Case Studies: An Insider's Guide to a Great Perfusion Program

Here is an excerpt from the March Heartbeat E-Newsletter. If you'd like to subscribe to our monthly news, click here and enter your email address.

JFK Medical Center in Atlantis, FL is recognized as Thomas & Reuters Top 100 Cardiovascular Hospitals in America. JFK is one of only four Florida hospitals to earn this benchmark recognition, which is based upon patient outcomes studied within 971 hospitals. JFK's Open Heart Program is a perfusion services contracted facility with Trident Health Resources, Inc. We are proud of this prestigious award and the contributions of our perfusionists which play a role in JFK's success.

What is it that makes YOUR program successful? What things can be learned from what others do to enhance what you are already doing? How do you know when it's time for a change and to consider outsourcing to a professional perfusion services company?

When you're evaluating your perfusion program, you want a frame of reference. Social Proof is what you are looking for; which means you want to find someone else like you who has been in the same position you are in now. You want to know others who made the decision to choose a company to manage staffing. Social Proof is not new, it's a marketing concept that is a sociological phenomenon. It means simply that people's behavioral patterns are highly influenced by the actions of the people or community around them. Some of the most effective social proof for Trident Health Resources, Inc. comes from the penetration of our company name in the marketplace, the number of accounts we have, and our longevity in the industry. But most importantly, it's the number of satisfied clients we have and have retained year after year.

To parallel this concept, consider that in your personal life when you are about to make a significant purchase such as a car or appliance, you might check online for consumer reviews and ratings. This gives you a sense if a product is worth its price and how it compares to the competition. Likewise, in your profession, when you're thinking about outsourcing perfusion services, it only makes sense to find out how others' experiences are with the company they use. Trident's account base is stable with numerous long-term contracts as well as a number of locum tenens accounts. We'd like to share their stories with you if you're interested.

Our industry continues to grow and the need for program changes and enhancements within hospitals is apparent. Quality is important! Patients are more informed than ever and are selective about their surgeon and hospital choices. It's important to ensure your open heart program caters to patient needs, that your perfusionists are aligned in team spirit with the surgical and nursing staff, and that your program offers superior performance in cardiovascular service in outcomes of care. We offer the services that gain you these results and save you money, too.

If you'd like to receive more information and letters from our hospital accounts, please email your request to marketing@tridenthealth.com. If you'd like a comparative analysis of your current perfusion program, complete the form here and we will get back with you right away.

Shaun White: From Open Heart Surgery to Olympic Hero

I'm reposting a recent news article which I think is relevant to our industry, not only because it's about Heart Surgery and a famous person, Olympic Gold Medal winner, Shaun White... but because that makes me think of all the people in perfusion who make a difference every day. What makes Shaun White excel in his field are the very same things that are common among excellent perfusionists who assist in open heart surgeries every day... It's commitment and passion. Shaun White practices his sport every day with commitment. He falls down, he gets up and tries again. The desire for perfection is a passion. In our profession, perfection is a passion as well.

I found this article inspiring.... and thought you might, too.


Shaun White: From Open Heart Surgery to Olympic Hero
Posted at Globalgrind.com

When you are born with congenital heart failure the odds are stacked against you. No one would expect you to be a superstar athlete, and any thoughts of being an Olympic winner are dismal. Yet, snow boarder Shaun White has proven that he can be that and more.

White was born with a congenital heart defect called tetralogy of fallot, in which the heart has four abnormalities. Within his first year of life White had undergone two open heart surgeries. It was a mere five years later that he stepped foot on a snow board and found his calling. From ages 6 to 12 White racked up snow and skate boarding trophies all over California, eventually going pro at the age of 13. Not only is White the first two time Olympic gold medalist in his sport he was also the first person to compete in the 2003 Summer and Winter X games.

It seems that for Shaun, his heart condition as a child hasn’t stood in the way of something he was destined to do. In actuality it’s just a tiny part of what makes him the success he is today.

After wining his second gold White was interviewed by Oprah and said of his accomplishments:

“It brings me back to all the kinds of strange times, because when my parents first got introduced to snow boarding and I started snow boarding there were no Olympics, no X games, no money or anything in the sport, they just basically knew I had a talent and went for it.” White goes on to say “I had some heart conditions when I was first born so going from that struggle to now letting me go out there and do all these things...you put a dream in front of somebody and your so young and it just seems so close and I said I can do this and I just took every step towards it.”

Beyond his heart defect what Shaun White has is tenacity, “I’ve just always had this fight since I can’t even remember,” said White in an interview with 60 Minutes. If there is anything fans can learn from White is that passion and commitment fuel your dreams. Despite any road blocks on your path to success there are tools that motivate you as a person to make goals for yourself and reach them. Shaun White shows commitment and dedication for his sport but most of all he shows his great love for it. Who else owns their own half pipe so that they can continuously practice and come up with new tricks- Shaun White does, thats who.

For someone with such great accolades, White is humble and there is reason to believe some of that humbleness comes from the fact that he knows how lucky he is. White may have been born with a heat defect but even more he was born with the talent that has over shadowed his health condition. This flying tomato will surely continue to make himself a house hold name, all while following his dreams.

Historical Perspective On Perfusion - News Story Reprinted

Open heart patient looks back

Toledoan underwent surgery in 1959

By JULIE M. McKINNON BLADE STAFF WRITER
Link to Story

Sandra Katschke has had a heart murmur for more than 50 years.

Still, that defect is far better than the likely alternative for the 62-year-old Toledoan, the first locally to have open heart surgery using a heart-lung machine.

Without the November, 1959, surgery purportedly to widen her pulmonary valve, the then-12-year-old Sandra Schermbeck probably would never marry and have children, one of her doctors said.

"He told me I wouldn't live to be 21," Mrs. Katschke recalled. "I'm doing really well."

At age 12.At age 16 with Mother.



Dr. Michael Moront, a Toledo cardiac surgeon who met Mrs. Katschke last week after learning of her story, said she probably needed the area above the valve widened, not the valve itself, because it wouldn't have lasted this long if it was congenitally defective. Dr. Moront listened to Mrs. Katschke's heart last week and noted the murmur, and he termed the grandmother's longevity, especially without further surgery, "miraculous."

"Today, most people would say you would require more surgeries," Dr. Moront said. "They did a remarkable job for you."

Much has changed in cardiac surgery since Mrs. Katschke was operated on at Toledo Hospital by a team of 14, including several doctors. A couple dozen more doctors observed the novel surgery, for which a heart-lung machine was used to mechanically circulate and oxygenate blood so work could be done on her heart.

"It was very exciting stuff back in the '50s, and it still is today," Dr. Moront said while showing Mrs. Katschke and her husband of 40 years, Ed Katschke, a heart-lung machine currently used at Toledo Hospital.

Heart-lung machines, first successfully used in Philadelphia in 1953, are one aspect of cardiac surgery that has changed since the specialty was in its infancy and Mrs. Katschke underwent surgery.

Before heart-lung machines, some surgeries were performed by connecting a child to a parent, who kept blood flowing, Dr. Moront said. "The adult would serve as a heart-lung machine for a child," he said.

Oxygenating blood was the trickiest function with heart-lung machines in those days, and improvements have been made through the decades, said former perfusionist Terry Kirch of Northwood, who started working at Toledo Hospital in 1968. A perfusionist is a medical technician responsible for blood transfusion and the heart-lung machine during cardiopulmonary surgery.

Originally, patients could be on heart-lung machines for only minutes; now they can be on for days, Mr. Kirch said. Plus, heart-lung machines were primed with donated blood until the early 1970s, when a solution started to be used, he said.

"That, I think, is one of the biggest advances we had," said Mr. Kirch, who was one of the first 75 people nationwide certified as perfusionists.

Mrs. Katschke's grandparents, the late Marie and Warren Lincoln, who were her guardians, had to locate 30 volunteers to donate A-positive blood for her surgery. Volunteers included seven inmates from the county jail.

Preparing the heart-lung machine and donated blood for Mrs. Katschke's surgery probably took several hours, said Kevin Fleming, a Toledo Hospital perfusionist who explained last week to the Katschkes how the machine works.

"Back then, it would take about as long to prepare the case as it did to do the case," he said.
Mrs. Katschke, who prior to surgery was often sick, missed a lot of school, and was unable to play, returned to school after holiday break.

She remembers being afraid of surgery.

"There was one little boy who passed away before my surgery, and I was scared to death," she said of a fellow patient with a different heart problem.

An intensive-care unit to closely monitor patients was not used when Mrs. Katschke had surgery. Some medications used then still are around today, including epinephrine, but there have been many pharmaceutical advances since, Dr. Moront said.

There also have been a slew of advances in surgical techniques and equipment, he said. Three-dimensional ultrasounds, for example, give surgeons exact images.

Although Mrs. Katschke has had other health problems since her 1959 open heart surgery, she has not had cardiac issues.

The mother of three doesn't take heart medication either, although she does tire easily and regularly sees a cardiologist, she said.

"I still have trouble if I'm walking a long distance," Mrs. Katschke said. "I get out of breath. Other than that, I do fine."

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.

Meeting Notes from Society for the Advancement of Blood Management (SABM) Conference 209

The following report is a summary of reflections from the SABM 2009 Conference held in November. Many thanks to Anton Johnson, CCP, for preparing this and allowing us to share the information here.

SABM 2009
Latin American
Blood Management Conference

Attending the Society for the Advancement of Blood Management meeting in Cancun, Mexico, was an opportunity to gain current perspectives on techniques in allogenic blood conservation, if not elimination.

A diverse schedule was on tap and, refreshing was the review of current literature and reiteration of well established methodology.

If allogenic blood use is to be scrutinized, the goal should not be reduction of use but total elimination. The religious conviction of the Jehovah’s Witness may be the best philosophy to adopt in the best interest of every patient. The approach, or belief, that any use of allogenic products constitutes failure can easily be adopted and, seeing that it has been implemented elsewhere, can be attained with reasonable effort.

Working at a facility where autologous cell saver product is often discarded, the belief of the surgeons is that it contains heparin and thus is responsible for post protamine bleeding, only to use allogenic products, this meeting was very refreshing. The environment in which we practice can often result in ‘dumbing down’ in our approach; we must continue to practice in support of the surgeons who dictate our patient care. Thus, this meeting was invigorating in reaffirming practices that have been proven nationwide.

The key phrases being presented included adjectives including ‘peer reviewed’ and ‘evidence based’, along with ‘double blinded’; these seem to cover a vast array of scientific papers whose conclusions serve to shape and drive practices whose ultimate goal is the elimination of allogenic blood use.

While I will contend that I am not a physician; listening to anesthesiologists who report practicing guidelines, that reduce transfusions until the mixed venous saturations fall below 55%, provided significant food for thought coming from a practice where we transfuse at saturations below 70%!

Several approaches warrant closer observation; the use of erythropoietin to stimulate the bone marrow to produce red blood cells and thus raise the preoperative hematocrit has merit. Folic acid, iron supplements and Vitamin B-12 have been successful in the management of patient’s hematocrit who may have presented in anemic conditions.

Reducing all blood draws preoperatively, in addition to reducing the volume of these samples has been encouraged. Reports that the volume of these samples have not changed in years, while the testing devices have continued to reduce their required volumes, leads one to think that further change is necessary. Englewood Hospital, New Jersey, has gone completely to pediatric tubes in this regard; they reported a several 100mls reduction in just laboratory specimens and consequent gains in patient’s hematocrit.

Preoperative blood management requires a multi-disciplinary approach to create an infrastructure that provides evidence-based actions. Actions are the alternative transfusion pathways that have been proactively configured to maximize clinical and cost benefits.

Each unit of blood, allogenic or autologous, transfused or collected, has an impact on either the patients’ outcome or the costs to provide appropriate care.

In-depth clinical and costs/benefits analysis is required to assure accurate and effective outcomes.

Establishing an effective Transfusion Committee is essential to implementing transfusion practices. This committee should be lead by an opinion leader and contain a multi-disciplinary membership covering; physicians, nurses, blood bank staff, perfusionists, risk managers, representatives from Information technology and Quality Managers.

Their goals should be;

1) Educate
2) Improvement Strategies
3) Collect Metrics

Sobering statistics were presented;

Price Waterhouse reported $210 billion in defensive medical tests which included redundant, inappropriate or unnecessary tests.

The US ranks 15th out of 19 industrial nations in quality of care of their patients, although we spend twice as much per patient in care rendered.

100, 000 patients per year die in hospitals for reasons other than their admission diagnosis.

Platelet Gel reimbursements were a small issue, several practitioners reported on billing strategies that boarded on the unethical. While no specific coding exists for platelet gel, methods of procuring positive billing results included using codes for blood draws and analysis. I suspect that this will not last for long, nor will they be encouraged by institutions.

On another note; the practice of using 3L bags of saline for cell salvaging during the wash phase was considered. These bags are indicated by the manufacturer for irrigation only, not intravenous use! I thought it overly ambitious that this practice was endorsed. It would seem that substituting an ‘irrigation only’ substrate in place of an easily obtained intravenous product, benefits the user only. Any patient benefit is not being considered. This practice should be brought to the attention of the institution’s risk manager for further review. Personally, I feel like it is a flawed approach and will not support its practice.

In closing; thank you for allowing me to attend this refreshing meeting devoted solely to the conservation of blood products. Other meetings try to cover too much material, even while pertinent, and current ‘hot’ topics are left in supporting roles. I look forward to practicing the principles gained from this attendance.

The Heartbeat

Trident Health Resources, Inc.'s February edition of The Heartbeat was released today. For this month's issue, click HERE

Looking for earlier month's issues? Visit Trident's home page HERE for the archive of previous month's newsletters.

And So It Goes....

As we watch the news on TV, we are bombarded with stories that affect us:

The crisis in Haiti enters our living room and it is difficult not to be affected by human suffering.

In other world news, conflict in Iraq and Afghanistan continue.

In domestic news, there are the usual political shake-ups and editorial bashings; except this week was historical. The win of Senator Scott Brown changes the face of the Senate with Brown the first Republican elected in the State of Massachusetts since 1972. The health care reform will now take a new path.

In Economics, new laws affect how Americans will use credit during hard times.

In Sports, Tiger Woods is in rehab for sexual addiction.

But now and then something in the news grabs this country and unites its people in the spirit of something silly and fun. I decided to re-post a news piece here, because we all need a little comedic relief. Not sure if you saw last week's episode of, American Idol, but it's truly funny and seems to have taken the country by storm. I hope you enjoy General Larry Platt's performance of Pants on Ground....



Ralph E. Jordan
President & CEO
Trident Health Resources, Inc.

Perfusionist Job Opportunity

Trident Health Resources, Inc. is growing again and we are hiring in Salt Lake City, Utah.

Utah is known for its majestic landscape. Money magazine ranks four of its Utah’s Cities around Salt Lake City as Best Places to Live in 2009. All that’s missing is You!

If you are a certified clinical perfusionist with a minimum of three years of experience, we would be pleased to receive your resume. Please mail, e-mail or fax for a confidential review of your employment interests and qualifications. Forward your resume, references, and letters of recommendation to employment@tridenthealth.com or fax to (727) 738-9436. Please reference "Utah Perfusionist" n the subject of your email or fax.

Trident Health Resources, Inc. is the premier national locum tenens and long term contract management services company with over 22 years of continuous exemplary service. Trident is an Equal Opportunity Employer. Employee benefits include: 401K Retirement Plan, Health, Dental, Flex Spending & Professional Liability Insurance with an A.M. Best rating of "A", Long & Short Term Disability and Life Insurance.

January Edition HEARTBEAT Newsletter

Trident Health Resources, Inc. released the January 2009 Heartbeat e-newsletter today.

Click to View.

From All of Us at Trident Health Resources, Inc.

Christmas Message to All

As each of us plans holiday festivities with family and friends, I think of Christmases past and the present... from my own childhood through the wonder of raising a family, now grown. Today, I am reminded of the simplicity and joy of the holidays as I see the glimmer of excitement in the eyes of my innocent grandbabies . I hope you, too, are taking time for simple joys and to reflect on the true spirit of Christmas.

Simple joys are bountiful when we take the time to see them. Unfortunately we tend to get caught up in hustle and bustle this time of year and not seem to notice little things. Important and consistent acts of simple care are around us, especially in the healthcare industry. Here at Trident Health Resources, Inc., we want every surgeon, hospital staff member with whom we work, and every patient who is cared for by one of our team, to feel the attention and commitment to quality that each of our employees offers. Every encounter with those whom Trident serves provides an opportunity for us to make a positive difference.

As we get closer to Christmas, I take pause to notice the little things my employees do each day in the spirit of giving. I thank all who choose Trident Health Resources, Inc. as an employer or partner in healthcare and wish you all a very warm and wonderful holiday.

Sincerely,

Ralph E. Jordan
CEO & President

A Trident Thanksgiving Message

I’m blogging from my new Apple I-Phone with much gratitude for such great technological advancements that allow me to write you in this balancing act of working effectively from home as I celebrate the holiday with my family over the next few days. I should add that I’m like a kid with a new toy, enjoying the heck out of touch screen communications and the many applications the I-Phone provides to make my job easier. At Trident, our embrace of technology bodes well for the future, not just in our office efficiency, but in terms of our plans for expansion. We're growing again and recently expanded with new accounts in several states. Also, we are excited about Vivo, our real time data system platform which virtually transforms the way hospitals do charting and manage information. Given new governmental policies for hospitals to become paperless beginning in 2012, we are in the right place at the right time. I think we're doing a great deal of right things that demonstrate Trident's values and dedication to patient focused care, utilizing the very latest techniques to always be improving. I'll be blogging about some of our exciting plans over the course of the next several months, and much more about health care technology and its new directions.

It is Thanksgiving this week, and there is much for which I give thanks and praise, even amid the economic and political climate that challenge this fine country. Our service men and women in the military are thought of with special thanks this week. Closer to home, it's important for me to pause and give thanks to the many people who make a difference each day at Trident in the work they do to serve patients, surgeons and staff, as well as making a difference each day in their own lives, with their family, and the in the community at large. I want to thank the home office staff, all the Chiefs and their teams and recognize with appreciation what they do every day. Trident's influence and reputation is founded on the competence of its people and work ethic, even though we are all different, performing different tasks and in different time zones... we are connected and a highly effective functional team. It makes me proud and appreciative to have such quality people working with us at Trident.

My Thanks and Blessings to all from my family to yours, each and every one, and may you enjoy some time together with your loved ones to give thanks, share a holiday meal, and celebrate.

Happy Thanksgiving!

Ralph E. Jordan
President & CEO
Trident Health Resources, Inc.

Performing Open Heart Surgery - A Virtual Experience

An Australian News Channel featured on its website a link to a "virtual" game in which the player performs Open Heart surgery. Is it really a game? Numerous gaming websites and blogs have posted the Virtual Open Heart Surgery link to attract gamers who have enjoyed various virtual experiences such as Nintendo Wii Trauma Center and Ed Head's Knee Surgery Game

It is interesting that on a more serious note, virtual heart surgery was designed as a fairly new tool for training in complex heart surgeries. It is a surgical simulator which helps doctors to perform surgery in a virtual environment.

Here's a link to Virtual Open Heart Surgery. The site gives a warning: Not for the Faint Hearted. So Good luck and report back your Virtual Experience!

Ralph E. Jordan
President & CEO
Trident Health Resources, Inc.

Trident is Growing!

Click image to enlarge.

In Consideration of HIPAA Laws and Social Networking Risks.

You've heard about them... chances are, statistically, you're a member of one or more and you might even be somewhat addicted to them... I'm referring, of course, to social networking websites (Facebook, Myspace, Twitter, LinkedIn, among an increasing number of new sites daily).

I read a statistic today that two weeks ago Facebook reported to news sources that its user base almost matches the population of the United States (article here). And in July, a report stated that on Facebook, "there has been a staggering increase in the number of age 55+ users – with total growth of 513.7% in in the last six month alone."

Social networking offers people a way to connect with classmates, friends and family far and near, as well as business contacts. Sometimes, however, conflicts can emerge if users are not careful. Many social networking services, such as Facebook, provide the user with a choice of who can view their profile. This prevents unauthorized user(s) from accessing their information.

This brings me to an issue for discussion here today. What about Health Insurance Portability and Accountability Act (HIPAA) laws? Take a hypothetical... a hospital employee posts a fairly innocent comment on the "wall" of one of his network sites about a rather difficult case/work problem or patient scenario. A reader takes personal offense and feels the post exposed too much information about the work situation. Because we are in the healthcare business, we are held to HIPAA privacy laws and must be careful that in social networking that no specifics of a case are mentioned, such as patient names. Even so, for a medical professional to post ordinary work frustrations may be exposure and subject the writing to interpretation by others.

Are hospitals and healthcare companies providing guidance to employees about their online activities (such as not refer to work situations on a public board)? Are policies being instituted on social networking, such as a Social Media Best Practices Policy to sheild the ugly side of internet communications? I welcome discussion from other companies and facilities as to what their current policies are.

On HIPAA... I came across an internet site which specializes in interpreting some of the law for laypersons in the healthcare industry. HIPAA.com describes itself as this:

The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards for electronic health care transactions. The great thing about HIPAA is that it reflects a move away from cumbersome paper records and an increased emphasis on the security and privacy of health data. But the magnitude of the complex changes it requires can sometimes be overwhelming for healthcare providers, compliance officers and other affected professionals. We’re here to help you meet the challenge and stay current with extensive documentation, helpful resources and expert commentary.

There are good things that come from social networking. A 2007 peer reviewed journal article on social networking in the medical field stated that, "Social networks are beginning to be adopted by healthcare professionals as a means to manage institutional knowledge, disseminate peer to peer knowledge and to highlight individual physicians and institutions. The advantage of using a dedicated medical social networking site is that all the members are screened against the state licensing board list of practitioners."

While all that is well and good, that doesn't mean problems won't happen.

Today I advised my employees with the following words to ponder, "As a yardstick, consider that whatever you put on the internet today might appear on the front page of tomorrow's New York Times."

What do you think? Have you run into any issues with social networking and privacy concerns?

Ralph E. Jordan
President & CEO
Trident Health Resources, Inc.

Emerging & Being Successful

As I ponder another growth spurt for Trident Health Resources, Inc. in which we, once again, will be hiring experienced perfusionists, adding new accounts far and wide across the country, and exploring expansion into other related services beyond those of our 21 years experience in contract services/staffing ,capital equipment, disposables and management… I am troubled. Where will we find the qualified, really good candidates that we will need? I am reminded of the universal struggle facing so many of us today. It's the struggle to reach and maintain a certain level of excellence and to be constant despite hardships, and find a way above the mediocrity of a sometimes less than inspired world.

Back in 1993, I read a book written by a Booz-Allen Health Care consultant, J Philip Lathrop , entitled Restructuring Health Care, the Patient Focused Care Paradigm. It was a turning point in the emerging corporate philosophy of our relatively new company. Patient focused care… so simple and yet so powerful. And it was a standard that we have tried to live by ever since and is a part of the Trident culture and the perfusion community, as well.

I am reminded...

In the early 1990's, American Scholar published a startling and prophetic essay by the late New York Senator Daniel Patrick Moynihan entitled, How We've Become Accustomed to Alarming Levels of Crime and Destructive Behavior. Although Moynihan referenced the culture of crime in his writing, his terminology, “Defining deviancy Down “ rings true in its application of how some societies , countries, and even companies deviate from standards of excellence, in our case , the contracted health care services sector, thereby lowering the bar for others to aspire to less than excellent levels of performance. Moynihan argued that in American culture and politics, that as deviant behavior (or behavior that was less desirable, not up to standards previously held) increases, some crimes or poor behaviors become normalized and almost acceptable as the “new” standard, and only extraordinary events are considered truly egregious. While Moynihan was relevant in 1993, it is worth pondering in consideration of a changing landscape of business and healthcare… are we living up to the old standards that were so important when we were growing up or getting started in our Clinical or Business careers? Or, are we content to allow those standards to erode…to diminish…to slip down to a more comfortable acceptable level…defining deviancy down? With that pervasive attitude goes a "cutting corners" mentality in which the greatest services become average. Such is the risk , the reality and the challenge of applying Moynihan’s argument to present situations. How soon we forget that standards of excellence are not meant to be broken or diminished.

We've got to care and not succumb to the influences which can bring down our industry. I aspire to the old mantra , "Lead, follow , or get out of the way," and it's been said that if you don't adopt a philosophy to live by, then one will adopt you.... and the next thing you know, you are a follower of someone else's dream. Trident strives to stay current in the industry, embracing new ways, new technologies, choosing to grow instead of becoming victimized by the stagnation that any business might face. We have incorporated state-of-the-art technologies and computer systems to make sure our information data is secure and efficient. We place a premium value on service that is singularly patient focused. And we encourage our greatest assets…our employees… to not deviate from the standards that so successfully have inspired us to continue to be the best that we can.

I think of some of the important examples of such desire and zeal within Trident and of some in our Perfusion Community… The Aaron Hill's of the world left their mark. I remember the early years in this perfusion contract business, "The Golden Age," coined to represent the times when this industry could count on excellence in the graduates from Texas Heart, Ohio State, Medical University of South Carolina, for example. Perfusionists who were trained in the Army were both PA’s and then perfusionists were terrific candidates for employment. Bob Rush and his Shady Side School from Pittsburg was turning out exceptional grads who were experienced, well rounded, and had in excess of 150 solid cases to their name before graduation. You could count on these folks to make a difference... a lasting impression. Then, sadly, money and misdirection of motivations seemed to infiltrate some of the industry inasmuch as a patient focused care philosophy diminished as a key priority and the end product from many of the schools just do not have that spark, that zeal , that basic knowledge base , the case experience and the over all grasps of what is important and what is not.

Trident remains impassioned to succeed with excellence and fairness... We want to see this all around us. There was a time when there were no off-pump cases. Today, 40 cases are required to keep certification and yet the certifying board's standard for this hasn't kept up with the changes that are all around us. Perfusionists who are in involved with off pump programs sometime struggle to get enough experience to hone skills. It takes everyone to make changes... for things to get better.

Our sector is changing exponentially with the advancements of technology. I am very excited about the training simulators that are now available and by the advancement in technology that will aid us in sharpening our skills. I recently saw a video highlighting the statistics about the speed of change affecting us. Wow. Some of the stats are shocking and reveal how it is essential we be prepared to face the accelerating rate of change. This video clip, below, is a Must See and impacts all of us. The video is full of quotable facts regarding our current state of global competitiveness and underscores how we can continue to expect Shift to be a constant.

Please take a moment to view this clip (close to 5 million people have watched since it was released last year). Feel free to post comments.


Sincerely,

Ralph E. Jordan
CEO & President

The Heartbeat - An ENewsletter.

Trident Health Resources, Inc. released the Aug/Sept enewsletter, The Heartbeat. Read it here and you may sign up for a free email subscription.

Performing Heart Surgery in Consideration of the Age of Patient -- An Ethical Question for You

I have a question for you:

Should a 97-year-old man undergo an expensive, dangerous open-heart operation to repair a lethal tear in a main artery of his heart? A Pennsylvania news article this week asked the question. (If interested: Click link for referenced article: For America's aged, surgery at any price? )

The question begs for consideration of the "value" of life. Physicians are reminded of the Hippocratic Oath, which is founded on moral code and respect for human life. What about quality versus quantity of life? Where is the line that society crosses in playing God? Given the advanced medical technologies of 2009, the medical profession provides us all many choices and options in health treatments, both from a user/patient perspective and from a professional/physician perspective.

I can't help but consider the dilemmas of our times: the U.S. economy in 2009, the ensuing politicking about national health care, the issues of our aging Baby Boomers (and the generations following) and the wonderment and concern of social security benefits' future as a viable source of help to people. Given all the technological advancements and capabilities to extend life, when does it become imprudent to do so?

In our business, we tend to see (although not always) the sickest of the sick and oftentimes those who are elderly receive open heart surgery. Asking the hard ethical questions is important.

My memory brings back to me a quote I heard which may incite some readers:

I hate the men who would prolong their lives
By foods and drinks and charms of magic art
Perverting nature's course to keep off death
They ought, when they no longer serve the land
To quit this life, and clear the way for youth.

-Euripides 500 B.C.

The above quote is ages old, but it's a way of thinking a large population espouses. Dan Callahan, PhD an ethicist and founder of the The Hastings Center , published books on this topic 20 years ago and blogs about it. He's 78 years old now, which is interesting in that he still stands behind his comment that that health care should be rationed for the elderly as a way to keep Medicare solvent. Further, he once stated 20 years ago that the age of 80 should be a cutoff point for the most expensive technologies (e.g. open-heart surgery), even if they might be life-saving.

I'd be interested to hear your reaction to these thoughts. Comments Welcomed.

Sincerely,

Ralph E. Jordan
CEO & President
Trident Health Resources, Inc.

Computer Gaming and Medical Technology in 2009: The Role of Nintendo in Medical Education and Practice

I was reading in this week’s news that the American Heart Association (AHA) pledged $50,000 towards the completion of a project to support CPR training through applications on Nintendo’s, Wii. That shouldn’t be all too surprising… other games on the market allow players to play doctor and perform knee surgery, for example. So it seems, it’s just fun and games for now. But when the AHA project is ready, the CPR training will be offered for free at its website.

Like many of you reading this blog post, the wave of computer gaming is probably not a foreign concept, regardless of your generation… You may be a player, yourself, unwinding after work; you might be the concerned parent of the proverbial lump on the couch (your teen who spends too many hours playing); or, perhaps you’re like me, a grandfather who truly gets a kick out of a sporting event involving swinging an invisible golf club or competition against the grandbabies whereby I am punching the air, which simultaneously knocks out the bad guy on the TV screen. Whatever your involvement, gaming is, has been, and continues to be integrated with American entertainment.

But recently, scientists have stepped in to explore the outcomes of gaming on more of paradigm shift and considering the implications in the medical field. In our business of cardiovascular surgery and perfusion, it is noted that robotics are a surgical method which is seen in several procedures. Laparoscopic surgery is used for hysterectomies, some heart procedures, on prostates, colons, gall bladders and almost anything that can be accessed by a small incision. Given this fact, recognize that the surgeon’s hands are not inside the patient’s body when robotic surgery takes place. Instead, the surgeon uses tools which are not unlike a computer gamer’s “joystick”. In surgery, it is through a tiny incision that the work is done through manipulation of tools. These are watched on a video screen, coordinating the hand motion remote movement.

Several published research papers in the past year reported on the (positive) effects of gaming in healthcare learning and performance. Specifically, in an article by the American Psychological Association, several studies about gaming and its parallel to surgery were made. Specifically, in Four Dimensions of Video Game Effects by psychologist Douglas Gentile, PhD, and William Stone, it was found that 33 laparoscopic surgeons who gamed could not only perform advanced surgeries more quickly but also made fewer errors in surgery (APA, 2008). Another study, focusing on 303 surgeons, found that their spatial skills and dexterity were improved by games that require both (APA). The Wall Street Journal blog reported on another study (unnamed) and stated that,“…playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.” An article in Science Daily reported the following statistics: surgeons who played three hours or more games made 37% fewer mistakes. They were also faster by 27%.

Fascinating. Technology has come a long way since a little yellow ball chased ghosts and ate them in the classic and highly addictive early computer game called, Pacman. Who would have thought that the Pacman experience would be the precurser stimulating the Robvotics Industry as a reality in our future?

Comments welcomed.

Sincerely,

Ralph E. Jordan
CEO & President
Trident Health Resources, Inc.

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Important News! Heparin Case Award

Jury Awards 10 million in Heparin Case
This is a reprint from: Injuryboard.com 7-4-2009 Article
Beth Janicek

In Houston, Texas, a jury recently awarded 10 million in a medical malpractice case against Methodist Hospital and the doctors who treated John German. He sustained an amputation of his left leg above the knee, all the toes on his right foot and all of his fingers following heart surgery. The lawsuit claimed the hospital nurses failed to properly monitor him after he had been administered Heparin. He had a reaction commonly referred to as HIT, heparin-induced thrombocytopenia. The hospital claimed the nurses had not done anything wrong and had helped save Mr. German’s life. Apparently, the jury did not agree.

The jury award will help provide for the extensive medical care Mr German will have in the future.

As he stated,” It’s like closing a painful chapter in my life, even though I have to live every day like this.”

The hospital intends to appeal the case. Hopefully, the verdict will stand on appeal. I have blogged in the past about the devastating damages which result from HIT and the importance of the medical community to be vigilant in monitoring patients following heart procedures. This Texas jury has sent that message to the medical community.

Trident's July HEARTBEAT Newsletter

Unique Staffing Conditions
in Hospital Heart Programs
and the Dedicated Perfusionists Within Them

It's not just about the bottom line-- certainly not in our business so focused on patients and employees. Want to read more?" Click to see Trident's July Newsletter.

Comments welcomed here!