Out in Front
Having overcome the immense challenges of the past year, the Philadelphia area’s medical community leads the way forward.
by Bill Donahue

In March 2020, just a few short weeks after Chester County Hospital celebrated the grand opening of a $300 million expansion to its West Chester campus, the COVID-19 pandemic took hold in Pennsylvania. The mood of celebration quickly shifted as the hospital’s leadership had to clear a path through the uncertainty. 
“We were tending to the physical and emotional needs of the staff, patients, and patients’ families,” says Michael J. Duncan, the hospital’s president and CEO. “Once we understood what patient care would look like, and what we needed to do clinically, our highest priority became keeping healthcare workers safe.”
A nationwide shortage in personal protective equipment did not help matters; Duncan put $30,000 worth of facemasks on his credit card. Despite having to cope with the gravest health crisis in a century, Chester County Hospital still found ways to better serve patients. 
“Even though we were up to our ears in COVID-19, we went live with our structural heart disease initiatives,” says Duncan. “We replaced a bunch of heart valves [for patients]. We did our first bypass surgery using a [robotics-assisted surgery system]. And we performed some other procedures to help patients with congestive heart failure.”
He cites the CardioMEMS HF System, a small pressure-sensing device—“the thickness of a credit card,” he says—implanted directly into a patient’s pulmonary artery. The device sends information wirelessly to the patient’s cardiology care team so they can identify and address any troubling changes in the patient’s heart health before the disease worsens.
Chester County Hospital is not alone in terms of healthcare providers that have made progress in the face of unprecedented change and challenge. Other hospitals, medical centers, and practices throughout the Philadelphia area have pushed forward to protect the health of the communities they serve.

‘The Sky’s the Limit’
The treatments to cure or stop the spread of cancer have long had a reputation for being extraordinarily harsh on the patient undergoing care. Shelly B. Hayes, M.D., has been heartened by advances in radiation oncology that have the potential to not only reduce the duration of treatment, but also mitigate the toll it takes on the human body. In particular, she describes SBRT, an acronym for stereotactic body radiotherapy, as a “game changer.”
“SBRT is a newer treatment modality that delivers high doses of radiation in a very precise area,” says Dr. Hayes, associate professor of radiation oncology at Fox Chase Cancer Center and director of Fox Chase Cancer Center Buckingham. “It’s been done for many years for tumors in the brain, but we’re now treating tumors outside the brain, escalating the dose and killing more cancer cells with no collateral damage to the surrounding area.”
Lung cancer is a prime example, according to Dr. Hayes, as SBRT may be a viable option in cases that may be difficult to treat surgically. She has been seeing similar results for patients with prostate cancer, offering a cure that is equivalent to surgery while focusing on the patient’s post-treatment quality of life. Likewise, SBRT may also be an effective course of treatment to help patients with metastatic disease.
“We may be able to potentially change their survival in ways we never thought possible,” she says. “Now, for people with few areas of spread—one to four—we can treat each of those areas with SBRT and improve their chances of survival.”
Surgery remains an important aspect in the armamentarium, but Dr. Hayes says SBRT represents another tool in the figurative toolbox.
“If a tumor is in a really tough spot and it’s not resectable, SBRT gives us another option,” she says. “I do see its role only expanding. … One of the exciting areas of research is how to pair [SBRT] with immunotherapy, stimulating the body’s immune system to attack the cancer.”
SBRT was “just starting” when Dr. Hayes was finishing her residency in 2007. In the years since, she says, the dosage per treatment has gotten increasingly higher and better targeted to limit the number of sessions patients must undergo. She wonders if treatment will one day be delivered with a single super-high-dose SBRT session. 
“We’re doing things now we didn’t know were possible,” says Dr. Hayes. “The sky’s the limit on what we can do going forward. Personalized medicine is where oncology is going.” 
At Einstein Medical Center Montgomery in East Norriton, Kimberly Mikula, R.N., is excited about a new initiative currently in motion in the intensive care unit. Specifically, the initiative focuses on early mobilization in the ICU to foster better outcomes for patients contending with life-threatening illnesses. 
ICU MOVE, short for Mobilization Optimization Via Exercise, aims to limit the negative impact ICU stays can have on patients, their families, and society at large. Early mobilization has been recommended to prevent or limit cognitive and physical dysfunction; reduce the duration of delirium and improve muscle strength; decrease the number of days on mechanical ventilation; decrease the length of stay in the ICU and hospitals; and, ultimately, improve the quality of life for patients once they leave the ICU. 
“Getting patients to maintain their level of muscle strength helps decrease the number of rehab days clients need to rebuild their strength,” says Mikula, director of clinical care for Einstein Montgomery. “This initiative should help to take the burden off other facilities, while getting patients home sooner and keeping them safe. That’s the whole goal.” 
Patients are evaluated for early mobilization using a protocol implemented by a multidisciplinary group of clinicians, including intensivists, nurses, and physical therapists, among others. Each ICU patient who qualifies for the MOVE initiative will receive a tailored exercise plan to help him or her recover from illness. The hospital has also invested in specialized equipment—and will continue to do so—to facilitate early mobilization.  
Mikula says Einstein Montgomery has followed the lead of organizations such as Johns Hopkins. The mobility protocol is strictly for the ICU right now, but Mikula hopes to “see it grow” and be utilized for patients in other applicable departments.
“Here we are, a small community hospital, having a positive impact,” she says. “It takes a group of goal-driven people and senior leadership support to make a change like this happen. There are a lot of sad situations and sad families who walk away from the ICU without happy endings. Everybody wants to hear a success story.”

Reaching Out
Noha Eltoukhy, PharmD, has vivid memories of a day late last year, when her boss came to her with a question: “How would you like to lead the task force for [COVID-19] vaccines?”
Dr. Eltoukhy is a clinical pharmacy specialist with St. Mary Medical Center in Langhorne. She has had an interest in infectious diseases since pharmacy school, so she jumped at the chance to work on something as important as vaccinating her colleagues and fellow community members against a public health crisis.
“I’m not typically a morning person, and we would have 7 a.m. meetings every day,” Dr. Eltoukhy says. “We knew the vaccination program would be geared toward health professionals, so we focused on how to get [the vaccine] to colleagues and health providers who were at risk every day.”
The task force had to answer a lot of unanswered questions involving vaccine storage, recipient registration, volunteer coordination, equity in vaccine distribution—all during a surge in COVID-19 cases. With the task force’s initial work completed, St. Mary opened its vaccination clinic to St. Mary healthcare personnel on December 18.
“We ran the clinic for 12 to 13 hours a day, five days a week,” Dr. Eltoukhy recalls. “Considering the level of anxiety people had [about the virus] and how exhausted we were as a medical team, some people came in in tears. Physicians were coming up and saying, ‘Can you take a picture [of me getting vaccinated] so I can show my family members and patients that it’s OK?’”
The clinic later expanded to a larger group of individuals outside of the St. Mary’s circle, and then grew to a second clinic located off campus. According to Dr. Eltoukhy’s estimates, approximately 20,000 people have received at least one dose of the vaccine as of press time. 
“I was so sincerely touched by the amount of teamwork involved,” she says. “To help the community work to end the pandemic—it was an amazing experience for me. We will continue to do our best to serve as many people as we can.”
COVID-19 hasn’t been the only challenge healthcare providers have sought to address in recent months. The social unrest that began in the summer of 2020, sparked by the killing of George Floyd beneath the knee of a Minneapolis police officer, spurred Chester County Hospital’s Michael Duncan to begin a dialogue with those most affected.
“I could see in the eyes of our black and brown employees that they felt wounded and traumatized,” Duncan recalls. “I met with some of them one on one last summer, and I also connected with an African-American gentleman on our board who’s a former HR director, asking, ‘How can I take care of these people?’”
Duncan had approximately 50 one-on-one meetings with members of the community to get a better understanding of how people were feeling and how the hospital could help. One of the issues he uncovered in the process was a high level of hesitancy and mistrust surrounding the COVID-19 vaccine. Again, Duncan extended a hand—this time to pastors of area churches and other community leaders, asking for their help in mobilizing their respective congregations. 
“We explained the safety of the vaccine and started inviting pastors and others to bring in members of their group who were 1A eligible,” Duncan says. “Now you have everyone at the church who sees, ‘OK, the pastor has received the shot, the elders have gotten the shot, the 102-year-old patriarch of the church has the shot.’”  
The hospital set up vaccination clinics at local churches and community centers to try to increase vaccination rates among people of color. In all, the hospital connected with more than 60 groups serving black and brown communities, according to Duncan. 
“It became an opportunity to talk about disparities in health care,” he adds. “Part of the disparity is driven by the fact that we’re not speaking with and listening to each other. What changed for us is that we established a posture of listening first to frontline black and brown employees, then listening to black church leaders for their perspective. 
“We turned a crisis into lasting change in the community,” he continues. “We did that by talking about how we can use our voice and our expertise to meet the needs of the communities we serve.”

Published (and copyrighted) in Suburban Life magazine, April 2021.