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A Critical Choice

Steve Garelick of West Hills needed surgery to fix his leaking heart valve — and right away. It was already late February and the 54-year-old certified public accountant knew he couldn’t wait until after tax season, the busiest time of year for him. What to do?

For Garelick, the choice was simple: Have the procedure in a hospital that offers minimally invasive robotic surgical technology — in this case, Cedars-Sinai Medical Center, the largest mitral valve repair center in the Los Angeles area.  

Garelick was back in his office just 2.5 weeks after his surgery. By having the valve repaired rather than replaced with an artificial one, he was able to recover quickly and avoid long-term use of blood thinners and problems such as infection.

“With robotic technology, surgeons can visualize the mitral valve in such a way that they gain a much better understanding of the valve’s pathology when compared to traditional sternography,” said Garelick’s surgeon, Dr. Alfredo Trento, director of cardiothoracic surgery at the medical center. “We can actually see inside the valve. It’s amazing technology.”

Hollywood talent manager Louis Bershad was diagnosed with kidney cancer during an MRI to check for kidney stones. Based on several factors, Bershad’s physician recommended a new nonsurgical procedure called radio-frequency ablation, which requires no cutting and only local anesthesia.

“I considered my options carefully — and the choice was clear,” Bershad said. “I didn’t want to go through an operation or the loss of my kidney.”

An interventional radiologist performed the procedure at Cedars-Sinai — a needle straight into the tumor that delivers a blast of intense heat that kills cancer cells but not healthy tissue.  Kidney removal usually requires at least a week in the hospital.  Bershad was back at work and living a normal life a day after his procedure — pain and scar free.

Remember: Not all hospitals are created equal, and choosing the right one for specialized needs can make a big difference in outcomes and recovery.

Leveling the field

Few medical conditions are as potentially complicated as a problem pregnancy.  Whether the cause is a condition such as diabetes, heart disease or preeclampsia, complications during childbirth can require a delicate medical balancing act with high levels of specialized care.  And choosing the right physician and hospital is paramount.  

It’s especially important to consider the levels of obstetric care available at various medical centers, which are classified into three categories: Level 1 is your basic community hospital, fine for routine needs but without specialized staff and often lacking an emergency room. Level 2 facilities provide basic care as well as some specialty and subspecialty care, including routine, uncomplicated Caesarian births. But the most difficult and unpredictable obstetric conditions require a Level 3 medical center, typically a university facility, said Debbie Suda, R.N., perinatal unit director at Ronald Reagan UCLA Medical Center.

“Level 3 hospitals are equipped to handle most anything and have cardiologists and neurologists and anesthesia available in-house 24/7,” Suda said. “Emergency Caesarians can be performed at any time, and Level 3 neonatal intensive care units are equipped to deal with any complications that can arise with newborns.”

Suda recalled a woman in late-term pregnancy who collapsed from a stroke during a workout. She was rushed to UCLA Medical Center, a Level 3 medical center, and received coordinated care from an obstetrician and neurologist, eventually recovering from the stroke and successfully delivering her baby.

Doing the homework

Before committing to a hospital, it’s smart to look at research websites that compare quality rankings, such as www.hospitalcompare.hhs.gov, said Dr. Danielle Scheurer, a specialist in hospital medicine and a physician advisor for the Society of Hospital Medicine. Plus, she said, it never hurts to ask around: “Always try to find people that work at the hospital or who have been cared for in the hospital and ask them their opinion.”

For patients being admitted for procedures, it’s important to research how many of those procedures are done at a particular hospital, or by a specific surgeon — information that can usually be found on the Internet, Scheurer said.

Other informative sites include the Agency for Healthcare Research and Quality (www.ahrq.gov/qual/) and the Centers for Disease Control (www.cdc.gov/LifeStages/), which has tools for comparing hospitals.

—Bob Young, Brand Publishing Writer

Copyright © 2014, Los Angeles Times
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