Triangle Hospital Update

by Danielle Jackson

With so many health care options around the Triangle, how do you pick where to go when you are sick or injured? Well, when you have great hospital systems like we do here, you can go virtually anywhere and receive excellent care. That’s what we found out when we delved into the area’s hospital systems for our annual update. From new technologies to advanced care initiatives and national recognition, area hospitals have no shortage of great news — and it is just the beginning, as the following updates prove.

Rex
Lots of great things are happening at Rex Healthcare in Raleigh, ranging from new valve replacement procedures that are less invasive to new health care groups that target neurosurgical and psychiatric care.
Photo: Rex Healthcare
Rex Healthcare

Enhanced care
Among Rex Healthcare’s many achievements over the past several years has been the opening of its Rex Neurosurgical Specialists, which is just part of the hospital system’s focus on enhancing patient care in as many areas as possible.

“The group is comprised of three well-known neurosurgeons who have teamed with Rex to help us develop our neurosciences program here,” says Steve Burriss, the hospital system’s chief operating officer. “They bring with them great community reputations and really have fostered a very collaborative relationship with Rex.”

Another area of enhanced patient care has been the gynecologic services provided through Rex’s relationship with UNC Health Care.
“Dr. Catherine Matthews has been instrumental in the development of a pelvic-floor clinic, which is a much-needed service for women in this area,” Burriss says. “Considering the subject matter of pelvic-floor issues and the personal nature of that, she has really hit it off well with women in the area.”

Most recently with respect to enhanced care, Rex has opened the Raleigh Orthopaedic Surgery Center, a four operating-room, two-procedure room center on Edwards Mill Road that is devoted purely to orthopaedics. The center is a collaboration between Rex and the Raleigh Orthopaedic Clinic.

“This stand-alone facility drives an incredible patient experience for those who utilize it,” Burriss says.

Enhanced innovations
Innovation has always been a hallmark of Rex Healthcare, and several key developments have played a role in keeping this innovation at the forefront.

“Innovation, teaching and research are what keeps an organization young,” Burriss says.

He is most excited about a development that began almost a year ago, which involves a new form of valve replacement.

“We essentially are working on something that replaces an aortic valve in a noninvasive way,” he says. “This will save patients a major trauma of having their chests cut open to replace a valve. We have been doing two per week since last fall, with outstanding results.”

According to Burriss, most patients who have the procedure done — who are an average of 85 years old — are more mobile a day or so after the surgery than they would be had they gone the traditional replacement route.

“We have been able to bring together the physicians from Wake Heart & Vascular, Rex Heart & Vascular, Rex Cardiothoracic Surgery Specialists, and UNC,” he says. “It takes a room full of people, but it’s a wonderful procedure.”

Its innovative approaches extend into other areas as well — 80 or so, to be exact.

“We are conducting more research than ever, with about 40 vascular trials and 40 oncology trials open right now,” Burriss says. “We’re excited to make these trials available to people in Wake County.”

Last year, it developed Rex Strategic Innovations and Rex Health Ventures, two efforts that are geared toward facilitating innovation in the region and supporting those with innovative ideas in health care. The groups make select investments after reviewing innovations from within and outside of the community, and then either make grants or investments with the hope that the next great invention comes from the area.

Another cool innovation has been the Rex Cancer App, which lets Rex connect with patients in an entirely different way.

“They can log medications, keep track of appointments and share with family members,” says Kerry Grace Heckle, director of marketing for Rex. “There’s even a wig app where they can virtually try on different wigs after uploading their pictures. We’re keeping it light but also having it serve as a useful tool that really benefits patients.”

“These innovations really do create more emphasis on wellness as opposed to us taking care of acute, episodic illnesses,” Burris says. “We need to be in the business of helping people manage their health instead of just helping those who are sick. It’s a huge undertaking, stressing healthy nutrition, exercise and prevention, but we’re looking at ways to make that work under new health care reform.”

Enhanced infrastructure
Building upon its focus on cardiovascular care, Rex recently announced plans to construct a heart and vascular hospital at its main campus in Raleigh. It recently received state approval for the state-of-the-art facility, which brings together academic medicine, research, community medicine and clinical trials all under one roof.

“There’s a year of design ahead of us and then more time before it’s open, but it will be unlike anything as far as we know on the East Coast when it’s done,” Burriss says.

It also is working closely with UNC Health Care on addressing behavioral health.

“All local hospitals deal with this every day, but we don’t have assets in the community to take care of this need,” he says. “Our first step has involved working with UNC to open 16 much-needed inpatient psychiatric beds at the WakeBrook Campus off
of Sunnybrook Road, and then 12 beds at some point after we receive approval.”

Lastly, Rex is continuing with its approval process to build a hospital in Holly Springs, which would bring high-quality care to yet another segment of the Triangle community.

WakeMed
A cardiologist, assistant and circulator perform a procedure in one of WakeMed Health & Hospitals’ cardiac catheterization labs, which are staffed 24/7.
Photo: WakeMed Health & Hospitals
WakeMed Health & Hospitals

New developments
WakeMed Health & Hospitals’ commitment to enhancing community access to quality medical care continues to grow. The current expansion of WakeMed North Hospital, the August 2013 anticipated opening of the Garner Healthplex and the addition of eight rehabilitation beds to its Rehab Hospital are just a few of the projects currently underway to help meet the growing health care needs of Wake County.

The WakeMed Garner Healthplex in particular is making waves. Located on a 20-acre site just off of U.S. Highway 70, the 50,000-square-foot facility will feature a 10-bed emergency department, lab and imaging services, as well as physician offices. An estimated 12,000 to 15,000 patients are expected to receive treatment at the WakeMed Garner Healthplex Emergency Department during the first year of operation. It will be the seventh such healthplex for the hospital system, with $17 million in investments already made and with 150 full-time-equivalent employees staffing the facility. It is scheduled to open Aug. 19, and it also will serve as the base for WakeMed’s Air Mobile medical helicopter operations.

The expansion of the existing WakeMed North Healthplex on Falls of Neuse Road into Wake County’s fifth hospital is underway and scheduled to open in May 2015. It will be a 61-bed acute care hospital with a focus on inpatient women’s specialty services ranging from obstetrical and gynecological services to diagnostic and therapeutic care.

“While we fully expect WakeMed North Hospital to eventually expand into a full-service hospital, serving men, women and children, the immediate need is for women’s services,” says Carolyn Knaup, vice president of WakeMed ambulatory services.

“Transitioning to a hospital was the next logical step as the infrastructure is already in place, and the community has a critical mass of more than 262,000 residents living within a seven-mile radius of the facility,” adds Dr. Bill Atkinson, president and CEO.

Expansion of services
WakeMed has long been known as a leader in heart care, but now it will be even more so as it improves upon its WakeMed Heart Center.

“Since the first open-heart surgery in Wake County was performed at WakeMed more than 40 years ago, our team of cardiac specialists has continued to pioneer the use of the latest technology and techniques to help patients achieve the best possible outcomes,” says Betsy Gaskins-McClaine, vice president of WakeMed Heart & Vascular Services.

The hospital is the only one in the state that has 24/7 catheterization labs.

“Having a staff onsite 24/7 means our cardiac patients receive treatment faster, which also is known as door-to-balloon time,” she adds. “Every minute is crucial, and lowering door-to-balloon time also lowers a patient’s risk of death and serious damage to the heart muscle.”

Averaging a 39-minute door-to-balloon time, which is far less than the American College of Cardiology and American Heart Association’s recommended 90-minute guidelines, the center offers dramatic results to its patients. Also newsworthy is the fact that 100 percent of all WakeMed Cath Lab staff members received registered cardiovascular invasive specialist, or RCIS, credentialing in 2012 — a huge milestone, Gaskins-McClaine says.

Also of note is the transcatheter aortic valve replacement, or TAVR, procedure for heart valve repair that Drs. Bryon Boulton, a cardiovascular surgeon, and cardiologist Walter Tan, MS, FACC, FSVM, lead together. The less-invasive procedure is ideal for patients suffering from severe aortic stenosis, which is a narrowing of the aortic valve opening that does not allow for normal blood flow.

Expanded infant care services
For more than 35 years, WakeMed has been at the forefront of specialized care for premature babies as young as 23 weeks of gestational age and weighing as little as one pound. It also is home to Wake County’s only Level IV neonatal intensive care unit (NICU) and was an early proponent of a pioneering neonatal treatment called NIDCAP, or the Newborn Individualized Development Care & Assessment Program. Its NICU also was recognized as one of only four facilities in the world to earn nursery certification from the NIDCAP Federation International, which acknowledges nurseries that have integrated developmentally supportive and family-centered care into all aspects of care.

“WakeMed’s team of dedicated neonatologists, nurses, support staff, and volunteers provide a remarkable level of care for infants and their families,” Atkinson says. “For 35 years, WakeMed has provided the highest level of care to the tiniest patients. This accomplishment is evidence of the exceptional care provided to NICU infants and their families.”

In addition to being named a NIDCAP-certified nursery, WakeMed is home to the Carolina NIDCAP Training Center for medical professionals — one of just 10 in the country and 20 worldwide. Led by pediatric development specialists Jim Helm, Ph.D., psychologist Melissa Johnson, Ph.D., and Dr. James Perciaccante, WakeMed’s director of neonatology, the team follows patients from birth to two to three years of age to ensure families are receiving the best possible care to help their children grow and thrive.

Additionally, there is a current expansion in progress that will add 12 beds and convert some existing neonatal beds into private rooms so parents can sleep in the same rooms as their newborns while they are under care.

New specialties
WakeMed’s roster of physicians and health care professionals continues to grow across Wake and Johnston counties as well. Last November, it added four new cardiologists and one cardiovascular surgeon to its physician practices division. Last year also marked the expansion of WakeMed’s primary care network in the community, with new practices in Cary, Morrisville, Fuquay-Varina and Garner. This past February, the Parkway Primary Care center opened with three experienced providers.

This trend continues well into 2013, with more than a dozen physicians joining the rapidly expanding division, including in the areas of neonatology, maternal fetal medicine, obstetrics and gynecology, ENT, and cardiology, to name a few.

“WakeMed is proud of the growth of our physician practices, and we are fortunate to partner with primary care physicians, specialists, and subspecialists to help ensure area families have access to the highest-quality medical center in convenient locations throughout the region,” Atkinson says.

Duke
In its biplane angiography suite, Duke Raleigh’s team of doctors can more effectively capture X-ray images from two different angles, giving them more realistic visualizations of their patients.
Photo: Duke Raleigh Hospital
Duke Raleigh Hospital

New leadership
Effective Jan. 1, Duke Raleigh Hospital welcomed new president Richard Gannotta, NP, DHA, FACHE. Gannotta previously served as the hospital’s chief operating officer for more than six years, so he is very familiar with Duke Raleigh’s mission, its operations, and its dedication to serving the community.

Gannotta is a nurse practitioner who has spent a significant amount of time working by patients’ bedsides and also has some great insight into creating a caring environment for patients and staff.

“My mentor, colleague and friend, Doug Vinsel, has laid an incredible foundation for the hospital, and I plan to maintain the same focus areas he has established and worked tirelessly to build,” Gannotta says.

As part of the Duke University Health System, Gannotta says Duke Raleigh will continue its commitment to providing the very best care for patients and to leading the way in clinical areas including oncology, neurosciences, and orthopaedics.

“We also will continue our mission to be a community leader,” Gannotta says. “I believe that we play an integral role in the health and well-being of the citizens of Raleigh, Wake County and the greater Triangle, and that won’t change. A healthy community is good for all of us, and I want to inspire healthy behaviors and make sure that Duke Raleigh will be there when you need us.”

Biplane angiography suite
Duke Raleigh’s biplane angiography suite is the first of its kind in Wake County. As the name implies, biplane angiography captures X-ray images from two different planes, or angles, allowing physicians a more realistic visualization of the anatomy that is projected on a monitor in real time.

“Traditional X-ray imaging flattens our view of the body to two dimensions,” says Dr. Ali Zomorodi, a neurosurgeon and medical director of skull base and cerebrovascular surgery at Duke Raleigh. “By directing an X-ray beam from both the side and the front of the body, we can gather continuous imaging of complex structures three dimensionally. This allows us to perform procedures without having to open up and directly visualize the inside of the human body.”

Biplane technology spares surgeons from having to perform open procedures and enables them to access the affected area endovascularly instead, which not only is less invasive but also less risky. Thanks to endovascular techniques and the use of biplane imaging, patients who undergo neurosurgery at Duke Raleigh can experience the benefits of a faster recovery, fewer complications, and less postoperative pain and discomfort.

The new biplane lab also allows electrophysiology physicians, or EPs, to diagnose and treat atrial fibrillation (AF), which occurs when the upper chambers of the heart beat fast and irregularly.

“It’s unique for a hospital of our size to have this capability,” Zomorodi says. “Patients can be put off by the sense of anonymity they feel at large, metropolitan medical centers. With amenities such as the biplane angiography suite, Duke Raleigh Hospital can offer the same advanced services as a large hospital while still providing personal, small-town care.”

Advanced lung cancer care
Duke Raleigh Cancer Center’s lung cancer care program is a multidisciplinary clinic comprised of lung cancer specialists who provide comprehensive care.

“Our life’s passion is to help patients with lung cancer, caring for them from illness to recovery,” says Dr. Jennifer Garst, a medical oncologist, director of clinical research at Duke Raleigh Cancer Center and chair of the North Carolina Lung Cancer Partnership. “We combine the skills and experience of lung cancer specialists to form our team, which includes a medical oncologist, radiation oncologist, pulmonologist and two surgeons.”

Duke Raleigh Cancer Center recently added a Lung Cancer Screening Clinic to help those at risk for lung cancer and a Survivorship Clinic to empower lung cancer survivors to be engaged in their health.

In its Lung Cancer Screening Clinic, which has locations in Durham and Raleigh, individuals at high risk for developing lung cancer can participate in a screening program that for the first time provides access to the most advanced diagnostic screening tool: low-dose spiral computed tomography (CT) scans.

In addition, smoking-cessation evaluation and counseling is provided, as well as follow-up treatment if needed — all from a team of lung cancer specialists.

Led by Garst, oncology clinical nurse specialist Susan Bruce, MSN, RN, OCN, and Kelly Young, D-NP, the Duke Raleigh Lung Cancer Survivorship Clinic empowers patients and their families to make healthy lifestyle choices to positively impact their ongoing quality of life and help minimize the risks of developing other illnesses or secondary cancers. It follows a lung cancer survivorship care plan and offers individual assessments, both group and individual support, and education during a single, specialized clinic visit.

Expanding programs
Duke Raleigh Hospital’s newly developed Advanced Digestive Care program is the only one of its kind in Wake County and features an interdisciplinary team of subspecialists with a high degree of expertise on hepatobiliary and pancreas disorders, advanced endoscopy, colorectal diseases, and esophageal diseases. The program’s team of specialists uses sophisticated technology and innovative surgical and endoscopic techniques in a coordinated approach to manage common and complex gastrointestinal conditions. With a patient-centric approach, the program’s patient navigators assist patients in coordinating appointments and providing information.

Additionally, Duke Primary Care recently opened two new practices in Wake County: Duke Primary Care Blue Ridge in Raleigh and Duke Primary Care Waverly Place in Cary. Both practices offer family medicine services. Two existing primary care practices in Wake County also joined Duke Primary Care: Peak Family Medicine in Apex and Wakelon Internal Medicine. Peak Weight Loss Clinic in both Apex and Holly Springs also is now part of Duke Primary Care.

The new Duke Spine Center brings together specialties in pain management, exercise science, and the nervous and skeletal systems, making it easier for sufferers to access the help they need in one location.

“The multidisciplinary nature of the spine center allows us to focus on the patient’s needs, not just find a possible treatment that fits within our specialties,” says Dr. Carlos A. Bagley, FAANS, a neurosurgeon and the center’s co-director. “My patients aren’t limited to the neurosurgery I offer or to the orthopaedic surgery my colleagues provide. Instead, we bring everyone together so patients don’t have to guess which spine specialist would best meet their needs. We work together to answer that question for them.”