Communicating With Aphasic Patients after Stroke

By: Shelia Carlisle, Speech Pathologist, HealthSouth Lakeshore Rehabilitation Hospital

 A common diagnosis patients present at HealthSouth Lakeshore Rehabilitation Hospital is stroke. One of the many deficits a stroke patient may incur is aphasia, a speech and language disorder that causes difficulty using or comprehending words during listening, speaking, reading and writing. Although symptoms may vary from patient to patient, the difficulties and frustrations people with aphasia and their families encounter are consistent.

Aphasia changes the way healthcare providers communicate with these patients. When communicating with an aphasic patient, consider the following tips:

1) Make sure you have the patient’s full attention before communicating.

2) Eliminate background noise or distractions such as televisions, radios, phones or staff/visitors.

3) Speak to the patient as an adult, using appropriate tone, volume and pitch. Do not talk down to the patient.

4) Keep your instructions simple. Speak at a slow rate and emphasize key words.

5) Do not pretend to understand the patient if you do not.

6) Encourage and use all modes of communication including speech, writing, gestures, drawing, facial expressions, eye contact, pointing, choices and yes/no responses.

7) When asking the patient a question, ask questions that can be answered with a “yes” or “no”. Visual cues are very helpful (i.e., head nods and/or written choices).

8) Give the patient adequate time to respond to questions. Sometimes this can be longer than you expect.

9) Resist the urge to finish the patient’s sentences or offer words.

10) Be ENCOURAGING and PATIENT!

Involve family members in the patient’s care as much as possible especially during communication attempts. Encourage independence and allow the patient to do so much as he or she can for themselves. It may help a person with aphasia, as well as their caregivers and families, to have a book or page with pictures and/or words about everyday topics so the patient can communicate more easily. The inpatient and outpatient speech therapy departments at HealthSouth Lakeshore have many of these tools available for patients and staff use and can assist in educating family members about aphasia and the most effective way in which to communicate with the patient (i.e., gestures, writing, verbal, etc.).

HealthSouth Lakeshore is certified for Disease-Specific Care in stroke rehabilitation. The Joint Commission’s Gold Seal of Approval™ was awarded to the hospital for its compliance with the organization’s national standards for healthcare quality and safety for stroke rehabilitation.

Studies indicate 60 percent of stroke survivors can benefit from comprehensive rehabilitation. Eighty percent of patients receiving this level of therapy return to their homes, work, schools or active retirement, according to the National Rehabilitation Caucus. The Joint Commission’s acknowledgement of HealthSouth Lakeshore’s continuum of care for stroke offers patients and families peace of mind in knowing they are getting quality stroke care for maximized results.


About HealthSouth Lakeshore Rehabilitation Hospital

HealthSouth Lakeshore Rehabilitation Hospital is a 100-bed inpatient rehabilitation hospital that offers comprehensive inpatient and outpatient rehabilitation services. Serving patients throughout north central and central Alabama, the hospital is located at 3800 Ridgeway Drive in Homewood and on the Web at www.healthsouthlakeshorerehab.com .

Technological advances in the hands of a gifted team result in saved lives

By: Yung Lau, M.D.
UAB Professor and Director, Division of Pediatric Cardiology

Thanks to improved technology, pediatric cardiologists at Children’s of Alabama are seeing improved survival rates in children with hypoplastic left heart syndrome and other critical heart conditions.

Hypoplastic left heart syndrome, or the condition of babies born with only one ventricle, is a condition requiring surgery at birth, at 4 to 6 months, and again at 3 to 5 years of age. We discovered that a certain percentage of babies between the first two surgeries could be expected to die suddenly at home.

As a result, Children’s launched Hearts at Home, a program intended to help parents and physicians work together using remote technology to improve that percentage of inter-stage mortality.

With software by Vivify Health, physicians can monitor a child’s condition through a HIPAA-compliant secure system. Parents are provided with a tablet and Vivify’s proprietary software that enables them to enter information such as weight, weight gain and oxygen saturation. That information, along with graphs and trends, is uploaded to physicians. The camera on the tablet even allows practitioners to view the child when a parent is concerned in order to assess whether he needs to come to the hospital.

Another technology, AirStrip ONE, allows us to monitor patients in the hospital from anywhere in the world and consult more effectively with colleagues. With AirStrip ONE, physicians use the Internet and a simple app on their phone to see results from a hospital bedside monitor within five to 10 seconds. We can check on patients periodically, and when needed, we can enlist the support of colleagues for a consult, even when every participant is in a different location. Several eyes almost always mean improved care, as each team member looks at a different aspect of the data. For instance, when a cardiology intensivist recognizes that a particular incident may have been significant, she can ask a pediatric electrophysiologist to look at the rhythm at a particular point in time. The technology allows us to look at trends remotely and adjust our course of care accordingly. Thanks to AirStrip, we have been able to improve and save lives.

Of course, even the best technology is limited by the people who apply it, and the team at Children’s works together in impressive ways to apply these technological advances to make a difference in the lives of our patients. We are part of an organization, Children’s of Alabama, that is dedicated to the care of children. Supporting professionals from therapists to social workers to child life specialists to pharmacists on our team are all focused on forming a cohesive, multi-disciplinary team.

The results have been impressive. Nationally, the average mortality rate for all pediatric cardiac patients is 3.5 percent. Our Birmingham group’s mortality rate in 2015 was 1.6 percent, and that improved to .7 percent in 2016. In addition, while the national mortality rate for hypoplastic left heart syndrome is 8 percent, thanks to Hearts at Home and our team of surgeons, intensivists, cardiologists, anesthesiologists and supporting professionals, we had no deaths due to that condition in 2016.

That’s a result we can all live with.

Got Millennials?

By: Tammie Lunceford, CPC Healthcare Consultant with Warren Averett LLC

As we meet with clients and evaluate the trends affecting the day to day growth of the practice, it is evident that technology is an important consideration. In the past, physicians relied on referrals from other physicians to keep new patients entering the practice. Once the millennial leaves the pediatric physician, the process they utilize to seek treatment may now be vastly different than it was a few years ago.

Smart phones have allowed millennials to utilize the web in seeking medical treatment based on convenience rather than a valued relationship. Your website must be sleek, mobile-friendly, and allow users to get location maps and contact information. If your website is outdated and a mobile phone can’t be utilized to find information in 30 seconds, they’ll move to another website. Millennials are more likely to engage with applications such as Facebook, Twitter and Pinterest than emails and blogs.

Millennials are interested in health and wellness, and they are looking for value and a healthcare organization they can relate to—a genuine brand that is doing something to make a difference. Communication is key. A phone system that directs a patient to a voicemail box will drive patients away from a practice. A patient portal is a vital tool to enable secure messaging, appointment scheduling and live chats. A patient kiosk is helpful in expediting check-in, even better is an app which allows patients to check-in and pay a co-pay before leaving home.

Access to care is essential in capturing a millennial as a patient. Conveniences such as, drive through windows, remote controls and the internet have allowed us to get almost anything quickly. There is tremendous competition in access to care with the growth of urgent care on every corner and the rapid evolution of telemedicine. Practices must be able to offer immediate access instead of expecting that the patient fit into the strict schedule of the practice. Extending practice hours, expanding service, and making your practice accessible to potential patients through the use of mobile technology is part of the formula for keeping your practice healthy with new patients.

Moving a medical practice can be a daunting task

 

By Thomas Kane, CEO

Keep IT Simple.

Keep IT Simple has participated in 150+ moves, in-place relocations, new office constructions, and renovations.

Moving a medical practice can be a daunting task. A medical office move can be a result of needing a bigger space, physician retirement, or practice acquisition. While making patients aware of a major change is most certainly a priority, it is equally important to make sure their documents and all office data and service equipment survives the move as well.

What are some things to consider when moving a medical practice? Why is this important?

Whether a medical practice is renovating, moving upstairs, or across town, it is very important to consider how the computers and network equipment will be affected. Are you going to use a new internet provider or a new phone service? Who will be responsible for transporting your computers and network equipment? Who will set it all up again? When will your practice be able to see patients again or take payments?

When planning for a major move, consider having a technology company perform additional backups before the transfer, transport your equipment, and set it back up again. Using a technology company is important because traditional moving companies are not equipped to handle medical technology equipment properly. In most cases, servers and workstations house all patient information and must be transported safely by a professional familiar with using information-sensitive software.

If your medical practice is still using paper charts, it is critical to have your moving company sign a business associate agreement. When a company will be responsible for transporting medical records, they will have exclusive access, even momentarily, to patient information.

In most cases, your office will need to stop seeing patients for equipment to be taken down, backed up, and packed up for a move. Aside from the physical move of your equipment, it is equally important to consider how long it will take to move your equipment. During the hiatus, you can adjust your schedule accordingly, and let patients know when you’ll be available for appointments.

Additional things to take into consideration are:

• the location of computer equipment, and

• what services will be used in the new space.

It is important to know where the computer equipment will be located in your new space so that power plugs, network plugs, phone plugs, and counter-top holes are accessible and the equipment can be properly set up. Most services, like internet, TV, and phone, can be moved to a new location with advanced notice. Sometimes, you will want to take this opportunity to change internet providers, add additional TVs, or upgrade your phone system. These are things that a good technology consultant can help you prepare for so that you don’t have any surprises.

Moving technology equipment is best left to the original installers. Is it common practice for IT companies?

Best case scenario is that the original installers are involved in taking down and setting back up the technology equipment for the new office. The original installers are experienced with all the nuances of your technology and have the best knowledge of how it all fits together. It is very difficult for a technology company, or even the practice owner, who is not very familiar with what all the equipment is, how it is setup, and how it all works together, to come in and take it down properly and put it all back together to work again in the new space.

If a medical practice operates from more than one location, it may be necessary to install new networking equipment so that there is a secure and HIPAA compliant connection between the two or more offices so that data can flow between them in a secure way. This is much easier to coordinate with a good technology consultant that can guide you through purchasing the right equipment, getting the correct services from your internet provider, and successfully setting up the connection.

Most technology companies, like moving companies, will charge for services that include transporting and setting up your technology equipment. Considering that “technology equipment” in most cases is inclusive of all your patient information, this is most certainly worth the investment. Since most moving companies do not operate with proper knowledge of how medical technology works, expensive equipment can get thrown in a truck, damaged, exposed to high or low temperatures that will affect its performance, dropped, or mishandled in such a way that affects your ability to see patients.

What about other moves that aren’t physical, such as acquired practices?

Acquiring practices will require sometimes tricky situations. If the practice that is being acquired has technology, it may require an upgrade or additions to become part of your practice. If the practice is also acquiring the patient data, decisions will need to be made on how you that data will be accessed. Are you going to convert it and import it into your own data? Are you going to setup access to be able to see both systems side by side? These are important questions to ask.

Advice for medical practices making a move.

Reach out to your IT support company early on to find out if they offer services to help during your move. They can properly help your plan. One of the biggest mistakes a medical practice can make is to not include IT support early enough. This can affect how long your system is down, where you can locate your equipment, and how the equipment will perform when it is ready to use in your new space.

Keep IT Simple can help you as early as the blueprint planning stage to be sure that you are building out exactly what you want, for exactly what you need, so that it works and looks great. We have the experience and knowledge to work with your architect, contractors, cabinet installers, electricians, and low-voltage installers. We work with your staff to help provide an easy transition that is safe for your patients’ valuable information.

Keeping Promises with Irene Bailey, M.D.

By: Lori M. Quiller, APR

Director, Communications and Social Media
Medical Association of the State of Alabama

Physicians Giving Back Keeping Promises with Irene Bailey, M.D.

Irene Bailey, M.D., is a woman who believes in the power of faith, family and medicine. Running two practices, one in Tallassee and a new extended-hour family medicine/urgent care facility that recently opened in Montgomery, can take its toll. But for Dr. Bailey and her husband, Shaikh Wahid, M.D., there’s always time in the day to enjoy a cup of tea and a piece of chocolate.

Born and raised in Bangladesh, Dr. Bailey’s dream of being a physician began when she was a young girl with a promise made to her father.

“I lost my baby brother when I was 10 years old and he was three months old. That was the first dead body I had ever seen and I was shocked. Now I’m the baby in the family. My parents were devastated,” Dr. Bailey explained. “But, that’s when my father told me, ‘Be a pediatrician and help these kids.’ It was my dream, too. I wanted to help even though I was so young.”

She went to medical school and after just one internship moved to New York with her husband and two-year-old son in 1993. While her husband looked for his residency program, she worked as a nursing school instructor. In 2001, she discovered the UAB School of Medicine Montgomery Regional Medical Campus.

“Through the Family Medicine Residency Program, I realized that I could see everybody. I knew I wouldn’t be bored. Today I see everyone from grandbabies to grandladies. We touch every part of every life, and I love it! I enjoy every day because I’m so blessed!” Dr. Bailey said.

Before long, Dr. Bailey found herself in a unique situation when she became the only full-time physician working with The Learning Tree in Tallassee. The Learning Tree is a nonprofit organization providing educational, residential and support services for children and adolescents with developmental disabilities, including autism. As a statewide organization, The Learning Tree serves more than 600 children and adolescents in 30 Alabama counties, but in Tallassee, the residential school also services Jacksonville and Mobile for about 100 children.

“Treatment can pose a challenge,” Dr. Bailey said. “Sometimes I visit them there at The Learning Tree, but sometimes the children will need to come here. My other patients have always been very understanding, and we make every accommodation we can to get these patients in and seen quickly. But, sometimes I’ve had to go outside to the van to see them because there are just too many distractions here in the office.”

Dr. Bailey said that as her relationship with the administration and staff of The Learning Tree has grown over the past four years, so has the willingness of other specialty physicians to lend a hand when necessary. In fact, Dr. Bailey said, some of these patients who are not part of the residency program in Tallassee travel as long as five hours to see her.

“Autism presents special circumstances, but we all try to rise to that occasion so the children are as comfortable as we can make them,” she said. “I could have said no when this opportunity presented itself, but I’m so blessed. I’m happy that I have this opportunity with these children. If I can help them just a little bit, it’s not them – I’m the one who’s blessed.”

With her work in the Tallassee community and The Learning Tree, and the success of two medical practices, one has to wonder about that promise she made so many years ago.

“My mother and father have both been able to visit and seen me practice medicine. They were so proud! I was also blessed to have had so much support from my father-in-law, who was also a physician. Although it was a promise to my father when I was a child that I become a physician, this has been for me, too,” Dr. Bailey said.

Ribbon Cutting VenaSeal _ BHC Vein Center has recently been named a Center of Excellence for the VenaSeal™

Birmingham Heart Clinic’s Vein Center has recently been named a Center of Excellence for the VenaSeal™ closure system to treat venous disease. In addition to being the first and only practice in Alabama to use this technology, this means that BHC is now being utilized as a training site of this device for professionals from several surrounding states.

The VenaSeal™ closure system is a medical adhesive for the closure of greater and lesser saphenous veins in the legs. Overall, it reduces discomfort and recovery time for patients, and is designed to allow patients to return more quickly to normal activities. This unique approach eliminates the risk of nerve injury when treating the small saphenous vein. The procedure is administered without the use of tumescent anesthesia, and only one needle stick is needed to numb the area. It also eliminates the need for post-procedure compression stockings, and reduces post-procedure pain and bruising.

"This is a unique, almost painless procedure performed in our clinic that is much more comfortable for our patients than traditional treatment methods for venous disease,” explained Dr. Foster. “VenaSeal technology is currently the most advanced vein treatment available, with less discomfort and faster recovery for patients. In fact, patients undergoing this procedure can return immediately to normal activities and exercise.”

Symptoms of venous disease include painful, heavy or swollen legs, as well as dry skin, cramps, ulcers and itchy skin.

BHC also held a ribbon cutting for its fifth practice downtown at St. Vincent’s Birmingham Cardiology Clinic located at 2700 Tenth Avenue South, POB 2, Suite 305. Drs. Monica Hunter, James Towery, and Richard Vest provide high-quality cardiovascular care for patients at this location. Services include diagnostic testing, interventional treatments and procedures, and the management of pacemakers, arrhythmia and Coumadin.

In addition to the downtown location, BHC sees patients at four other clinics: the main campus at 100 Pilot Medical Drive across from St. Vincent’s East in Trussville, at Northside Medical Associates campus in Pell City, St. Vincent’s Blount in Oneonta, and in Gardendale.

The Women of CVA – Heart Health Tailored for Women

Cardiovascular Associates of the Southeast opened its doors in Birmingham, AL in 1946. The private cardiology group is comprised of over thirty physicians who specialize in an array of diagnosis and treatment options with a balance of nationally recognized experts, as well as recently trained cardiologists, in order to maintain our position at the forefront of cardiovascular care.

CVA is unique because they employ the most female cardiologists in private practice in the metro Birmingham area. These women are dynamic and each as passionate as the next about providing their communities with comprehensive women’s cardiology services.

One of the longest standing partners at CVA is Elizabeth Branscomb, MD, FACC. “I came here in the 80’s because the best people in my medical class were here,” says Branscomb. “At that point, CVA had been around for 60 years and Echocardiography was in its infancy. It was an opportunity for me to join a great team to develop new noninvasive procedures.”

Branscomb, the female cardiology trailblazer, helped develop nuclear cardiology and Positron Emission Tomography (PET) stress testing, a noninvasive form of testing. “We were one of the first places in the world to do high volume PET stress testing which can be better for women as they are less likely to have false positives,” says Branscomb. Coupling that with a high volume availability of stress echo which has no radiation, the cardiologists are able to either completely avoid radiation exposure or greatly minimize it in female patients under fifty or of childbearing age in whom ionizing radiation is associated with an increased risk of breast cancer. “Women often get unnecessary testing and procedures,” says Dr. Anuradha Rao. “We offer a thoughtful approach to women’s cardiac care.”

Anuradha Rao, MD, FACC, heads up the CVA Women’s Cardiology. “We are unique in our community because we have a dedicated focus on women’s cardiac issues,” says Rao. Before joining CVA, Rao developed and ran the Women’s Cardiology Program at Tulane. “When I interviewed with my future CVA partners and I met with the women’s specialty groups at Brookwood Baptist Medical Center, there was an overall sense of support,” she says. “A lot of hospitals claim to be women’s hospitals, but Brookwood offers services that go beyond reproductive health from bone health, to cardiac, to mental health services. It’s truly a comprehensive women’s hospital that offers holistic health for women.”

Rao was able to bring her expertise for pregnant women with cardiac issues. “Traditionally, there is no formal training for physicians treating pregnant women with heart problems,” says Branscomb. “Those patients need someone who has experience treating pregnant women and can identify the slight differences in their care.” Rao worked alongside high risk obstetricians while at Tulane to develop that expertise.

Community outreach is important to the practice because often women don’t recognize heart disease and don’t seek proper care. Saema Mirza, MD, FACC, works with the CVA outreach program. “Normally, patients don’t have access to female cardiologists in outreach programs,” says Mirza. “We are able to give them the choice to have a woman and our patient’s gain access to the world class expertise of the CVA group”

Joyce R. Koppang, MD, FACC, has been with CVA for twelve years and also works with some of the group’s outreach communities. “Some of our patients are in areas where they can’t get into town for the care they need,” says Koppang. “We have so many locations for convenience of expertise and we have plenty of options to help provide services that would be totally unavailable to them. We maintain our patients because they have so many places to go.”

The women of CVA don’t feel the need to compete; they work together as a team. “Cardiology has gotten so subspecialized. We don’t hesitate to tap our colleagues for their expertise because as a collective group we have greater knowledge to provide the highest quality of care to our community,” says Rao. “It’s a pleasure being here and on any given day because we have such positive comradery.”

“We are on the forefront of women’s health,” says Branscomb. “Not only do our partners at CVA care about women, they are open to women’s health and would not feel complete without a women’s cardiology program.”