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Let’s talk about vaping

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Contributor: Chelsea Newman, PA-C, KVH Family Medicine – Cle Elum

The news has recently been inundated with stories of a mysterious illness affecting those who use vaping products. The illness has led to serious lung disease and death in several previously healthy individuals. The CDC and FDA are currently investigating these vaping-linked illnesses and as of October 8, 2019 there are more than 1,299 lung injury reports and 26 confirmed deaths in the US linked to vaping products. Many of these cases involve vaping products containing nicotine and THC, the principle psychoactive ingredient of cannabis. Symptoms of the illness include coughing, shortness of breath, chest pain, fever, nausea, vomiting and diarrhea. Currently, no specific ingredient or chemical has been identified as the cause of the lung disease but all those affected have used vaping products.

Rates of vaping have been on the rise for several years and the most rapid increase has been with teenagers. Among the current vaping associated epidemic, more than 1/3 of reported lung injuries are in those 18 and younger. The 2018 National Youth Tobacco Survey found alarming increases in e-cigarette use among middle and high school aged students and 68% of kids using e-cigarettes are using flavored vape products. Manufacturers of these devices are directly appealing to children with flavors like bubble gum, cotton candy and watermelon. Devices are also made to resemble USB drives in order to discretely use without notice and deceive parents and teachers. Most e-cigarette and vapes contain nicotine, an extremely addictive substance that only reinforces the desire to smoke or vape. Nicotine also has a host of negative health impacts in the body and can alter the development of the maturing adolescent brain.

So what can be done? How can we as healthcare providers, teachers, parents, family members and friends help discourage vaping and e-cigarette use among those that we care about?

One strategy is to talk about it. Don’t assume the sweet, 14-year-old volleyball player sitting in front of you wouldn’t do that kind of thing. Kids are impressionable and easily swayed by peer pressure. Whether you are talking with your patient, student, child or friend, don’t be afraid to ask about vaping use. Be non-judgmental and give advice out of concern. Learn about the variety of vaping products and delivery systems available so that you can recognize them.

We should also be talking with adults who vape. Vaping has been touted as a smoking cessation aid for some but there are significant health risks associated with continued use of nicotine and with so called nicotine-free vape. There are several carcinogens in the agents used to aerosolize the vapor. Also, kids with parents that vape are more likely to think it is safe or acceptable.

Another strategy to curb use is to make these products less appealing and less available. Earlier this month, the Washington State Board of Health passed emergency legislation to ban the sale of all flavored vape products. This legislation lasts only until February 2020 and will be up for renewal. While it helps to address some current safety concerns, it is also a strategy to curb adolescent use and to make these products less appealing and less available while investigators look for the cause of this vaping epidemic.

If you or someone you know is vaping and would like to quit, there are abundant resources to help. Washington also has several resources including counseling with a smoking cessation coach at 1-800-QUIT-NOW or www.quitline.com. There is also a new free app called 2Morrow cessation with a customized quit plan with lessons, daily messages and reminders and access to a live coach. Healthcare providers are on the front line of treating nicotine addiction and a great resource for behavioral and medical strategies to help abstain. Please contact your local health care provider or health department for more help on smoking cessation.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Collaborative Care

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KVH Contributor*

Auren O’Connell, DNP, PMHNP
KVH Family Medicine – Cle Elum

In a medical emergency or when you are not feeling well, one word often comes to mind, “doctor”. According to Merriam-Webster, “The word doctor comes from the Latin word for ‘teacher,’ itself from docere, meaning ‘to teach.'” 

Patient education and teaching are not my first expectation when I seek medical care. “Give me something to feel better” or “make me better” is often on my mind.

Thankfully, many medical conditions are easily treatable and only require brief treatment or interventions. Other conditions are not so simple, requiring occasional follow-up and/or chronic management.

As a society we are living longer, and as we age we are more vulnerable to chronic conditions and mismanagement thereof. If managing our health condition didn’t seem like enough, then comes the cost and coordination of various visits, all of which can snowball and seem overwhelming. 

As a whole, healthcare and funding are transitioning from volume-based (fee for service) to value-based (fee for value). Within this paradigm shift, evidence-based practice models of team-based collaborative care are being deployed, most targeting chronic conditions and/or mental health problems.

There are many terms being tossed around: integrated, medical home, collaborative care, chronic care management, etc. All these terms are important, but all emphasize patient-centered, collaborative, and team-based interventions.

At the core of these models is an emphasis on teaching and collaboration by all members of the care team, including the patient, who teaches the care team about his/her own strengths, needs, and preferences.

The primary care provider is the head coach on the team and is empowered to deliver comprehensive and connected healthcare through a shared treatment plan with measurement-based targets. Nurses and/or care managers help to coordinate the treatment plan, offer self-management support, and answer questions by phone and in person visits.

All of this equates to more value and resources for both the patient and the team.

Quality and collaboration are core values of Kittitas Valley Healthcare. In my experience as a psychiatric nurse practitioner, whole health and value-based healthcare is at the core of what drives both leadership and providers within Kittitas Valley Healthcare. Fortunately, reimbursement models with payers are emerging which will allow for expansion of value-based healthcare that emphasizes quality evidence-based interventions, care coordination support, and collaboration for patients who need it most.

Your primary care provider may approach you about participation in our new chronic care management program or our collaborative behavioral healthcare program, which will be launching in the future. I plan to share more on collaborative behavioral healthcare at a later date, but these are my thoughts on value-based healthcare and collaboration as a whole. 

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Play time for children

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Play time for children

As a pediatrician, I often tell parents that with the exception of books (which are free from the library), they have everything they need within them to raise a happy and healthy child. Reading to your child, getting outside, and playing cost nothing, are technology – free, fun and easy.

Play in particular is generating a lot of interest right now; it has been shown to promote brain development as well as social and emotional well-being. ‘Unstructured’ play (no adult control or directing) allows kids to explore their world, try on different roles and work through their fears. Kids learn how to interact in groups, lead and share, and resolve conflicts, thereby developing vital positive behavioral skills. This type of play encourages creativity and experimentation. It also helps kids work on their “executive function” which is important with decision making and controlling impulsivity. There is evidence that neural pathways in kids’ brains are enhanced through the skills that develop with unstructured play.

Of course the physical benefits of playing including running, jumping, throwing, climbing, etc., are obvious. Playing outside offers even more benefits. Kids tend to burn more calories playing outside than inside, important in our current fight against childhood obesity. Fresh air and contact with nature are helpful in reducing stress levels. Research has shown that kids who play outdoors regularly tend to stick with tasks longer, be more curious and self-directed.

Quite simply, then, play is crucial to child development and learning. Unfortunately, play is threatened on a variety of fronts. There is increasing pressure on children (even kindergartners) to perform academically, and school days can be packed with ‘orderly activities’ with less time for unstructured and especially outdoor play. Many school districts have decreased the amount of recess time as well as PE. The draw of passive entertainment (TV, computer, you tube, video games) is such that the American kids age 5 to 16 spend an average of 6 ½ hours a day in front of a screen, much of it on personal devices such as tablets and smart phones. These personal devices mean kids are usually by themselves without parental involvement—not ideal. Unstructured play is getting squeezed out by this, and our children are the worse for it.

In general, children seem to have a lot more scheduled activities in their increasingly busy days, leaving less time for unstructured play. Between sports, music, etc. parents often feel they hardly have enough time to meet for dinner with their children (but please make time for those family meals!). So how to make time for this important activity? Something may have to give for your child to have the recommended minimum 60 minutes a day of unstructured play, but keep in mind that the benefits of this type of play are many and long lasting. And although unstructured play means you won’t be directing the play, you can still be involved – just let your child lead. Good for everyone!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Behind the Scenes: Materials Management

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Materials Management

We sat down with some of the Materials crew for insights on how they make sure we have what we need, when and where we need it. (Photo: Materials poses at the hospital’s back loading dock.)

“A par level is an inventory management method through which you determine the minimum amount of stock you always need to have on hand.” – dashboardstream.com

Morgan (M)
Bonnie (B)
Michael (MB)

Materials is a generic term. What does it represent?

M: It’s basically all the supplies needed to run the organization and to support patient care.
Are there various roles on the team, or does everybody cover the same areas?

B: No, we have various roles. The techs do all the inventory control, making sure all departments are filled to the par, and also they do all the shipping and receiving.

M: There’s also the buyer role, which is Bonnie and Rhonda. Bonnie is the OR-specific buyer. And Rhonda does all the rest, and Med/Surg. And there’s my role as director. The whole team is great at supporting one another with their workload whenever possible.

The technicians go out and inventory?

M: They make sure that the departments are stocked to their par level. Each item that is stocked in their department is set at a level. So it could be that they have five of something or they have a hundred of another. Our Cerner system tells us how many of each item each department should have at the beginning of the day.

But you’re going, they’re going out to the departments?

M: Every single morning. That’s why they start so early. They do the clinics and all the departments in the morning. They go out and scan first thing, come back and pull all the product that’s needed, and then go back and stock it. Then again later if they need to delivery additional orders that have come in. The team puts on a lot of miles each day.

Does materials stock the entire organization or just the hospital? I’m assuming there’s nothing to stock up at Radio Hill.

M: Home Health sends bins and totes down every day for us to stock and send back up with the courier. We support all KVH clinics. We also provide supplies to external entities as well, so if KVFR is out of a supply and they need something, we will issue it to them. 

Are there any misconceptions about Materials people might have that we could clear up?

B: Maybe that our jobs got easier when the departments began scanning their items?

M: That would be a major misconception.

B: We still reset all the pars, when the levels get off from them not scanning, and we still have the same amount of work, filling blue bins, yellow bins, ordering product.

What would surprise somebody about the work you do here?

MB: I know when I started working here, I was surprised that this small department covers orders and supplies for all the clinics, and the hospital.

What are some of the challenges of working in materials?

B: Not getting enough information to place orders. The amount of back and forth we have to do from not getting all of the information…

MB: It’s a lot more complex than most people probably think.

M: And I think people get frustrated, too, when you ask them for more information. I’ve always told the team we’re not going to play “Bring Me a Rock,” because I don’t know if you want a big rock, a little rock a flat rock, a jagged rock. You’ve got to give us a little bit more information, because we have hundreds of people every day asking for things, and if you don’t give us a little bit more information we cannot guarantee you will get what you need.

They’re going to get the wrong thing –

M: They are, and they’re going to be upset about it or they’re going to be upset that we have to email them multiple times with questions.

Do you have particular vendors or people you’re interacting with regularly as you place orders?

B: The main distributor is Medline. We try to get all of our supplies through them, except for things that they don’t carry or various times where it’s cheaper to buy direct. Then we do have multiple vendors. We probably have 20 to 30 different vendors that we place orders with daily. We have a buying group called Intalere. We make sure that we’re getting the best value and the best rebate back from purchasing.

And then random stuff happens. Like, we need carpet for five buildings, and that lands in your world.

M: Anything that comes through the door comes through our area. We do pretty much all of it except for Pharmacy, Food & Nutrition Services, and some of IT. I chair the capital committee, so all capital requests come through us. We get quotes with buyers and have to run it through analysis, through MD Buyline, to make sure it’s cost competitive, that they’re giving us the best price, that they’re referencing our contracts, then we present it to capital. We get all of the supply requests for remodels and builds. MAC (Medical Arts Center) is huge on my plate right now.

B: Everything funnels through here first, which kind of makes it so everybody thinks everything comes back here.

M: Office Depot is the only group that actually will deliver to ancillary locations. Other than that, every single purchase order and every single purchase has to come through these doors, which is frustrating for clinics up in Cle Elum because there’s a delay while it gets here, gets checked in, and then sent up.
But if we weren’t checking things in, there’s a downstream effect for Accounting where it doesn’t show it was received in the system. We don’t have an accurate way of tracking it if it just starts going out to other locations before we have a chance to check it in, to check the quality, to make sure it’s the correct item. That’s why this has to be the central hub for all incoming products.

What are the rewards of working in Materials?

MB: Definitely the people

M: I think our team is amazing.

MB: We all get along really well, and that can make or break the job.

B: The team dynamic that we have right now makes it nice to be here, even when it is stressful. Everybody pitches in and helps one another. We look out for each other and care about each other.

M: We have a good time when we’re here. We laugh, we joke, you know, it feels like you’re spending time with your friends and your family. And you don’t always get that at work.

MB: This position goes to every department. You get to see, a little glimpse of the goings-on and to meet people from almost every department, too.

Are you expert packers? (“No!!”) Do you get cardboard cuts? (“YES!”) You ought to get hazard pay for that. So what does it take to have a great day at work?

M: No backorders.

B: That’s another thing I think people don’t realize, is how much time we spend navigating backorders, substitutions, and trying to make good decisions cost wise; that it’s going to work for the facility, just how much time we really have to spend on each order, and making sure it comes in correctly.
How does this team’s work support the patient care mission of KVH?

B: Getting supplies in a timely manner at the best cost possible, making sure that everybody has what they need to provide patient care, and that we’re also providing a service that is cost effective.

Imagine if we took Materials out of the equation and clinic staff had to run over here and try and find something or place an order when a provider runs out of supplies. I guess, in a good way, you’re taken for granted because everything is where we need it when we need it for the most part.

B: I think the surgeons would realize pretty quickly if they were short on supplies.

M: Bonnie’s great about looking at the OR schedule ahead of time. Two weeks out, she’ll look to make sure what’s on there. She’ll know what supplies are needed based on their preference cards. She’ll make sure that they have enough on the shelf.

That’s amazing. That’s a direct impact on patient care. Thanks for the work you do to keep us equipped and ready to provide quality care. Clearly, we couldn’t do it without you.

Pediatric food allergies

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Pediatric Food Allergies

We seem to hear a lot more about food allergy lately – and for good reason. Food allergy is more common in kids than adults, the prevalence of it is increasing, and 8% of all kids under the age of 6 have food allergies. Understanding food allergy and the newest recommendations about peanut allergy is important for parents and anyone interacting with children.

A food allergy is an abnormal immune response of the body to a particular food. You must be exposed to a certain food at least once (either by eating directly or via breast milk) in order to have an allergic reaction. An allergic reaction occurs when the immune system’s IgE antibodies react with the food, which releases histamines. These histamines cause the signs and symptoms of food allergy that range from mild to life threatening.

90% of all food allergies are caused by the following foods: milk, eggs, wheat, soy, tree nuts (walnuts, almonds, etc.), peanuts, fish, and shellfish. In children, eggs, milk and peanuts are the most common causes of food allergy. Severe reactions are usually caused by peanuts, tree nuts and seafood. Children often outgrow their allergies; 80-90% of milk, egg, wheat and soy allergies resolve by age 5 years. Allergies to peanuts, tree nuts and seafood are more likely to persist. Approximately only 1 in 5 children will outgrow their peanut allergy.

An allergic reaction to a food usually occurs within minutes to hours of eating it. In addition to hives and wheezing, a child may also have itching, swelling of lips/ tongue, shortness of breath, stomach pain, lowered blood pressure, vomiting, diarrhea and/or anaphylaxis (a severe shock-like reaction). Testing for food allergy is only done if there is a strong suspicion of allergy; an abnormal test does not always mean the child is truly allergic. Testing may include blood tests or a skin prick test.

Treatment for food allergies most importantly means avoiding that food (and similar foods) – not easy in today’s world of processed foods that may contain many ingredients. Even a tiny amount of the offending food can trigger a reaction. Epinephrine is the only treatment for severe allergic reactions and comes in the form of an auto-injector called Epi-Pen. Allergy specialists typically do allergy testing and decide if a child should have an Epi-Pen. It is crucial that anyone who will have contact with a child who has a severe food allergy is aware of this and has access to (and knows how to use) an Epi-Pen.

There has recently been exciting news about peanut allergy, which affects 2% of all children. Previously the recommendation was to wait until at least age 1 year for peanut products but it has been shown that earlier introduction actually decreases a child’s risk of peanut allergy. New guidelines from the National Institute of Allergy and Infectious Diseases state that for those children at highest risk – those with severe eczema and/or egg allergy – blood testing should be done by age 4-6 months, and if abnormal the child should see an allergist.

For children who have mild to moderate eczema, peanut products may be introduced and given regularly starting at age 6 months. If the infant has no eczema or food allergy, peanut products may be introduced “freely” into the diet and given regularly with other foods at age 4-6 months (ideally solids are begun at 6 months for breast-fed infants). It is important to remember that peanut products may be a choking hazard. A small amount of smooth peanut butter blended into other foods such as applesauce or oatmeal is ideal. If a rash or any sign of allergy occurs, a doctor should be contacted.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Behind the Scenes: Environmental Services

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Environmental Services

We sat down with some of the team that keeps our facilities clean. 
McKenna – 2 years
Patty – 12 years
Paula (PC) – 31 years
Sara – 10 years

What does environmental services look like? Is it different in patient care areas?

PC: I do the Critical Care Unit, Imaging, Surgical Outpatient, three rooms on Med/Surg, the Doctor’s Room and Social Services.

M: Some deal directly with patients and some don’t. Some of us do offices.

S: I do both. I deal with offices, the cool crew up here, you know, and I deal with patient areas too, so I have both sides.

Who works in the clinics in this group?

S: Me.

P: I used to work in the clinics, and now I’m in the Emergency Department. I really enjoy the faster pace there.

Does environmental services handle the OR? That’s like a whole other level is it not? I mean, I know you have to have things clean, but, like, there’s *stuff* going on in there.

M: It’s pretty detailed. After a surgery, I go in, take up the trash, then move everything to the middle of the room and mop the ceiling, mop the walls –

Why do you move everything to the middle of the room? I’m picking up housekeeping tips.

M: So I make sure I get everything and don’t miss anything.

So you move everything to the middle of the room and then you sweep, you mop –

M: No, we can’t sweep. No dust is allowed back there. I can’t use a duster. You just don’t want a lot of dust in the air. So I mop the ceiling and I mop the walls.

You mop the ceiling? That’s something I didn’t know.

M: Yeah, it’s basically like a microfiber flat mop. So I can throw it away. It’s a one-time use. And I have a pole extension so I can get the ceiling.

That is crazy. But you know there’s a concern that everything be clean, so, okay. Wow. Okay. That’s just the tip of the iceberg, I’m sure.

S: It’s the same as what you do if you have a contact room, like if you have MRSA, you basically have to do the room the same way. With surgeries, you do the ceiling and the whole thing once a day at the end of the day, unless we have totals, which happens on Tuesdays.

(For the more sensitive souls out there, I’ll just summarize what they shared next, and say that total hip replacement surgeries need to be cleaned up after, every time. Now, back to the interview.)

So when you’re doing a room in Med/Surg or CCU, there are different signs on the doors, right? They’re clues that something’s different about this room. Tell me about those.

PC: We have a sign that is brown and that’s enteric. So you clean that with bleach water, 1:10 (ratio) bleach water solution. Droplet is the green sign. We use Virex disinfectant cleaner for that. We have the orange signs for contact. You have to go in there and use your Virex, change curtains, wash walls…

Do you guys mask up for any of this?

S: Yes, and you have to gown up.

PC: With droplet, you have to wear a mask. With contact and enteric, you have to wear a gown.

Is there always somebody here on duty? 24/7/365/Christmas day?

S: Every day, yes. And pretty much all day. From 1:30-3:30 there’s a night janitor available to help with anything that comes up.

PC: I’m here at 4 a.m.

How are the clinics and outbuildings handled? Are there dedicated staff for clinics?

S: There’s someone that does Family Medicine – Ellensburg, Orthopedics, and Pediatrics, so they just clean those. And then there’s someone that just does Radio Hill, Physical Therapy, and Occupational Therapy & Speech Therapy. Then there’s Laura, she does Internal Medicine and Workplace Health. I do Women’s Health, General Surgery, and here (upstairs at the hospital).

So in the hospital, this is the place where cleaning could happen at any time, but with the clinics and the external buildings, it’s pretty much before or after hours.

S: Right. When the clinic staff leaves, then the housekeeper comes and cleans.

Environmental Services is an 18-person crew, plus 3 in Laundry, responsible for keeping clean 135,000 sf of KVH facilities.

Are there any ideas people have about the work that you do that you want to correct?

PC: Well, some people think that literally all we do is mop the floor and collect garbage. It’s more detailed than that. I’ve actually had patients say to me, “Oh, you got the fun job cleaning up after us,”  and I go, “Well, you know, it pays the bills.” (Laughter) And I’ve done it for a very long time. So then they ask me how long, then they say, “Wow, you’re a lifer!”

One of the things I forget is that your jobs are 100% on your feet, all the time.

Is there anything that might surprise us, like mopping the ceilings, about the work you do?

M: You’re tested on how well you clean the room. There are invisible dots everywhere.

Oh, what? Tell me about this!

M: It’s from the company Ecolab. Before surgeries, someone will go in and dot the room with these little invisible dots that I can’t see. After I clean, they go in with a black light and see if the dots are still there.

Is it some kind of substance that would come off if the surface was cleaned, is that the point?

M: And you can’t just wipe it, you have to really rub hard on it to make sure it’s actually gone.

How often does that happen?

M: Several times a month.

S: They do it in Med/Surg and CCU, too. And OB, when you clean the C-section room, there’s a checklist, so someone has to check everything in that room to make sure that it’s clean. So it’s not just your eyes that have been on that, it’s other people, too. So that’s kind of cool.

Well if you think about it, like the number one piece of health advice that people give is wash your hands. And I don’t know if you realize or if people think about how important the work is that you do, because if we didn’t have a clean environment here, can you imagine how sick everyone would be? So, bless you for all you do.

What are the challenges of working in environmental services?

M: When someone calls out sick, because then you’re covering multiple areas.

S: Being in more than one place at a time. It’s like, be here, do this, do that. And the hours, you know, the hours aren’t always super ideal. It’s common for people at KVH to have an 8-4:30 job, but most people in our department don’t.

What are the rewards of working in your department?

S: I would have to say, the people. Speaking for myself, General Surgery, Women’s Health, the people here. At first, I never wanted to work upstairs ‘cause it’s all administrative staff. And now that I’ve been up here, I really like these people. I can get used to working up here, you know?

Let’s put it this way. If you’re that special person who loves cleaning, then maybe that’s what you like. But otherwise I would think it would be about the patients, and the people.

M/S (unison): I like to clean!

PC: I really like interacting with patients.

It must be tough, ’cause you guys have physically demanding jobs, but you have the opportunity to be a bright spot for somebody that’s probably not having a good day. I’m sure you are very much appreciated by patients and families.

What does it take to have a good day at work?

Everyone: Sense of humor!

PC: Also have a positive attitude and respect each other.

How does environmental services support the KVH mission of providing quality patient care?

PC: A clean environment, I would think.

M: We help not to spread infection.

S: Yes, infection control. Make sure everything’s clean.

You’re protecting patients, right? And staff. You should have police badges. I’m seriously in awe of the work you do. Everyone else will be, too.

Chores and Children

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Chores for Children
Little girl washing dishes in the kitchen

As parents, one of our goals is to raise our kids to become responsible, independent adults. Part of this process is having kids do chores, although it is safe to say most kids do not see the value in this activity. Besides becoming proficient at basic household duties, chores also teach kids responsibility and the importance of making a contribution. Doing chores makes kids feel needed and valued – even if they complain about it!

Chores seems to be a waning part of family life, squeezed out by pressure for kids to compete academically and be involved in lots of extracurricular activities.  It has been shown, however, that giving kids chores early (starting at age 2-3) leads to good relationships with family and friends, as well as academic and early career success. Besides creating a sense of self-sufficiency, doing chores teaches empathy and consideration for others, according to psychologist Richard Weissboud of the Harvard Graduate School of Education.

So how to make those kids do chores? Ideas abound, including household chore apps and chore charts. Just the way we adults phrase the concept can make a difference. Saying, “Thanks for being a helper” was much more persuasive to kids than “Thanks for helping,” according to a recent study in the journal Child Development. Emphasizing the child’s identity as a ‘helper’ was very motivating. Telling kids that they “get to help” as opposed to “have to help” feeds into a child’s desire to be ‘grown up’.

We all like to have a choice in life – and the same holds true for kids and chores. Listing all jobs to be done and letting kids choose from the list each week increases the odds they will feel positively about their tasks. Rotating jobs is a fair way to divvy up responsibilities. Tying chores to allowance has actually been shown to be counterproductive; when paid to do housework, kids actually are less motivated to work hard and help out the family. When creating a chore chart, remember to be specific, stating the steps to a job. “Cleaning the bathroom” is vague; “scrub the toilet, clean the sink and tub” is more precise and easy to follow.

Being consistent with a time for the family to do chores together makes it more of a group activity – everyone pulling together for the greater good. Phrasing it as a time to do “our” chores as opposed to “your” chores emphasizes that doing chores is a way we take care of each other. Listing time for chores on the calendar makes the expectation very clear. Kids are also more likely to have a good attitude if we remember not to complain about our own household duties – those little ears are listening!

Start kids out early in terms of household responsibilities. Toddlers can help by putting away toys, clearing unbreakable dishes from the table and putting clothes in the hamper. Preschoolers can sweep, wash plastic dishes and empty wastebaskets. By age 8 or 9 kids can load a dishwasher, vacuum, pull weeds, etc. The child “gets to do” more and more as they get older, and you get the satisfaction of raising a self sufficient and responsible child! There might be some grumbling along the way, but doing chores is an important part of childhood and ultimately kids feel good about contributing and becoming more self-reliant.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Behind the Scenes: Engineering

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Engineering

INTERVIEW #1
We sat down with the Engineering team to learn more about the ways they take care of KVH facilities. Mitch (team lead, with 12 years at KVH); Terra (department secretary, 11); engineering techs Robert (.5), Tim (8), Jody (26), and Ben (2).

Who’s the go to person for what, on your team? Jody’s the painter.

M: So is Terra. We go to Tim for locks and doors. Robert’s our HVAC guy.

J: Ben’s master plumber.

(To Mitch) And you’re the enforcer.

Tim: He’s the phone guy.

What’s the best thing about working in engineering?

J: We’re never doing the same thing, day after day after day.

What’s the most challenging thing?

M: The frustration sometimes of not being able to fix things as fast as they need to be fixed. It’s challenging. When heating goes down when it’s cold out, or the cooling goes down when it’s hot out, how fast can you get it going?

‘Cause you’re only going to hear from several hundred people.

M: Another challenge is the 13 houses that we own; they need constant care. And then we have all the outer facilities, too.

Including Cle Elum?

M: That’s where Ben is now. Ben’s our Cle Elum guy. We spend a minimum of one day up there every week. We have preventative maintenance that needs to be done. It comes in huge sheets. Hundreds and hundreds of things that we have to do besides emergent things.

There’s a checklist about a mile long is what you’re saying.

Your work covers such a wide range. Can you give me a simple definition for engineering?

M: General maintenance. And sometimes we have to actually engineer something to keep it working.

Any engineering misconceptions you would like to clear up?

Tim: We’re not security.

M: We’re part time security when needed. And we have these little vests we can throw on. Other than that. Yeah. I think they look at us like we are, it’s not what we do.

Any other misconceptions or surprises?

M: I’ll take people on a tour, and they get to talking about the heating and cooling, and to actually see how that works is kind of fascinating if you’ve never seen the large scale of it, with the giant chiller and boilers making hot water and cold water, sent throughout the whole building.

With surgery, there’s things that have to be a particular temperature…

J: And humidity. We have to control humidity. We fought it all last week with the rains.

You can’t change the weather. So how do you control the humidity?

J: By computer. There are units installed that can add humidity or dehumidify the surgery suites.

R: With room temperatures, people have different preferences, but we have to find happy mediums.

M: Our goal is to be 71 degrees. That’s, that’s the happy place, really.

I love that. That should be your motto.

So why do you guys come around to offices with a stick and a piece of ribbon attached to it?

Checking air flow. To see if air is blowing. If not, then that is probably part of your problem.

Now is that one of those checklist things that you do periodically or is that when you’ve got a complaint or both?

M: That’s if there were complaints.

You have supply and you have return. We want to make sure the air that’s being blown in is being taken out. If you go up on the heliport, you open the door to that fan and it’s a hurricane. That’s the kind of pressure it takes to fill the building. And if you’re going to pressurize it, you have to remove it, too. So we’re dealing with huge fans to make this work.

We think of “call” as a patient care thing, but you have 24/7/365 coverage. How does that work?

M: We rotate. We each get one week, through the weekend.

J: From Monday to Monday.

Have you ever been called in in the middle of the night?

J: On a weekly basis, yeah.

“It’s 65 degrees. Get down here!”

R: Sometimes people think we’re not getting to their problems, but it takes time to fix things. And with outside vendors, we’ve got to wait even longer. “I put that two weeks ago.” “Yeah. I haven’t gotten the part yet.” And then there’s money concerns. I mean, if it’s a big item, we’ve got to wait for approval. People can get frustrated waiting.

I think a lot of us are used to instant fixes. Right? Need to get that fixed in 30 minutes or less.

M: You may have a light out right here for you in your office. We go through the work orders and make sure that the patient care items are handled first.

I’ve heard you say that before, that you prioritize patient care. It’s why I’m always shocked when somebody shows up for my thing. I’m like, don’t you have a list a mile long of really important stuff?

R: We might be waiting on a part! (Laughter)

You all work so hard. How do you survive a day in engineering?

J: What keeps me coming back every day is the crew that I work with. The people on this team.

You’re in it together, right? That makes all the difference.

Baseline responsibilities: 2,000 pieces of equipment, 3,597 PMs, and 33 systems

INTERVIEW #2
Director Ron Urlacher currently spends about half of his time focused on facility renovations. He’s grateful for a capable team that expertly handles the department’s ongoing work. Ron shared some additional insights with us about the work of KVH Engineering.

One of the difficult things to wrap my brain around is defining what Engineering does. It seems like a pretty broad spectrum.

Ron: And it is. Maintenance calls – plugged toilets, changing lights, hanging up whiteboards, all those little things – and lots of square footage to take care of, including the district houses, with lawns to be watered daily, garbage to be set out for weekly pick-up, and general maintenance.

When one of those systems goes down you have to put on your problem solving hat. It’s a whole different skill set. Even if you can’t fix the problem, you need to understand the problem so you can call the right contractor and relay the right information so they can come prepared.

For example, let’s say an air handler goes down. You need to determine if it’s a mechanical problem, electrical problem, control problem, or other system feeding it such as boiler or chiller and everything associated with that. With each of these problems come different contractors. It could even be IT infrastructure as our controls are computerized. Anyhow, that’s when the fun starts.

We also handle office moves, interjected into the normal workflow. And there’s all the preventative maintenance that we do. I wish I had a count of the pieces of equipment.

I’m sure it’s hundreds or thousands or…

Ron: Literally. And each piece has to be maintained. Which gets into the world of compliance. A lot of things have to be documented on a regular basis, things that inspectors look for.

How is engineering different in a healthcare environment?

Ron: There’s so much variety. The hospital has 33 distinct systems we manage and maintain. There are some commonalities, but each system is unique. Trying to keep up on the science of all those is a challenge.

How does Engineering support the mission of KVH?

Ron: Through safety, really. Some of these systems are high risk. Like when a patient is on oxygen, the expectation is that oxygen will flow and that’ll flow at the right rate and it won’t be liquid, you know? It’s about creating a safe environment. We work behind the scenes so that you can take it for granted.

Patients won’t even realize that you’re there, because everything is working as it should be.

Ron: Exactly. I always say if they don’t see you, that’s a good thing.

Childhood Obesity

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Childhood Obesity

Childhood obesity is truly an epidemic. In the past 30 years, the percentage of American kids who are overweight has tripled to 17%, or about 1 in 5 children. Additionally, the very heaviest children are even bigger than previously. Adults also have an increasing rate of obesity, but it is especially sad to see kids now dealing with what used to be adult-only health issues due to obesity: Type 2 diabetes, high blood pressure, high cholesterol and lipid levels, fatty liver, sleep apnea and joint problems. Obese children are more likely to grow up to be obese adults, with increased risk of stroke, heart disease, high blood pressure and diabetes.

The emotional and psychological side of obesity is significant as well. These children have greater occurrence of depression, low self-esteem, poor body image and eating disorders. Overweight kids are also more likely to be bullied, compounding their distress.

There is no single cause of childhood obesity, but there are know factors that contribute, including the child’s diet. Diets higher in fats and simple sugars and lower in fruits and vegetables are linked to obesity. Drinking sweetened liquids such as soda and juice can count for lots of extra calories with minimal nutrition. Even diluted juice can give a child extra calories and sugar they do not need and is not recommended on a regular basis. Milk, although a good source of calcium and protein, should be limited to 16 ounces per day.

Snacking can be a major source of calories for American kids, as snacks are increasingly processed and high calorie. Some kids snack almost continuously and can take in more than a quarter of their daily calories in this way; this is especially true in 2-6 year olds. Having regular family meals with minimal snacking decreases the risk of childhood obesity.

Genetics may play a role as well, although the bigger issue may be the environment—high calorie snacks, inadequate exercise and lack of regular family meals probably contribute more than actual genetics.

Exercise helps kids maintain a healthy weight by not only burning calories but also by keeping them busy and elevating their mood. Like adults, kids may eat out of boredom or for emotional reasons; exercise works against this. Due to computer, TV, personal electronic devices and video games, however, kids are more sedentary than ever. Limiting the usage of electronics and encouraging kids to get at least 1 hour of exercise a day (with most of this being aerobic exercise) is important.

A surprising contributor to childhood and adult obesity is lack of sleep. This may be due to hormonal alterations, less regular meals and poorer food choices when sleep-deprived. It is recommended that kindergartners get 10-12 hours of sleep a night, with the amount decreasing as kids get older, with the goal for the teen to be 9-10 hours per night.

So what’s a parent to do? Like many issues, setting a good example is important. Regular family meals, minimal snacking of healthy foods such as fruits and vegetables, routine exercise (ideally outside to elevate the mood and keep us away from the kitchen!) and regulated use of technology all help. The goal should also be a healthy lifestyle and healthy habits, not a number on the scale or the desire to be thin, as this could backfire and predispose to an eating disorder. Have fun with your family as you enjoy regular meals together as well as getting out and being active, and preventing childhood obesity will be a natural healthy side effect!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Behind the Scenes: Central Billing Office

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Located in two separate facilities, the KVH Central Billing Office covers a range of services and responsibilities. We sat down with three long-time CBO employees for a glimpse at the work they do to serve our patients, the community, and the organization itself.

Photo (L-R): Tara, Kelly, Leah

Leah, you and Jill and Yvette are the faces of KVH Hospital. What’s a typical day for you?

L: As a Registration Clerk, I register hospital patients for all the different areas, like lab, imaging and emergency. I also train our staff on the patient registration process.

Does everybody in Registration work the main desk and ER?

L: Yes. We train everyone to work at both.

What was it like for you when you first started here?

L: Well, I’ve worked in healthcare since I was 18. Before I came here, I worked at Swedish and at Overlake Hospital. So I was able to draw on those experiences.

So, say somebody comes up to your window and they don’t feel well or they’re upset. How do you deal with that?

L: I’m very compassionate with patients. Some come regularly for care. One patient comes to mind who, when she checks in, she could be crying or happy, but I always reach out my hands for her to grab onto, and she feels better right there.

A lot of folks get comfortable with you and they don’t want to go to anyone else to get checked in. I try to do everything I can.

Tara, what is the billing office like?

T: No day is the same, with the constant changes in payers (entities paying claims, such as insurance) and healthcare.  We review claims for errors and fix them, submit claims to payers, do claim/denial follow up, post payments, send patient statements, and do self-pay follow-up and collections.

And as Billing Office Supervisor, what does your team look like?

T: We have three billers for primary (main) insurance, two billers for secondary insurance (which happens, for instance, when a patient has insurance through their work and also has coverage through a spouse’s insurance – one insurance is primary, the other is secondary), two self-pay financial counselors, a revenue cycle clerk who collects patient payments, and a cash poster who posts patient and insurance payments.

Kelly, what do you do?

K: I’m the Charge Master Coordinator. Tara and I’ve been here just about the same amount of time – 14 years, and some change.

I manage the charge master, which is a database. Anything that could possibly be charged, for clinic and hospital care, is housed either in our charge master or in the pharmacy’s charge master. I work closely with Coding and Billing to ensure every CPT (Current Procedural Terminology) code is attached to a charge, that the codes are correct, that they’re hitting the bill correctly, and that we’re not overcharging.

I audit a lot of accounts. The Quality team reaches out if they need a chart audit done. So by the time it hits my desk, there’s a problem or it’s one we didn’t look at. And then they’ll have denials or claims that won’t get pushed through because something’s wrong. So I look at those, as well.

When people ask, “What do you do?” I’m like, “It’s probably easier to say what I don’t do.”

How have you spent your 14 years at KVH?

K: I started actually in Revenue Cycle Management, which at the time also covered nighttime registration. I did a lot of the cash posting and chart auditing.

T: I started working as a Registration Clerk right out of high school, and also worked for a short time in Home Health before I came to Billing.

So, you all spend a good amount of time on the phone in your jobs. How do you feel about that?

L: It’s more about how the patients feel, right? Until recently, when folks called for Imaging, we’d answer the phone, then they’d be transferred to Imaging’s phone tree. It was backwards. Now, when you’re calling the hospital, a phone tree picks up with options for Billing, Imaging, Lab, HIM (medical records), and ‘Other’. Callers can select ‘Imaging’ and connect with a live person in Imaging. It’s so much better for patients.

Tara and Kelly work in traditional office settings, but your work environment is…

L: It’s like the mall. (Laughter)

With busy times and quiet times. What do you do when there’s no one to register?

L: We have other duties, and we try to do them when we can, but it’s tough to get things done between patients, so we do more on the weekends and early mornings and evenings.

So you didn’t mention the mail, you guys do mail?

L: We take mail out in the morning and then I take it in that afternoon to the post office. 

I’m sure it’s fun when somebody does a massive mailing.

L: Like Marketing. (Ouch!)

What are the challenges of your jobs?

T: One of the biggest challenges we have is keeping up with the changes in healthcare as everything effects our department.

K: People don’t think about us until the end. Absolutely everything that happens upstream stops with us. If it’s broken, if it’s not working right, if the charge didn’t drop, if the documentation isn’t there to support the charges, if there’s the wrong information on the claim because it was registered incorrectly – things that if looked at upstream would make our jobs a lot easier.

T: We have really been working to improve the communication between departments organization-wide. We have implemented weekly and bi-weekly meetings with other departments to discuss any current issues we may be having.

As billers, we are wired to correct issues regardless of where they originated, so we can quickly get the claim out the door. Because of this, we’re not always the best at communicating those issues. That’s why we’ve implemented Registration and Coding work queues, and are able to send any issues we come across back to the departments for corrections. Plus, when we implement changes like these, we see our AR decrease.

L: For registration, the challenge is making sure things are done accurately from the start, with the right insurance and demographics for the patient. Our CFO recently told us our self-pay list went from 4% to 2% after all the training we did at the clinics. That’s a good improvement to help with Billing’s challenges.

In your roles, you’ve got to be compassionate, but do you ever feel like you are absorbing people’s stress? Are you there for each other?

L: Definitely. We also have good bosses. In Registration, Yvette is there whenever we need to troubleshoot or be encouraged.

T: We’re a family. We really are. We’re pretty blessed with our departments.

So you kind of tiptoed into the next question: what are some of the rewards of working in your areas?

L: I love challenges in my job. If there is an issue, I usually can fix it. And when my shift’s over, it’s over. I can go home and be with family and leave work at work.

How do you see what you do as being part of the mission to provide patient care?

K: We talk the patients through complaints a lot of times before they even get to Quality. We’re able to work out billing issues, charge issues, things like that. If we keep the patients happy, we keep them coming back. You know, times are tough right now. Just having a conversation is helpful for many patients, who don’t necessarily understand their insurance, let alone charges from the hospital. Just giving them that additional information, then they’re like, okay, I get it. Nobody wants to pay those bills, but they get it, you know?

T: Even though we’re not providing direct patient care, we are the last department that the patient encounters, so we have a huge responsibility to meet their needs – whether that’s explaining their charges or insurance benefits, or helping them set up payment arrangements. One of our biggest challenges is that most patients don’t understand their insurance benefits.

Anything else you’d like to share?

K: It’s always important to remember what it was like before we got involved in healthcare: how much did we really know? You know, you presented your insurance card and you didn’t worry about it. Remembering that, and having understanding and compassion for patients is so important.

We all feel that way, and it helps that we work with a really good team of people.