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Poisoning is the Leading Cause of Injury Deaths in Arizona

June 6th, 2013

When you think of the leading cause of deaths related to injuries, the first thing many people will think of is car crashes. While automobile crashes can be deadly—especially when drugs and alcohol are involved—the leading cause of injury-related deaths in Arizona is poisonings.  A new report we recently released shows that there were 1,144 deaths due to poisoning in 2011- accounting for 25% of all the injury-related deaths in the state. 

Poisoning also caused more than 6,900 hospitalizations and more than 12,500 ER visits in 2011. In addition to the human toll these deaths and hospitalizations have on Arizona families, poisonings also carry a financial burden. According to the report, hospital charges for non-fatal poisoning-related inpatient hospitalizations totaled more than $127M and Arizona residents spent a total of 13,822 days hospitalized for these injuries. 

It’s no surprise that the leading cause for poisoning deaths in the state come from easily accessible things like alcohol and prescription drugs. The report shows that the most common causes of poisoning deaths were alcohol, Oxycodone or Hydrocodone, and heroin. At least these deaths are preventable- and we’re working together with our partners in the community to reduce these deaths. 

One project we’re working on is the new Arizona Prescribing Guidelines for Emergency Rooms. The guidelines were developed with several community partners and are intended help ERs establish standard practices for prescribing pain medication. Pain medication is an important tool when it used for medical treatment, but it’s deadly when abused. The guidelines will help medical providers reduce the amount of pain medication in the community, and reduce the access to these drugs to people who may abuse them and suffer from an accidental poisonings.

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To Decolonize, or Not to Decolonize

June 5th, 2013

…  that is the question- at least when it comes to whether to take standard measures to decolonize intensive care patients with antibiotic ointments in their nose to remove Staphylococcus bugs.  Hospital associated infections are a critical public health and healthcare cost problem.  While we’re losing ground in our fight against obesity- we’re making progress toward reducing healthcare associated infections both here in AZ and across the country. 

A study published in the New England Journal of Medicine this week found that that “universal decolonization” of intensive care patients can reduce MRSA infections by up to 37% and other  bloodstream infections by 44%.  This was a big study (about 74,000 patients in 43 hospitals), meaning that these results carry a fair amount of statistical weight.  This study will provide additional information to the infectious disease practitioners in AZ as they craft and implement hospital infection control plans. 

We’re making it a priority to prevent hospital associated infections by maintaining our HAI Program and by licensing and inspecting healthcare facilities across the state.  We also facilitate a multidisciplinary HAI Advisory Committee that identifies and addresses priority areas for Arizona.  This dedicated group of partners has collaborated continuously since 2009 to coordinate prevention efforts across the state. The partnerships and open dialogue help us improve surveillance, report and prevent hospital associated infections, which support our Strategic Map goal of reducing healthcare associated infections and re-admissions.

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National Spotlight on AZ’s High Risk Perinatal Program

May 1st, 2013

The March edition of the Association of Maternal and Child Health Program’s Issue Brief highlights the great strides Arizona has made in decreasing neonatal deaths since the inception of our High Risk Perinatal Program/Newborn Intensive Care Program. When the program started in the 1970s, 1.8% of neonates died within a month of being born.  As a result of a host of Maternal and Child Health interventions over the last 40 years, that percentage has dropped to about 0.4%.  

One key component includes using community health nurses to follow and support families as they transition from the hospital to home.  Community health nurses do developmental, physical and environmental assessments, provide education and guidance to families, and direct families to programs and services. While in the home, the community health nurses can also asses other children and screen mothers for postpartum wellness. This is a great example of how long-term public health programs can have a significant impact on the overall health of the people of Arizona. This national report highlights Arizona’s programs as well as programs in California, Colorado and Utah.

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Preventing Hospital Associated Infections in AZ: New Performance Data

February 15th, 2013

A new CDC report released this week gave a status update on the national Winnable Battle to reduce hospital associated infections.   Not all medical procedures carry the same risk of infection, so the report uses something called a standardized infection ratio to compare infection rates among hospitals. It’s a complicated statistic, but basically, it divides the number of infections that actually occurred in a hospital with the number of infections that were expected in the same time period.  The lower the score the better.  

Arizona’s 2011 overall score was less than 1… meaning we did well.  Our overall average (2011) score was 0.575, which was better than expected for Arizona, and better than the national average score of 0.592. The report also shows a decrease in scores since 2010, meaning that the work Arizona hospitals are doing to decrease infections and make care safer for their patients is making a difference. If you’re interested in seeing the score for your local hospital, you can check it out on Hospital Compare. Right now, this site only shows CLABSI scores, but it’ll soon display scores for catheter-associated urinary tract infections and some surgical site infections. 

We’re making it a priority to prevent hospital associated infections by maintaining our HAI Program and licensing and inspecting healthcare facilities across the state.  We also facilitate a multidisciplinary HAI Advisory Committee that identifies and addresses priority areas for Arizona. This dedicated group of partners has collaborated continuously since 2009 to coordinate prevention efforts across the state. The partnerships and open dialogue help us improve surveillance, report and prevent hospital associated infections, which support our Strategic Map goal of reducing healthcare associated infections and re-admissions.

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New Year, New MEDSIS

January 14th, 2013

Over the past two years, folks in ITS and Epidemiology and Disease Control have been working together to enhance our state’s electronic communicable disease surveillance system called MEDSIS.   This week the new version of MEDSIS went live. Major enhancements include the integration of tuberculosis reporting, case management and surveillance; expanded case management capabilities for all diseases; and additional functionality to better meet the needs of all users. This system isn’t just used by ADHS staff- it’s used by folks across the healthcare system. 

All 15 county health departments and four tribal public health organizations use MEDSIS to monitor cases of infectious disease and manage their case investigations; infection preventionists at hospitals enter infectious disease cases to satisfy our requirements for reporting selected infectious diseases; and laboratories electronically report positive test results directly into the system. There’s even a Spanish version of MEDSIS to allow us to share bi-national cases with our counterparts in Sonora to improve public health on both sides of the border. Thanks to all of those involved in making MEDSIS a success including Raghu Ramaswamy, Ravikumar Pitti, Sara Imholte, Lloyd Kalicki, Srinivasa Venkatesan, Paula Mattingly, Michael Conklin, Javed Mukarram, Arup Sinha, Teresa Jue, Jessica Rigler, and Shoana Anderson.

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Midwife Scope of Practice Draft Proposal

January 11th, 2013

Our next Midwifery Scope of Practice Advisory Committee meeting will be Monday (January 14th) from 6-8 pm in the Lab conference room.  The Agenda is packed with 2 full hours of information and discussion.  We’ll be reviewing data from other states, and what scopes of practice they allow, as well as reviewing our own data collected from the midwives’ quarterly reports along with data from AZ birth certificates.  This data will give us a better picture of how many Arizona home deliveries had successful outcomes, and how many required transfer to a hospital for delivery or complications.  Two of our advisory committee members will be providing a presentation on a successful midwifery home birth model from the State of Washington, called Smooth Transitions. 

We’ll also be going over some interim draft regulations (for discussion purposes) that would allow licensed midwives to (under certain circumstances) attend a delivery at home even if the mom is carrying twins, if their baby is in a breech position, and when the mom has had a previous Caesarian-section (also known as vaginal birth after cesarean, or VBAC).  For example a midwife could attend a birth at home even if the mom has had a previous C-section if she’s:  1) had a successful vaginal birth since their last C-section; or 2) it’s been more than 18 months since the last C-section and she had a low transverse incision and an ultrasound that shows the placenta in the right place and growing normally. 

Because there are higher risks with these types of deliveries…  the draft language has certain conditions.  For example, the language asks: 1)  midwives to develop an emergency action plan for patients with one of these conditions; 2) the patient is to meet with an OB/Gyn to discuss the risks, adverse outcomes, benefits and alternatives of a home birth for their condition (this is known as obtaining informed consent); and 3) midwives to send the patient’s medical records to the hospital listed in the emergency action plan at 32 weeks. Once the patient goes into labor, the midwife would need to call the hospital to let them know her patient is in labor, and then again after the baby is born or if the mother needs to be transferred for delivery or a complication. 

Getting ready for this high-profile meeting has been an effort of teamwork from almost every part of the agency.  Thanks to staff from IT (Jennifer Tweedy, Gannon Wegner, and Jesse Lewis) and Preparedness (Paul Barbeau, Tim Singleton and Steven Becker) for setting up the meeting so that it can be viewed on Livestream.  Fernando Ortega in Facilities has been instrumental in coordinating for after-hours security and parking.  Also, thanks go out to Kristin Feelemyer, Shoana Anderson, and Khaleel Hussaini for developing a special database that we’re using to mine our data.  Also, thanks to the Rules and Administrative Counsel team (Patti Cordova and Teresa Koehler) for working hard to provide draft rule packages language for the committee to review, as well as researching other states and their rules and regulations for licensed midwives. 

This is just one of many examples of the team work and collaboration within our Department.  It’ll result in an evidenced based decision that will hopefully improve birthing experiences and outcomes for patients that want to have a planned at-home birth.

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Posted in Licensing

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Influenza Going Gangbusters in US and AZ

January 10th, 2013

During the 2009- 2010 influenza pandemic, we saw how influenza can be unpredictable in terms of who it affects most, when it occurs, and what strains will circulate. This season is no exception. While the circulating strains are exactly what we predicted, the peak of the flu season is hitting earlier than usual (now) and it’s really spreading fast.  In fact, this week’s new Influenza Activity Report moved us into the “Widespread” category along with just about all the other states.  The CDC Summary Site will probably be updated today with the latest US data.  I bet just about every state will be on widespread status. 

In AZ, a few of our licensed medical facilities are currently on “Divert or Caution” meaning that they are at or near capacity with sick folks.  Our Licensing team will be in contact with several hospitals today.  Many are managing patient flow by prioritizing medical procedures and postponing those that are optional in order to save space and staffing for acutely sick folks.  We’ve given a couple of facilities permission to make adjustments to their normal procedures to better serve sick patients.

Preparedness is working on bed polls and communication with the county health officers/counties and media. We’ll continue to reach out to facilities to find out about capacity issues and work with them on messaging for alternate care sites and transferring patients within their own facilities. 

It’s too late to get the flu shot for the folks that are sick with influenza right now.  But if you haven’t gotten sick yet and have been putting it off- you better get on the stick. 

 

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Valley Fever Season Peaking

January 8th, 2013

Valley Fever typically peaks in late fall and early winter with a minor peak from June to August (refer to the 2007-2011 Valley Fever Report). Those who’ve been in Arizona for a while may know that Valley Fever is a lung infection caused by a fungus that is common in the soil here. In most cases, people with Valley Fever have very mild symptoms like cough, fatigue and shortness of breath that they may confuse with the common cold. Sometimes people can have serious disease including meningitis (brain infection) and pneumonia (severe lung infection).  People can have symptoms for a long time or may need to be hospitalized–especially the elderly or those with weak immune systems. 

Arizona’s numbers for Valley Fever have increased significantly over the last decade. This increase could be because more people that have not been exposed to Valley Fever before are moving to or visiting the state and also because doctors and the public are more aware about Valley Fever and are testing more for it.  In addition, some folks think that increased exposure to dust, like being around construction or standing outside in a dust storm is maybe one of the reasons for the increase in Arizona. Our numbers this year have been lower than last year, and this may be due to the mild monsoon season this past summer. 

To help address this Arizona disease, we’ve been collaborating with the University of Arizona’s Valley Fever Center of Excellence to provide a free online training for clinicians in addition to a host of other interventions designed to raise awareness.   Our Office of Border Heath has also been working with colleagues from Sonora Secretaria de Salud Publica and other border states to collaborate and share our experiences.  Epidemiologists from Sonora have come to Arizona to participate in trainings and learn more about our surveillance system.  Last year, the CDC and Mexico’s federal partners conducted a training which enabled Sonora’s State laboratory to test for Valley Fever.  Together Arizona and Sonora will continue to work to better understand the burden of Valley Fever in the region.  For additional information, please visit: www.valleyfeverarizona.org.

 

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Another Acronym?

December 6th, 2012

This is one to remember.  SBIRT is an acronym for a behavioral health intervention that stands for “Screening, Brief Intervention, and Referral to Treatment”.   The technical definition is “ … a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders…”  A more metaphorical (is that a word?) way to put it is that it catches patients at the top of the waterfall rather than at the bottom.  It’s an evidence-based intervention that’s proven effective at primary care centers, hospital emergency rooms, trauma centers, and other community settings. 

AZ was awarded a $7.5M federal grant to implement SBIRT in primary care offices and emergency rooms… helping primary care providers to identify patients at risk for or who have substance abuse problems that might otherwise go unnoticed a& untreated.  The grant will help reduce the number of substance use related deaths and the prevalence of substance abuse disorders in the five northern Arizona counties: Apache, Coconino, Mohave, Navajo, and Yavapai. 

We picked these counties because the rates of injuries and deaths due to alcohol and other drugs are the highest in that part of the state.  Medical providers at several community health centers and one emergency department will be trained to use the SBIRT screening tool to identify those at risk and conduct brief interventions.  Integration of behavioral health services into primary care centers and the hospital emergency rooms provides opportunities for early intervention with at-risk substance users before more severe consequences occur.  As always- we’re making it a priority to measure our results.

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Posted in Behavioral Health

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AZ’s Pre-Hospital (EMS) – Trauma System Continuum

November 30th, 2012

The effectiveness of a State’s EMS and Pre-Hospital & Trauma System makes the difference when it comes to saving lives (and quality of life) from injuries.  Injuries are the leading cause of death for Arizonans from age 1 to 44- so you can see how important it is for states to have an effective EMS & trauma system. But what is it?  The easiest way to picture the pre-hospital and trauma system is to look at it as a continuum.  

Let’s start with a car crash.  The first link in the chain is the bystander that knows to call 911 first and then starts helping any way they can.  The next step is 911 dispatch.  Dispatcher education and training is crucial in coaching the Good Samaritan and getting the paramedics and EMTs on the way.  Paramedic & EMT training and effectiveness is the next link in the chain.  Good awareness of the latest science and practice results in good interventions by paramedics and EMTs in the field.  Next is the transport.  We need a good well-regulated network of ambulance providers that know how to properly triage and transfer patients to the right place at the right time- taking into consideration the severity of the injury, distance to facilities, traffic, and other factors.  Solid on-line medical direction is also a key at this level.  Finally, it takes a solid network of trauma centers (specialized and certified hospitals) that can handle a wide variety of injuries in an effective way- along with good post-surgery rehabilitation within medical facilities. 

Complicated- I know.  But it really is a system.  Each component plays a role in improving the outcome of a severe injury.  The bottom line is that the public, 911 dispatchers, first responders, the ambulance team that transports the injured to a trauma center, the specialized care provided at that center, and the post-surgery rehabilitation within a medical facility are critical components of a state’s trauma system. 

Developing an excellent statewide EMS and trauma system has been one of our top priorities and we’ve come a long way in a short time.  We’ve been working with stakeholders to implement system improvements including dispatch training, performance improvement, mode of transport decisions and data quality checks and everything in-between. 

For example: one of the programs we have put in place is our Premier EMS Agency Program.  The EMS Agencies that meet our criteria are listed on the website above.  You can check out our participation materials including our; Schematic; Application; Handbook; and Data Dictionary.  By bringing in more EMS partners to the Premier EMS Agency Program- we’ll be able to continue to make Arizona’s pre-hospital system the envy of the nation. 

We’ve also recruited 17 rural hospitals (up from 0) into our trauma system in the last 3 ½ years.  For the first time, Arizona’s rural trauma patients have timely access to good trauma care.  Our State trauma registry has been strengthened by undergoing validation checks and audits and is now one of the best registries in the country, allowing us to conduct all kinds of research to improve care across the state.

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Posted in Preparedness, Prevention

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