2008 News Stories

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Surgery is an intimidating process for many. However, great strides have been made in the last 25 years to help quell patients' suffering through surgical procedures that reduce bodily trauma. In Hawai’i, two doctors are paving the way, and they can be found at The Queen's Medical Center.

"Why kick in the door when you can look through the key hole?" asks Racquel Bueno, MD. For laparoscopic surgeons like her and Cedric Lorenzo, MD, (see photo) the question comes up often as they consider new and better minimally invasive methods. They specialize in laparoscopic cholecystectomy (minimally invasive gallbladder surgery) which uses a breakthrough breakthrough technique called Single Incision Laparoscopic Surgery (SILS).

A single incision no more than a half inch long is made in the belly button. By contrast, other minimally invasive laparoscopic procedures usually require four small incisions. Specialized tools such as a thin wire-like camera and cutting instrument are then inserted. The healing process is exponentially faster than other methods: patients can leave the hospital as soon as 24 hours and the recovery process is reduced from five to six weeks to one to two weeks.

"It's caught on like wildfire on the mainland," says Dr. Lorenzo of SILS. While it has become increasingly popular on the mainland, the doctors performed the first SILS surgery in Hawai’i at Queen's just last August. Seven patients have undergone the procedure since its inception. Queen's is currently the only known hospital in Hawai’i to offer SILS.

The doctors say that along with faster recovery times, fewer incisions can also mean less risk of infection, less risk for bleeding and less pain. Patients are generally attracted by the aesthetic appeal of having fewer post-operative scars.

For now, the procedure is being used for gall bladder removal, but the doctors see vast potential for SILS. In the near future, the technique could be used for other fixed organs such as kidneys and ovaries, as well as common gastrointestinal surgeries such as appendectomies and even weight-loss surgeries.

The Queen's Human Motion Institute offers a full line of specialists, including orthopedic surgeons, neurosurgeons and rehabilitation therapists.

The objective is simply stated: "To differentiate The Queen's Medical Center Human Motion Institute® (HMI) as the clear choice for musculoskeletal care in the Pacific." This objective is reachable because, at the heart of Queen's HMI is a simply stated, patient-centered goal: "To return patients to normal function as quickly and safely as possible."

Queen's HMI encompasses all services for bone, muscle, joint and spine care, including the prevention, assessment, treatment and rehabilitation of musculoskeletal injuries. The Human Motion Institute is an organization which with hospitals to provide world-class musculoskeletal programs of distinction. Queen's partnered with HMI, which has associations with 155 hospitals in the U.S. and Europe, to take its musculoskeletal program to the next level in patient care excellence. "We wanted to put a face on our program and let people know who they can turn to for the care of their bones, joints and muscle ailments," said Karen Hadwin, RN, Director of Medicine Services. HMI enhances organizational effectiveness and reach so orthopedic surgeons, neurosurgeons, rehabilitation professionals and other staff at Queen's can do what they do best—care for patients with musculoskeletal injuries.

Queen's has led musculoskeletal treatment in Hawai’i since 1971, when the first total hip and total knee replacement surgeries were performed here. Since those beginnings of modern orthopedics in Hawai’i, Queen's has consistently provided leading edge treatments and the most advanced technologies in the field. Today, Queen's performs more total joint replacement and reconstruction surgeries than any other hospital in Hawai’i. With eight out of 10 Americans experiencing life-altering episodes of back pain, Queen's HMI also specializes in preventing and providing relief for back pain and spinal disorders. Another specialty at Queen's HMI is the treatment of the uniquely complex hand and upper extremity parts of the human body, which includes the joints, bones and muscles of the fingers, hand, wrist, arm, elbow and shoulder. Specialists are also trained to treat foot and ankle pain.

An essential part of the treatment process is rehabilitation. Queen's HMI employs a variety of advanced techniques to restore normal strength, motion and flexibility, and reduce pain as quickly and as safely as possible.

A growing subspecialty is sports medicine. In addition to providing specialized assessment and treatment for sports-related injuries, the Queen's HMI team is actively involved in educating athletes, coaches and parents about injury recognition and prevention. For a physician referral or for more information about the Queen's Human Motion Institute, call 808.545.8800, or visit http://queens.humanmotioninstitute.org.

The Queen’s Medical Center recently selected Christy Passion, RN, as Employee of the Year. The Queen's Employee of the Year is chosen from 12 Employees of the Month who represent a staff of over 3,500. Christy earned her Bachelor of Science in Nursing at the University of Hawai’i and advanced her training at Queen's to become a Crisis Nurse. She was selected for her actions in increasing safety for Queen's patients. Calling patient falls in hospitals across the country "unacceptable," Christy took it upon herself to increase education among staff. She researched the issue, lobbied for funds for new equipment and classes, and then trained 17 others to help teach them.

"I really don't believe it's only one person, or even one service line that makes patient care happen," Christy said, reflecting on her newly bestowed honor. The crisis nurse went on to elaborate that doing her job alone would not be possible. "There are many hands along the way. When a patient crashes, the entire team is there for me. I say a patient needs help, and they come running." Christy acknowledges the respiratory techs, CT techs, x-ray techs, pharmacists and the residents as always being there for her. Her multi-discipline training and ability to interface with teams served her well when it came time to develop her special project, falls training. She called on everyone she knew, and met anyone she didn’t know but thought could help, from ambulance drivers to Emergency Department staff. They were all willing to help, and in the end, some 900 QMC staff members were trained in patient falls care and prevention. "It was a very big collaborative effort," Christy said. "I created the program, but I had so many great resources."

It can truly be said that Christy Passion reflects Queen's C.A.R.E. Values—Compassion, Aloha, Respect and Excellence.

On December 2, 1959, the year of Queen's 100th anniversary, a team of Queen's surgeons performed the first open heart surgery in Hawai’i. "It was considered a huge risk," said Albert Chun, MD, who was one of the surgeons. Queen's has come a long way since then. On August 8, 2008, at 8:08 am, Queen's Heart reopened as a completely redesigned 12,754 square foot, interconnected facility, marking another milestone in the treatment of cardiac disease.

"The remodel is operational as well as physical," notes Cathy Young, RN, Vice President of Patient Care. "Our new operational model connects all the dots and makes it even better for patients." The new model emphasizes one solid team with a mind-body approach to treatment. It gives patients the tools to get well and stay well. Other fairly recent improvements have been Cardiac Curbside, for patients who have no way to get to Queen's, and Cardiac Transfer, which guarantees beds and easy, one-phone call transfers of patients from other hospitals.

While Young emphasizes that Queen's Heart extends far beyond its physical boundaries to include anywhere patients are treated by Queen's practitioners, the remodel conveniently consolidates many of the department's functions. For example, there is now one place for all Queen's Heart patients to get registered, whether they are outpatients or inpatients, and no matter what type of procedure. Bypassing general hospital registration, patients simply take the Pauahi elevators to the third floor, where they are greeted by a soothing, inviting, waiting and registration area. Non-invasive testing, such as electrocardiology (EKG, holter monitoring, etc.), echocardiograms and stress testing are located here.

Just down the hall from the registration/waiting area are four, advanced technology catheterization labs, where invasive procedures are performed. Near the cath labs is a new, 20-bed, cardiac pre- and post-procedure recovery area.

Queen's Heart's physical area is almost mirrored above on the 6th floor, where heart inpatients are cared for. "Basically, you have a heart hospital within The Queen's Medical Center," commented Joana Magno, MD, Chief of the Department of Cardiovascular Medicine.

Other advancements put in place this year at Queen's Heart include the beginning of da Vinci robotic open heart surgical techniques; the equipping of 27 ambulances to transmit EKG readings directly to the ER; and the Cardiac Integrative Care program, which offers wellness consults, and mind, body and spirit therapies which complement traditional care.

"It's also been a remarkable year for outcomes," said Dr. Joana Magno. "This year, the mortality rate for acute myocardial infarctions (heart attack) is just 2.6%." Coronary angioplasty is down to 0.88% (the national average is 1.1%), and coronary open heart surgery is 1.2% (1.4% nationally)."

Queen's Heart offers the best and most comprehensive cardiac program in Hawai’i, but the bottom line is the patient—and the Queen's Heart team is committed to the patient in every way.

This year, The Queen's Medical Center honors two outstanding physicians for 2008: Whitney Limm, MD, as Hospital-Based Physician of the Year, and Morris Mitsunaga, MD, as Community-Based Physician of the Year.

Dr. Whitney Limm earned his undergraduate degree in biology from Stanford University. He earned his medical degree from the UCLA School of Medicine, then completed his internship and general surgery residency at the University of Hawaii's John A. Burns School of Medicine (JABSOM). He completed his fellowship at the Cardiovascular Research Lab at Queen's. During his residency, Dr. Limm also completed a clinical transplantation fellowship at the California Pacific Medical Center in San Francisco.

Dr. Limm serves as medical director for Queen's Operating Room and Same Day Surgery Center and is an associate professor at the Department of Surgery at JABSOM. His private surgical practice is with Surgical Associates, Inc. Last year, he agreed to be the physician champion for Surgical Care Improvement Project (SCIP) Core Measures, a national effort in which hospitals voluntarily incorporate measures proven to reduce surgical complications such as infections, blood clots and myocardial events.

Those who work with Dr. Limm say he is an effective leader who always listens and requests feedback and ideas from everyone. "You always leave feeling you were in a collaborative discussion and never in a directive one," a colleague wrote in nominating him as Physician of the Year. Others said that Dr. Limm treats everyone with respect, and that, above all, his goal is to always do what is right for the patient.

Dr. Limm notes that he has devoted most of his professional time to Queen's because it uses its resources to help the community. "Queen's has been very supportive," he says. "For example, the minimally invasive surgery program, APEC (Anesthesia Preoperative Evaluation Center, the Women's Health Center, Queen's Cancer Center, Same Day Surgery Center and the new ER have all been in response to community needs and physician input."

Dr. Morris Mistunaga serves as Chief of Orthopedics at Queen's. Dr. Mitsunaga entered pre-med training at Creighton University, earned his medical degree at Creighton University School of Medicine, developed an interest in orthopedics and performed his residency in orthopedic surgery at the Mayo Clinic. Always intending to return to Hawai’i, he naturally came to Queen's, "where the action is." Dr. Mistunaga is serving his second consecutive appointment as Chief of Orthopedics.

Dr. Mitsunaga is very proud of the Orthopedics Department, citing all the advances in technology; high independent health rating scores; the starting of the Human Motion Institute and Spine and Joint Centers; volunteerism from many physicians to cover the Queen Emma Clinics; attendings stepping up to help residents; the core group of doctors who take trauma calls; the SCIP initiative to improve patient care; and the establishment of clinical pathways so physicians can follow best practices and give efficient medical care. "Patients always come first," he concludes.

His team, in turn, gives credit to a great leader, calling Dr. Mitsunaga a humble, approachable, caring, upbeat man of action. "He supports resident training with time and monetary support," one of his POY nomination forms said. "[He] is always helpful to staff for orthopedic consultation with a friendly attitude." Dr. Mitsunaga thanks everyone at Queen's—all the people who make things happen day to day. He says, "I'm thankful to all the people who help me take care of patients."

Queen's two Physicians of the Year represent just a few examples of excellence among over 1,200 physicians. It is with pride that we acknowledge these outstanding individuals who represent the Queen’s family.

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