Posted by: Duke Raleigh Hospital | July 8, 2020

International Coordination Leads to First for Duke Health

Dr. Kishan Parikh, Silvia Macagno and her husband in early 2020 (before COVID-19).

In December 2019, a patient visiting Duke from Argentina underwent a CardioMEMS implantation at Duke Raleigh Hospital. Silvia Macagno, who has a longstanding history of heart failure, pulmonary hypertension and multiple heart surgeries, is Duke University Health System’s first patient to receive the device for clinical use with international remote monitoring.

 “Doctors first discovered a malformation of my heart at my first physical exam in school, when I was six years old,” Macagno remembered.

Macagno was connected with Duke Raleigh Hospital for care through Dr. Alex Barbagelata, an adjunct professor in Duke’s Department of Medicine, who practices in Argentina.

“When I first saw Macagno she had already had four surgeries,” said Dr. Barbagelata. “Her heart was weakening and her pulmonary pressure was increasing.”

Macagno traveled to North Carolina to be assessed for potential advanced heart failure therapies. Once here, though, her care team decided on pulmonary hypertension care, including the implantation of the CardioMEMS.

Dr. Kishan Parikh a Pulmonary Hypertension/Advanced Heart Failure Specialist with Duke Health, lead implantation of the CardioMEMS device. The device is implanted into the pulmonary artery to measure lung pressures from the patient’s home. This allowed Dr. Parikh to more closely manage Macagno’s heart failure and pulmonary hypertension.

“Fluctuations in these pressures can predict clinical changes. If we can act on this data, we can reduce heart failure complications,” said Dr. Parikh. “The information provided by the CardioMEMS device is like having data from a right heart catheterization procedure daily.”

The data from Macagno’s device is transmitted to an online portal where Dr. Parikh monitors the readings, allowing him to work with Dr. Barbagelata to manage Macagno’s condition from Raleigh while she is at home in Argentina.

“This device helps bring care delivery from inside the hospital and clinic, to the patient’s home,” added Dr. Parikh. “It allows us to see trends, instead of just a snapshot every couple of months, so we can be proactive instead of reactive in our care of Ms. Macagno.”

Dr. Barbagelata sees Macagno as a model for future patients. “You can be 5,000 miles away and access data on your cell phone and decide the patient needs a change in their care or treatment,” Dr. Barbagelata said. “This new collaboration for the well-being of the patient is exciting and fascinating.”

Typically, this implantation is an outpatient procedure but, due to other complications, Macagno spent five weeks receiving care at both Duke Raleigh Hospital and Duke University Hospital.

“If we weren’t in North Carolina, I might not be alive,” said Macagno.

Dr. James Mills, interventional cardiologist, performed the CardioMEMS implantation. Much of the cost of the necessary procedures was covered through donations. Dr. Sean Pokorney, MBA donated his time to implant a cardiac resynchronization therapy defibrillator, which was also donated. This implantation was performed at the same time as the CardioMEMS to avoid multiple procedures. The anesthesia team also donated their time for the procedure.

“In Argentina, we have very good insurance, but it doesn’t work here,” said Daniel Macagno, Silvia’s husband. “We have had to go through many steps to get here and to pay for treatment here in the United States. This means a lot.”

Members of the team that performed Macagno’s procedure in December 2019 (before COVID-19).

For Macagno, this procedure could mean fewer hospitalizations as symptoms, and new treatment strategies will now be monitored in real time.

“This has really taken a lot of coordination and teamwork,” said Dr. Parikh. “And I really appreciate Duke Raleigh Hospital leadership for their support, Abbie Faircloth in planning and organizing the care, and Duke Raleigh Heart Failure Clinical Nurse Specialist Amelia Ross for helping with the coordination of care between here and Argentina for Silvia.”

For Dr. Parikh, of the Duke Raleigh Hospital team, the hope is that this procedure leads to big improvements in Macagno’s quality of life. He hopes “this procedure leads to improving heart failure care for more patients at Duke Raleigh Hospital and strengthens our partnership with Dr. Barbagelata and his patients in Argentina.”

–By Stephen McNulty

Posted by: Duke Raleigh Hospital | June 26, 2020

Independence Day Service Changes

The following Duke Raleigh Hospital clinics and services will have scheduled changes in observance of the Independence Day Holiday.

Adjusted Hours

Café Hours for Friday, July 3
7:30–10 a.m. Breakfast
11 a.m.–2 p.m. Lunch
4:30–8 p.m. Dinner
10 a.m.–8 p.m. Grab & Go

Coffee Shop Hours for Friday, July 3
9 a.m. –3 p.m.

Service Closures for Friday, July 3

*The Symptom Management Clinic, a resource for symptom management to help minimize cancer patients’ use of the Emergency Department for care, will be open at 3404 Wake Forest Road (Medical Office Building 7) from 8 a.m.-1 p.m. on Friday, July 3, to Sunday, July 5, by appointment for our Wake County cancer patients. Patients in need of an appointment should call 919-862-5400.

Service Closures for Saturday, July 4

Appointment-only drive-up testing.

Posted by: Duke Raleigh Hospital | June 24, 2020

Updated Visitor Restrictions

Visitors are an important part of patient care and wellness, which is why we are looking forward to being part of Duke Health’s modified visitor restrictions. These modified visitor restrictions begin June 24. Learn more about these updates.

Posted by: Duke Raleigh Hospital | June 23, 2020

Visitor Badges Extended Across Hospital

When visitors come to Duke Raleigh Hospital the afternoon of June 23 they will receive the above visitor badge.

Beginning at noon on Tuesday, June 23, visitors that accompany patients to the main Duke Raleigh Hospital building will be issued a badge.

Visitors of patients to the front entrance of our hospital will be assisted by a Duke Raleigh Hospital team member who will utilize an iPad to scan a visitor’s driver license to capture their name, or allow them to fill in the information themselves, to create a badge sticker. The badge will also include the room number of the patient the visitor is permitted to see.

When visitors leave the hospital building, they should remove their badge and give it to a Duke Raleigh Hospital team member at the front entrance. Visitors will be required to revisit the screening entrance at the front entrance of the main hospital for a new badge, should their visit extend longer than 24 hours.

This change allows our team members to better track visitors and patients in our care areas. A similar system has been used in the Duke Raleigh Hospital Emergency Department since November 2019.

Please review our present visitor policy in place across Duke Health hospitals and clinics.

Posted by: Duke Raleigh Hospital | June 22, 2020

Three Good Things Make the Difference on Orthopaedics Unit

Bethany Gallagher completed training and became the well-being ambassador for her unit. Gallagher is pictured on February 10, 2020, prior to the COVID-19 response. Photo by Kevin Seifert Photography.

Bethany Gallagher, RN, BSN, ONC, clinical nurse IV on the orthopaedics and neurospine unit at Duke Raleigh Hospital, volunteered to become the resilience ambassador for her unit in an effort to reduce turnover and make it an even better place to deliver care. ​

The training, offered through the Duke Center for Healthcare Safety and Quality, focuses on decreasing team member burnout and increasing team member resilience and well-being.

While many tools are explored in training, Gallagher implemented the “Three Good Things” tool, which quickly became a team favorite.

“I wanted something we could do while on the unit and not make it feel like homework,” said Gallagher. “I wanted to focus on increasing positivity without adding any stress.”

As a group, each shift was encouraged to write three good things that happened that day on a special white board by the nurse’s station. The good things were then read to the next shift to start their day on a positive note. 

“This tool gave us a chance to reframe the events of our shift to better appreciate the positive and not get lost in the negative,” said Gallagher. “It also gave us the opportunity to take part in the positives that other team members had experienced that maybe we didn’t personally experience.”

Fellow clinical nurse, Babou Touray, RN, CNII, said he participates in the “Three Good Things” tool every time he works. “We enjoy seeing each other highlighted on the board. It’s really inspirational.”

After trialing it for three months, the group voted to continue the “Three Good Things” tool. It has been added as a permanent part of the team’s huddle.

According to Touray, the “Three Good Things” tool helped his team become more positive.

“Everyone is happier since we began incorporating this into our daily routine,” he said. “I think it has helped morale on the unit, which will enable us to work better together and deliver the best possible care to our patients.”​

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