Healthy people, healthy planet

Karla Karapetian: Report on the Penny George Institute Conference on Hospital Based Integrative Care

Summary: Imagine this: A hospital system has delivered 61,000 inpatient visits. It is committed to serving as a model for the nation so offers a conference on hospital-based integrative care. Would that be a smart place to be if one wishes to learn the ins-and-outs from experts? Or if not go, have a proxy attend? The Penny George Institute, part of Minnesota’s Allina Hospitals & Clinics, and led by Lori Knutson, RN, BS-HN, happens to have offered such an educational opportunity for 4 days in July 2010. For those of us who didn’t or couldn’t attend, here is a report from our collective proxy, Karla Karapetian. Karapetian, a manager with the American Massage Therapy Association, is a communications professional. Here is her very useful report.

Karla Karapetian: Report on the Penny George Institute Conference on Hospital Based Integrative Care

Summary: Imagine this: A hospital system has delivered 61,000 inpatient visits. It is committed to serving as a model for the nation so offers a conference on hospital-based integrative care. Would that be a smart place to be if one wishes to learn the ins-and-outs from experts? Or if not go, have a proxy attend? The Penny George Institute, part of Minnesota’s Allina Hospitals & Clinics, and led by Lori Knutson, RN, BS-HN, happens to have offered such an educational opportunity for 4 days in July 2010. For those of us who didn’t or couldn’t attend, here is a report from our collective proxy, Karla Karapetian. Karapetian, a manager with the American Massage Therapy Association, is a communications professional. Here is her very useful report.


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A commitment to integrative health care

Under my hat as executive director for the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), Lori Knutson, RN, BS-HN is a colleague as a member of ACCAHC’s Council of Advisers. Knutson, director of the Penny George Institute for Health and
Healing
at Allina Hospitals and Clinics, runs the nation’s most significant inpatient integrative care center, with over 61,000 inpatient visits. As such, Knutson is also the nation’s chief employer of licensed acupuncturists and massage therapists for inpatient care. Her experience is invaluable given ACCAHC’s focus on developing competencies for optimal practice in integrative environments.

When Knutson began developing her July 26-29, 2010 conference entitled Hospital-Based Integrative Care: Transforming Health Care Practice, she graciously volunteered ACCAHC a pass for one of our participants. Karla Karapetian, Industry Relations Program Manager with the American Massage Therapy Association, took us up on the offer. Karapatian, a communications professional by training, produced this thorough report. She subsequently allowed me to publish it here.

My thought is: Why not get a view inside this remarkable pilot project for the nation. Attendees were a diverse assemblage? Karapetian notes that nurses, doctors, massage therapists,
acupuncturists, physical therapists, social workers, chiropractors and
dietitians were all present. Nurses and massage therapists were the two largest categories. Enjoy this look inside the George/Allina operation.


For past Integrator articles on the Penny George Institute/Allina initiative:


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Hospital Based Integrative Health Care
Conference: 
Transforming Health Care
Practice


July 26-29, 2010


Penny George Institute for Health and Healing


Minneapolis, Minnesota

Karla Karapetian
Industry Relations Program Manager

American Massage Therapy Association

 



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Contributor Karapetian: Attendee reports on conference

The first annual Hospital
Based Integrative Health Care Conference: Transforming
Health Care Practice
presented by the Penny George Institute for Health and
Healing
(PGIHH) brought together practitioners and healthcare professionals who
were interested in understanding what integrative health is and how it can be
applied in a hospital setting.


The conference provided an
overview of current best practices from the Penny George perspective in key
areas of integrative health. 


PGIHH is a leader in
providing integrative medicine in a hospital setting. The Institute is with Abbott Northwestern
Hospital
(629 beds) and is
part of a larger health care network call Allina Health Systems that includes:

  • 11 hospitals

  • 90 clinics
  • 23,000 employees  

PGIHH began in 2003 and
consists of inpatient hospital care, an outpatient clinic and a fitness center.
They provide acupuncture, biofeedback, healing coach
sessions, healing touch, herbal consultation, integrative medicine physician
consultation, massage therapy, nutritional consultation, therapeutic yoga, and exercise
therapy
at the LiveWell Fitness Center
to both inpatients and outpatients.

   
Definition of health promotion


… the art and science of helping
people discover the synergies
between their
core passions and

optimal health, enhancing their
motivation to strive for
optimal

health and supporting them in
changing their lifestyle to move
toward a
state of optimal health …

 

It was exciting to see such a
diverse group of individuals that included nurses, doctors, massage therapists,
acupuncturists, physical therapists, social workers, chiropractors and
dieticians.  Out of this group, the
largest groups of attendees were nurses and massage therapists.  The majority of people were from the Midwest
(Minnesota, Wisconsin,
Illinois and Iowa).


Each day began with an
overview of why there is a need for integrative health.  Statistics on health spending per country as
well as the annual costs of an unhealthy lifestyle illustrated the need for a
shift in how health care is defined and delivered in the United States.  A definition of health promotion as the art and science of helping people discover the synergies between their
core passions and optimal health, enhancing their motivation to strive for
optimal health and supporting them in changing their lifestyle to move toward a
state of optimal health
was shared as well as the gaps in current care that
include self care knowledge, self care skills and self confidence in health/health
care decisions.  It was acknowledged that
the health promotion/wellness focus with insurance companies is still up in air
as far as who will pay for these things but it is up to us to create that
future. 

Integrative Hospital Based Massage Therapy


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Knutson: Director of experience-based integration conference

A clinician panel featuring
massage therapists (and AMTA members) from PGIHH discussed their experiences
and approach to massage in a hospital setting. 
They shared how important it is to be cross-trained (i.e. massage,
aromatherapy, energy work) because each patients’ needs are different and change
from moment to moment.  For example, a
patient may have indicated pain relief as their main compliant at the time of scheduling
but at the time of treatment they may be experiencing nausea or anxiety.  And each patient is unique so what might have
worked on one patient for nausea may not work on another.  Therapists also have to assess whether to use
hospital lotion or work on skin without lubricant.  Therapists also need to know themselves
enough to identify that sometimes another practitioner would be better for a
particular patient.

   
The panel shared the importance
of massage therapists being cross-
trained (i.e. massage,
aromatherapy,

 energy work) because each patients’
needs are different and change

from moment to moment. 

 

The panel also shared their
opinion on the traits of a successful massage therapist in a hospital setting
including critical thinking skills (which they believe come with experience),
trusting in the work (many times results are not immediate), and being
comfortable operating in a hierarchical system.  


General Principals for acute
care massage were explained as:

  • Massage in the hospital is slow and gentle
  • Areas massage are the back, posterior neck,
    scalp, shoulders, heads and feet
  • Patients can be positioned side, supine, or
    sitting
  • Light to medium pressure only
  • Checking in with patient and asking about
    pressure often
  • Adhere to universal precautions
  • Frequent hand washing

 


Body mechanics is also very
important when working on patients in a hospital setting.  Massage therapists must work around the
patient, equipment, and other staff.  One
of the panelists demonstrated proper body mechanics when treating someone in a
hospital bed. 

     
 All the therapists on the
panel shared

the unique emotional environment
of working in a hospital.

   
     

All the therapists on the
panel shared the unique emotional environment of working in a hospital.  You are not working in a quite, soothing
setting.  Rather, it is sterile, loud,
and busy with an undercurrent of anxiety and pain.  The need to stay centered and set your
intentions for compassionate, intentional touch is very important.  You may not have a “positive” experience with
everyone you touch.  The staff shared
they affirm their position by letting go of expectation and take on the belief
that whatever is suppose to happen, will happen. 

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George: Disseminating to others a key component of philanthropist’s strategy

Hospital Based Integrative Care: Mind Body Medicine


Gary Carlson, MD gave an
overview of the traditional and non-traditional (CAM)
healthcare system.  He discussed how
integrative medicine is the best of both systems and this view allows it to
become more mainstream and less territorial. 

The concept of integrative medicine is looking at the whole terrain of
the person – mind, body and spirit.  The
integrative healing concepts are:

  • Heal (thy) Self (teach patient to fish rather
    than give them a fish)
  • Proper paradigm – meet with the patient where
    they are in the paradigm, not where they think they are
  • Compassion
  • Not “or” but “and” – a combination of both
    traditional and non traditional
  • Good communication
  • Individuality – treat the person not the disease



The model for how traditional
and nontraditional medicine works in a hospital setting puts the patient and
symptoms in the center of care.  The
health care team looks to treat the imbalances rather than treat the diagnosis.  For example a patient may be experiencing
symptoms of depression and back pain. 
Under the integrative approach, they may be prescribed medication
(traditional medicine), massage, exercise, a social worker and a sleep
plan.  All of these treatments work
synergistically to treat the present and underlying causes of the
symptoms.  It also allows the patient to
play a role in their own health and wellness. This approach supports the new
government health promotion and prevention initiative.

CAM

Research in the Hospital Setting:  Inpatient and Outpatient Exemplars


The Director of Research of
Integrative Medicine at the Center for Health Care Innovation at Abbott Northwestern
Hospital shared the
results from inpatient integrative medicine. 
Referrals for integrative medicine are initiated by the medical and
nursing staff.  They are ordered in an
electronic health record.  The medical
record is reviewed at a triage meeting at PGHII and treatments are
scheduled.  The treatment always consists
of an intake, education of the modality prescribed and the actual therapy.  After the treatment, the practitioner
documents the visit in the electronic health record.  Abbott has complied statistics from the data
since 2004 and here are some of the results of integrative medicine:

  • 61,000 inpatient visits (they do an average of
    12,000 per year but this number is not reflective of need/demand but of
    capacity – need/demand much higher – average of three treatments per
    patient per hospital visit)
  • 17,215 people received services from the Penny
    George Institute between July 2004 and December 2009.  They did not share what percentage of
    this was massage therapy.
  • The breakdown of specialty areas where patients
    received integrative medicine – 14% women’s care, 15% cardio/vascular, 16%
    ortho/spine, 19% neuro/rehab and 36% med/surgical
  • Anxiety, nausea and pain scores went down by half
    after integrative medicine visit

     
The data show an exciting
trend

among physicians.  The number
referring integrative medicine went

from 4 in 2003 to 400 in
2010.

 

   
     

The data they have received
supports the feasibility in providing integrative care for acutely ill
patients.  It also shows an exciting
trend among physicians.  The number of
physicians referring integrative medicine went from 4 in 2003 to 400 in
2010.  The data also shows there was
significant improvement in the reduction of pain and anxiety.  Abbott is about to release some very exciting
research through medical journals that shows integrative medicine increases
patient satisfaction and is profitable. 

The data will be release in August or early September.  


Referrals are so high for the
integrative doctors and acupuncturists at the outpatient clinic at PGHII they
are booked 8-10 weeks in advance.  They
are now running into patient satisfaction issues because people can’t access
these services when they want to.  It’s
important to note that these services are reimbursable through insurance.  They also offer massage therapy at the
outpatient clinic but on a cash basis only. The PGIHH did not share any data
that explains why referrals for the integrative doctors and acupuncturists were
so high.  This may indicate people are
more apt to try something if it is covered by insurance rather than out of
pocket.  What they do know is that people
are very receptive to an alternative approach to health care.  

Guided Imagery


Guided imagery is used
frequently at Abbott in dealing with pain, anxiety, and stress.  Studies have shown a thought process produces
a physiological response.  The role of
the guide includes:

  • Center – attention/intention
  • Create a safe environment and hold the space,
    keeping self out of the process
  • Guide the person through their experience
  • Trust the process and let go of the outcome
  • Be comfortable with affect




These principals are very
similar to that of massage therapy and many therapists at PGHII are cross
trained in this modality. 

Creating the Organizational Culture for Integrative
Health Care


PGHII shared their advice on
how integrative medicine practitioners can begin building a presence in
hospitals and clinics.  Pain management
is the biggest challenge for all hospitals and it is also the area where
integrative medicine can be most effective. 
Below are some of the starting points:

  • Assessing attitudes, beliefs, and knowledge
  • Determining the gap in care (physicians, nurses,
    patients, system) in attaining optimal patient outcomes
  • Creating the opportunity (pilot the
    partnership/look for your physician champions)
  • Keep it simple but effective, and in a short
    timeframe
  • View every encounter as a teaching opportunity.

 

These points could be useful
for those wanting to do research in a hospital setting as well.  They also stress to keep it simple – one
indication (symptom): one intervention and to provide simple tools for
physician to begin to learn the language of integrative medicine.  The biggest hurdle for massage therapists and
acupuncturists is to have the confidence and professionalism to speak and
interact peer-to-peer.  If you don’t have
those traits, physicians won’t respect or listen to you.  This is something that the Institute had to
work on with their staff.  Another tip is
to have integrative medicine staff encourage their patients to write/email
letters to the hospital administrators about their experience. 

Demonstrating Clinical and Operational Outcomes for
Success and Sustainability

   
  These data help evolve the practice
of these therapies and
they hope
to become a national warehouse for
all data for hospitals all over
the U.S.

for integrative medicine.

PGHII had to build onto the
existing electronic medical record database to ensure that they would be able
integrate fully into the system while having the ability to pull reports and
collect data on integrative medicine. 
One of the items they included was narrative notes so they could
document the unique stories (qualitative data). 
They now have an ongoing research database that is updated quarterly
that collects clinical, financial and indirect (teaching research, program
development, etc) data used for research, operations and for continuous
improvement.  They have captured 18,000
recorded services (70% women and 30% men) and attempted 22,000 services.  This means they were able to service 75% of
patients.  They are pioneers when it comes
to tracking data on all aspects of providing integrative therapies to patients
in a hospital setting.  This data helps evolve the practice of these therapies and
they hope to become a national warehouse for all data for hospitals all over
the U.S.
for integrative medicine.

 

   
 The most common aromatherapy
types are
lavender, mandarin, ginger,

spearmint, sweet marjoram, Roman
chamomile and
frankincense.

There were 2,074 patient
visits (using)

aromatherapy from July 2009
through March 2010.

 

Aromatherapy in the Clinical Setting 


Aromatherapy is another
therapy the Institute uses within the hospital. 

Many of the massage therapists also are certified in this therapy.  They use oils both topically and for
inhalation.  The most common types are
lavender, mandarin, ginger, spearmint, sweet marjoram, Roman chamomile and
frankincense.  There were 2,074 patient
visits from July 2009 through March 2010. 
The top three symptoms treated by aromatherapy were pain, anxiety and
nausea.  All three symptoms were reduced
statistically significantly by the treatment. 
They are now cross training nurses who want to become certified.  Aromatherapy is a component of holistic
nursing.     

Conclusion


This four day conference was
a glimpse into the future of health care. 
PGHII is forging the path for integrative medicine in many ways.  They have built an environment that allows
the therapists to thrive while putting in place a database to prove the
efficacy of their work.  They have
created the balance of providing integrative care within a traditional medical
model.  The rapid increase in physician
referrals is a testament to their ability to connect and educate the hospital
staff.  Their compassionate approach to
treating the whole person is resonating with patients and staff.  This approach of seeing the patient as a
unique whole person is very familiar to massage therapists and other
integrative health providers.  However,
this is a paradigm shift for the western medical model and it is exciting to
see this change in motion. 


Lori Knutson, executive
director of PGHII charged each of the attendees to decide how they were going
to be the agents of change and what role they will play in bringing integrative
health to their organization.


Comment: Karapatian’s conclusion stands on its own. Here it is, in bullet form:

“This four day conference was
a glimpse into the future of health care. 

PGHII is forging the path for integrative medicine in many ways. 

  • They have built an environment that allows
    the therapists to thrive while putting in place a database to prove the
    efficacy of their work. 
  • They have
    created the balance of providing integrative care within a traditional medical
    model. 

  • The rapid increase in physician
    referrals is a testament to their ability to connect and educate the hospital
    staff. 
  • Their compassionate approach to
    treating the whole person is resonating with patients and staff. 

“This approach of seeing the patient as a
unique whole person is very familiar to massage therapists and other
integrative health providers.  However,
this is a paradigm shift for the western medical model and it is exciting to
see this change in motion.”


Affirmative. Thanks Karla.

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