Advancing Health Podcast

00:00:00:06 - 00:00:18:22
Tom Haederle
Welcome to Advancing Health. The recent outbreak of the dangerous hantavirus infection on a cruise ship sent countries around the world, including the US, scrambling to bring their citizens home for quarantine and treatment. We learn more about America's ongoing response to the threat in today's podcast.

00:00:18:25 - 00:00:47:24
Chris DeReinzo, M.D.
Hi everyone! This is Dr. Chris DeRienzo, Thank you so much for joining us again on the Advancing Health podcast. I am incredibly excited to welcome to the podcast this week, Dr. Angela Hewlett. She is a professor of infectious diseases at the University of Nebraska's Medical Center, also called UNCW and the medical director of Nebraska's Biocontainment unit, which is not a thing that I imagine many of you know exists, and something that we're going to talk a little bit about over the course of our conversation today.

00:00:47:25 - 00:00:51:00
Chris DeReinzo, M.D.
Dr. Hewlett, thank you so much. Welcome to the podcast.

00:00:51:01 - 00:00:52:09
Angela Hewlett, M.D.
Oh, thanks for having me.

00:00:52:10 - 00:00:58:14
Chris DeReinzo, M.D.
Before we jump in, if you would tell us just a little bit about yourself and what brings you to the conversation today?

00:00:58:15 - 00:01:34:09
Angela Hewlett, M.D.
Well, I'm an infectious diseases specialist by training, and so I, I am originally hail from Houston, Texas, and did all of my training at University of Texas Medical Branch in Galveston, Texas, including an infectious diseases fellowship. And then I transitioned to Nebraska for my first so-called real job in 2009. And part of that package actually did involve the need for an associate medical director of the Nebraska Biocontainment Unit, which at the time I didn't really know existed, and like many people, but I was absolutely just floored by this facility when I visited this university.

00:01:34:09 - 00:01:54:12
Angela Hewlett, M.D.
And it really was part of the reason that I landed here in Nebraska in 2009. So I became associate director of the Nebraska Biocontainment Unit, at that time under the direction of Dr. Phil Smith, who was my mentor and the founder of the Nebraska Biocontainment Unit. And he was the director of the unit until 2016, when he retired.

00:01:54:12 - 00:01:59:00
Angela Hewlett, M.D.
And then I've been the director of the biocontainment unit since 2016.

00:01:59:06 - 00:02:23:08
Chris DeReinzo, M.D.
Wow. We've seen a lot in those ten years. But perhaps let's start the conversation with a little bit more about the role that that UNMC plays in the nation's critical medical infrastructure. Because truth be told, before I joined AHA three and a half years ago, I really had no concept of just how deeply integrated you are into how America manages emerging infectious diseases.

00:02:23:08 - 00:02:27:03
Chris DeReinzo, M.D.
So really, what is the biocontainment unit and what kind of work do you all do?

00:02:27:08 - 00:02:53:06
Angela Hewlett, M.D.
Well, here in Nebraska, we actually have two facilities that are designed for the care and monitoring of both patients and individuals who have either exposures to high consequence infectious diseases or are infected with high consequence infectious diseases. And we're part of a network called the National Emerging Special Pathogens Training and Education Center - NETEC. And this network was actually built after the 2014 Ebola experience.

00:02:53:06 - 00:03:18:01
Angela Hewlett, M.D.
And there are 13 regional emerging special pathogen treatment centers, or the RESPCs in the United States currently, as well as multiple level two facilities which are also designed for the care of high consequence pathogens. So those 13 facilities serve as the leads within their regions within the United States and here at UNMC Nebraska Medicine we are one of the originators, the founders of NITEC.

00:03:18:01 - 00:03:46:04
Angela Hewlett, M.D.
So one of the three facilities alongside Emory and Bellevue, New York City as well. And so we brought this network up, actually to enhance preparedness throughout the United States. But our facilities have actually are - the Nebraska biocontainment is actually been here since 2005. So this unit was dedicated in 2005. And our first official activation was actually in 2014, when we did care for three patients infected with Ebola virus disease.

00:03:46:04 - 00:04:07:27
Angela Hewlett, M.D.
But we do have two facilities here at UNMC that are designed strictly for this purpose. And the first facility is a national quarantine unit, which is actually the only quarantine unit of its kind in the United States. And it's a federally funded facility. It has 20 beds in the unit, and it's designed to monitor individuals that have exposures to high consequence infectious diseases.

00:04:07:27 - 00:04:32:11
Angela Hewlett, M.D.
So this is not a patient care facility per se. It's more like more designed like a hotel. Because we know that our guests can potentially be with us for a prolonged period of time. And so we have things in the rooms like, you know, refrigerator and a TV with streaming capabilities and exercise equipment in every room just to try to make this kind of difficult quarantine as comfortable as we can be.

00:04:32:16 - 00:05:01:06
Angela Hewlett, M.D.
Our guests have access to, you know, in person and virtual behavioral health support, which is, I think, critically important. And a mission like this, where we have individuals who do stay with us for a prolonged period of time. We host a daily town hall meeting where our guests can communicate with our team and with each other, just to kind of interact and discuss the different scenarios and things like everything from testing plan to food to, you know, really anything else that they would like to discuss throughout the day.

00:05:01:10 - 00:05:22:04
Angela Hewlett, M.D.
Although that facility is designed sort of like a hotel, it also does have some interesting capabilities in that it is all negative pressure. We are monitoring these individuals, which should they become ill, we have negative pressure throughout our unit, as well as an autoclave that we could potentially use for waste disposal if necessary. So there are some more unusual aspects.

00:05:22:04 - 00:05:28:20
Angela Hewlett, M.D.
So it's not your typical hotel, but it was really designed to monitor individuals with those types of exposures.

00:05:28:21 - 00:05:48:28
Chris DeReinzo, M.D.
That is the understatement of the century. Not your typical hotel. Well, before we go one level deeper, you've used the term high consequence pathogen or high consequence infectious disease a couple of times. For a non ID doc, for our general listener population, what is a high consequence pathogen and what are the kinds of potential infectious diseases that folks would be exposed to

00:05:49:00 - 00:05:53:22
Chris DeReinzo, M.D.
where this would be a unit that we might send them to for the kind of monitoring you're describing?

00:05:53:24 - 00:06:33:22
Angela Hewlett, M.D.
So a high consequence infectious disease. And I will say there's been a lot of work on this because the terminology has changed quite a bit over the years. You may have heard highly infectious disease or highly hazardous communicable disease or a special pathogen. Those terms are all essentially interchangeable to really mean the same thing. And that is a disease for which there is a chance for transmissibility between humans, a disease that has potentially a high mortality rate or for which there are minimal or none as far as therapeutic agents or vaccines, and so typical diseases that fall in that category of high consequence infectious diseases include things like viral hemorrhagic fever.

00:06:33:22 - 00:07:05:25
Angela Hewlett, M.D.
So things like Ebola virus disease, Lassa fever, Marburg,  smallpox is in that category. Certain types of mpox potentially, depending on the facility, could be classified as that. So there are multiple types of diseases that could fall in that category. The most recent that we've been dealing with is the Andes virus, which is a hantavirus. But it's the only hantavirus known to be transmissible person to person and has all of the things that I mentioned as far as limited therapeutic options and no vaccine.

00:07:05:25 - 00:07:09:28
Angela Hewlett, M.D.
So we would classify that as a high consequence infectious disease as well.

00:07:10:01 - 00:07:30:25
Chris DeReinzo, M.D.
Well, let's spend a minute then on the subtype of the hantavirus, the Andes virus, it sounds like what it is called by those in the know. We know that that hit the news in a substantial way earlier this year. Help us understand the role that y'all played in Nebraska in the nation's response. And you know, where are we in the arc of that response right now?

00:07:30:27 - 00:08:06:02
Angela Hewlett, M.D.
Well, so the initial cases of Andes virus were actually reported off of the MV Hondius cruise ship. That was an expedition ship that was started in Argentina and made its way across the Atlantic to some very remote areas around the world, mostly territories, actually. So again, an expedition ship with a lot of very active outdoor exposures and other things that that occurred while unfortunately an individual on that on that ship became ill very quickly after boarding the ship in in early April and succumbed to his illness on board.

00:08:06:04 - 00:08:30:12
Angela Hewlett, M.D.
Subsequently, his wife became ill, as did another passenger. And so then there started to be some concern for is this disease that's transmissible human to human, what could this possibly be? And as more people got sick, eventually those individuals, when they were transferred off of the ship for medical care, eventually the diagnosis was made of a hantavirus and then eventually the Andes strain of hantavirus.

00:08:30:12 - 00:08:55:23
Angela Hewlett, M.D.
And so that occurred in all throughout April, essentially. In early May, you know, many of these people were still on the ship, and they had individuals who had become ill, who had been transported off of the ship, but also a fair number of people who had had various exposures during the cruise. And if you think about a cruise ship, there are potentials for lots of in-person contact with each other, lots of close contact potentially.

00:08:55:23 - 00:09:18:13
Angela Hewlett, M.D.
And this was a special voyage. It wasn't your typical kind of large cruise line. This was very much an expedition where they had a lot of close contact with each other. It was a small ship, but still a lot of prolonged contact with other people on the on the boat. And so because of that, that introduced the possibility of transmission of Andes hantavirus, which is what was occurring on the ship.

00:09:18:13 - 00:09:44:03
Angela Hewlett, M.D.
So when the ship eventually docked, all of the individuals on the ship had potential for having exposure just due to the number of cases of hantavirus that individuals that became ill on the on the ship, including the ship's physician, actually. And so after that happened, then each individual country flew a plane essentially to, to the area and actually which was the Canary Islands at the time and actually then took their citizens back to their home country.

00:09:44:03 - 00:10:05:27
Angela Hewlett, M.D.
So this happened all over the world. This was a cruise that had many countries involved from all over the world. And those countries actually were came back and essentially, you know, picked up their exposed individuals and took them back home for quarantine. And so here in the United States, because we have the national quarantine unit here on our campus, that was our job is to monitor those individuals.

00:10:05:27 - 00:10:28:10
Angela Hewlett, M.D.
And, you know, should they become ill, then we have the possibility of transferring them into the Nebraska Biocontainment Unit, which is our patient care unit. We originally accepted 16 individuals that had exposure to Andes hantavirus on the cruise ship. Later we received an additional two individuals and so we had a total of 18 when we started this on May the 11th.

00:10:28:10 - 00:10:54:28
Angela Hewlett, M.D.
And so we're still currently monitoring eight individuals. We since that time, some of our individuals have actually been transferred home for home quarantine. So they're still they're still under quarantine for 42 days total, which is the maximum incubation period of Andes hantavirus. The average incubation period is around 18 days. And we have definitely surpassed that. And so we are definitely past the average incubation period, but not completely out of the woods with our individuals yet.

00:10:54:28 - 00:11:01:03
Angela Hewlett, M.D.
We're very fortunate to have PCR testing capability here on campus, which is a very unusual entity.

00:11:01:08 - 00:11:19:04
Chris DeReinzo, M.D.
Especially for such a for such a rare virus. In order to be able to test for it, you truly have to be in, in like the top leading center in the country, which what you all are. And it really sounds like the connection there between the quarantine unit and the bio containment unit make it a potentially seamless experience.

00:11:19:04 - 00:11:31:12
Chris DeReinzo, M.D.
So it sounds like I think I heard you say we're not out of the woods yet, but in terms of timing here, we're on hopefully the back end of what could have been much more significant kinds of exposures.

00:11:31:16 - 00:11:57:25
Angela Hewlett, M.D.
Yeah, absolutely. And I think just to highlight the reason that the national quarantine Unit is here on our campus is because of the Nebraska Biocontainment Unit, which is our patient care facility. So that is where as in all ages, all hazards unit, we can provide a full spectrum of clinical care in the Nebraska Biocontainment Unit, everything from typical supportive care to critical care modalities like mechanical ventilation, dialysis, ECMO, really the full spectrum of clinical care.

00:11:57:25 - 00:12:20:21
Angela Hewlett, M.D.
And that unit is also negative pressure throughout with the gradient. It has HEPA filtration of all of our exhausted air. We have dual autoclaves for waste management. We have an in-house laboratory as well as laboratorians who train with us on our team and come in and process specimens for us right inside the unit. We have a large trained team of healthcare workers that includes physicians from multiple different specialties.

00:12:20:21 - 00:12:44:21
Angela Hewlett, M.D.
And I mentioned all ages unit. We have pediatricians. We have pediatric infectious diseases specialist, peds critical care docs, neonatologist. We have a cadre of surgeons actually on our team as well. We have a CT surgeon who's actually part of our team as well as obstetricians. You know, there's a chance that we could need you need to care for a pregnant individual and potentially a neonate as well.

00:12:44:21 - 00:13:03:09
Angela Hewlett, M.D.
So all of our team members, including the physician groups as well as the nursing team, which comprises a variety of different specialties of nurses. We have respiratory therapists on our team. We're an all volunteer team, actually, so none of our health care workers are compelled to do this type of work. We have a lot of team maintenance activities.

00:13:03:09 - 00:13:24:01
Angela Hewlett, M.D.
We have ongoing training that we're required to participate in, as well as drills and exercises and team building events and things like that that really enhance our teams. So, you know, again, these two facilities are an unusual entity. And the fact that they're co-located on our campus makes us sort of the spot to be, if you will, for individuals who require quarantine.

00:13:24:02 - 00:13:33:06
Angela Hewlett, M.D.
Also keeping in mind that that's the reason that these facilities are here is so that should we need to care for someone with an infection, we're able to do that readily.

00:13:33:10 - 00:13:57:03
Chris DeReinzo, M.D.
Well, they truly sound like a one of the kind duo. And you know, you mentioned back in the 2014-15 Ebola virus disease response, the unit was active. I got to be honest, in 2026, the recurrence of Ebola virus in the conversation globally was not on my dance card. But we know that there's one of the most significant Ebola virus disease outbreaks going on in history right now.

00:13:57:07 - 00:14:12:01
Chris DeReinzo, M.D.
What are you all seeing again? We know you are as plugged in as any unit could possibly be in the global conversation. Where are you seeing that outbreak trending at the moment? And what, if anything, should hospitals be doing in preparedness?

00:14:12:03 - 00:14:36:10
Angela Hewlett, M.D.
I'm really concerned about what's going on in the Democratic Republic of the Congo and Uganda. You know, there have been a large number of cases and deaths associated with this outbreak, which actually is reminiscent of the earlier days of the 2014 outbreak, which occurred in a different part of Africa. So in West Africa, but still just the large number of cases and the ongoing increase in case counts that we're seeing on a daily basis.

00:14:36:13 - 00:14:56:21
Angela Hewlett, M.D.
The 2014 outbreak resulted in around 28,000 cases and about 11,000 deaths. And I'm really hopeful that we won't see that number of cases with this outbreak. But I'm very nervous about that, just given the kind of volatile situation that's occurring, particularly in this area of the Democratic Republic of the Congo, which has a history of outbreaks in the past.

00:14:56:21 - 00:15:17:15
Angela Hewlett, M.D.
So this is not the first time that they have seen Ebola virus disease, but they also have a very mobile population in that area, limited access to health care, which subsequently results in limited access to testing, as well as a history of conflict in the area, which really makes this scenario very difficult. And so I'm definitely concerned about what is going on overseas.

00:15:17:19 - 00:15:41:03
Angela Hewlett, M.D.
You know, as far as preparedness locally, we should all be aware of what's going on throughout the world because these outbreaks are occurring regularly, and they're also something that we need to take note of because, you know, there could always be imported cases of any infectious disease with travelers who either are from the United States and go travel abroad and return, or travelers from other countries who are coming to the United States.

00:15:41:03 - 00:16:01:28
Angela Hewlett, M.D.
And a great example that is occurring right now is the World Cup. Just in the fact that there are a lot of people who a lot of fans who are coming to the United States and traveling to other parts of the world for these games. And so facility preparedness is, is incredibly important. And I think infectious diseases, we use a mantra that we call identify, isolate and inform. Facilities -

00:16:02:00 - 00:16:22:22
Angela Hewlett, M.D.
regardless of the size of your facility - it could be the smallest kind of critical access hospital or a clinic or the emergency department or a large academic center. People can present to any of these settings, and so even the smallest hospital needs to be ready to at least identify, isolate and then inform appropriate authorities should there be concern for high consequence infectious diseases.

00:16:22:22 - 00:16:53:26
Angela Hewlett, M.D.
And the way to do that is to make sure that you have protocols in place that can identify symptoms that are appropriate and concerning, as well as a history of travel, which we actually have frontline in our facility. We utilize our electronic medical record, and we ask patients a set of questions on intake, whether they're coming into our emergency department or to any clinic setting, and then that the answers to those questions sometimes lead to the isolation of that individual or further questioning or, you know, the activation of some of our protocols.

00:16:53:26 - 00:17:04:13
Angela Hewlett, M.D.
So I would just emphasize that it's really important that every facility is prepared, and it doesn't matter the size of your facility, because people definitely will present. And so we need to be ready for that.

00:17:04:14 - 00:17:25:12
Chris DeReinzo, M.D.
Dr. Hewlett, that is the perfect note to end today's conversation on. You hit the nail on the head. I've been to every conceivable kind of hospital in America, and none of them, except UNMC, have your unique combination of the national quarantine unit in a biocontainment unit. But every hospital can follow those kinds of steps in every clinic and every outpatient center.

00:17:25:14 - 00:17:40:27
Chris DeReinzo, M.D.
Those steps really are sort of the foundational baseline of us being prepared. And that's what today's conversation has been all about. Thank you so much for joining the podcast. This has been a fascinating conversation, and I certainly wish you all the best as the summer goes on.

00:17:41:02 - 00:17:43:18
Angela Hewlett, M.D.
Thank you so much. I appreciate you having me.

00:17:43:20 - 00:17:52:13
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;08 - 00;00;18;01
Tom Haederle
Welcome to Advancing Health. Today we learn about geriatric psychiatric programs offered by two rural New England hospitals, and how both organizations are leaning in to meet the mental health needs of older adults in their communities.

00;00;18;04 - 00;00;43;10
Rebecca Chickey
My name is Rebecca, and I'm the vice president of the Health and Trustee services for the American Hospital Association. And it's my honor today to be joined by three leaders at rural hospitals who are improving access to mental health services in their rural communities. I am joined by Holly McCormack, who is president and chief executive officer of Cottage Hospital.

00;00;43;13 - 00;01;24;09
Rebecca Chickey
I'm also joined by Doctor who is a consultant psychiatrist and medical director at senior Behavioral Health unit at Sharon Hospital, which is part of Northwell Health, and as well the CEO and president of Sharon Hospital, part of Northwell Health. Christina McCullough rounds out this wonderful panel discussion today. So I'm going to jump right in. And Holly, I'm going to start with you, if I may share with the listeners a little bit about Cottage Hospital and why you decided to open your unit for older adult behavioral health care called the Ray of Hope.

00;01;24;15 - 00;01;49;05
Holly McCormack, DNP, RN
Sure. Happy to. So Cottage Hospital is an independent critical access hospital located in Woodsville, New Hampshire. We were founded in 1903, and at the time, the community built this hospital to respond to a lot of surgical type needs that were happening, from injuries related to working in logging and other industry in the area. And so we have been here supporting our community for over 123 years now.

00;01;49;10 - 00;02;20;06
Holly McCormack, DNP, RN
We are a 35 bed critical access hospital, and that's because we have our 25 bed hospital with our med surge unit and our ICU beds, but we also have a ten bed distinct part unit that is focused on geriatric behavioral health. And so we call that unit the Ray of Hope unit. We also have multi-specialty rural health clinic across the street from a hospital campus which has internal medicine, podiatry, endocrinology and behavioral health integrated into the care there as well.

00;02;20;14 - 00;02;44;16
Holly McCormack, DNP, RN
So the Ray of Hope unit was opened in 2016 as a response to the behavioral health crisis that was happening in New Hampshire. We found that a lot of hospitals were boarding behavioral health patients in the emergency department, and we decided to do something to become part of the solution. The demographic of Woodsville, New Hampshire, tends to be older, and we have a lot of older adults in our community and in communities that we serve.

00;02;44;17 - 00;03;05;10
Holly McCormack, DNP, RN
So this made a lot of sense for us. So early in 2016, we had a unit that we were using for physical therapy. We moved them to a different part of the building, and we were able to redesign this unit to safely house acute beds for ten Jerry psych patients. And so on October 1st of 2016, the unit opened.

00;03;05;16 - 00;03;15;16
Rebecca Chickey
What is the unit look like for the listeners? If you can paint a picture of what it looks like and also how it's staffed, because with only ten beds, I know that can be a challenge.

00;03;15;23 - 00;03;53;28
Holly McCormack, DNP, RN
Yeah. So the unit has ten private bedrooms. The unit is painted in calming colors that you would see in nature. So sage green, a lovely cream yellow color that we find to be very soothing. The artwork on the walls is inspired from local landmarks, but also things that might inspire. Reminiscing when patients are to tour the unit. One of the pictures is very popular is we have a photo of older trucks that look like they're rusting in a field, but you wouldn't believe how many patients actually gather on the picture and talk about having had a truck like that in their younger years, or knowing what kind of truck that was, or knowing somebody that

00;03;53;28 - 00;04;16;01
Holly McCormack, DNP, RN
had that truck. So it's very interesting. We have an activities room. We have a quiet room so that we can separate patients if they need a space that's quieter while we're doing group therapies. And then we also have an outside area with a patio where patients can go and be in a covered space outdoors. And we have raised garden beds so that they can work in the garden beds.

00;04;16;01 - 00;04;51;11
Holly McCormack, DNP, RN
Or sometimes we'll just do our morning activities and our morning stretch out there. The unit is staffed with registered nurses, lens nursing assistants. We have a recreational therapist, a licensed clinical social worker, and we have a psychiatrist that is affiliated with the local academic medical center that oversees the aprons, who are on site seven days a week, and that relationship with the local academic medical center, providing the expertise has been a way for us to have this specialized care locally, where we don't have to transfer people to a higher level of care.

00;04;51;13 - 00;05;14;24
Rebecca Chickey
I think that is great. I grew up in rural Alabama, and so I know how important it is for individuals to be able to stay close to their community, to stay close to their homes. And that provides a healing element that I think is hard to measure. But when you talk to the patients, equally important. And so that's my next question to you.

00;05;15;00 - 00;05;26;00
Rebecca Chickey
What type of patients do you treat in terms of diagnoses, and what impact have you seen? What's been the response from the community and from the families that you've helped as well of those you treat?

00;05;26;06 - 00;05;42;03
Holly McCormack, DNP, RN
The patients and families that we treat are very thankful to be able to have a place in the state of New Hampshire where we can care and provide the specialty care for them. But we've not only cared for patients in the state of New Hampshire, we provide care to patients in the state of Vermont and also Maine and Massachusetts as well.

00;05;42;10 - 00;06;10;21
Holly McCormack, DNP, RN
These specialty units are very hard to come by, and typically we'll have a waiting list for patients to get into the beds on our unit. In the state of New Hampshire, there are 221 towns, and we have represented patients from 110 of those towns so far. And we typically see diagnosis such as depression, bipolar or dementia schizophrenia. But the providers on the unit describe Jerry psych as complex and involving overlaps of psychiatry and neurology, internal medicine and palliative care.

00;06;10;27 - 00;06;14;12
Holly McCormack, DNP, RN
Those are the types of things when you see patients in this particular age group.

00;06;14;17 - 00;06;42;09
Rebecca Chickey
It's interesting. There's been a lot of discussion over the last couple of decades around med psych units. And I think that geriatric psychiatric units by default are medical psychiatry units, because by the time you're over 65, more than likely you have more than one comorbid physical condition, much less a mental illness or addiction. So such an important aspect of care to bring to a critical access hospital, to any rural hospital itself.

00;06;42;16 - 00;06;58;24
Rebecca Chickey
So thank you so, so much. It is my honor now to transition to Sharon Hospital. So doctor, tell us a little about Sharon Hospital and why the organization decided to open your senior behavioral health unit.

00;06;58;27 - 00;07;30;06
Sabooh Mubbashar, M.D.
It was established more than 20 years ago, and this was in response to a growing recognition that the rural communities, they really lacked adequate resources for older adults suffering from severe psychiatric and neurobehavioral illnesses. And as Holly mentioned, this is truly an area of great need. Just given the statistics of geriatric psychiatric problems that we are dealing with, which are actually expected to double in the coming decade.

00;07;30;08 - 00;07;59;24
Sabooh Mubbashar, M.D.
I personally have been involved in this role as the medical director with a unit for about 18 years. Probably also goes to show how much I believe in the work that we're doing. Despite the hospital and the unit being located in a rural community. You know, we started out with an 11 bed geriatric unit, and the demand increased so significantly that we then expanded into a 17 bed inpatient unit, as Holly was mentioning.

00;07;59;26 - 00;08;30;17
Sabooh Mubbashar, M.D.
We received referrals from much larger metropolitan areas, including New Haven, Hartford, Albany, upstate New York areas, Massachusetts. And I think some of that all to do with the unique location of Sharon Hospital, because we're at the northwest border of Connecticut. So we are right at the at the border of New York and Massachusetts. But also it has a lot to do with the with the very unique patient population that we serve.

00;08;30;22 - 00;08;38;16
Sabooh Mubbashar, M.D.
Expansion is really part of, as I said, much larger national reality with the patient population that we serve.

00;08;38;22 - 00;09;01;23
Rebecca Chickey
Well, the baby boomers are aging. And I think I heard a statistic about something like 10,000 people turned 65 every day. So if one out of every four of those has a psychiatric or substance use disorder in the year, then the math is clear that the demand is going to increase. Holly shared what her unit looks like physically and how it's staffed.

00;09;01;24 - 00;09;06;01
Rebecca Chickey
Can you share some similar perspectives for the listeners?

00;09;06;04 - 00;09;35;04
Sabooh Mubbashar, M.D.
Absolutely. So, you know, I think that given the uniqueness of this population, as Holly was describing it, I could hear a lot of overlapping themes. So what makes geriatric psychiatry unique is that, you know, their symptoms in psychiatry are rarely isolated from the rest of medicine. These are patients with significant medical frailties, mobility limitations, swallowing difficulties, chronic medical illnesses.

00;09;35;04 - 00;10;13;08
Sabooh Mubbashar, M.D.
So as far as the multidisciplinary care model is concerned, all patients getting admitted to our 17 bed unit get evaluated by a psychiatrist and an internist within 24 hours of admission, or multidisciplinary team has physical therapy, occupational therapy, speech therapy, and these evaluations are all completed within 24 to 48 hours of admission. Because these are again frail patients from nursing homes, sometimes from community, high aspiration risks functional decline around their mobility.

00;10;13;09 - 00;10;51;23
Sabooh Mubbashar, M.D.
So we really like to get a sense from the get go about what we're working with from the moment they come in. A staffing includes registered nurses, licensed practical nurses, mental health workers, full time social workers, activity therapists and we also actually incorporate massage therapy several days per week. And we also have pet therapy several times a month as part of our therapeutic environment, because we find that both these modalities actually go a really, really long way in helping some of these patients.

00;10;51;23 - 00;11;16;14
Sabooh Mubbashar, M.D.
So the structure of the unit is that we have five private rooms, we have six semi-private rooms, we have two large day rooms and two small TV rooms. We also have a quiet room, as Holly mentioned, which is to, you know, separate if a patient is looking for a relatively low stimulation environment. So we can utilize that from time to time as well.

00;11;16;16 - 00;11;39;17
Rebecca Chickey
Both of those units sound so phenomenal, both in their structure, their staffing, and the incredibly integrated way in which you treat the whole person, not just their mental illness or addiction, but all of their health and getting upstream about it when they're first admitted so that you're not dealing with complications later on. Thank you so much for that.

00;11;39;18 - 00;12;03;06
Rebecca Chickey
I'm going to turn now to Christina, president of Sharon Hospital. And Christina, the two programs that have been described here are really for older adults in need of acute inpatient psychiatric care. But Sharon has begun to go upstream to provide prevention services. Can you share a bit about the senior meals program for adults aged 65 and older?

00;12;03;08 - 00;12;40;02
Christina McCulloch, RN
Yes. Thank you Rebecca. So our senior meals program has really been an honor to stand up here at Sharon Hospital. Our journey really started over a year ago and looking at our community through our community health needs assessment, through assessing our service area that we serve. And there were a few themes that were identified through that assessment. The first is really emphasizing that we are serving an aging population, and we really needed to implement new measures and initiatives to really support the full well-being of the seniors in our community.

00;12;40;07 - 00;13;17;18
Christina McCulloch, RN
28% of Sharon Hospital's service area is age 65 or greater, compared to the average 19% nationally, the significantly higher. And when we look at our future predictions, we know that that population is only going to grow as both Holly and doctor had mentioned. Also, through our assessment, we identified two other opportunities, one being food security, especially in a rural setting where transportation isn't as easily accessible as some other communities in the in the last being mental health.

00;13;17;19 - 00;13;46;25
Christina McCulloch, RN
And so when we looked at these opportunities, we saw a program at one of our sister hospitals that they called the Senior Supper Program, and we set forth to implement that program on a small scale. Here in Sharon, we call it the Senior Meals Program. We started with providing meals at lunchtime at a discounted rate. So we were able to provide affordable, healthy meals to seniors in our community here at the hospital.

00;13;47;02 - 00;14;12;28
Christina McCulloch, RN
We saw that there was great interest in the program. There was a lot of demand. So over the year we grew. We added days that the service was available. We added educational seminars, we invited clinicians, we hosted dinners, and the program really has grown into what it is today, which we call the C program. It's a senior education and engagement program.

00;14;13;04 - 00;14;38;18
Christina McCulloch, RN
We're looking to further expand this program so that we can have these offerings outside of the hospital, out in the community. We've already hosted a couple of events at different settings in different towns in our community, where seniors can go out to a venue, have a nice meal, listen, connect with one of our clinicians on a topic related to aging.

00;14;38;21 - 00;14;59;08
Christina McCulloch, RN
We've done seminars on heart healthy fall prevention, and so our goal over the next year is really to continue to expand. In addition to having affordable, accessible meals, this is really helping to combat that social isolation that so many of our seniors are facing in our community.

00;14;59;09 - 00;15;35;20
Rebecca Chickey
So it sounds to me that you're addressing the loneliness epidemic that you are addressing food insecurity that you're able to perhaps prevent, as you indicated, the social isolation, which can often trigger depression, and really getting into the prevention mode so that perhaps you won't have to expand the unit again by more beds. I'd like to ask each of you to maybe give a sentence or two of what call to action would you share with the listeners?

00;15;35;21 - 00;15;37;11
Rebecca Chickey
Holly, I'll start with you.

00;15;37;15 - 00;16;00;26
Holly McCormack, DNP, RN
Well, I think what we've already discussed regarding the aging of our country and how important it is that we provide services for patients that need our help, especially the geriatric community. But it's not only the patients, it's the families. What we see with the caregivers often is there's a high degree of burnout trying to care for their loved one, trying to find the services they need for their loved one for many, many years now.

00;16;00;26 - 00;16;18;23
Holly McCormack, DNP, RN
And they are feeling guilty about not being able to provide that support. And so that's something that we need to consider. And it's also important for us when our patients come to us, they're frightened. They're often grieving. They're confused. Sometimes there's a loss of independence. And so we need to help them cope with that. And we need to help families cope with that.

00;16;18;24 - 00;16;40;13
Holly McCormack, DNP, RN
The last thing I'd like to leave with all of you about the Ray of hope is we say that we measure success differently at the ray of hope, and this came directly from my nurse practitioner that works on the unit. She likes to say we help people sleep through the night. We reduce fear, we reduce stress, we avoid restraints, and we return them safely to their community or to long term care environment.

00;16;40;13 - 00;16;46;20
Holly McCormack, DNP, RN
And we provide families with hope and guidance so that we can help them get through a very overwhelming time period.

00;16;46;22 - 00;17;06;00
Rebecca Chickey
I mean, if each and every one of us could go home every day saying that that's what we did with our time, what a beautiful place this would be. So thank you for that very much, doctor. I'll turn to you. How would you inspire others to go on this journey, since you've been doing it for 18 of the 20 years that the unit has been open?

00;17;06;02 - 00;17;47;25
Sabooh Mubbashar, M.D.
Yeah, I really believe that when it comes to serving this patient population, rural hospitals can make a profound difference when it comes to treating older adults with dignity, humanity and clinical sophistication. With the right model development that I'm very proud that we have been able to emulate at senior behavioral health, multidisciplinary infrastructure and a long term institutional commitment, rural programs can actually develop a highly specialized, niche serving population at times that larger tertiary care hospitals come to rely upon.

00;17;47;25 - 00;18;12;06
Sabooh Mubbashar, M.D.
So this only is not only is an area of great need, this can actually be a lifeline on many levels for rural hospitals. And I think I strongly feel that this is how it should be looked at as not only a clinical need, but something that actually would probably help the bottom line of most rural and small hospitals that are struggling.

00;18;12;10 - 00;18;40;19
Sabooh Mubbashar, M.D.
I'm very aware of the almost crisis like shortage of specialists, especially psychiatrist. Not well. Health now also has a residency program and we actually have residents rotate for about three months. And I can tell you as a as a teacher and mentor that they will routinely say that out of all of their rotations, working with geriatric patients is actually some of the most satisfying work that they do.

00;18;40;19 - 00;18;46;02
Sabooh Mubbashar, M.D.
So there is plenty of hope for us to be able to deal with this shortage of psychiatrists as well.

00;18;46;05 - 00;18;59;04
Rebecca Chickey
We need to get that message to every medical school across the country. So, Christina, I'd like you to bring us home. What are you going to leave the listeners with in terms of inspiring them to go on this journey with you?

00;18;59;04 - 00;19;31;04
Christina McCulloch, RN
So my call to action is for more advocacy. We need advocates not only for seniors and their families, but we need advocates for our hospitals, our communities. We need funding. We need resources in order to provide these services that have such a great impact on this population. And so advocacy is critical. And so my call to action is advocate for your community, advocate for your hospital, both at a local, state and federal level.

00;19;31;05 - 00;19;42;13
Christina McCulloch, RN
Because in order for us to provide these this comprehensive care to support the full well-being of our seniors, what we all do is crucial.

00;19;42;16 - 00;20;07;07
Rebecca Chickey
That's phenomenal. So, Holly, Christina, doctor, thank you so much for being willing to share your time and expertise with the listeners to inspire them to consider the fact that their rural hospital can become a center of excellence for the treatment of older adults with mental illness and or addiction. Thank you so much for what you do each and every day.

00;20;07;09 - 00;20;16;01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:06 - 00:00:16:02
Tom Haederle
Welcome to Advancing Health. In this episode, we hear from a father-daughter physician team who are delivering babies in their hometown, keeping care in the family, and exploring what it means to care for families across generations.

00:00:16:04 - 00:00:45:18
Julia Resnick
It's not every day you get to practice medicine alongside your family, let alone deliver babies together. Today's guests are doing just that. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Today, I'm joined by a father-daughter duo from Southwest Health in Platteville, Wisconsin. Dr. Kevin Carr is a family medicine physician who also provides obstetric care, and his daughter, Melissa Carr, has returned to her hometown to practice as an obstetrician and gynecologist.

00:00:45:25 - 00:00:56:00
Julia Resnick
We'll talk about what it's like to work and even deliver babies together, and what it takes to provide high quality maternal care in a rural community. Drs. Carr, welcome to the podcast.

00:00:56:04 - 00:00:56:26
Kevin Carr, M.D.
Thank you.

00:00:56:27 - 00:00:58:00
Melissa Carr, M.D.
Thanks for having us.

00:00:58:01 - 00:01:13:24
Julia Resnick
So this episode feels especially meaningful as we think about Father's Day. And the two of you are not only colleagues, but father and daughter working side by side. What has it been like to build a professional relationship alongside your personal one? Kevin, I'll start with you.

00:01:14:00 - 00:01:38:06
Kevin Carr, M.D.
Well it's awesome. It's obviously very exciting to see your daughter do well and be well liked in the community. She's actually now starting to deliver people that I actually delivered. So I think fair amount of those has happened. It's also very nice to have somebody very knowledgeable that I can walk down the hallway and ask questions to that I think knows more than I do right now.

00:01:38:07 - 00:01:40:22
Kevin Carr, M.D.
So it's pretty it's pretty awesome all the way around.

00:01:40:26 - 00:01:43:03
Julia Resnick
Amazing. Melissa, what's it been like for you?

00:01:43:06 - 00:02:03:06
Melissa Carr, M.D.
Yeah, kinda just to reiterate that, I think it's just it's really an amazing experience. I mean, he's such a great role model and just an overall mentor. I mean, he's been practicing medicine here at this location for 35 plus years. So, you know, with that, he brings a wealth of knowledge and all the experience that comes with it.

00:02:03:06 - 00:02:23:28
Melissa Carr, M.D.
And he's just so willing to offer that advice both clinically and, you know, from a personal standpoint as well. So, you know, there's just so insightful. And it's like you said, his office is down the hall. So, you know, you can just pop in and, you know, ask questions and bounce ideas off of him. And it's just it's so such a nice resource to have, you know, readily available to me.

00:02:24:00 - 00:02:28:04
Melissa Carr, M.D.
So I take advantage of it as much as I possibly can.

00:02:28:06 - 00:02:36:12
Julia Resnick
That's amazing. And my dad used to work in the building next to us, so we'd have lunch all the time. But that's different than being in the same profession and actually working together.

00:02:36:14 - 00:02:54:27
Kevin Carr, M.D.
And I'll have one more little anecdote. My dad was a veterinarian, and so for many years when I heard Doc Carr, I was looking around because it was my dad they were talking to. And I think Melissa will share that same anecdote that it's we're used to having that in the background.

00:02:55:02 - 00:03:01:01
Melissa Carr, M.D.
Yes. In fact, I had a patient this morning bringing up Doc Carr, who is Grandpa Carr, the veterinarian.

00:03:01:01 - 00:03:07:08
Julia Resnick
I love that. And I imagine that your dad being in this field influenced your decision to go into it as well.

00:03:07:10 - 00:03:14:22
Kevin Carr, M.D.
I was not sure if I was going to do veterinary medicine or people medicine, so obviously I made what I think is a very good choice.

00:03:14:25 - 00:03:18:07
Julia Resnick
And Melissa, you stuck with delivering babies.

00:03:18:09 - 00:03:46:15
Melissa Carr, M.D.
Yeah, same thing. I mean, I had a front row seat to, you know, to healthcare from a very early age. Growing up, I just remember seeing, you know, number one, seeing, you know, get up in the middle of the night to go deliver a baby or, you know, that side of things. But then, you know, you'd walk into the grocery store or to a ball game and there would be a patient that would track him down and telling stories about their family members or their loved ones that he took care of, and just or just being thankful and expressing their gratitude for the care he provided them, you know,

00:03:46:16 - 00:03:59:26
Melissa Carr, M.D.
so I saw from a very early age kind of how meaningful that was. And I feel like that's kind of a perspective that not a lot of people get going into healthcare. If you haven't been exposed to that, especially in more rural type setting.

00:03:59:28 - 00:04:08:16
Julia Resnick
Absolutely. So as you've been working together, what have you learned from each other, both as clinicians and his family members? How does that shape how you're caring for patients?

00:04:08:20 - 00:04:29:10
Melissa Carr, M.D.
Well, again, to kind of just like as I mentioned, you know, I saw the relationships that he developed with patients, both in the clinical setting and outside. You know, how patients just felt so grateful for their care. And I just I got to see how, you know, how you played that role in their lives. And I would just, you know, thought that was really pretty amazing.

00:04:29:11 - 00:04:36:07
Melissa Carr, M.D.
And so that really kind of impacted, number one, me to go into medicine. And then, you know, continuing to build those types of relationships with my own patients.

00:04:36:09 - 00:04:37:06
Julia Resnick
And Kevin.

00:04:37:12 - 00:04:54:12
Kevin Carr, M.D.
Well, again, I kind of go back to my parents again, I think kind of I was always taught you show up, be there and care for people and the rest will take care of itself. We're small town of 10,000, and it's just different care out here than using the big city because of that. And I think the patients see that.

00:04:54:13 - 00:04:59:14
Julia Resnick
Say more about that. What makes providing maternal care in rural communities special?

00:04:59:16 - 00:05:22:25
Melissa Carr, M.D.
So our model for maternal health care here is a little bit different than what you're going to get in some of the bigger health care systems. And we tend to have one provider that follows their patients through their prenatal care from the first visit through delivery and then postpartum. And so because of that, we really start to build these relationships with patients.

00:05:23:00 - 00:05:38:09
Melissa Carr, M.D.
You get to know them at a much more personal level. And I just think that that brings a whole other level of care to these moms and babies. So it is a little bit more of a unique experience here. And I think that that's part of what makes us special.

00:05:38:15 - 00:05:40:18
Julia Resnick
Kevin, anything you want to add to that?

00:05:40:20 - 00:05:55:27
Kevin Carr, M.D.
Yeah, I think especially with OB, once you take care of somebody and see them 12, 13, 15 times, they kind of remember you forever because it's one of the biggest days of their life that they're going to remember for every single day. And you're a big part of it.

00:05:55:28 - 00:06:15:06
Julia Resnick
Absolutely. And it's one of those few times in healthcare where you're getting care for a happy reason, and it's amazing that you get to be there for them throughout that entire journey. So, Kevin, I know you're an FM who does OB and Melissa, you're an obstetrician/gynecologist. And you know, how does that work together, working as a care team?

00:06:15:12 - 00:06:19:26
Julia Resnick
And how can those kind of collaborations help improve care for patients?

00:06:19:28 - 00:06:42:26
Kevin Carr, M.D.
Yeah, it works amazingly well. We have five family practice docs that deliver OB patients, and one of the family practice docs actually does C-sections, along with three of the OB doctors here. We still take care of our own patients. Obviously, they're very available for any consult, anything that happens, and if a C-section happens on their patient, we're also there first assisting.

00:06:42:26 - 00:06:58:19
Kevin Carr, M.D.
We're helping out and taking care of the baby. So it absolutely works very seamlessly. There's no turf battles. There's a lot of helping each other out and very willingness to answer questions if there's any problems or concerns about any kind of care.

00:06:58:24 - 00:07:15:24
Melissa Carr, M.D.
And we are located in the same building. We're two separate clinics or two different offices, but we're separated by hallway. So people will pop into my office all the time just to bounce ideas or ask questions, and vice versa. I'll do the same thing. I'll put my head in and say, okay, I got this patient. What do you think of this?

00:07:15:25 - 00:07:28:09
Melissa Carr, M.D.
And everybody is always so willing to, you know, to help out and provide advice and, you know, just kind of help coverage. And like you said, it's, you know, we're a pretty well oiled machine and it works really well for us.

00:07:28:12 - 00:07:43:24
Julia Resnick
That's amazing. And in a lot of rural communities these days, we're hearing about hospital closures or hospitals that are having to retract their OB services. But it sounds like you all are doing the opposite of that. So what do you think has been driving that growth and how are how are you adapting to meet that need?

00:07:43:26 - 00:08:14:28
Melissa Carr, M.D.
So we've seen that firsthand. We had a hospital in a neighboring county closed their maternal health services probably about ten years ago, give or take. And so those patients now had to travel further for their obstetrical care. Many of them do come our direction now. Another hospital, neighboring hospital, has also lost some of their OB providers and their gynecologist for whether it was from those providers relocating or retiring.

00:08:15:01 - 00:08:36:08
Melissa Carr, M.D.
So there's just less access to care. And so we have seen more patients coming our direction because of just there isn't as many options available to them. And they're now having to travel further. So to kind of combat that, number one, we've increased our OB providers since I've been here. We have more physicians that are providing OB care, whether it's family medicine, physicians and OBGYNs.

00:08:36:10 - 00:08:56:00
Melissa Carr, M.D.
And we've also opened outreach clinics through our organization. So that's where OB care is available. So people aren't having to drive as far for their prenatal care visits. They still come to our main hospital campus for deliveries, but at least for their visits, they're not having to travel as far.

00:08:56:07 - 00:08:58:20
Julia Resnick
Fantastic. Kevin, anything you want to add?

00:08:58:26 - 00:09:19:26
Kevin Carr, M.D.
Just to show you the numbers, in 2010, we were about 140 deliveries, and I believe this year we're going to be at 240 delivery. And some of it's the culture of the hospital. The whole hospital has exploded over this period of time. Going back to the American Hospital Association meeting a few years ago, quite a few years ago, we started a Journey to Excellence program

00:09:19:26 - 00:09:40:27
Kevin Carr, M.D.
after one of the meetings, we learned at the Rural Health Leadership Conference. And our hospital does that, and patients that walk in the door from the outside can tell the difference in every single employee the attitudes, the smiles, the willingness to help out everybody from the janitor to the CEO, every single step along the way. Every person is important.

00:09:40:27 - 00:09:57:07
Kevin Carr, M.D.
And it shows in how we take care of patients and how patients respond to what we do. And it's every single one of our sort of different programs, you know, OB, ortho, everything has literally exploded because of some of the things we've done.

00:09:57:09 - 00:10:05:22
Julia Resnick
That's fantastic and really just speaks to, you know, your organizational culture and how that exudes between providers and also to the people you care for.

00:10:05:25 - 00:10:31:02
Melissa Carr, M.D.
And I think there's a lot of word of mouth that spreads too, you know, people are very grateful for their care here. And they really enjoy their experience. And they spread that to their friends, their family members. And, you know, so that catches on. And we're starting to see patients that are willing to travel further for their OB care, even if they have options that are closer to home, because they're choosing to come to our facility to come to deliver and coming to see us for their prenatal care.

00:10:31:04 - 00:10:44:28
Julia Resnick
That is great. And so you've both really been talking about like, the human piece of this. And I know a lot of hospitals, including yours, are using technology to help extend care. Can you talk about how you're thinking about incorporating technology into your work?

00:10:45:01 - 00:11:03:15
Kevin Carr, M.D.
They are starting to do AI to help with notes here. We just started six months ago. So we're learning from many of the providers. There's some very good things about it. There's some things they got to learn. But it sounds like so far so, so good that it's saving some time so they can spend more time with the patient and do those things.

00:11:03:15 - 00:11:05:19
Kevin Carr, M.D.
So that's one of the things they're doing.

00:11:05:24 - 00:11:10:00
Julia Resnick
And wasn't there a piece about a telemedicine program for neonatology.

00:11:10:02 - 00:11:42:02
Kevin Carr, M.D.
Oh yes. We were the first - and it might still be the only program in the state - that has a telemedicine NICU program, neonatal intensive care unit program associated with University of Wisconsin-Madison. And it's been going on for a couple of years. It took us a while to tweak and fine tune some things, and it's really nice in the sense of in our newborn nursery, we have computer set up, we have cameras set up, and we basically call a number and usually within minutes we have a neonatologist on the phone.

00:11:42:02 - 00:12:01:03
Kevin Carr, M.D.
We can see them, they can see us. There's a video on us, there's a video on the baby. And back in the day where we take care of lots of babies who need a little bit of oxygen, need a little bit of help, a little CPAP to help them get through the breathing, and you kind of sit there and try to decide, okay, is this baby sick enough to be transferred?

00:12:01:03 - 00:12:20:06
Kevin Carr, M.D.
Can I watch for another two hours? Well, now we make that call right away and we talk to them and we go, hey, I'm pretty comfortable with this, but I just want to make sure that I'm doing the right thing. And you have them on the phone, they assess the baby, they help you sometimes in making the decision, do we order a few tests and then, hey, we'll keep an eye on things and get back to us an hour.

00:12:20:07 - 00:12:29:20
Kevin Carr, M.D.
And if the baby transitions and looks great, wonderful. If the baby doesn't do well, then we already have the numbers in and they're ready to send the transport team.

00:12:29:25 - 00:12:34:28
Julia Resnick
That sounds incredibly helpful for rural hospitals that probably don't see a ton of cases like that.

00:12:35:00 - 00:12:57:27
Melissa Carr, M.D.
We also have a new SIM lab here as well, so we can run different types of simulations for both physicians and the rest of the hospital staff that are on the OB unit. And that's been really helpful, especially in a rural setting, because, you know, our volumes are lower, which also means that our types of high risk clinical scenarios are also going to be lower.

00:12:57:27 - 00:13:18:09
Melissa Carr, M.D.
So you may have a nurse that might not experience a postpartum hemorrhage or a shoulder dystocia or those types of situations, but have only heard about it. So this allows people to, you know, get that training and doing that repetition through simulation, even if we don't necessarily see it very often to keep those skills up.

00:13:18:12 - 00:13:33:00
Julia Resnick
Absolutely. And to close, I just want to bring this back to Father's Day, since that's when we're releasing this. And you are a father-daughter duo, so can you just share a moment or a story that reminds you why this work is so important to your community?

00:13:33:02 - 00:13:54:16
Kevin Carr, M.D.
I called a patient this morning to ask if I could share this story without saying her name. Obviously, I've delivered a lot of patients and this specific family, I delivered all four of the girls. Several of them, I believe they're all going into nursing school. And so back in the start of Covid in 2021, she was in nursing school and came to me with symptoms.

00:13:54:24 - 00:14:13:18
Kevin Carr, M.D.
You just get gut feelings if something isn't right. And I basically did a chest X-ray and she had an apple sized lesion by her heart. And I immediately had my nurse call her mom, said I want her mom here now. I want to talk. I want to get her here before I get my CAT scan. I did a CAT scan. The next day

00:14:13:18 - 00:14:42:18
Kevin Carr, M.D.
I got her in with the hospitals at UW hospital to get a biopsy, and she ultimately had lymphoma. She did take six months in nursing school off and is now cured. Now, to add to that story, three years later she came, wanted to see me and she was somewhat tearful, so I wasn't sure what was going on until she got here and found out she was pregnant. And she was somewhat tearful because she just is finishing school.

00:14:42:20 - 00:15:07:19
Kevin Carr, M.D.
She's not married yet and she's worried, how are my parents going to take this? And we had a long discussion, and I kind of used some old quotes from my former nurse who was outstanding and said, this won't define who you are as a human and won't define who you will be in your lifetime. And she asked if she could give me a big hug and two days later told her parents and her dad was in tears,

00:15:07:19 - 00:15:23:09
Kevin Carr, M.D.
he was so excited. Because three years before that, they're worried they're going to lose their daughter. And now their daughter is bringing a life into this world. And so there's a huge turnaround. And that's why we go into medicine. Now I'm going to add to one step further to that I know this, I know her very, very well.

00:15:23:09 - 00:15:36:01
Kevin Carr, M.D.
I know this family very well. She told me there is nobody else that's going to deliver her baby except for me. Except unfortunately, that few days I was in Canada fishing. So guess who delivered my baby?

00:15:36:02 - 00:15:37:24
Julia Resnick
The other Doc Carr?

00:15:37:26 - 00:15:57:06
Kevin Carr, M.D.
The other Dr. Carr. And so she got to experience the best of both worlds. And now she had her second baby about eight months ago. And so I did deliver that one. So she was thrilled that both of us had an opportunity to care for her. And to be blunt, when I called her and asked if I could use her story today, I could tell she was in tears on the phone.

00:15:57:06 - 00:16:02:27
Kevin Carr, M.D.
She's an outstanding family, just core the earth people from southwest Wisconsin.

00:16:02:28 - 00:16:05:27
Julia Resnick
Amazing. And Melissa, on your end.

00:16:06:00 - 00:16:27:14
Melissa Carr, M.D.
One that comes to my mind is so my very first delivery that I did as a brand new grad or fresh out of residency was a C-section that I did with my dad. It was his patient and she needed a C-section. And so I was the primary surgeon. And then he was my first assist.

00:16:27:14 - 00:16:48:06
Melissa Carr, M.D.
So, you know, looking back, you know, you're just you're eager to do the delivery and, you know, be there for your patients. But at the same time, you know, looking back, it was just such a special cool moment. And now the other really neat thing is that particular patient, she takes care of my kids at daycare. So, you know, I see her every single day when I drop my kids off and, you know, so it's just it comes full circle.

00:16:48:08 - 00:17:07:01
Kevin Carr, M.D.
And to add to that story, the grandmother of that patient was an OB nurse here that I have delivered 500 babies with. And so she was in the operating room. And this is one in the morning, we're doing the C-section. And she thought it was the coolest thing ever, that her granddaughter was in there in the room with both of us.

00:17:07:03 - 00:17:22:00
Julia Resnick
That's amazing. And it's keeping in the family, both your blood family and your community family. So, Doc Carr, Doc Carr, thank you both for the work you do for your communities, for sharing your stories. And Happy Father's Day to all of our listeners out there.

00:17:22:02 - 00:17:24:19
Kevin Carr, M.D.
Thank you. Thank you very much.

00:17:24:21 - 00:17:33:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:09 - 00:00:17:02
Tom Haederle
Welcome to Advancing Health. New York City has long been considered one of the great food meccas of the world, and these days some of the best tasting and most nutritious meals in the Big Apple are served in hospitals.

00:00:17:04 - 00:00:41:16
Tom Haederle
Hello friends, I'm Tom Haederle, senior communication specialist with the American Hospital Association. And it's a pleasure today to talk about a vast improvement in patient care that is sometimes overlooked: the meals patients and families are served during their health care journey. I'm not just talking about taste and presentation, but significant upgrades in nutrition value, high quality ingredients, and the ability to tailor meals to patients and their needs.

00:00:41:16 - 00:00:50:04
Tom Haederle
I'm joined today by Dan Dilworth, senior director of food and nutrition services at NYU Langone Health. Dan, thanks so much for joining me on Advancing health today.

00:00:50:04 - 00:00:51:24
Dan Dilworth
Awesome. And thanks for having me.

00:00:51:26 - 00:01:01:27
Tom Haederle
Let's set things up. You and your team have invested enormous effort in the past several years radically overhauling, I guess, Langone's food system. Please give us a picture of what's been going on.

00:01:02:01 - 00:01:21:03
Dan Dilworth
So our journey actually began about 12 years ago after Hurricane Sandy. You know, NYU was decimated by that storm and they had to rebuild. So really we said, how do we want to do that? We have this opportunity to build new buildings and rebuild a program. And we really wanted to be the best in class in doing that.

00:01:21:04 - 00:01:39:10
Dan Dilworth
So, you know, the approach we took was actually very, very simple. It was let's focus on using really wonderful products, the best ingredients, and start making everything in-house. And that's sort of the base of how we did it. Of course, it's a lot more complicated and it's been a long, winding road. But you know, that's really what we prioritized.

00:01:39:12 - 00:01:46:21
Tom Haederle
What has the reaction been from patients and their families who are customers, so to speak, of Langone Health?

00:01:46:24 - 00:02:13:09
Dan Dilworth
Our changes have gone over very, very well. I must say that, you know, as part of our process, we removed all deep fryers from every kitchen within our organization. So the removal of French fries did upset some people. But aside from that, I think it's been overwhelmingly positive feedback. And, you know, funny enough, this morning in snail mail, which is a rare thing these days, I actually received a letter from a patient who was here at some point in the last several months thanking us.

00:02:13:09 - 00:02:29:07
Dan Dilworth
And she cited, you know, the salmon with the Salsa Verde and our sauteed kale, and was calling out these specific dishes, saying how wonderful it was to get this level of food at a hospital. And I think those are really the best moments when we can hear from a specific patient, you know, letting us know about their experience.

00:02:29:07 - 00:02:31:25
Dan Dilworth
But yeah, overall, it's gone over very well.

00:02:31:27 - 00:02:47:04
Tom Haederle
And nice to get that thumbs up, I imagine people are delighted. You come from a restaurant rather than a health care background. So how is that an advantage in looking at the menu and deciding what kinds of changes needed to be made? And did anything surprise you when you took this on as a project?

00:02:47:09 - 00:03:07:06
Dan Dilworth
So yes, you mentioned I come from restaurants, but it's a little bit more than that. I've worked in just about every area of food and beverage that you can imagine: catering, airlines, hotels, restaurants. And it's funny because I think hospitals are actually a conglomeration of all of those things. Each of those different areas has its own set of challenges that you have to navigate.

00:03:07:08 - 00:03:27:13
Dan Dilworth
You know, on an airplane, you're pre-making food and it has to get reheated in the air in a steel box. You know, in catering, you're doing kind of the same thing, but on the ground. You know, I've pulled a lot of sort of skills that I've learned in those areas over the years to help inform what we do here at NYU, knowing that, you know, we don't have a kitchen next to every patient bed.

00:03:27:14 - 00:03:47:27
Dan Dilworth
And that's something that's really interesting to me is the sort of logistics behind this. How do you make really fresh, amazing food and then transport it through hallways and up elevators and then get it distributed to a patient bed, which is decidedly not a restaurant table? I think just pulling from that background and different things I've learned over the years has been really helpful in this.

00:03:47:27 - 00:04:03:19
Dan Dilworth
But again, it just comes down to the same things. It's, you know, using great fresh ingredients, the best quality fish, the best quality vegetables and then delivering it with wonderful hospitality, I think is the key, no matter what happens with the logistics and behind the scenes.

00:04:03:21 - 00:04:21:28
Tom Haederle
I would think New York is probably...and correct me if I'm wrong, but maybe one of the easier places to source fresh ingredients. Is that an advantage just because so many ingredients coming to the city for so many different reasons, but you don't have any trouble getting your hands on the kinds of things that you want to be serving patients.

00:04:22:01 - 00:04:44:04
Dan Dilworth
100%. I mean, we're in probably the best place in the country to get amazing ingredients past maybe California. You know, our fish comes from the same purveyors that I've used for years in, you know, Michelin starred Manhattan restaurants. But having said that, we don't have the advantage of being able to run down to Union Square Green Market and pick up vegetables because of the sheer volume of the food that we're serving.

00:04:44:07 - 00:05:03:28
Dan Dilworth
So we're serving over 9000 people a day across all five of our campuses. And you know, that that does put some limitations on it. So we really focus on working with great purveyors to figure out how can we get local vegetables and the best quality items at that scale, and then knowing that in theory, this is an easy thing.

00:05:03:28 - 00:05:18:10
Dan Dilworth
But we do have campuses ranging from Manhattan all the way out to Suffolk on Long Island. There is a level of complexity there, but the number of amazing purveyors and vendors that we have to pull from make it, make it pretty, pretty straightforward and easy, which is a great, great asset.

00:05:18:15 - 00:05:33:22
Tom Haederle
Well, it's also remarkable, you just mentioned you're serving 9,000 patients a day. And I understand that Langone system puts a premium on tailored meals, when possible, that are aligned to a patient's personal taste and preferences. How do you pull that off?

00:05:33:25 - 00:05:57:12
Dan Dilworth
So that's really interesting. So just one caveat. So we're serving 9,000 people a day. So that's patients along with our coffee shops, our restaurants, our cafes, our catering. But when it comes to medically tailored meals, we have over 15 different special therapeutic diets. So that could be anything from a consistent carbohydrate diet to a low sodium diet.

00:05:57:13 - 00:06:18:26
Dan Dilworth
So depending on what a patient's condition is, the doctor can sort of flag them for that specific diet. And that tells us how much sodium can that patient have? What level of sugar can they have if somebody has diabetes? Any number of different conditions will fit into that. And we have essentially different menus, mini-menus that are put together that we will make available to that patient.

00:06:18:26 - 00:06:37:02
Dan Dilworth
But the best part about what we do here at NYU is we have a pretty expansive patient menu. We have daily specials, and every patient has the ability to pick what they want to eat. We're not telling you what you have to eat. We're not just sending something up to you, but you know, as long as you're not in surgery, when orders are being taken, patient can pick.

00:06:37:03 - 00:06:59:24
Dan Dilworth
Do they want pasta bolognese or do they want mac and cheese? Do they want chicken breast or do they want roasted salmon? And I think that level of choice is something that's really amazing. And that's something that's very personal to them. I think it really helps give a better experience as part of the overall stay at the hospital and being able to know, you know, pick what kind of tea one or what you want, what kind of cereal you want for breakfast.

00:06:59:25 - 00:07:07:04
Dan Dilworth
You know, that can be something that just gives a sense of sort of comfort and home when you're in a place that's definitely not your home.

00:07:07:10 - 00:07:23:21
Tom Haederle
That's a great point. And I was thinking it's probably also a big psychological advantage to feel like you have some control over the things you're picking to be brought to you to eat when, you know, depending on the nature of your of your stay in the hospital, you don't always have control about some other aspects of what's going on there.

00:07:23:21 - 00:07:41:05
Tom Haederle
But I was wondering if there's any -in addition to patient feedback, which I imagine is very positive - do you have any data that would indicate that this move to healthy food is actually making a medical difference? You know, sodium levels dropping or diabetes being treated just through food?

00:07:41:06 - 00:08:00:07
Dan Dilworth
So we're actually right now working on developing a number of different dashboards to start tracking data like this. It's not something that's one, very easily trackable, but it hasn't historically been tracked across the board. So we're really prioritizing right now, how do we gather more data? How do we turn that into something that you can see on a day to day basis?

00:08:00:07 - 00:08:18:06
Dan Dilworth
And that could be anything from, you know, things you're talking about to what utilization do we have of different menu items. What are patients ordering most frequently? How long does it take for a meal to get from our kitchen to different hospital units? And I think we're taking this holistic look at data, because NYU as a whole uses data as a tool to make decisions, right?

00:08:18:07 - 00:08:36:20
Dan Dilworth
We're not making decisions because Dan thinks it's good. We're making decisions because, you know, there's proven facts behind it. I'm really excited to see those dashboards come to life, and we're going to continue growing and refining them over the coming years, and hopefully be able to share some data that's really impactful to the world through the use of those.

00:08:36:22 - 00:08:55:19
Tom Haederle
That's exciting, and I'm looking forward to hearing more about that when that data becomes available. At the same time, you're also moving ahead on so many fronts at once, and I'm referring to carbon emission goals. Also trying to reduce the amount of single use plastics as part of part of the overhaul. What can you tell me about that?

00:08:55:20 - 00:08:57:03
Tom Haederle
How's that working out?

00:08:57:06 - 00:09:21:19
Dan Dilworth
So NYU has a goal of carbon neutral by 2050. In researching where the bulk of our carbon emissions come from, you know, one would think, oh, it's from the electric and the utilities that you use. A lot of it is from the products. And I say that because something made of plastic that's produced overseas has to go on a boat, in a box, in another box, get uncreated, repackaged, distributed, delivered.

00:09:21:21 - 00:09:40:28
Dan Dilworth
That whole process is incredibly impactful. We're sort of starting to focus in our department on things that we can make a big change with immediately. And for us, a lot of that has to do with removing plastics. It's not great for the world, it's not great for your body. And more and more on the market, there are better alternatives, especially for things like bottled beverages.

00:09:40:28 - 00:10:04:08
Dan Dilworth
There are a lot more bottled beverages out there right now that are packaged in glass or aluminum, which are endlessly recyclable and definitely ideal. So this last year, we reduced our plastic bottle beverages by 44%, and we're working pretty aggressively to turn that into a zero, hopefully by the end of the year. But that's a that's a loose goal.

00:10:04:10 - 00:10:26:14
Dan Dilworth
You know past that it's you know we're also looking at the health benefits of removing plastic from food service. So you know there's the benefit to our planet of using less plastic. But you know, more and more there's research saying that plastic, especially when it's heated, is really terrible for our health. So there are some really cool researchers here at NYU that are really focusing on this, so as a department

00:10:26:14 - 00:10:47:26
Dan Dilworth
we're partnering with them to figure out, as we get rid of plastic, which items are we bringing in and which have the least amount of risk to our bodies, our patients bodies, our staff and our guests. But overall, I think moving towards compostable is a huge goal. In the last couple of months, changed all of our cutlery over to being compostable in our retail cafes.

00:10:48:02 - 00:11:10:22
Dan Dilworth
Patient meals are next and I think alone that move saved us about 2.5 million pieces of single use plastic going into landfills a year. So a lot of good stuff. And, you know, it's amazing to work for an organization that puts resources behind this because it's not cheap to do these things. And NYU's dedication to this mission has really enabled us to make some moves here.

00:11:10:25 - 00:11:33:02
Tom Haederle
Congratulations. You're really making an important progress on so many fronts and advancing health at the same time. It's amazing. You're probably aware about a month ago, the Centers for Medicaid and Medicare Services announced a voluntary pledge hospital could sign related to their efforts on healthy food. The AHA has endorsed this. It seems like you guys have really been out ahead of the curve on this whole thing.

00:11:33:04 - 00:11:53:27
Dan Dilworth
Yeah. So that's the that's the great thing about this is for years, we've already been doing a lot of the things that are a part of that pledge. So using minimally processed foods, prioritizing from scratch, cooking simple vegetables and proteins, reducing the amount of added sugar. You'd love to reduce all added sugar. However, you can't get rid of ginger ale for patients, and that's always going to have added sugar.

00:11:53:27 - 00:12:15:00
Dan Dilworth
But even several years ago, we switched our ginger ale to a product that uses cane sugar instead of high fructose corn sirup. So even in those places where, you know, it's a sort of necessary evil, we're still trying to use the best thing possible. But at the end of the day, you know, like I said at the beginning, if we prioritize great, fresh, simple ingredients, where we're headed on the right track.

00:12:15:02 - 00:12:31:26
Tom Haederle
You're really, really setting the setting the standard for the field right now. And I congratulate you for that. I've got to ask, I've read that Langone's food is so excellent that some patients actually ask for recipes. So will we see a Langone Health cookbook coming out one of these days, or a show on the on the Food Channel?

00:12:31:28 - 00:12:55:21
Dan Dilworth
There's nothing I would love more, but funny you should ask about a cooking show. So we actually do shoot a cooking show right now. We've shot it for about six years. We've done 58 episodes so far. It's called Cooking for Wellness. It can be found on our YouTube channel. You know, historically, this this program has been sort of directed at our internal stakeholders, and it's featured all of the amazing clinicians and experts we have on our staff giving guidance on food.

00:12:55:24 - 00:13:28:19
Dan Dilworth
We're going through a bit of a relaunch on this right now, where we're redirecting this as a tool for our patients to provide them with, like real life, actionable guidance on cooking on nutrition surrounding specific diseases. We have this wealth of expertise from our doctors, from our nurses, from our researchers. So we love the fact that we're able to leverage that and then combine it with our culinary team and really create a program that's teaching everyone out there, sort of, how can you cook at home in a realistic way to solve for having a certain disease, to being on a certain medication.

00:13:28:21 - 00:13:38:26
Tom Haederle
Given your experience in redesigning the menu at Langone, what advice would you have for other organizations, health systems, or hospitals who are interested in doing the same thing?

00:13:38:28 - 00:13:59:10
Dan Dilworth
I think one big piece of advice I'd give other health systems is typically, you know, frozen food is a big part of the food and nutrition program in health care organizations. And, you know, everyone assumes that going to fresh vegetables is a sort of big mountain to tackle. You know, in my opinion, it's much easier. It's actually just that simple: buy fresh vegetables.

00:13:59:13 - 00:14:17:15
Dan Dilworth
When you buy a frozen vegetable, you have to store it. You have to thaw it. You have to process it more differently. You have to dry them out. It actually it's much easier and it ends up being a bit of a labor savings if you just go with straight vegetables. It's kind of counterintuitive. However, in the long run, you know it's going to give better nutrition, a better quality product.

00:14:17:16 - 00:14:33:08
Dan Dilworth
Many of the purveyors that sell these frozen or canned or processed ingredients also have fresh vegetables. And even if you start small, like you don't have to reinvent the wheel overnight, just switch from frozen carrots to fresh carrots. That's an amazing first step and pretty accessible.

00:14:33:10 - 00:14:47:10
Tom Haederle
Well, it may be an overused word, but I think what Langone Health is doing is truly awesome. And congratulations on the effort you're leading and the difference it's making in your patients lives and those are their families. So thanks again for your time and really appreciate you being on Advancing Health today, Dan.

00:14:47:16 - 00:14:50:01
Dan Dilworth
Awesome, thanks so much.

00:14:50:03 - 00:14:58:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:28:00
Tom Haederle
Welcome to Advancing Health. June 8th through 12 is Community Health Improvement Week, a perfect time to recognize Denver Health's award winning approach to the stubborn and difficult problem of homelessness. Hello, friends, I'm Tom Haederle, senior communication specialist with the American Hospital Association. Homelessness is complicated by the reality that many unhoused people also deal with complex medical, behavioral health and social challenges.

00:00:28:00 - 00:00:48:15
Tom Haederle
And as most will attest, it's all too easy to fall through the cracks. That's why it's a pleasure today to welcome someone who is driving real progress on a problem that defies easy solutions. Dr. Sarah Stella is the co-leader of Denver Health's Housing Outreach, Partnerships and Engagement, or HOPE program. Dr. Stella, thank you for joining me on Advancing Health today.

00:00:48:16 - 00:00:49:18
Sarah Stella, M.D.
Nice to be here.

00:00:49:22 - 00:01:08:21
Tom Haederle
First off, let me offer my congratulations on the HOPE program's recognition last month with the American Hospital Association's 2026 Dick Davidson NOVA Award, which is our award that honors outstanding collaboration by hospitals and health systems working to build healthier communities. It's quite an honor. So hats off to you.

00:01:08:26 - 00:01:13:15
Sarah Stella, M.D.
Thank you very much. It was a real honor to be in Dallas to receive the award.

00:01:13:18 - 00:01:23:09
Tom Haederle
Why don't we start at the beginning and please share with our listeners what HOPE is designed to do and the role that community partnerships play in helping Denver residents access the services they need.

00:01:23:16 - 00:01:51:00
Sarah Stella, M.D.
Well, I love that you mentioned seeing folks fall through the cracks. So I'm a hospitalist. I'm an internal medicine trained hospitalist physician. So I've worked at Denver Health for nearly the last two decades, and a lot of what I do is and what we do at Denver Health is catching people that are falling through the cracks, which sometimes are more like gaping holes in our systems.

00:01:51:04 - 00:02:24:04
Sarah Stella, M.D.
The HOPE program is really unique because it is an interdisciplinary team that lives at the intersection of the hospital system and the Metro Denver homelessness response system. And so I think sometimes what we see is, although hospitals like Denver Health are disproportionately caring for folks that are experiencing homelessness and other really significant social needs, that we're often separate from the response systems.

00:02:24:08 - 00:02:53:24
Sarah Stella, M.D.
And so a lot of what I've been doing - so I still practice hospital medicine with part of my time - but a big part of what I've spent the last decade doing is really building partnerships beyond the hospital walls to improve care for some of our most vulnerable and at risk folks experiencing homelessness at Denver Health. About 1 in 5 of the patients that I treat in the hospital is experiencing literal homelessness.

00:02:53:25 - 00:03:30:06
Sarah Stella, M.D.
So this is a significant challenge. We know that our folks experiencing homelessness have longer length of stay, really complicated discharge plans sometimes. And so working with a range of different partners is really important to improve the quality of care that we provide as well as our financial bottom line, because we know that if you don't have a safe place to go, you're likely to be in a hospital bed far longer sometimes than is needed.

00:03:30:07 - 00:03:37:04
Sarah Stella, M.D.
So having trusted partners on the other side of that transition is critical.

00:03:37:10 - 00:03:58:02
Tom Haederle
And what kind of options has that created working with these partnerships? If a patient comes into the hospital for a medical condition or reason, but you realize they're going to need a little bit more than that, you know, a stable housing situation, a roof over their head that they can count on -what are some of the options that that you can provide, and are they temporary or are they or try to be permanent?

00:03:58:09 - 00:04:39:19
Sarah Stella, M.D.
Yeah. Great question. So we do have a partnership with the Colorado Coalition for the homeless. They are a long existing provider of integrated housing and health care. And they operate a large recuperative care center in Denver. And so one of the ways that we partner is by investing in our partners. And so we help fund a portion of recuperative care beds in the John Parvensky Stout Street Recuperative Care Center to use as a discharge destination for many of our folks experiencing homelessness that have really complex medical needs.

00:04:39:19 - 00:05:09:21
Sarah Stella, M.D.
So things like wounds or needing IV antibiotics for a prolonged period of time, broken bones where people are unable to bear weight and they really need a safe place to rest and recuperate following that hospital stay. So that's a great partnership for us and that has helped us to reduce our length of stay. That is not housing. And so we still need to think about what is the next step for that, that patient.

00:05:09:21 - 00:05:38:16
Sarah Stella, M.D.
But it's a really great place to get medical care, to be able to heal and then get connected with housing and other supports that can help someone take the next step. We also had operated a transitional housing program at 655 Broadway. That's a partnership with the Denver Housing Authority, and that is specifically for elderly and or disabled patients who are experiencing homelessness.

00:05:38:19 - 00:06:09:08
Sarah Stella, M.D.
Again, to transition them out of the hospital, provide wraparound supports, and then try to get them connected with longer term housing in the community. And then we just work really closely with our city partners who can provide non congregate shelter, like motel rooms with some wraparound case management. We partner on the Denver Housing to Health program, which is a permanent supportive housing program that provides -

00:06:09:08 - 00:06:34:02
Sarah Stella, M.D.
not only do we have a very responsive partners on the end of that transition and a warm handoff to those partners during a hospital stay - but folks also are provided with a housing voucher and get connected with long term, permanent supportive housing. Really actually, how we learn to do a lot of the way that we work and we make connections and have these strategic partnerships.

00:06:34:03 - 00:07:06:20
Sarah Stella, M.D.
We learned how to do that through our Denver Housing to Health program. It's sort of proof of concept that when we have the right data to identify folks and outreach them, we have the right team on the ground to outreach them, and we have partnerships and resources on the back end, it is possible for someone to go from hospital into housing. And I think that's a great model for hospitals to think about in terms of what we can do to meaningfully partner to address homelessness.

00:07:06:22 - 00:07:29:01
Tom Haederle
That's wonderful, inspiring work. I'm really, really impressed. I would like to pull on that thread a little bit. You mentioned there is an issue of identification. Who needs these services? I read an article that you wrote that was published last October. I guess it was "the conversation.com" was the website about your frontline experiences as a care provider. And you made some, some excellent points.

00:07:29:01 - 00:07:47:00
Tom Haederle
You noted that Denver and I would say probably most cities tend to undercount the homeless, and I wanted to share one quote from that article that really struck me. You said "others are hard to spot, staying out of sight on couches or in creek beds, or hiding in plain sight while they serve our food and fix our roads."

00:07:47:04 - 00:07:51:14
Tom Haederle
So how do you reach that population and direct them to the available resources?

00:07:51:16 - 00:08:20:28
Sarah Stella, M.D.
Yeah, that's a great point. And I think, you know, a lot of times what we think of as a homogeneous population of people is actually a very diverse, heterogeneous population of people with very different pathways into homelessness, very different needs. And so one way that we do that is we use data to help us identify folks really early in their hospital course.

00:08:21:00 - 00:08:58:14
Sarah Stella, M.D.
And so that allows us to proactively identify people experiencing homelessness. To do that, we use Denver Health's homeless registry. And so that helps us kind of more inclusively and comprehensively identify people who may be experiencing homelessness. And that's sort of our starting point. And then we use the Homeless Management Information System or Colorado HMIS, and that really helps us better understand who this patient may be connected with in the community in terms of partners and resources.

00:08:58:16 - 00:09:22:12
Sarah Stella, M.D.
It helps us understand if they may be eligible for specific programs, and that is a good way to kind of see information that often hospitals are really blind to. Those data sources are really important for us to proactively identify folks and enable outreach to happen. And then we meet with the patient. So we have a consult based team,

00:09:22:12 - 00:09:49:15
Sarah Stella, M.D.
so an interdisciplinary team of social workers, care coordinators, myself and others who are on the ground, who really have a unique expertise and an understanding of the resources, which can often change. So they're not static. The team is really working closely on a day to day basis with a whole range of different community providers. When we're meeting with someone,

00:09:49:18 - 00:10:24:10
Sarah Stella, M.D.
we are really trying to meet them where they're at. We're really trying to understand what their unique story, what their specific barriers are, and we're really trying to make the best recommendation and connection for them based on not only their housing needs, but their health needs. And so we know that the patients that we care for in the hospital setting often have complex needs such as functional impairments, mobility impairments, difficulties sometimes completing their activities of daily living.

00:10:24:10 - 00:11:00:20
Sarah Stella, M.D.
And that's about 60% of our patients on the inpatient side. And so these are folks with really complex needs. And so we're really trying to understand those specific barriers and what their preferences are, what their medical needs are, and make the best recommendation and connection for them in that moment. We're often seeing patients at their some of their worst moments. And it is a privilege to walk beside them, to sit with them in those worst moments and to restore hope.

00:11:00:26 - 00:11:35:01
Sarah Stella, M.D.
So a lot of what I see as a hospitalist is loss of hope and what that can do to a person. And the last thing that people are expecting when they come to a hospital is a connection to housing or a partner, which ultimately could lead to more stability for them. That's often what they need most, because it's very hard to improve someone's health and well-being when their basic needs are not met and they're focused on survival.

00:11:35:04 - 00:12:14:04
Sarah Stella, M.D.
So it feels really good to be able to provide something that is unexpected and that is hopeful, because I think that, you know, myself as a physician who works in a hospital, I don't get to see the good outcomes. I see people during their worst times in times of crisis. And so to be able to provide these connections really helps us as health care providers, because witnessing the needless suffering that we see, especially in this group of patients that is preventable, it's hard.

00:12:14:04 - 00:12:46:22
Sarah Stella, M.D.
And it's really what I am passionate about. So I've seen sort of the, use case. I've seen all the negative impacts of homelessness on folks health. Preventable loss of life, loss of limb, lots of complications. And I've also seen the reverse, that when we are able to restore hope, make a meaningful connection and get someone to a place where they have more stability and their basic needs are met, it feels really good.

00:12:46:22 - 00:12:50:09
Sarah Stella, M.D.
And that's what really motivates me and drives me in my work.

00:12:50:12 - 00:13:11:01
Tom Haederle
It sounds immensely satisfying. I know there's no such thing as a foolproof system that's going to catch everybody and treat all of their needs and but, but it sounds like you've covering as many bases as you possibly can. And that's just it's just so impressive. As we wrap up, I just wanted to ask, you know, for anybody listening today who thinks, well, my hospital should be or could be doing something like that as well.

00:13:11:03 - 00:13:27:16
Tom Haederle
What advice would you have? And I'm thinking more in terms of the financial burden on a safety net hospital and how much all of this kind of thing costs. Is it within the reach of hospitals of similar size or serving similar size, metro areas or smaller markets for that matter?

00:13:27:19 - 00:13:56:13
Sarah Stella, M.D.
Yeah, I mean, I think this is a great case of, you know, not only is this the right thing, the best thing for my patients, but it also financially is the right thing as well. A good place to start is always going into community, being curious, not I think sometimes health care and hospitals go into community when there's a problem, when they want something, when they know how to fix it and they want to tell people how to do that.

00:13:56:13 - 00:14:23:19
Sarah Stella, M.D.
And I don't think that that's the right approach to community engagement. I think going with an open mind and curiosity and learning and understanding. Sometimes there are resources that exist and we're just not aware of them. Other times, we have significant challenges with scarcity of supportive housing. And so those are significant challenges that we cannot solve within the hospital system.

00:14:23:25 - 00:15:00:14
Sarah Stella, M.D.
We cannot solve unless we come together as a community. And think about this as an ecosystem where health systems can use our strengths, but we need partners. We can't solve all this on our own. But yeah, I think it's very important to think about our ability to provide care to people that that need us. I think that looking at the financial benefits and the reduction in length of stay and uncompensated costs are important, as well as seeing how stable housing can provide.

00:15:00:20 - 00:15:10:12
Sarah Stella, M.D.
It's really a platform for engagement in care and ultimately it's what's needed to improve someone's health and well-being.

00:15:10:14 - 00:15:25:16
Tom Haederle
Well, I think the work that the HOPE program is doing in Denver is I already said this, but I'll say it again, it's inspiring and I hope that people listening today will give some thought and think, you know, maybe there's something we can learn from here. Maybe there's something in this model we can duplicate and do in our own backyard.

00:15:25:16 - 00:15:35:16
Tom Haederle
And so I thank you for coming on Advancing Health today and for the fantastic work that you're doing on behalf of the people of Denver. So congratulations and keep it up.

00:15:35:20 - 00:15:37:22
Sarah Stella, M.D.
Thank you very much.

00:15:37:25 - 00:15:46:16
Tom Haederle
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