Quality Improvement Initiatives

This article was published in our Cancer Program 2014 Annual Report.

Rebecca O'BerryBy Rebecca O’Berry, vice president of surgery and operations

In 2014 the Cancer Program has focused on improving our screening efforts for colorectal cancer, the one cancer that can be prevented. Our two quality improvement goals for 2014 were to improve the tracking process we use for hemoccult cards given to patients and to increase the number of people screened for colorectal cancer.

Historically, less than half of the hemoccult cards given to patients are returned to the physician’s office for testing. We implemented a follow-up plan to increase our return rate and modified the system we use to track these cards. Our efforts were successful, and we were encouraged to explore bringing in a different test that is easier for patients to perform at home. This new laboratory test will be part of our quality initiative for 2015.

Throughout the organization we worked to increase the number of patients who receive some kind of colorectal screening. In the target age group of 50-75, our screening numbers increased from 59 percent (in 2013) to 90 percent (in 2014). This is a significant improvement, and shows how effective a targeted educational effort on the benefits of some form of colorectal screening can be! Unfortunately a large number of our patients still refuse to undergo colorectal screening. In 2015 we will work to improve patient access to screening by increasing the variety of our testing methods.

In 2014 we also increased our social services support for patients undergoing cancer treatment. To ensure that everyone has the help they need while moving through treatment, our patients now have easy access to a social worker and our Blueprint team. We also created a binder to collect all the information needed by someone undergoing cancer treatment.

The MagView program implemented at the end of 2013 has helped our radiology department track screening mammography in a more systematic way. This program keeps all a patient’s information in one location, and allows a much faster turnaround time for notification of results. The time a patient must wait to receive a mammography result notification letter is now less than two days!

Our providers are excellent communicators and have put a lot of time and energy into community education about prevention, early detection, and treatment of cancer. We work closely with our local senior centers to provide education sessions that are open to the public. Topics covered in these community outreach efforts include: skin cancer screenings and education (in several locations); discussions on breast cancer, bladder and prostate cancer, and colorectal cancer. We will continue to provide this education in the upcoming year.

In 2014, 53 new cancer cases were identified, with breast cancer continuing to be the most prominent followed by lung, colon, and prostate. A total of 41 of those 53 cases were discussed at Tumor Board meetings.

2014 Gifford cancer statistics

Click here to read our full Cancer Program 2014 Annual Report.

Finding Patient-Friendly Colorectal Cancer Screening Options

This article was published in our Cancer Program 2014 Annual Report.

Gifford cancer program

One of our program goals for 2014 was to screen more people for colon cancer to help decrease the number of later-staged colon cancers found in our patients. Providers and nursing staff talk with patients during office visits about cancer screening services available at Gifford, and the benefits of detecting cancer early—especially with colon cancer, the “preventable cancer.”

A typical colorectal cancer starts as a slow-growing polyp in the lining of the colon or the rectum. These precancerous polyps and early cancers can be detected (and removed) during a colonoscopy, which is the preferred colon cancer screening test. But many patients delay or refuse colonoscopy screening, and we still want to encourage those people to at least have a fecal blood cancer detection test with their annual physical.

The hemoccult cards traditionally used for this screening required a patient to collect multiple samples at home and bring them back to their provider’s office. Even with an improved follow-up system to remind people to return their cards, less than half of the tests made it back to Gifford. Many patients reported that the dietary restrictions, multiple sample collecting, and the embarrassment of having to carry the card back to their provider caused them not to complete the test.

Cancer program staff explored other screening options and found a test that detects blood in the stool more accurately, is easier for patients to use and, more importantly, can be discretely mailed back to the lab for analysis. The FIT (Fecal Immunochemical Testing) cancer detection test is now offered as part of annual physicals at Gifford.

Click here to read our full Cancer Program 2014 Annual Report.

Expertise, Personalized Care, and Comprehensive Support Close to Home

This article was published in our Cancer Program 2014 Annual Report.

Brenda CaswellWhen someone is given a cancer diagnosis, their world is turned upside down. Suddenly there is a lot of information to absorb, many tests to take, and hard decisions that have to be made quickly—all when people are feeling most vulnerable.

Travelling to receive treatment and follow-up cancer care can be expensive, exhausting, and complicated to organize. At Gifford patients with cancer have treatment options that can relieve these stresses.

Most cancers—especially breast, colon, prostate, and bladder cancers—can be treated here in our community hospital with caregivers that patients know and trust, close to the family and friends who will support them during treatment.

“Our goal is to make sure people know that they can receive the same quality of care offered at larger hospitals close to home, with a support network they know,” said Rebecca O’Berry, vice-president of Surgery and Operations at Gifford. “Battling a cancer diagnosis is hard enough—I’m thankful that we can provide quality cancer care locally and decrease our patient’s travel time during treatment.”

First accredited by the American College of Surgeons Commission on Cancer in 1965 (we received our most recent 3-year accreditation in December of 2014), our cancer program has been delivering quality cancer care to our community for nearly fifty years. Our oncology services include cancer care from an experienced oncologist, hospital specialists and surgeons, and specially certified oncology nurses; lab and diagnostic services; advanced diagnostic services, including stereotactic breast imaging; outpatient chemotherapy; preventive cancer screenings; and a strong palliative care program. Our multidisciplinary approach to each patient’s care includes identifying social service needs as well as appropriate medical expertise.

Experience, expertise, and compassionate care close to home

“With cancer, making the right diagnosis and getting the right treatment is key,” says Dr. Richard Graham, a Gifford urologist who treats prostate, bladder, and renal cancers. “Experience with specific cancers is also important. We have the expertise and technology to diagnose a lot of rare cancers, but we are small enough to see patients as individuals: You are not a number here.”

Graham notes that he saw an increase in patients whose small cancers were treated with cryosurgery and laparoscopic surgery in 2014.

Personalized support for the cancer care each patient chooses

When a patient chooses cancer treatment that is not offered here, our providers make referrals and collaborate with outside oncologists so things go smoothly. Patients have the option to receive post-operative care and chemo treatments close to home.

Brenda Caswell, a Randolph mother of five, regularly comes to Gifford for medical care and annual mammogram screenings. She missed three years of annual visits because of her pregnancy and the birth of her youngest child, and when she resumed her check-in’s her provider insisted that she get a mammogram.

“My provider didn’t let me out of the office without scheduling a mammogram,” Caswell says. “She knew me, knew that my mom had had breast cancer, and knew that regular screening was especially important for me.”

A small tumor was detected, and after a biopsy and two consultations with Dr. Ciccarelli, she decided to have mastectomy and reconstructive breast surgery through a program offered at a larger hospital. Dr. Ciccarelli’s team made referrals and helped her arrange treatment. When her cancer was found to be more invasive than originally thought, she had to plan for chemotherapy after surgery. Then, when post-operative complications required a week of inpatient care right before the holidays, she knew she wanted to be close to home and with her family.

“I was able to be at Gifford, just down the street from my home,” Caswell said. “The doctors were wonderful—they collaborated with the oncologists who were treating me, sharing blood counts and test results. It was a very smooth process.”

Click here to read our full Cancer Program 2014 Annual Report.

Customized Support for Patients Receiving Cancer Treatment

This article was published in our Cancer Program 2014 Annual Report.

patient information bindersCancer treatment can be a complicated and lengthy process. It takes time to absorb and process information, and most patients find it helpful to return to reports, schedules, and resource listings at home, so they can bring back questions they didn’t ask when meeting with their provider.

Since cancer patients often see multiple specialists, a lot of paperwork is accumulated along the way. Patients who feel informed and involved in their treatment are less stressed, but things can quickly feel overwhelming.

This year Gifford’s Cancer Program initiated new efforts to improve communication, personalize support services, and simplify processes so patients will have the help they need at a time when life can feel out of control.

Patient Information Binder: Each patient starting cancer treatment at Gifford is given an 11 x 13 inch zippered binder with five multicolored section dividers to organize care team contact information, treatment plans, information on care at home, support services available at Gifford, and general cancer information and community resources. Other folders and pockets can store reports, medication lists, appointment schedules, and important treatment information.

“It helps keep life-with-cancer organized,” said Jessica Spencer, an oncology nurse who helped design the binder. “It also has lots of information and resource listings, so patients have a place to turn to when they are not at the hospital.”

Our oncology nurses have also found that using the binder with patients can help identify support services a patient may need earlier in their treatment process.

New Psychosocial Screening Tool: There are aspects of cancer care that go beyond actual medical treatment and oncology nurses, who establish ongoing relationships with patients as they take blood tests, administer medication or chemotherapy, and monitor treatment, are often the first to learn about patients who need extra support.

A new psychosocial screening discussion with patients at their initial treatment session now helps nurses identify and track these needs more effectively. The completed forms are reviewed and referred to a social worker for further follow up if needed. Patients have received assistance with insurance issues, finances, transportation or housing needs, or emotionally adjusting to their illness.

Click here to read our full Cancer Program 2014 Annual Report.

The “Preventable Cancer:” Spreading the Word about Colorectal Screening

This article was published in our Cancer Program 2014 Annual Report.

preventing colon cancer

The providers in Gifford’s Cancer Program regularly visit senior centers, nursing homes, church meetings, and other community gatherings to offer skin cancer screenings, give free talks on cancer prevention and the importance of early detection, and host educational discussions of breast, bladder, prostate, and colorectal cancer.

In talks like “Everyone’s Got One: A Discussion of the Colon and How to Keep it Healthy,” surgeon Dr. Olveto Ciccarelli uses humor to help people learn about the importance of colorectal cancer prevention and screening.

“Everyone has these organs, but people are reluctant to talk about problems with their colon or their rectum,” said Ciccarelli. “Men especially find it difficult to discuss these matters, but this is one area where medical science has proven that cancer can be avoided, lives extended, and quality of life improved.”

This is especially true with colorectal cancer, which was a program focus for 2014. Colorectal cancer is called the only “preventable cancer” because it is the one cancer where regular screenings can help to keep cancer from forming. A colonoscopy detects any slow-growing polyps that may form in the colon so they can be removed before becoming cancerous. Because early colorectal cancer often has no symptoms, screening is even more important because it can detect existing cancer when treatment is most effective.

Still, colorectal cancer is the third most common type of cancer in men and women in the United States. The good news is that deaths from colorectal cancer have decreased as more people take advantage of screening tests like colonoscopies, specialized X-rays, and tests that check for cancer in the stool.

So far, Gifford has had significant success with our efforts to increase colorectal screening rates for our target age group of 50-75 (an increase to 90 percent in 2014 from 59 percent in 2013).

We will continue to spread the word in our community. With colon cancer, it is simple: Regular screening could save your life.

Click here to read our full Cancer Program 2014 Annual Report.

Gifford Cancer Program Overview

Gifford's cancer program

This article was published in our Cancer Program 2014 Annual Report.

Gifford cancer committeeEstablished in 1959, Gifford’s Cancer Program is accredited by the American College of Surgeons Commission on Cancer.

A dedicated cancer committee meets regularly to provide leadership for the program, including setting program goals and objectives, driving quality improvements and best outcomes for patients, and coordinating Gifford’s multidisciplinary approach to cancer treatment.

Operating out of our relaxing Ambulatory Care Unit, Gifford’s Oncology Department includes:

  • Cancer care from an experienced oncologist
  • Specially certified oncology nurses
  • Planning options for cancer treatment following a diagnosis
  • Outpatient chemotherapy
  • Treatments for some hematology conditions

The medical center is home to advanced diagnostic technology, including stereotactic breast biopsies; a breast care coordinator providing education and outreach; a patient care navigator; many surgical offerings; data management and quality oversight; and cancer prevention programs, including a “Prevention into Practice” model that works with patients and their health care providers to bring screenings to the forefront.

Click here to read our full Cancer Program 2014 Annual Report.

Gifford’s 2014 Highlights: October – December

The following article appeared in our 2014 Annual Report.


Gifford completes its upgrade to electronic medical records (EMR). Throughout the year, Gifford primary care and specialty care outpatient practices moved from paper to candidates' debateelectronic records as part of a federal initiative.

Gifford and the White River Valley Chamber of Commerce collaborate to hold the only local candidates’ debate for Senate and House of Representatives candidates.

Gifford's Woman to Woman FundGifford employee Teresa Bradley and her niece, Krista Warner, once again hold a bowling tournament in memory of Teresa’s mom and Krista’s grandmother, Ruth Brown. Money raised supports Gifford’s Woman to Woman Fund and brings awareness to the importance of mammograms.

Gifford announces it has met its state-approved operating margin for the 15th consecutive year.

Gifford meets operating margin


Major Melvin McLaughlin

Gifford loses one of the greatest heroes of our time, Major Melvin McLaughlin. Affectionately known as “the Major” and “Major Mac,” he spent the last 40 years volunteering at the hospital, encouraging staff and patients with words of love and friendship. He will be greatly missed, but never forgotten.

Hannaford gift certificate for Project IndependenceHannaford Supermarket in South Barre presented Project Independence with a gift certificate worth $1,500. The gift is used to offset the cost of groceries for the program which provides a daily breakfast, lunch, and snack for roughly 38 participants. When the store manager asked staff which nonprofit they should contribute to, the adult day program was at the top of their list.

Dr. Lou DiNicolaPediatrician Dr. Lou DiNicola receives the Green Mountain Pediatrician Award from the American Academy of Pediatrics Vermont Chapter. He was acknowledged for over 38 years of service as a Gifford pediatrician. Along with a plaque, Dr. DiNicola was presented a 7-foot-long handwritten scroll describing what makes him special.


Gifford once again invests $40,000 into the regional economy through the Gifford Gift Certificate program.

Gifford’s Oncology Program Receives American College of Surgeons Accreditation

Renewal marks hospital’s 49th year
of providing local quality cancer care

Commission on Cancer accredited programThe oncology program at Gifford Medical Center has received accreditation from the Commission on Cancer (CoC) of the American College of Surgeons.

Every three years the CoC accreditation program reviews hospital oncology services to ensure that they conform to commission standards and are committed to providing the highest level of quality cancer care (learn more here). After a rigorous evaluation process and on-site performance review, Gifford received accreditation through 2016.

“Our goal is to make sure people know that they can receive the same quality of care offered at larger hospitals close to home, with a support network they know,” said Rebecca O’Berry, vice-president of surgery and operations at Gifford. “The accreditation process is work for our entire oncology team, but it is worth the effort. Battling a cancer diagnosis is hard enough—I’m thankful that we can provide quality cancer care locally and decrease our patient’s travel time during treatment.”

One of smallest hospitals in nation to hold CoC accreditation, Gifford has done so since 1965. Gifford’s oncology services include:

  • Cancer care from experienced oncologist Dr. John Valentine
  • Compassionate and specially certified oncology nurses
  • Lab and diagnostic services
  • Advanced diagnostic technology, including stereotactic breast imaging
  • Patient navigator help with planning options for treatment and to coordinate care
  • Outpatient chemotherapy
  • Preventative cancer screenings
  • Hospital specialists, surgeons, and a robust palliative care program

For more information, visit www.giffordmed.org/Oncology, or call (802) 728-2322.

Sprinkle with Experience: 2013 Medical Staff

The following is an excerpt from our 2013 Annual Report: A Recipe for Success.

Gifford medical staff in 2013

“Creating private inpatient rooms at Gifford will further enhance patient satisfaction and overall experience in the hospital. We strive very hard to deliver great nursing care, high level hospitalist and ancillary services to the community. Very soon we will have expanded facilities to offer private rooms to our patients, which will allow for less disruption and a greater opportunity to heal. I am extraordinarily impressed and proud of the care we deliver at Gifford, and fortunate to have the opportunity to be part of this great place.”
~ Dr. Martin Johns, Hospital Division Medical Director

Here is a complete list of all those who worked at Gifford in 2013:

Bernd Dotzauer, MD
Anthony Fazzone, MD
Dennis Henzig, MD
Jon-Richard Knoff, MD
Nazek Shabayek, MDMadeline
Waid, MD
Andrea Williams, MD

Bruce Andrus, MD
Tim Beaver, MD

Chiropractic Sports Medicine
Hank Glass, DC
Andrea Kannas, DC

Emergency Medicine
Gretchen Andrews, MD
Jared Blum, MD
Steven Fisher, MD
Sarah Johansen, MD
Martin Johns, MD
Marc Keller, MD
Thomas Leeson, DO
Wayne Misselbeck, MD
Todd Morrell, MD
Duane Natvig, MD
Paul Newton, MD
Saul Nurok, MD
Kevin Rodgers, MD
Scott Rodi, MD
Brian Sargent, DO
A. Nicole Thran, MD
Joshua White, MD

Family Medicine
Kenneth Borie, DO
Terry Cantlin, DO
Marcus Coxon, MD
Jonna Goulding, MD
Barbara Lazar, MD
Brian Sargent, DO
Mark Seymour, DO
Sheri Brown, APRN
Tammy Gerdes, PA-C
Emily LeVan, APRN
Tara Meyer, APRN
Megan O’Brien, APRN
Rebecca Savidge, PA-C
Starr Strong, PA-C

General Surgery
Ovleto Ciccarelli, MD
Maury Smith, MD
Laurie Spaulding, MD
Nikki Gewirz, PA-C

Hospitalist Medicine
William “Sandy” Craig, MD
Martin Johns, MD
Joshua Plavin, MD, MPH
Kevin Rodgers, MD
Wendell Smith, MD
Sheri Brown, APRN
Sue Burgos, PA-C
Amanda Flyckt, APRN
Megan O’Brien, APRN
Fred Staples, PA-C

Internal Medicine
Milton Fowler, MD
Mark Jewett, MD
Cristine Maloney, MD
Mary LaBrecque, APRN

Internal Medicine and Infectious Disease
James Currie, MD

Internal Medicine and Pediatrics
David Pattison, MD, MPH
Joshua Plavin, MD, MPH

Mental Health
Cory Gould, LPMA
Robert Vaillancourt, LPMA

Donna Butler, CNM
Ellen McAndrew, CNM
Laureli Morrow, CNM
Kathryn Saunders, CNM
Meghan Sperry, CNM
Tanya Waters, CNM

Naturopathic Medicine
Christopher Hollis, ND
Erica Koch, ND

Robin Schwartz, MD

G. Brent Burgee, MD
Anne Galante, MD
Dina Levin, MD
Ellamarie Russo-DeMara, DO

John Valentine, MD

Christopher Soares, MD

Jesse Hahn, MD
Stephanie Landvater, MD
Jayne Collins, PA-C
Bradford Salzmann, PA-C

Cathy Palmer, MD
Brian Travis, MD

Louis DiNicola, MD
Elizabeth Jewett, MD
Joseph Pelletier, MD
Robert Smith, DO
Pamela Udomprasert, MD

Podiatry and Sports Medicine
Nicolas Benoit, DPM
Kevin McNamara, DPM
Robert Rinaldi, DPM
Paul Smith, DPM

Pulmonary Medicine
Marda Donner, MD

Yvette Bailey, MD
John McIntyre, MD
Scott Smith, MD

Sports Medicine
Peter Loescher, MD
Andrea LaRosa, APRN

Michael Curtis, MD
Richard Graham, MD
Nancy Blessing, PA-C

Vascular Studies
Andrew Stanley, MD
Georg Steinthorsson, MD

Two Cups of Comfort: Diagnostic Imaging and Inpatient Care

The following is an excerpt from our 2013 Annual Report: A Recipe for Success.

Ben Cronan

Radiology technologist Ben Cronan, Donna Baker and nurse Shane Parks

Donna Baker is a cancer and MRSA survivor. Unable to walk, she also has COPD. These conditions have meant considerable hospital time for Donna. Of her time spent at Gifford, two faces are particularly memorable: inpatient nurse Shane Parks and radiology technologist Ben Cronan.

“Shane is a very good nurse. He’s very thorough and you feel confident when you’re with him … . When I would have trouble breathing, it would scare me and he would stay there until I calmed down.”

“Ben, I pick on him. When I would need chest X-rays, I would be on a stretcher. He would get right on up on the stretcher. He would like give me a hug around my arms and pull me forward, so (an image receptor could be placed under) me.”
~ Donna Baker