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.

New Tool Brings Hope for Those with Chronic Bone and Muscle Pain

This article was published in our Fall 2015 Update.

Ginger PotwinAnyone who has suffered chronic muscle and bone pain knows that it can be difficult to find a treatment that relieves the discomfort. Sometime these injuries can significantly impair mobility, or your ability to enjoy daily activities.

“We’re always looking for new ways to treat these conditions because one person’s response can differ from that of someone else who has the same condition,” said Sharon Health Center Sports Medicine Specialist Dr. Peter Loescher.

Loescher suffers from chronic tendonitis of the knee himself, so he was especially open to trying out a new technology that might help similar conditions. He recently tested the EPAT (extracorporeal pulse activation technology) tool, a hand held device that looks like a small hairdryer, which uses pressure waves to increase blood flow to regenerate damaged tissue and promote healing. He liked that the tool offered a non-invasive treatment option to traditional cortisone injections or plasma replacement needle therapy.

“EPAT is especially good with repetitive injuries—carpenters elbow, tennis elbow, and some knee conditions,” Loescher said. “The body has long since given up trying to heal these daily repetitive injuries, and EPAT can help restart the body’s own healing process.”

After successfully using the technology on himself and other staff members at the Sharon Health Center, Loescher began a 3-month trial with patients who had not found a successful treatment plan and were willing to try something new.

Chronic shoulder pain interfered with work, limited daily routines
Randolph Personal Fitness Trainer Ginger Potwin came to see Dr. Loescher when the exercises and anti-inflammatory medication prescribed by an orthopedist failed to ease increasing pain in her shoulders. Over the course of a year, her daily activities caused flare-ups, and each time her symptoms worsened. She worried that she would be unable to continue working as a trainer.

“The flare-ups in both shoulders prevented me from doing outside activities like raking the lawn, shoveling, and gardening. Also, doing household chores such as mopping and folding laundry proved challenging,” she said. “I was unable to demonstrate exercises to clients.”

Initially Loescher used a needle to break up significant calcium deposits in both of Potwin’s shoulders. He mentioned that EPAT therapy might help her condition, and Potwin decided to try it.

I felt immediate results,” said Potwin, who has had four EPAT treatment sessions. “Following each session I noticed increased range of motion in my shoulders and the pain significantly subsided—including the flare-ups with regular activities.”

Potwin says that the EPAT session lasted about seven minutes (her needle therapy sessions were about 40 minutes), with a post-treatment recovery time of a few days compared to the two weeks she had previously experienced. When she first began EPAT she had about 20 percent use of her shoulders—this increased to about 70 percent after the first treatment. Very quickly she was once again able to demonstrate exercises to her clients, which is critical for her work.

“I am back to my normal routines: I am able to rake my yard, garden, and fold clothes without pain or potential flare ups,” says Potwin. “I am also training for a thirteen mile obstacle race (Spartan Beast Race) in Killington this fall. I would have not been able to participate in this race if my shoulders were in the condition they were in prior to the EPAT treatment!”

To learn more about EPAT therapy, call the Sharon Health Center at
(802) 763-8000.

Expanded Behavioral Health Team Enhances Primary Care Services

This article was published in our Fall 2015 Update.

Gifford's behavioral health clinic hoursWith the unique ongoing relationship primary care providers establish with patients and families, they may be among the first to recognize that someone is struggling with depression, anxiety, or even substance abuse.

This year Gifford expanded the Behavioral Health team (it now includes a psychiatrist, a master’s level psychotherapist, a licensed drug and alcohol counselor, and a psychiatric nurse practitioner) to help primary care providers identify ongoing issues and help patients get the support and care they need.

“There are people in our community who are struggling with sadness, depression, are grieving a loss, or are overwhelmed by money issues. We want them to know that they can get help,” said Gifford’s Chief Medical Officer Dr. Martin Johns.

He notes that the new Behavioral Health team will complement the work of the Clara Martin Center, which handles more long term psychotherapy needs, and offers a depth of expertise that is unusual in a small rural hospital.

“Having behavioral health expertise onsite to assist in the emergency room if needed, or to consult on inpatient and outpatient care, will allow our primary care provider to help more patients manage mental illness issues,” he said.

Behavioral Health Director Dr. Peter Thomashow says his team looks closely at how biological, psychological, and social factors influence health. They offer individual, couples, and family psychotherapy and education and also collaborate with primary care providers to help them manage depression in patients.

“We are especially interested in helping individuals having difficulty coping with chronic medical illness,” said Thomashow. “Behavioral health needs to be integrated into a primary care plan, especially when treating chronic illness.”

The Behavioral Health clinic services include comprehensive evaluation and treatment for a wide range of psychiatric disorders for adults (age 18 and older) including:

  • Depression
  • Anxiety
  • Stress
  • Insomnia
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Dementia
  • Substance abuse


Peter Thomashow

James Tautfest

Cory Gould

Morgan Dion

Personalized Care, a Healing Space Near Home

Vision for the Future co-chair experiences first-hand the importance of quality local care

This article was published in our Fall 2015 Update.

Lincoln ClarkLincoln Clark, Gifford trustee and co-chair of the Vision for the Future campaign, has been actively raising funds for the new Menig Nursing home and the subsequent private patient
room conversion at the hospital.

In an odd twist of fate, the Royalton resident recently experienced first-hand just how important quality local care and private patient rooms can be to both the patient and their family.

While on an annual fishing trip with his son in northern Maine, Clark fell and broke his hip as they were taking their boat to get the motor serviced. After a 178-mile ambulance ride to Portland, ME, he found himself facing surgery by a surgeon he’d never met.

“I spent approximately four minutes with him prior to the operation. I was doped up to the gills, and I couldn’t understand his precise and very technical description of the procedure,” Clark said. “The next day he was off-duty so his partner, a hand surgeon, looked at my wound.”

That same day a care management representative visited to say that he would be released the following morning—they were looking for a rehabilitation facility that could take him.

Clark asked if he could go home to his local hospital, and was told that Medicare would only pay for an ambulance to the closest facility (to pay for an ambulance to Vermont, would cost him thousands of dollars). He was transferred to a facility in Portland the following morning.

“The new room was sectioned off with brown curtains, the bed pushed up against a wall, and there was a 3-foot space at the bottom of the bed for my wife, Louise, to sit,” he said. “It was smaller than most prison cells! My roommate’s family (six of them) was visiting, and they were watching a quiz show on TV at full volume.” This was the low point.

Overwhelmed, the Clarks struggled to figure out the logistics of a long stretch in rehab for Lincoln, and the hours-long commute for Louise, who had to maintain their house in Royalton.

After an unimpressive start in the rehab physical therapy department, they made an unusual but obvious choice: Louise packed Lincoln into the car and they made the 4-hour drive to Randolph.

“I wanted to be at Gifford. I knew the physical therapy team was first rate, and I was confident I would get the kind of therapy I needed to get me out of the hospital,” Clark said.

Fortunately, a room was open and he spent ten days at Gifford this summer. He worked on his laptop in the Auxiliary Garden, met with people in his room, and was even wheeled to the conference center to attend board and committee meetings. Once discharged, he was able to continue his therapy as an outpatient.

“After this experience I really can see how important a private patient room is,” he said. “And I can attest that the letters to the board, the positive comments patients make on surveys, and the occasional letters to the editor don’t begin to describe all that it means to be cared for by Gifford’s staff. This is just a great hospital!”

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.

Project Independence

The following article appeared in our 2014 Annual Report.

Project Independence

Adult Day participants at both of Gifford’s locations enjoy many activities: sing-alongs, live performances, arts and crafts, exercise, games — even visits from a therapy dog!

Another senior-health initiative came to fruition in 2014 when the boards of Gifford and Project Independence, an adult day center located in Barre, unanimously
agreed to a merger in May after studying the relationship for more than a year.

The merger took place at the conclusion of Gifford’s fiscal year on September 30.

Project Independence got its start in 1975 when a nursing home activity director, Lindsey Wade, encountered residents who didn’t seem to medically belong there. Wade envisioned a social adult day program, a new concept at the time. An active board and an interested city brought to life Project Independence on Washington Street, and in the decades since, its model has expanded statewide. There are currently 14 adult day programs in Vermont.

Today’s Project Independence serves 23 towns in Washington and northern Orange counties, welcoming an average 38 seniors and the disabled each weekday. The project includes meals, showers, medication management, and ample activities, providing participants with a fun and safe day care experience while also allowing them to stay at home—a far more affordable model than nursing-home care.

But an ongoing struggle for funding—combined with property damage caused by flooding in 2011 and a sewer issue during Barre’s “Big Dig”—prompted small, standalone Project Independence to seek help in the form of a partner. The board was drawn to Gifford because of the adult day program in Bethel, the medical center’s mission of supporting seniors, and its commitment to community.

Under the full-asset merger, Project Independence retains its name, location, and fund-raising dollars. Its board will become an advisory board to provide local perspective and experience, and employees will become part of Gifford, opening the door to enhanced benefits. Project Independence will be helped by Gifford’s staff, from financial to billing to nursing help, as well as its buying power as a larger organization.

“When someone has a humble request for help as it relates to the delivery of health care services, we take that seriously,” said Gifford Administrator Joe Woodin, praising Project Independence’s board, values, volunteers, and hardworking team. “For us, that’s extraordinarily appealing and we’re thankful that they’ve asked us.”

Joining with Project Independence is in keeping with Gifford’s mission and provides support to a needed service that will no doubt grow as the state looks for more affordable ways to care for a growing senior population, said Gifford Board Chair Gus Meyer.

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.