there are 2,153 robotic systems throughout the United States. There were 422,000 robotic-assisted procedures performed in the country in 2013 – up 15 percent from 2012.

“For this generation of surgeons, ro-botics is going to be the new technol-ogy that becomes the norm – just as generations before have transitioned from traditional procedures to the more minimally invasive procedures such as laparoscopy,” Nelson said.

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Advanced Care for Moms and Babies

By Mary Minor Davis

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Northwest Medical Center’s Women’s Center has developed a long-standing rep-utation of offering a comforting environ-ment for moms, dads and their newborns. Yet in the last year, the center has gone even further – completing voluntary certi-fication from the Arizona Perinatal Trust. This certifies the special care nursery as a Level IIE, which means the center can of-fer perinatal care for mothers and babies born as early as 28 weeks.

What’s more, the hospital invested in a number of technological advances and expanded its special care nursery for pre-mature infants. In addition to more space, The Women’s Center added five continu-ing-care beds, with 15 dedicated to prema-ture newborns needing medical attention, two well-baby beds for stabilization of newborns, and one isolation bed for babies with infectious illness upon delivery. State-of-the-art monitoring equipment and por-table nursing stations round out the tech-nology upgrades.

Overhead cyclic lighting may help devel-op a premature infant’s circadian rhythm, sleep schedule and neurologic function. Lights change color depending on time of day from shades of amber at sunrise to blues and purples at dusk. The lights were the first of their kind in Southern Arizona, according to hospital officials.

“We provide an environment of neuro-developmentally appropriate, family-cen-tered care,” said Dr. Alan Bedrick, neona-tologist and medical director of the special care nursery at The Women’s Center. He is also a professor of pediatrics and chief of the division of neonatology and devel-opmental biology in the pediatrics depart-ment at University of Arizona Medical Center.

“We’ve learned that babies do very, very well in a less chaotic environment. No more machines that beep and send off sig-

nals or that ring out in the night,” he said.“We cluster care – trying to get labs,

monitor blood pressure, etc. when the baby is already awake. The adjusted light-ing helps keep babies relaxed, and we even adjust to day/night lighting as the baby gets closer to going home,” Bedrick said.

In this kind of environment, studies have shown that babies are taken off respi-rators and other machines earlier, go home earlier and “just have better outcomes,” Bedrick said.

The freestanding women’s center on the hospital campus also has a new addition to help mothers through issues that can arise before delivery. Dr. Christopher Sullivan is the medical director of The Women’s Center as well as a maternal fetal medicine physician. Sullivan serves as a case consul-tant for mothers in distress or facing high risks with pregnancy.

He said that high-risk pregnancies are on the rise because some women are wait-ing longer to have babies. This can lead to hypertension, type 1 and gestational dia-betes and genetic issues. Older moms have a higher risk of delivering children with Down syndrome or other genetic issues. Another challenge is obesity.

“There are a lot of moms coming into pregnancy with weight issues. This creates its own set of complications for mother and baby.”

Sullivan has been on staff at The Wom-en’s Center for two years. He said that NMC has “always been perceived as be-ing a nice birthing center – but with the changes the hospital has implemented, they now offer families so much more. I’d like to say that if you have any type of ob-stetric complication, with the exception of a few rarities, we can take care of you.”

Bedrick agreed. “We are one big multi-disciplinary team that offers seamless care before, during and after delivery.” Biz


Breast cancer is a diagnosis no woman wants. Knowing this, Northwest Women’s Imaging re-cently invested in the latest tech-nology for breast cancer screen-ing – tomosynthesis – otherwise known as 3D mammography.

“Early detection of cancer can dramatically improve a woman’s chance at surviving breast can-cer – and 3D mammography im-proves the rate of early detection. We believe this can potentially save lives,” said Dr. Gary Wood, radiologist and medical director of NWI.

The new technology produces a three-dimensional view of the breast providing greater visibility for the radiologist to see tissue de-tail in a way not possible before. 3D mammograms offer exception-ally sharp breast images reducing the need to call women back for a “second look” by up to 15 per-cent, according to recent studies.

3D mammography also finds cancers earlier than traditional 2D mammography alone – with a 27 percent increase in cancer detection and 41 percent increase in invasive cancer detection. The radiation dosage of NWI’s 3D equipment is about the same as 2D mammography.

Wood said breast tomosynthesis can benefit all screening and di-agnostic mammography patients. The 3D technology is especially valuable for women receiving a baseline screening, those who have dense breast tissue and/or women with a personal history of breast cancer.

Breast Health Saving Lives with Early Detection

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When Oro Valley Hospital announced the introduction of the robotic-assisted partial knee resurfacing system in the fall of 2012, there were two surgeons trained in its use and only a dozen or so procedures had been performed.

Just two years later, five surgeons are now using the surgeon-controlled tech-nology, and more than 100 patients have undergone the partial knee resur-facing procedure.

Partial knee replacement surgery is an option in lieu of a full knee replacement if conditions are caught early. Surgeons go into a single compartment of the knee and remove early stages of os-teoarthritis before it damages the entire knee. The minimally invasive procedure with the robot allows for the greatest precision to save as much of the natural knee as possible.

Orthopedic surgeon and Oro Valley Hospital’s Section of Orthopedics chair, Dr. Kevin Bowers was one of the first to use the technology. “The robot provides an element of control and an increased level of accuracy estimated at two to three times that of the traditional proce-dure. Getting the precise alignment can be the key to the longevity of the proce-dure. The robot’s biggest advantage is this level of accuracy.”

Partial Knee Resurfacing


Knees, hips and backs. For many people if their back isn’t bothering them, their knee or hip joint is. Physi-cal pain is often accompanied by the hesitation and anxiety related to having surgery, the recovery process and more.

Northwest Medical Center and Oro Valley Hospital strive to alleviate these fears through one basic principle – pa-tient education.

From the moment the patient de-cides to move forward with surgery at either hospital, the educational process begins.

“It’s no secret that patients who are actively involved in their care have bet-ter outcomes. So we took this principle and applied it one step further. We came together as a team – surgeons, nurses and staff – to develop compre-hensive patient protocols that would measure outcomes for our joint and spine patients,” said Mary Sotelo, a registered nurse and the total joint and spine coordinator at Northwest Medi-cal Center.

All joint or spine patients receive comprehensive education to prepare them for surgery and, more impor-tantly, recovery. This includes attend-ing a class that outlines what to expect before, during and after surgery. Each patient receives a handbook and is encouraged to use it as a journal and reference guide through the process. Additionally, every patient undergoes a thorough pre-procedural screening appointment, which ensures they are medically ready for surgery.

“Being able to connect with pa-tients one-on-one before their surgery is huge,” Sotelo said “Patients walking

out of class are astonished.” Registered nurse and medical/surgi-

cal manager Jennifer Miller is one of

three responsible for Oro Valley Hos-pital’s Total Joint Program. She said, “From the patient’s perspective, they understand not only the surgical aspect of what’s going to happen, but learn the importance of exercise and breathing, for example, which helps them recover more quickly. Our goal is to empower them to be an active partner in their care, helping them to get home faster.”

This focus on patient engagement sends a powerful message to patients, challenging them to take responsibil-ity for their health. Data – including length of stay, infection rate and dis-charge rate – is tracked by the hospitals and indicates how they perform against national standards. The results are as-tounding.

Total knee and hip replacement pa-tients at NMC and OVH stay an aver-age of two days in the hospital – com-pared to the national average of three days. NMC has an 81 percent discharge rate of two days for total knee patients, compared to the national average of 25 percent. For total hip replacement patients, it’s even higher – 98 percent – compared to the national average of 22 percent. These are 2012 statistics, the most recent available.

Sotelo and team attribute these im-pressive statistics to patient empower-ment. “Patients want to get better and get back to their active lifestyle. We give them the tools to get them there,” So-telo said.

When it comes to spine and neck sur-gery, the buzz word is minimally inva-sive surgery – or MIS.

“MIS is a muscle-sparing procedure.

Patient Engagement Improves Joint & Spine Outcomes

Patient Engagement Improves Joint & Spine Outcomes

By Mary Minor Davis

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That means surgeons don’t cut into the muscle but rather separate the muscle vertically to access the spine,” said Mandy Gessler, a registered nurse with NMC, who serves as the center’s spine navigator. Longer incisions that cut through the muscle used to be the norm in traditional spine surgery. The MIS approach uses smaller incisions to help reduce damage to surrounding tissue, lower risk of infection, reduce bleeding and pain and help patients heal faster.

Spine surgery patients follow the same protocol as joint patients – class, handbooks and pre-procedural screen-ing. Patients are also encouraged to call Sotelo with questions before or after

surgery, and she provides her email and direct phone number in the handbooks and during class.

Teamwork is also attributed to the program’s success. That team includes Sotelo, along with the surgeons, dedi-cated operating room teams, physical and occupational therapists, hospital-ists and the patient’s primary care phy-sician. Sotelo said Northwest’s spine team is “collaboration at its best for the benefit of the patient.”

The team, including surgeons, meets monthly to review outcomes and best practices. The goal is to continually evolve the program to give patients the best possible experience.

“It’s about giving our patients a one-

of-a-kind experience that gives them their lives back. We decide as a team on how to treat each case. We bring that experience of care so that patients can maximize their recovery,” Sotelo said.

As of December 2014 Northwest Medical Center is the only hospital in Arizona that has national certification for hip, knee and spine surgeries from The Joint Commission. It is also a des-ignated Blue Distinction Center for hip, knee and spine surgery.

Oro Valley Hospital received nation-al certification from The Joint Com-mission for its total knee and total hip replacement programs in 2013. Oro Valley Hospital does not offer spine sur-gery.

“Patients want to get better and get back to their active lifestyle. We give them the tools to get them there.”– Mary Sotelo

Total Joint and Spine CoordinatorNorthwest Medical Center

continued from page 152

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First in Tucsonto Offer LaparoscopicWeight-Loss Surgery

By Mary Minor Davis

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For most people who are injured or re-covering from surgery, wounds heal without incident. Yet for 2 percent of the nation’s population, non-healing wounds can be life-threatening.

In fact, chronic wound care has become a significant healthcare cost – with an es-timated $50 billion spent on treatment, according to a study published in 2012.

By 2009, Northwest Medical Center had already recognized this growing challenge in patient care and opened the Wound Care Center, setting quality benchmarks comparable to some 600 successful wound centers in the United States.

The center specializes in the treatment of a variety of wounds – including diabetic, arterial and pressure ulcers; chronic ve-nous stasis disease (which can lead to blood clots); soft tissue infection; osteo-myelitis (bone infection); skin tears or lacerations; radiation burns from cancer treatment; and non-healing surgical or other traumatic wounds.

Nationally, the average healing time is about 15 weeks with a 66 percent suc-cess rate where the wound is entirely healed. The Wound Care Center at Northwest beats that consistently – with 90 percent of patients becoming wound free within 45-50 days.

Dr. Scott M. Bolhack is medical direc-tor of the center. He said proper wound care is essential to prevent amputation and save lives. Diabetic patients are at especially high risk of amputation.

“The statistics around even having a sin-gle toe removed are really horrifying,” Bolhack said.

National studies show that any type of amputation can significantly shorten the patient’s lifespan.

Vikki Hensley, a registered nurse and certified wound care specialist, is clinical director of the Wound Care Center. She said the team’s mission is to “determine what’s causing the wounds, then apply the best treatment protocols to enhance the healing.”

IntensiveWound Care Saves LivesBy Mary Minor Davis

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Obesity affects between 28 to 32 percent of the population, according to recent data published by the United States Centers for Disease Control and Prevention. If the trend continues, 46 percent of Americans will be obese by 2018.

Annual healthcare costs for the obese average $1,429 more per patient than people of normal body weight, accord-ing to the CDC.

Dr. Patrick Chiasson and Dr. Ste-phen Burpee are working to address this epidemic as independent members of the medical staff practicing bariatric surgery at Northwest Medical Center.

Across the country over the past 10 years, bariatric surgery has surged. While the initial goal was to reduce obesity, Burpee said weight-loss surgery also alleviates many of the subsequent underlying diseases that occur as a re-sult of obesity – especially diabetes. It may also reduce the risk of stroke, coro-nary disease, cardiovascular disease, even death.

NMC was the first to bring laparo-scopic weight-loss surgery to Tucson. The surgeons said, “We have performed more than 2,000 surgeries since 2003.”

In 2009, NMC was the first program in Tucson to be certified by a national program that sets industry standards for surgical weight loss. Today NMC’s sur-gical weight loss program is accredited by the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program.

Burpee credits the NMC bariatric program with having a strong team approach – beginning with patient education, including classes, to walk pa-tients through their options, all the way through post-operative care.

Bariatric surgery has evolved dra-matically since the 1960s, Burpee said.

Surgeons removed part of the stomach to treat ulcers, which were a severe con-dition before medication was developed to alleviate their severity. It was soon learned that patients lost weight as a re-sult of the procedure.

Since then, the introduction of mini-mally invasive laparoscopic procedures “changed the paradigm of bariatrics completely” because it typically led to safer surgeries and faster recovery with reduced risk of complications, Burpee said.

Only 1 percent of the people who qualify for bariatric surgery actually end up getting it, he said. There simply are not enough resources in the indus-try to accommodate the need.

“The biggest detractor is the cost. It’s a great treatment on an individual ba-sis. It’s not practical on a population ba-sis. Doing surgery on all of the people who need it is not economically viable.”

Burpee said about 70 percent of pa-tients keep off the weight and see re-duced health risks. Lifestyle changes, behavior, diet and exercise all play into long-term success. Yet studies also show that it’s not just about “calories in/calo-ries out” anymore.

“We used to think weight loss oc-curred because the stomach was made smaller – but now we are learning that there are a lot of other chemical systems in place that support weight loss. The surgery affects hormonal systems that control body weight and metabolism. Much of our metabolism is out of our control no matter how much exercise or calorie restrictions we put in place.”

Burpee encourages people to learn whether weight loss surgery is right for them. The center offers free seminars that outline the various procedures and potential outcomes. “The better edu-cated people are, the better the results.”


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Sports, exercise, fitness – once you’re hooked, there’s no stopping you. Un-less, of course, you get hurt.

Whether a minor injury or some-thing more serious, it’s important to en-sure your injury heals properly so you can get back to the activity you love.

That’s why Northwest Healthcare re-cently launched a Sports Medicine pro-gram caring for athletes and physically active people of all ages.

The program brings together a multidisciplinary team – including or-thopedics, orthopedic surgery, neuro-musculoskeletal medicine, osteopathic manipulative medicine, sports medi-cine, physical therapy and family medi-cine. By incorporating a broad range of specialties, this program individualizes treatments for the patient, helping pa-tients recover from sports-related inju-ries as quickly and safely as possible.

Though many athletes may see their primary care physician when an injury occurs, a physician trained in sports medicine has additional non-surgical training in fracture manage-ment, concussion management, sprains and strains, joint injections and other sports-related treatments.

The sports medicine team has part-nered with local high schools to help them better manage athletes with con-cussions. During football preseason, student athletes receive a baseline test using a specialized computer program, which provides physicians with refer-ence points should a concussion be sus-pected throughout the season.

Dr. Troy Taduran, a sports medi-cine physician with Northwest’s Sports Medicine program, said concussion management is extremely important because of the potentially devastating consequences. If not managed correct-

ly, concussion can lead to major prob-lems – including Chronic Traumatic Encephalopathy, a permanent and degenerative condition occurring from multiple impacts to the head, and Sec-ond Impact Syndrome, which is brain swelling that occurs from impact to the head of someone who has not fully re-covered from concussion.

“It is vital athletes receive appropri-ate and expedited concussion manage-ment. Sometimes symptoms of con-cussion are obvious, while other times they are less apparent. The sooner we can diagnose and begin treatment, the sooner they can recover and get back in the game,” said Taduran.

Taduran, along with Dr. William Prickett, orthopedic surgeon and medi-cal director of the program, and Dr. Christopher Houdek, orthopedic sur-geon, attended high school football games to provide instant attention and treatment should an athlete need it for concussion or other sports-related in-jury.

Beacause Tucson is a mecca for run-ners, triathletes, cyclists, tennis players, golfers and a host of other sports, the program is expanding in 2015 to serve athletes and sports enthusiasts of all ages.

Taduran said his goal is to treat active adults and return them to their desired activity as safely and quickly as pos-sible. “We promote active lifestyles and do everything we can to facilitate that,” he added.

Northwest is set to open its new Sports Medicine clinic in the second quarter of 2015, which will include on-site imaging services, physical therapy, performance testing and nutritional services for sports medicine patients.

Getting Backin the GameGetting Backin the Game

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The aging process presents challenges that can be overwhelming. Sometimes these challenges cause symptoms that affect an individual’s ability to carry out basic life activities and roles. When this happens, many don’t know how to cope.

The 17-bed Senior Behavioral Health Unit at Oro Valley Hospital offers a specialized program for patients ages 55 and older to deal with and manage these symptoms. It is a voluntary pro-gram for those who decide they need help.

Whether it’s coping with stress, grief or addictive behaviors, the behavioral health team, led by Medical Director and Psychiatrist Dr. Vicki Berkus, works with patients to help empower them to be healthy and maintain balance as they age – and return them to their life and family.

Mental health resources for the elderly are few and far between in Pima Coun-ty. This specialized program for seniors is an important resource for the commu-nity.

“The elderly are more susceptible to ev-ery aspect of mental illness. They don’t have the defense systems, whether physiological or medical, to handle the effects of a mental illness that younger people have,” Berkus said.

Berkus challenges the referring person – whether a parent, spouse or doctor – to ask “what about this person has changed that requires an acute care set-ting?” It can be a change in cognition, behavior, memory or even eating hab-its, she said, with no other discernable medical reason.

Patients are admitted to the unit by a doctor or through the emergency room. The average length of stay is two weeks with follow-up outpatient therapy once the patient has left the hospital. The goal is to provide the tools to help them cope with the challenges of aging.

TheChallengesof Aging

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There is nothing more rewarding than a good night’s sleep – waking with a clear mind and an energetic body to start the day. Unfortunately, nearly 40 million Americans suffer from some sort of sleep disorder that robs them of that well-rested feeling.

The Sleep Center at Oro Valley Hos-pital helps patients overcome the obsta-cles to achieving a good night’s rest. Dr. Elias Kakish said that finding solutions to sleep deprivation isn’t just about feel-ing rested – it’s also about preventing other health risks that arise from loss of sleep.

Sleep disorders can affect anyone, though they are more often seen in peo-ple with increasing obesity or who are aging. Once referred to the sleep center, Kakish said, patients are scheduled for a sleep study designed to assess abnor-malities in their sleep patterns – rang-ing from brainwave activity to loss of oxygen, irregular cardiac rhythms and even seizures.

The most common sleep disorder is obstructive sleep apnea. This condi-tion results when the flow of air pauses or decreases during breathing while asleep because the airway is floppy, has been narrowed or blocked. A pause in breathing is called an apnea episode. A decrease in airflow during breathing is

called a hypopnea episode. An episode occurs if breathing is affected for at least 10 seconds. If a patient has more than five episodes per hour, they are diagnosed with sleep apnea. Five to 15 episodes is considered mild and more than 30 is considered severe.

“Even mild sleep apnea is significant enough to require treatment,” Kakish said. Sleep apnea has been linked to in-creased risk of stroke, heart attack, high blood pressure, coronary artery disease, depression and memory loss.

The center also studies insomnia, narcolepsy and restless leg syndrome.

More than half of those who suffer from a sleep disorder go undiagnosed, Kakish said. That’s why the hospital works to educate the public about the importance of treating sleep issues and what to look for to determine if you should have a study done.

“Among the symptoms that can indi-cate a sleep disorder are snoring, exces-sive daytime sleepiness, loss of energy, irritability, mood or behavior changes, morning headaches, inability to con-centrate and workplace mishaps or accidents,” he said. “It’s important to discuss these issues with your physician. Sleep deprivation can be a life-threat-ening condition. You should take care of your sleep.”

By Mary Minor Davis

Treating SleepDisorders

Treating SleepDisorders

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Managing occupational health issues is a complex business. That’s why more companies are seeking third-party sources to help manage regulatory com-pliance and costs.

The demand for this expertise led North-west Healthcare to launch its Occupa-tional Medicine program just over a year ago. Led by Troy Overholt, a regis-tered nurse, this program focuses on in-jury management for on-the-job injuries. It also provides routine drug screening, lab testing, blood pressure checks and health fairs.

“The key is that employers want to part-ner with skilled personnel in the area of occupational medicine because work-ers compensation premiums can come with a pretty significant cost, depend-ing on the employer’s history,” Overholt said. “Employers have a financial inter-est in keeping employees healthy.”

Private-sector employers spend an av-erage of $30.11 per hour worked on employee compensation. Just over 8 percent of that is for legally required benefits, such as workers compensa-tion, according to the U.S. Department of Labor Bureau of Labor Statistics.

The No. 1 work injury complaint is back pain. Overholt said his team can work with Northwest’s joint and spine programs to help identify the cause and treat or eliminate the problem.

“One injury can cost an employer thou-sands of dollars,” Overholt said. “We can help bring closure to some of these recurring injuries, resulting in better out-comes for all.”

ImprovingOccupational

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