AMSURG Center Performs Robotic-Assisted Knee Replacement to Restore Mobility

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Craig and Gaye Moody held hands as they strolled along the boardwalk near the Blue River Bridge in Port Huron, Michigan.

The Moodys walk to exercise and spend time together beside the St. Clair River, at nearby parks or in their neighborhood.

“It’s really good to have someone to walk with, and I knew he enjoyed it,” Gaye said. “We live in a subdivision that you can easily walk two miles just by going in and out of the various streets. So, it’s been a really important part of our life.”

Recently, pain and irritation in his left knee began to interfere with Craig’s walks with Gaye and other activities.

“Last year, I wasn’t able to walk as far and long as she could. It got to the point where I could only do a mile — and I could do it only at my pace,” he said. “The pounding of the concrete was very irritating and made it sore. So, that’s when I knew that something had to be done.”

Patient Chooses Robot-Assisted Surgery

X-rays verified that Craig, 78, had end-stage arthritis in his knee.

Orthopedic surgeon Rajesh B. Makim, MD, said Craig explored many knee pain treatments for more than five years. Nonsurgical measures included cortisone injections, physical therapy, weight loss and activity modification.

“He was using a cane,” Dr. Makim said. “His knee was very stiff and very painful, and it interfered with his activities of daily living. He couldn’t enjoy the things that he wanted to do.”

Craig opted to undergo robotic-assisted knee replacement surgery on June 14 at Blue Water Surgery Center, an AMSURG affiliated ambulatory surgery center.

“My knee wasn’t going to get any better,” he said. “Even with physical therapy before, it was just bone-on-bone. I just couldn’t move.”

In traditional and robotic-assisted surgery, surgeons replace the knee’s damaged bone and cartilage with prosthetic joint components called implants.

For Craig’s procedure, Dr. Makim used a robotics platform. The system uses a CT scan of a patient’s joint to develop a personalized surgical plan. During the surgery, the surgeon guides a robotic arm to remove arthritic bone and cartilage from the knee.

Robotics is a “very sophisticated tool” used under the guidance of the surgeon, said orthopedic surgeon William Braaksma, MD.

“It is not a substitute for judgment or skill in the operating room,” he said. “It requires skill, and the surgeon has to know what they’re doing to make it work.”

The accurate and precise robotic technology allows surgeons “to do the knee replacement with very minimal soft tissue releases and to use the implant in the cuts to balance the knee,” Dr. Braaksma said. As a result, he said patients should experience “less pain, less swelling and faster recovery.”

Regaining Mobility, Range of Motion

Within a few hours of his procedure, Craig was discharged from Blue Water Surgery Center. The center provided a walker for him to use at home, where his wife kept an eye on his progress.

Two days later, Craig underwent a post-operative exam. He scheduled physical therapy sessions to assist with exercises to strengthen his knee.

“When they tell you to do some exercises, you do these exercises,” Craig said. “If you don’t do the exercises, you’re not going to get the benefits that the surgeon’s done for you.”

Craig’s dedication to rehabilitation paid off. Two weeks after surgery, he regained his range of motion and his strength. He transitioned from using a walker to a cane and then to walking unassisted.

“I had my balance,” he said. “I could move around the house without a problem. As long as I was on concrete, I was fine.”

Four to six weeks after knee replacement surgery, patients generally resume daily household activities, including walking, sitting, standing and climbing stairs.

Craig was cleared to drive after four weeks and mowed his lawn two months after surgery. The Moodys also resumed their daily walks together.

“He’s at the same pace I am, and he is not lagging behind. He doesn’t stop and turn around and go back,” Gaye said. “And, if he thinks he hasn’t gone far enough, he’ll go another block or two.”

Most knee replacement patients experience significantly reduced pain, improved mobility and a better quality of life.

“That’s one thing about knee replacement — it’s basically one of the most successful operations in orthopedics,” Dr. Makim said. “And, it’s one of the most life changing for people.”

Surgery Centers Benefit Patients

Around 790,000 knee replacement surgeries are performed each year in the United States. Your doctor may recommend knee replacement surgery if you experience any of the following:

  • Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs and getting in and out of chairs
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of the knee
  • Failure to improve substantially with anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy or other surgeries

According to the American Academy of Orthopaedic Surgeons, more than 50 percent of joint replacements will be performed on an outpatient basis by 2026.

Various factors determine whether patients are suitable for outpatient surgery, such as their age, existing medical conditions and the support they receive at home.

Dr. Makim said procedures at ambulatory surgery centers benefit patients.

“The operation is basically the same as what we would do at the hospital,” he said. “The costs are lower, and we have a more streamlined approach to getting people in and out of the door without compromising any patient care.”

Don’t Delay Your Treatment

October is Bone and Joint Health Awareness Month. It’s important not to ignore chronic pain in your knee, hip, shoulder or back, or your condition may worsen.

“Thankfully, nowadays, knee replacement surgery is a very safe operation that is enjoyed by literally hundreds of thousands of people a year in the United States,” Dr. Makim said.

As Craig’s activity level increases, Gaye celebrates her husband’s recovery.

“I’m excited because it’s good to see him excited and not hurting,” she said. “He’s back, and it’s wonderful.”

Craig said he views the prominent scar on his knee as “a success story.”

“This knee was shot, and now it’s not,” he said, smiling.

This article is designed for educational purposes only. The information provided should not be used for diagnosing or treating a health concern or disease. It is not a substitute for professional care. If you have or suspect you may have a health concern, you should consult your healthcare provider.

Envision Healthcare’s 2022 Clinical Impact Report

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Envision Healthcare’s 2022 Clinical Impact Report Illustrates the Many Ways Teams Cared for and Positively Impacted Millions of People

NASHVILLE, Tenn. — Today, Envision Healthcare, a leading national medical group, released its 2022 Clinical Impact Report, detailing the many ways Envision teams continue improving healthcare for millions of people by providing care when and where it’s needed most. The full report is available at ImpactReport.EnvisionHealth.com.

“In 2022, Envision clinicians and clinical support teammates remained steadfast in providing the highest quality of patient-centered care,” said Jim Rechtin, Chief Executive Officer of Envision Healthcare. “While continuing to make patients our top priority, we focused on creating programs and services to support the well-being of the clinicians that care for those who need it most. We made investments and improvements to support our team members and the communities we serve. From advancing clinical quality standards and building communities of clinicians to championing philanthropic ventures that uplift patients across the globe, our 2022 Clinical Impact Report provides a glimpse into the incredible work Envision teammates do daily.”

Envision’s second annual Clinical Impact Report illustrates the organization’s significant contributions to the healthcare community by highlighting its innovations in care and dedication to patients. The report details Envision’s work within the pillars of Care, Connection and Community, showcasing everything from colon cancer prevention initiatives to patients’ testimonials of Envision clinicians providing extraordinary care.

Delivering Safe, High-Quality, Patient-Centered Care

Envision clinicians provide integrated, high-quality care to patients throughout their care journey. In 2022, they treated patients in communities throughout the United States through the following:

  • 29 million patient encounters
  • 16 million emergency department and inpatient encounters
  • 8 million radiology reads
  • 4 million anesthesia cases
  • 1 million colonoscopies
  • 182,000 cataract surgeries
  • 144,000 newborn deliveries supported
  • 87,000 orthopedic surgeries

Care

Envision is empowering clinicians to provide safe, reliable care and advance clinical quality by optimizing the transition of care through evidence-based practices and nationally recognized standards. In 2022, Envision clinicians continued outperforming national quality benchmarks while treating complex medical conditions and authoring two Centers for Medicare & Medicaid Services-approved national clinical quality measures. Through programs like Emergency Triage, Treat and Transport (ET3), Envision teams provided patients the right care at the right time and in the right place. They also contributed to healthcare advancements. In 2022, the Research Institute team conducted clinical trials and published 161 research publications, helping Envision earn a top three award at the prestigious Evidence Based Perioperative Medicine World Congress in London.

Connection

Envision is providing clinicians with the tools and resources they need to treat patients without distraction, furthering its commitment to investing in teammates and empowering them to thrive professionally and personally. In 2022, Envision redefined its organizational structure to build a transformative care experience for patients and drive clinical innovation. Envision focused on programs and services that inspire, protect, empower and engage physicians and advanced practice providers to prioritize their wellness. Envision’s Diversity, Equity and Inclusion efforts led to the launch of four employee resource groups, helping foster community. In addition, Envision helped care for patients and teammates during times of devastation. Following Hurricane Ian, Envision provided medical supplies and financial resources to help individuals.

Community

The Envision Healthcare Charitable Fund supports Envision’s philanthropic efforts, working to make a difference in people’s lives at the local, national and global levels. In 2022, the Charitable Fund donated $4 million to more than 50 community organizations, providing awareness, education and support to a variety of causes. Envision worked with United Way to assemble hygiene and smile kits for 4,000 individuals and supported the Dr. Lorna Breen Heroes’ Foundation to reduce clinician burnout and promote well-being. In collaboration with the Colorectal Cancer Alliance, AMSURG, a leading provider of colonoscopies, continued to educate the public about the importance of timely screenings to prevent and detect colorectal cancer. Envision also collaborated with Operation White Stork to deliver first aid kits to those on the frontlines in Ukraine. As part of their passion for improving healthcare worldwide, Envision clinicians and clinical support teammates cared for communities in need through Envision’s Global Health Initiative. They provided 495 patient consults in the Dominican Republic and performed 38 surgeries and 245 consults in Honduras in 2022.

To download and read the report, visit ImpactReport.EnvisionHealth.com.

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About Envision Healthcare Corporation
Envision Healthcare Corporation is a leading national medical group that delivers physician and advanced practice provider services, primarily in the areas of emergency and hospitalist medicine, anesthesiology, radiology/teleradiology and neonatology. As a leader in ambulatory surgical care, AMSURG holds ownership in more than 250 surgery centers in 34 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. In total, the medical group offers a differentiated suite of clinical solutions on a national scale with a local understanding of our communities, creating value for health systems, payers, providers and patients. For additional information, visit www.envisionhealth.com.

Patient Tells How His Hip Replacement Restored Mobility, Relieved Pain

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For years, John Bolt III enjoyed spending time outdoors playing golf and walking his dogs — until he started experiencing chronic pain in his right hip and back.

The Morehead City, North Carolina, resident said his pain limited his mobility and decreased his social time with his friends for about three years.

“I used to walk quite a bit with my dogs in the morning. I found that over an increasing period of time, it was getting harder and harder to get a full walk in,” John said. “And playing golf really became so painful that I just finally gave up on it.”

John’s pain also interrupted quality time with his wife of 54 years.

“My wife and I enjoy dancing,” he said. “For the last three years, prior to surgery, I pretty much wasn’t able to really get out there and dance. It was just too painful.”

Initially, physicians thought he may have had a sciatic nerve problem in his back. X-rays revealed the problem was actually in his hip.

Knowing Treatment Options Vary

Several years ago, John had a successful knee replacement surgery under the care of orthopedic surgeon Dr. Thomas E. Bates. Because of that physician-patient relationship, he consulted Dr. Bates about his hip pain.

For any joint pain, Dr. Bates said nonoperative and conservative measures are explored first for treatment. Nonsurgical measures may include physical therapy, activity modification, anti-inflammatory medication and sometimes injections into joints.

After considering his options, John chose total hip replacement surgery. This procedure replaces the hip’s damaged bone and cartilage with prosthetic components called implants.

“The pain had gotten chronic, and it just never [went] away. And that’s pretty mentally debilitating as well as physically debilitating. I was really ready to try to get something done to get rid of the pain and to become active again.”

Each year, more than 450,000 total hip replacements are performed in the United States, according to the Agency for Healthcare Research and Quality.

“Patients typically present with pain, decreased range of motion to their joints,” Dr. Bates said. “They sometimes have swelling and even mechanical symptoms that cause them difficulties when they’re doing certain activities.”

Orthopedic physicians might recommend hip replacement surgery if patients have one or more of the following symptoms:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy or walking supports

Recovering From Surgery at Home

After COVID-19 delayed John’s procedure at a nearby hospital, physicians determined he was a good candidate for outpatient surgery. He had surgery in February 2022 at The Surgery Center of Morehead City, an AMSURG affiliated ambulatory surgery center.

“We typically do a case in the morning, and patients are home by lunchtime,” Dr. Bates said. “We have physical therapy coming to our center getting the patient up immediately [after surgery]. I think that decreases the risk of complications for patients and it also puts their family members at ease when they’re involved in the process.”

John was discharged from the surgery center the same day to recover at home. The next day, he started at-home physical therapy with a walker while awaiting his first post-operative appointment.

“I knew that walking was going to be the best thing that I could do from that point on,” he said. “I did all my walking indoors for probably the first couple of weeks.

Three weeks after surgery, he transitioned from using a walker to a cane to walking unassisted.

“And, within six weeks, I was released to go back to playing golf if I wanted to. So, it was a very positive experience for me.”

Returning to an Active lifestyle

More than a year after his hip replacement, John reports significant pain relief and improved mobility.

“I was pleasantly surprised how quickly I was able to recover,” he said.

He and his wife walk about two miles every day with their dogs, and when the weather is suitable, he plays golf sometimes twice a week. He also enjoys date nights and dancing again.

The Importance of Not Delaying Treatment

If people experience chronic pain in the knee, hip, shoulder or back, they should not ignore these symptoms. They should discuss treatment options with a physician.

“Things have changed over the years since I first started doing joint replacements,” Dr. Bates said. “We have been doing outpatient total joints at our facility. That really has been a game-changer in the way of recovery and satisfaction from patients and their families.”

AMSURG teams always keep the patient’s health and safety a priority and look for the least-invasive and best way to repair patients’ hips or other joints. For surgical procedures, physicians use skilled techniques to improve patients’ mobility and help them maintain an active lifestyle.

“When [hip pain keeps] you from doing anything that involves any type of walking or movement … that’s just not a way to live,” John said. “Get [surgery] done, and then really work at the rehab part. I think that’s important. It gets you back to normal as quickly as possible.”

This is designed for educational purposes only. The information provided should not be used for diagnosing or treating a health concern or disease. It is not a substitute for professional care. If you have or suspect you may have a health concern, you should consult your healthcare provider.

AMSURG Centers Recognized by Press Ganey for Commitment to Patient Experience

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Several AMSURG centers were recognized for their exceptional patient care as recipients of the 2022 Press Ganey Human Experience Awards. The awards are part of Press Ganey’s annual ranking of the country’s top hospitals and health systems according to patient and employee experience performance.

“We congratulate the excellent work that our AMSURG centers and teams are doing in providing high-quality, evidence-based, compassionate care,” said Nina Goins, MSN, RN, CPPS, Vice President of Quality and Clinical Services for AMSURG. “Receiving the award is a testament to the centers’ commitment to enhancing the patient experience and advancing the delivery of care.”

When patients complete their outpatient care, they are invited by Press Ganey to complete a survey about the experience with questions about the Likelihood to Recommend, Overall Rating and Teamwork. Using this feedback, hospitals and centers improve their processes and training to provide a high-quality care experience.

2022 Pinnacle of Excellence Award

This award recognizes the top performers in each category based on the performance of designated award survey measures for the 3-year award period. Winners are identified based on performance data from April 2019 to March 2022.

2022 Guardian of Excellence Award

The Guardian of Excellence Award recognizes centers with 95th percentile or higher scores on survey measures. The award is given annually to organizations with sustained performance within the top 5 percent for the reporting period from April 2021 to March 2022.

Congratulations to these teams on a job well done.

White Paper: Social Determinants of Health

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Envision is committed to establishing best practices, implementing innovative approaches to care and advocating for reforms that will help attain the highest level of health for all people. As part of its efforts to improve health equity, the medical group released a new white paper examining social determinants of health and how clinicians and healthcare professionals can work together to address the social, cultural, economic and political factors that help or hinder individuals’ health.

Read the white paper here.

Introducing Candid Conversations

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I’m excited to introduce the new “Candid Conversations” video series, featuring Envision teammates in endearing and curiosity-fueled interviews.

We share stories about our lives and work caring for our communities. We also learn about the qualities that make us unique and find common ground on the ones that make us all human. Join us as we share some laughs and tears and gain a deeper appreciation for one another.

In this first conversation, Dr. Mansoor Khan talks about starting a business in a basement and caring for those in need through Envision’s trips to the Dominican Republic.


In my nearly three years with Envision, I’ve had the honor of meeting many of you. While these videos are snapshots of our interactions, I hope they bring us closer together and inspire you to create similar meaningful moments with your teams.

Look for more videos as we head into 2023 and engage with teammates.

In the Eye of the Storm

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When hurricanes happen, our thoughts first go to our teammates and partners in the path of the storm. Are they safe? Do they have the resources and support they need? But more than that, as a medical group, we have an obligation to the patients and communities we serve.

In preparation for Hurricane Ian, Envision leaders stood up the Incident Response Task Force, led by Dr. Brian Baxter, President of Alliance National Group, and Dr. Christopher Scott, Senior Vice President for HCA West Florida Region. “We have been doing hurricane response for years and have a good process in place for Florida, but Mother Nature gave us a break over the last three years. So, when hurricane season approached, we knew that we had to get ready,” Dr. Baxter said.

Sky Falls at Hospital in Port Charlotte

“No one anticipated the hurricane to turn toward Fawcett,” said Dr. Ali Vaziri, Hospital Medicine Site Medical Director for Fawcett Memorial Hospital.

In the days leading up to Hurricane Ian’s arrival, the team had been preparing for the storm, but all projections showed the storm moving north toward Tampa. However, on Tuesday, Oct. 4 the winds shifted, and the team braced for the Category 4 hurricane’s impact.

Dr. Alaina Hunt, Emergency Medicine Site Medical Director for Fawcett Memorial Hospital, was on point in the emergency department that day. “We knew from Hurricane Charlie that the ER flooded, so our team started by moving the ER up to the PACU, making a makeshift ER up there.”

Meanwhile, in the ICU, Envision hospitalists Dr. Michael Stagg and Dr. Elise Lambird were holding down the fort. The ICU is located on the fourth floor, making what that team did even more impressive, Dr. Vaziri says. “The roof of the ICU came off. Water started to collect and then started trickling down to floors below, causing the elevators to short out.”

Dr. Hunt and her team immediately jumped into action. “I immediately started assigning teammates to figure out where we could mobilize patients,” she said. “Our team started waking up and moving patients out of the ICU. Some patients were intubated and had to be manually bagged for transport.”

“One by one, the team carried patients down to floors below; wherever they could find a bed or a safe place to put them,” Dr. Vaziri said. “Truly heroic.”

At this point, the team began evacuating patients. Around 1,000 patients were evacuated from Lee County. Envision teammates at a different hospital in Brooksville took in several med-surg patients. Amy Nixon, DCI, Dr. Eric Sladek and Dr. Monicka Felix coordinated with the resident team to ensure patients were evacuated safely.

Scoping Out AMSURG Needs

Gulf Coast Endoscopy Center South, an AMSURG partner center in Fort Myers, was not immune to the storm’s devastating impact.

Teammates preparing supplies

“This team has truly stuck together through some of the worst times of their lives,” said AMSURG Director of Operations Alex Blair.

On Tuesday, Oct. 4, Blair loaded a truck with supplies and headed to the ambulatory surgery center. Nearing the facility, Blair said she encountered a city that looked more like a war zone than a thriving tourist town, with debris piled on the shoulders of roads, non-functioning traffic lights and National Guard members at intersections guiding traffic.

As Blair and the Gulf Coast Endoscopy Center South team have demonstrated, recovery isn’t measured by what you put back up. The recovery process begins as soon as people come together to bring hope to survivors.

“I was encouraged to see how they stuck together when they themselves are struggling through the hurricane aftermath,” Blair said. “They prevailed. Safe. And together.”

Radiating Hope

As stories rolled in from teammates across the state, Radiology Services’ Chief Clinical Officer Dr. David Dascal and Senior Vice President Dr. Roi Bittane jumped into action.

Dr. Dascal (left) and Dr. Bittane (right) loading up supplies

“We had called all our radiology teammates in the area where Hurricane Ian had made landfall,” said Dr. Dascal. “A few responded, saying they were in need of assistance. For some, it was help getting off shift – one physician had been at the hospital for three days. Others needed supplies.”

It was Roi’s idea to deliver the supplies. “We made a list of the needs we were hearing from people and loaded up.”

The duo arrived in Port Charlotte and Sarasota with resources like generators, gas, water and canned foods and a ready willingness to lend a hand.

“We realized quickly that we were going to have to get creative to get to everyone,” Dr. Dascal said. “Roi is the military guy, so he had a tow rope and all kinds of other gadgets to help. I was in good hands.”

Road conditions in Southwest Florida on Oct. 4

Throughout the day, they traveled to any teammate they could reach, providing supplies, support and a friendly face. Dr. Dascal reflected on the state of his team. “They were all so happy to see us, but they were struggling.”

Thank You From Dr. Baxter, Dr. Scott and Envision

“I really just want to say, ‘thank you,’” Dr. Baxter said. “The collaboration across teams was incredible. Everyone worked together. Everyone was focused on doing what was best for patients and each other. No one complained or asked why. When things got hairy, they jumped right in. And that sentiment has been echoed all over by both Envision leaders and our hospital partners.”

“I am most proud of the teamwork and comradery that was displayed,” Dr. Scott said. “Everyone came together. Providers stepped up to help each other and ensure patients were safe. It’s one thing to be a company, but when we start to think of each other as family, it takes a whole different slant.”

At Envision, caring deeply for each other is core to what we do and who we are. No matter someone’s role, the city in which they live or their proximity to the bedside, we each are here to make a difference. As devastating as events like Hurricane Ian can be, they also can bring out the best in people and unite us as a team and a community.

Envision Healthcare’s Inaugural Clinical Impact Report Details High-Quality Patient Care Initiatives

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NASHVILLE, Tenn. — Envision Healthcare, a leading national medical group, today released its 2021 Clinical Impact Report, highlighting its impact on patients’ lives and communities across the country last year. The full report is available at EnvisionHealth.com/Impact-Report.

“In 2021, we remained on the frontlines for patients, exceeding national care quality benchmarks and implementing new programs that improve patients’ access to the right care at the right time,” said Jim Rechtin, Chief Executive Officer of Envision Healthcare. “We also made strides in enhancing our Diversity, Equity and Inclusion and Clinician Wellness programs. While there is no way to measure the true impact the Envision team has had on the millions of people we serve, this inaugural report provides a snapshot of the many ways we make a difference.”

Envision’s 2021 Clinical Impact Report demonstrates how Envision is providing care when and where it’s needed most. Last year, the Envision team rose to the many unique demands for care and drove positive changes within the U.S. healthcare system. Grounded in its commitment to delivering high-quality, patient-centered care, the team continued combating the COVID-19 pandemic, responded to natural disasters and humanitarian crises and advanced innovative care approaches.

Envision remains focused on elevating the voices of clinicians and patients and championing solutions that improve the healthcare system for everyone. As the medical group moves forward in 2022, it will continue protecting the patient-clinician relationship, caring deeply for everyone and centering its actions on advancing the delivery of safe, quality care.

Making a Positive Impact
From providing lifesaving care to preventing colon cancer to welcoming newborns into the world, Envision is uniquely positioned to have a positive impact on millions of people in the U.S. In 2021, Envision’s 30,000 clinical and clinical support teammates and 4,000 ambulatory surgery center physician partners cared for America through millions of visits, including:

  • 30 million patient encounters
  • 16 million emergency department visits
  • 9 million radiology reads
  • 6 million anesthesia cases
  • 900,000 colonoscopies
  • 180,000 cataract surgeries
  • 132,000 newborn deliveries supported

Caring for Communities
Throughout the COVID-19 pandemic, the medical group has helped lead the nation’s COVID-19 response, caring for patients and working to mitigate the spread of the virus. More than 500 Envision clinicians have traveled to hard-hit communities to provide lifesaving care and relief since the beginning of the pandemic. In 2021, Envision clinicians treated more than 3.4 million COVID-19 patients through emergency department and inpatient visits, including in the intensive care unit. Clinicians also administered COVID-19 tests and vaccines to first responders and community members. Envision continues to educate the public about the importance of getting vaccinated, leading by example through its commitment to having a fully vaccinated team.

Through its disaster response program and years of expertise responding to crises, Envision teams are helping community members navigate some of the nation’s most challenging times. In 2021, Envision clinicians cared for more than 5,000 Afghan refugees for five months until they were resettled and had the resources needed to begin their new lives in the U.S. Teammates also supported communities during the deep freeze in Texas, Hurricane Ida in Louisiana, the tornadoes in the Midwest and the Marshall Fire in Colorado.

Providing Safe, High-Quality, Patient-Centered Care
Through Envision’s commitment to a culture of safety, clinicians are continuously evaluating clinical protocols and developing best practices to enhance patient outcomes and satisfaction. Envision operates one of 94 Patient Safety Organizations listed by the Agency for Healthcare Research and Quality, a U.S. Department of Health and Human Services division, which helps improve the quality and safety of patient care. Through the Physicians Quality Registry, a Qualified Clinical Data Registry approved by the Centers for Medicare & Medicaid Services, Envision is one of the largest submitters of performance data to Medicare and is helping define the quality of care nationally.

Last year, Envision clinicians developed one new Merit-Based Incentive Payment System measure. Clinicians also exceeded several national quality benchmarks, including measures regarding sepsis, non-opioid pain therapy and the care of babies born weighing less than 1,500 grams.

Empowering Teammates to Thrive
Envision is focused on caring for the people who care for America. In 2021, the medical group remained steadfast in its efforts to prioritize the health of its teams through its comprehensive Clinician Wellness program, which includes free mental health services, peer-to-peer support, crisis debriefs and leadership coaching. Envision also advocated for the Dr. Lorna Breen Healthcare Provider Act – a bipartisan bill designed to help change the culture and conditions that lead to burnout and eliminate the stigma that deters healthcare professionals from seeking mental healthcare.

Last year, Envision continued advancing its Diversity, Equity and Inclusion (DEI) program, raising awareness and providing teammates with educational opportunities and resources to support DEI. As a medical group caring for communities that reflect the country’s racial, ethnic, sexual orientation and economic diversity, Envision recognizes its responsibility to create a more just and inclusive society.

To download and read the report, visit EnvisionHealth.com/Impact-Report.

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About Envision Healthcare Corporation
Envision Healthcare Corporation is a leading national medical group that delivers physician and advanced practice provider services, primarily in the areas of emergency and hospitalist medicine, anesthesiology, radiology/teleradiology, and neonatology to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. Post-acute care is delivered through an array of clinical professionals and integrated technologies which, when combined, contribute to efficient and effective population health management strategies. As a leader in ambulatory surgical care, AMSURG holds ownership in more than 250 surgery centers in 34 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. In total, the medical group offers a differentiated suite of clinical solutions on a national scale with a local understanding of our communities, creating value for health systems, payers, providers, and patients. For additional information, visit www.envisionhealth.com.

CRNA Pays It Forward During National Public Health Crisis

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By Melissa Ramirez Cooper
Director, AANA Public Relations and Communications

When Hurricane Katrina ravaged New Orleans, Tanya Smith, DNP, CRNA, SMP, said it took a long time to recover. “My kids were young, and we had nothing,” said Smith, a member of the American Association of Nurse Anesthetists (AANA).

It was the kindness of others that aided in her recovery. “Everyone needs help at some point in their life,” said Smith. “And I knew that, one day, I would want to pay it forward.”

That opportunity came earlier this spring when Smith was extended an opportunity to work on the COVID-19 pandemic’s frontline of care in New York. Through her contract with AMSURG, a division of Envision Healthcare, Smith joined the national medical group’s travel team and was assigned to work in New York’s Mount Sinai Hospital in the upper West Side.

“My kids were on board with me going. I had the means and the opportunity to go. I was equipped with personal protective equipment and the appropriate resources, and I was ready.”

When Smith arrived at the hospital, she hit the ground running. “My first two weeks were very busy. I ran ventilator management and tended to the oxygen needs for patients in the COVID-19 unit. I did whatever needed to be done, working in the ER and ICU. Some days, I had 25-26 patients. That’s a lot of patients. I had never seen anything like it.”

In the beginning, little was known about the virus, and medical care was based on evolving knowledge. “We had to work to prevent the spread, protect patients and healthcare workers. We did everything to care for patients —I would go six to eight times a day from changing bipap to high-flow nasal cannula,” said Smith,” working to keep patients off ventilators and get them back to baseline to prevent damage and lung trauma.”

“Patients only have you to care for them and be at their side.  Some patients could not communicate. The enormity of the situation was overwhelming,” said Smith.

To help her through, Smith had a support system. “I had a lot of people to help keep me going.”

“It’s great that we have received so much support and that nurses are being recognized. But it’s hard for people to truly understand all the work that we do. We gave our all, and when a critical patient was able to leave the hospital, it was an accomplishment.”

As hospitals across the country continue to deal with the pandemic, CRNAs continue to care for critically ill patients. Their unique skills and expertise have allowed them to step forward in a way only a few others can, leading the way in advanced airway and ventilation management that has been essential in addressing the virus. During state emergencies federal and state governors temporarily removed barriers to CRNA practice, further reinforcing the need to utilize CRNAs at the full extent of their education and training.

During her time in New York, Smith admitted to being concerned for the public’s health and safety. “The virus does not discriminate and impacted people differently. But it was important to help. It’s important for everyone to help. You don’t necessarily have to go to the frontlines; it can be in so many other ways, but it’s important to help people.”

Smith completed her work in New York mid-May. While the experience will remain with her, one thing the pandemic has shown her is that, “There is good in everybody.”

CRNAs’ Expert, Diverse Skills Indispensable During Public Health Crises

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By Melissa Ramirez Cooper
Director, AANA Public Relations & Communications

Samantha Heavrin, CRNA, MBA, was among one of the first to arrive in New York City to serve on the COVID-19 pandemic’s frontline of care. Assigned to work at The Mount Sinai Hospital on Madison Avenue, Heavrin had three “identities” for her computer sign-in: nurse, advanced practice nurse practitioner, and Certified Registered Nurse Anesthetist (CRNA).

“Later in my deployment, I was also given a fourth identity as respiratory therapist,” said Heavrin, a member of the American Association of Nurse Anesthetists (AANA) who is chief of anesthesia at an ambulatory surgery center in Louisville, Ky. Through her contract with AMSURG, Heavrin was part of about 200 Envision clinicians who deployed to the greater New York City area to provide care.

“At Mount Sinai, we did whatever was needed, and that was true for all healthcare workers across New York City,” she said. “Whether it was changing drips, running labs, getting materials, or turning a patient, all of us worked outside of our traditional roles.”

Heavrin said her entire anesthesia team took on multiple responsibilities. “There was so much to be done to care for patients impacted by COVID-19,” she said. “We also served on ‘proning’ teams, which is a process of turning patients onto their stomachs so they can take in oxygen better. It can be a difficult process to have intubated patients move onto their stomach, but it made a huge different for patients to oxygenate, and our proning teams were great.”

Throughout the pandemic, tens of thousands of CRNAs like Heavrin were readily available to serve. CRNAs are expert clinicians with advanced specialized skills in airway management, ventilator support, vascular volume resuscitation, and advanced patient assessment. Because of their diverse and unique skillset, CRNAs have been utilized as advanced care providers and regarded as vital members of the nation’s critical care workforce. During the COVID public health crisis federal and state governors have temporarily removed barriers to CRNA practice, enabling them to practice to the fullest extent of their education and training.

Alongside her colleagues at the hospital, Heavrin had friends deployed in other parts of the city. “One of my nurse practitioner friends worked in tents set up in Central Park. When we looked out the window, we could see these MASH-type units set up by the military to triage patients.”

Heavrin is thankful to her employer for the support services extended to clinicians, which included, among many things, traveling logistics, supplies of personal protective equipment, and mental health and wellness resources.

“When we left New York, we had to go into quarantine for two weeks. We were encouraged to do video calls and talk about our experiences with our clinician peers. We were also provided resources and information. It was during quarantine when we really processed our experience, talked and cried.”

Since returning home to Kentucky, Heavrin and her friends journaled about their time in New York and wrote a book chronicling their experiences.