All posts by Angelo Antoline

Nutrition Administration and Ventilator Weaning in Long-Term Acute Care

Ernest Health, which includes Advanced Care Hospital of Montana, recently was recognized nationally for its work in nutrition management and administration for patients being weaned from ventilators in its long-term acute care hospitals (LTACHs).

The initiative, which was introduced and led by Cindy Tew, Ernest Health’s Director of Clinical Programs and Resources, and Anne Woodbury, Registered Dietitian Nutritionist at Utah Valley Specialty Hospital, won the 2017 Quality Achievement Award from the National Association of Long Term Hospitals.

“We wanted to see if we could track specific nutritional indicators that could positively influence patients being weaned from ventilators,” Tew says. In particular, the team wanted to find if the level of protein provided to a ventilated patient had any effect on the success of weaning the patient off the ventilator.

“Mechanical ventilation is a life-saving procedure that’s used to support patients who are recovering from critical illnesses or injuries,” Woodbury explains. “Patients who require prolonged mechanical ventilation need specialized medical assistance in healing and weaning from ventilator dependence, and nutrition plays a critical role in this.”

A team of Ernest Health dietitians led by Tew and Woodbury created a nutritional tracking form to collect data from its LTACH hospitals to monitor tube feeding tolerance and nutrition administration. That data was collected from patients who had been on a ventilator longer than 96 hours and were in respiratory failure.

After two years of collecting data from 204 patients, the team found more successful ventilator weaning results when a patient could tolerate 1.6-2.0 grams of protein each day.

“Data of this nature has never been recorded before, so we’re optimistic about the potential impact of our findings,” Tew says. “These are promising results not only for our patients, but for other post-acute hospitals to consider for their patients as well.”

Ernest Health’s LTACH hospitals will continue to collect data and measure protein intake values to substantiate significance with a larger data pool of patients being weaned from ventilators. The intent is to publish the results in the future for other post-acute hospitals to consider.

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Don’t Let Driving Distractions Wreck Your Summer Vacation

Distracted driving is a growing – and dangerous – recurring event in the United States. Distracted driving is any activity that takes your eyes off the road, hands off the wheel, or mind off driving.

A study through the National Institutes of Health found that drivers eat, reach for the phone, text, or otherwise take their eyes off the road about 10 percent of the time. This behavior can endanger the drivers, passengers and bystanders.

Distracted driving can include a myriad of activities, including:

  • Texting
  • Talking on a cell phone
  • Looking at a GPS system
  • Eating or drinking
  • Grooming
  • Talking to passengers
  • Adjusting the radio
  • Reaching for items elsewhere in the car

Probably the most alarming distraction of all is text messaging because it requires visual, manual, and cognitive attention from the driver. Five seconds is the average time someone’s eyes are off the road while texting. When traveling at 55 mph, that’s enough time to cover the length of a football field blindfolded.

With summer vacations in full swing, many of us will be driving to our destinations. Let’s remove our distractions and pay attention to road. The simplest and most effective way to do this is to turn off your cell phone when you turn on the car ignition. It’s simple.

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Communicating with a Family Member in Critical Care

Sometimes it’s hard enough to say what we mean. So what do we do if we have a family member in critical care? Rest assured, communicating is an important part of the healing process for your loved one as well as your family.

Here are 5 tips to help you out:

  1. Even if your loved one is on a ventilator, he or she will most likely be able to hear you. Speak in a calm, clear manner in a normal tone of voice. There’s no need to speak loudly. Read your family member a favorite poem, book, or prayer. If the staff says it’s OK, you could even play some music.
  2. Use short, positive statements. Reassure your loved one that you’re there, and that everyone is taking good care of him or her. Help orient your family member to the surroundings by sharing the date, day of week and time of day. Help describe the noises in the room.
  3. It’s OK to acknowledge that your family member may be experiencing discomfort. You can help by explaining what is going on, “That tube is helping you breath.” Remind your loved one that this is just temporary and helping him or her to get better.
  4. Don’t ask questions that can’t be answered. Make it simple. Suggesting hand gestures to communicate may be helpful. For example, a thumbs up or thumbs could indicate pain level. A small dry erase board may also be helpful in communicating as well. You could write words that your family member could point to, or possibly your loved one can write a few words as well.
  5. Human touch goes a long way. Ask the hospital staff first, but holding a hand or touching your family member gently is a great way to express your love and concern.

If you’re unsure about the best way to communicate, don’t hesitate to ask a member of the hospital staff for help. If one way doesn’t seem to be working, there likely will be another way that can be more effective.

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6 Things to Expect When Your Loved One is in Critical Care

It’s difficult to imagine a loved one being ill or injured enough to require critical care. But being prepared for what to expect can help you manage the situation.
Here are 6 important things to know:

  1. You have an experienced team on your side. The hospital staff that’s caring for your loved one is highly trained and prepared to treat the sickest – and most medically complex – patients. From the physicians and nurses to the respiratory therapists and dietitians – they all are specially trained to care for your loved one.
  2. The tubes and equipment in a critical care unit can be intimidating. But, they all have a role and purpose in providing your loved one with the intensive healthcare that he or she needs. The healthcare team will be able to explain the role of any equipment to help you better understand what it happening.
  3. Information overload can – and most likely will – occur. Everything will be new to you from the equipment and noises to the procedures and health professionals. Take a deep breath. Once you get your bearings, think of how you can best keep track of information. Write in a notebook. Keep notes on your phone. Jot down items like key information, questions you want to ask, purpose of treatments, and names of hospital personnel.
  4. Expect peaks and valleys. Critical care can be a bumpy ride. Some days will be better than others. As much as possible, try to be patient and keep perspective.
  5. Talk to your loved one. Communicating with your loved one is important for not only him or her, but for your entire family. Often patients can hear while in critical care. Speak calmly and clearly, and make short, positive statements. Hold your loved ones hand or touch them gently if a member of the healthcare team says it’s OK.
  6. Take care of yourself. It may be a long road to your loved one’s recovery, so be sure to take time to do things like sleep, eat, and shower. Don’t be afraid to leave the room for a bit. The healthcare team will be there 24/7 to provide care.
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Advanced Care Hospital of Montana First in State to Earn National Accreditation

Advanced Care Hospital of Montana First in State to Earn National Accreditation

Bringing nationally recognized care to the local community


Advanced Care Hospital of Montana is the first hospital in the state to earn The Joint Commission’s disease-specific certification in Respiratory Failure. The hospital earned The Joint Commission’s Gold Seal of Approval for Respiratory Failure after a rigorous on-site review Oct. 14.

“This certification is significant,” says Judi Powers, Chief Executive Officer of Advanced Care Hospital of Montana, “because it means that we’re providing the highest level of respiratory failure care available in the nation right here to patients in our own community. It reflects our commitment to providing safe and effective care to our patients.”

Respiratory failure occurs when there isn’t enough oxygen passing from the lungs into the body’s bloodstream.

“Oxygen-rich blood is needed to help the body’s organs – such as the heart and brain – function properly,” explains Dr. Hector Stella, Medical Director of Advanced Care Hospital of Montana. “Respiratory failure also can occur if a patient’s lungs can’t remove carbon dioxide from the blood. Carbon dioxide is a waste gas that also can harm a body’s organs.”

Different types of diseases can cause respiratory failure, including lung diseases such as chronic obstructive pulmonary disease (COPD), pneumonia, or cystic fibrosis. Respiratory failure also can be caused by conditions that affect the nerves and muscles that control breathing such as stroke, spinal cord injuries, and muscular dystrophy.

Certification through The Joint Commission’s Disease-Specific Care Program is voluntary and addresses three main areas:

  • Compliance with consensus-based national standards
  • Effective use of evidence-based clinical practice guidelines to manage and optimize care; and
  • An organized approach to performance measurement and improvement activities.

“Through our services, we want to provide hope and quality of life to our community members who are experiencing these debilitating events,” Powers says. “This certification provides us with the framework to continue a culture of excellence for patients in our community.”

The hospital provides hundreds of patients throughout Montana every year with long-term acute and critical care services. These patients, who are recovering from serious illnesses or injuries, often need care for medically complex conditions such as trauma, infectious diseases, wound healing, cardiovascular disease, stroke, amputations, and respiratory failure.

The hospital, which is located at 3528 Gabel Road in Billings, Mont., features all private patient rooms, and an 8-bed high-observation critical care unit. All patient rooms include cardiac monitoring equipment and mechanical ventilators. The hospital also features a 4,000-square-foot therapy gym with private treatment rooms.

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Alzheimer’s and Brain Awareness Month

June is Alzheimer’s and Brain Awareness Month; our hospital is very passionate about mental well-being. Keeping our patients healthy and happy is a top priority. Alzheimer’s effects 5.4 million Americans and that number is continuing to grow. We invite you to visit our website and read up on what exactly Alzheimer’s Disease is, the facts, symptoms and prevention.  

What is Alzheimer’s?

Alzheimer’s is an advanced mental corrosion that can occur in mid or old age. The disease is caused due to widespread degeneration of the brain, this the most common form of dementia. This disease effects everyday tasks, memory, thinking and behavior.

The Facts:

• The majority of people with Alzheimer’s are 65 and older. But up there is about 5 percent of people with the disease have early onset Alzheimer’s which can start effecting those as young as 40.
• Head trauma has been linked to Alzheimer’s.
• Alzheimer’s worsens over time.
• Alzheimer’s has no current cure, but treatments for symptoms are available and research continues.


• lose items easily
• forgetting simple words or someone’s name
• forget about current discussions or occasions
• get lost in a familiar place
• forget schedules or anniversaries.
• repeating themselves, forgetting they had already stated something.
visuospatial skills:difficulties adjudicating distance or seeing objects
• orientation: becoming jumbled or losing track of the date.


• Get your blood pressure and cholesterol levels at a healthy number. Both high blood pressure and high total cholesterol are associated with an increased risk of Alzheimer’s
• Stay active
• Keep a healthy weight
• Be social and have intellectual activity
• Seek preventative care
• To avoid head trauma ALWAYS wear your seat belt and when participating in sports wear the proper safety equipment.

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For more information on Alzheimer’s click on the link below.

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Advanced Care Hospital of Montana celebrates Hospital Week

This week at Advanced Care Hospital of Montana, we’re celebrating Hospital Week and the great staff and patients that we interact with every day.

Advanced Care Hospital provides long-term acute and critical care to patients recovering from serious illnesses or injuries in Montana, Wyoming, and western South Dakota. We accepted our first patient in 2008, and now treat more than 400 patients every year (or more than 2,500 patients since opening).

Our patients often require additional critical care services for medically complex conditions such as trauma, infectious diseases, wound healing, cardiovascular disease, stroke, amputations and respiratory failure.

With that being said, many people still don’t have a good understanding of a how a long-term acute care hospital compares to a short-term acute care hospital. So, here is a brief explanation:

A short-term acute care hospital is where a patient goes when he or she is first ill or injured. These types of facilities accept emergencies, deliver babies, perform surgeries, and have a wide variety of diagnostic capabilities like MRI or CT scans. Patients typically stay about 3-5 days in these types of facilities.

Patients with medically complex conditions may be referred to a long-term acute care hospital like Advanced Care Hospital of Montana – which also is a certified acute care hospital – for continued care beyond their original hospital stay at the short-term acute care hospital. These patients are in the treatment mode of their illness, but they are still too sick to go home or receive a lower level of care. These patients require a physician to see them on a daily basis and 24/7 nursing care.

At Advanced Care Hospital of Montana our medical team is led by a full-time medical director and includes specially trained physicians, nurses, therapists, specialists, pharmacists, dieticians and other medical professionals. Members of our staff have voluntarily earned – and continue to maintain – advanced certifications so they can deliver exceptional care to our patients.

For their commitment and dedication, today and every day, we celebrate our staff!

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Welcome: Dr. Tom James

Advanced Care Hospital of Montana welcomes Dr. Tom James as our Director of Palliative Medicine.

Dr. James has been an active member of our medical staff since 2008 and is a board-certified family physician. In 2012, he received a Certificate of Added Qualification in Hospice and Palliative Medicine through the American Board of Family Medicine. As a specialist in palliative medicine, Dr. James will be developing the Palliative Medicine service line at the hospital and will be available for consultations on patients with serious illnesses requiring additional help with symptom management.

Dr. James is a graduate of Montana State University and the University of Tennessee School of Medicine. He completed his residency training in Tallahassee, Fla. Dr. James has lived and worked in Billings, Mont., for the past 20 years. He is on the active medical staff of St. Vincent Hospital as well as Billings Clinic.

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Employment Open House! Wednesday, March 16, 2016

On Wednesday, March 16, 2016, Advanced Care Hospital of Montana is hosting an Employment Open House.
The event will be from 4pm to 7pm at the hospital, located at 3528 Gable Road.
Stop by and tour our facility and find out about our exciting job opportunities in a variety of healthcare positions!

View open positions here.

We currently have openings for:
• RN’s
• LPN’s
• PCT/CNA’s (entry level and experienced)
• Respiratory Therapists
• Radiology Technologist
• Pharmacy Technician
• Case Manager
• Clinical Liaison

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