Posts Tagged ‘hospital’

Community Paramedicine Workshops Scheduled

February 12th, 2014

On previous Blogs I’ve shared information about Community Integrated Paramedicine.  One of the most promising opportunities for Community Paramedicine is in working with hospitals to prevent readmission of patients with diseases like diabetes, asthma or congestive heart failure.  It’s also a great opportunity for EMS providers to provide some coaching on other prevention initiatives including childhood immunizations, smoking prevention and chronic disease prevention.  

Our Bureau of EMS and Trauma System hosted the first meeting of the workgroup a few weeks ago.  Membership was solicited from each of the four EMS regions representing various components of emergency medical care.  The participants have an aggressive agenda to research a number of topic areas, and then provide updates on these to the full workgroup.  

The deliverable from this workgroup will be a report that includes a survey of what Community Paramedicine initiatives look like and recommendations for what type of guidelines may need to be developed to move this promising practice forward.  The next meeting of the workgroup is February 20th.  Leveraging our state’s EMS system to improve health outcomes via Community Paramedicine is one of my top priorities this year…  and our EMS team will be investing a fair amount of their time on it this year.

New Abortion Clinic Regulations Established

January 27th, 2014

HB 2036 was passed and signed during the 2012 legislative session…  tasking the ADHS with several things related to the regulation of abortions.  Among them were requirements for us to: 1) Develop a parental informed consent form for minors seeking an abortion;  2) Establish a website with information identified in the Statute; and 3) Require abortion clinics to post signs stating that it’s unlawful for anyone to force a woman to have an abortion. 

We’ve already finished the items above.  Today we completed the last administrative step in implementing the Law.  This morning we filed a final set of new Rules for abortion clinics in Arizona.  The new Regulations will take effect on April 1, 2014, and will require: 

  • Ultrasound equipment in all abortion clinics;
  • Physicians performing a medication abortion to have admitting privileges at a hospital;
  • Physicians performing a surgical abortion to have admitting privileges at a hospital within 30 miles of the clinic;
  • Any medication used to induce an abortion to be administered in compliance with the FDA protocols as outlined in the printed label instructions;
  • An RN, NP, LPN, or PA to be on site for monitoring and care after inducing a medication abortion if a physician isn’t present;
  • Recovery room standards including immediate post procedure care for surgical abortions;
  • Care standards that must be provided after inducing a medical abortion;
  • Incident reporting including anything that requires ambulance transportation of the patient; and
  • Patient follow-up standards. 

We currently license 4 abortion clinics (3 in Phoenix and 1 in Tucson) and 5 outpatient treatment clinics authorized to perform abortion services (2 in Phoenix, 1 in Glendale, 1 in Tempe, and 1 in Tucson).   These new standards will apply to each of the facilities beginning April 1. 

BTW: We publish a comprehensive annual report with abortion statistics and demographic characteristics every year. The report presents data regarding elective abortions as well as complications resulting from an abortion.  Last year’s report found a 7.4% year-to-year decrease in overall abortions in AZ.

Electronic Birth Certificate Rollout Going Smoothly

January 6th, 2014

We rolled out a new electronic birth certificate system this week that will be a game-changer for public health.  Our system (which took about 18 months to plan, create & launch) will help us collect better surveillance data for our Winnable Battles like obesity, tobacco use, substance abuse, and better data about birth outcomes that will help with our maternal and child health interventions.  It’ll also help us do a better job ensuring that our licensed professional midwives are meeting our expectations.  And of course the reason we keep track of data is to find interventions that work to improve outcomes, like the home visiting program

Hospitals, birthing centers, county health departments and several state agencies will be able to enter and retrieve information more efficiently and quickly.  With the various levels of access, there are more protections for parents and babies alike.  

The system uses a standard that’s consistent with the National Center for Health Statistics- producing critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy. 

Thanks to the Office of Vital Records led by Krystal Colburn, our Vital Statistics Bureau and more than a dozen IT folks who made this happen including (but not limited to) Dimiter Pekin, Shobha Vaddireddy, Ellen Rayer, Michael Conklin, Shandy Odell, Michael Shaw, Alan Landucci-Ruiz, Matthew Marshall, Gordon Esra, Loretta Jackson, Smita Sahoo, Avinash Veerlapati, Cameron Pulcifer and Carl Farmis.

 

No Place Like Home

October 18th, 2013

Over the last 18 months, our licensing team in collaboration with trade organizations from every sphere of healthcare delivery, partnered with Health Services Advisory Group (HSAG), Arizona’s Medicare Quality Improvement Organization, in its statewide initiative designed to reduce by 4000 the number of preventable hospital readmissions. Aptly named the No Place Like Home Campaign, because there really is no place like home when it comes to patient healing, the campaign not only met their 18 month goal, but exceeded it by a large margin. Under the skilled leadership of Barbara Averyt, BSHA, Catherine Price, MSEd and the Care Transitions team of HSAG, the coalition partners were able to prevent 5,872 Medicare readmissions, an improvement of almost 20% from the 2010 baseline data. These results propelled Arizona to the #1 position in the nation for highest relative improvement rate in reducing Medicare hospital readmissions and became a model for many other states to replicate in their own campaigns to reduce readmissions. These stellar results are a tribute to the close collaboration and responsive partnerships between ADHS, HSAG and the multiple stakeholder organizations in the campaign. For information on the NPLH campaign, please visit their website at www.noplacelikehomeaz.com.

Evaluating a Trauma System II

October 17th, 2013

A couple of weeks ago, I introduced the concept of “Over Triage”…  which is when EMS transports a patient to the highest level of care (like a level I trauma center) when they could have taken them to a level III or IV trauma center closer to their home.  The downside of over-triage is that care at high-end centers is expensive. There’s a nice primer on trauma systems if you want to read more. 

This week’s focus is on “Under Triage” – when EMS transports a patient to a facility that’s not as qualified to care for their injuries.  There are a number of factors that contribute to under triage: it’s sometimes hard to assess how badly someone is hurt at the scene; emergency workers who don’t have a lot of experience with children may not understand how quickly they can get worse; some adults have high pain thresholds and may make it difficult to see just how badly they’re injured.  The perception of tort liability exposure might even play a role sometimes. 

The on scene EMS person needs to consider all these things when deciding which hospital is the best choice for their injured patients…  and it’s a critical decision.  Under triage delays getting the patient the care they need and increases the chance that an injury may be overlooked and under-treated. 

Under and over-triage are like a teeter-totter.  Under triage is to the left of the balance point and over triage is to the right.  The sweet spot is the point when you have just enough over triage necessary to guard against under- triage.  So – how do we get to the sweet spot?  I’ll cover that in a couple weeks.  In the meantime, the State Trauma Advisory Board finished a couple of great products this week.  A new five year State Trauma Plan and the 2013 Annual Trauma Report.

“No Place Like Home” Conference

September 12th, 2013

In early 2012, Arizona set the ambitious goal of reducing the statewide hospital readmission rate by 20% and averting 4,000 avoidable hospital readmissions. Curious to find out what we accomplished by working together?  Interested in learning about extraordinary best practices from all provider settings that may take your organization from ordinary to extraordinary?  Would you like to compare your organization’s readmission progress to the statewide result?  You can find out the answers at the No Place Like Home Campaign statewide conference, called “From Ordinary to Extraordinary”…  which will be held Wednesday, October 2, 2013.  Find out at the conference! Register here.

Hospital Associated Infection Report

September 11th, 2013

The 5 most common hospital-acquired infections cost the U.S. health care system almost $10B a year, according to a new study by Harvard researchers. The study was published online in JAMA Internal Medicine this week.  According to CDC, one out of every 20 patients admitted to a hospital will pick up an infection while there.  Central line-associated bloodstream infections averaged about $45,000 per case. Pneumonia infections that strike patients who are put on ventilators to help them breathe cost about $40,000 per case. The most common infections, surgical site infections, which happen in about one out of every 50 operations, cost around $21,000 each to treat.

What’s Community Paramedicine?

September 3rd, 2013

Community paramedicine is a paradigm shift for the use of paramedics in the US.  It’s an emerging model in which paramedics function outside their usual emergency response & transport roles- delving into the world of primary care.  As the health care world increasingly shifts toward prevention and well care- the system will increasingly demand more folks that can function in a community health (primary care and prevention) role.  Community paramedicine is increasingly being recognized as a promising solution to efficiently increase access to care (especially for underserved populations). 

For example- paramedics could shift from a sole focus on emergency response to things like: 1) providing follow-up care for folks recently discharged from the hospital to prevent unnecessary readmissions; 2) providing community-based support for people with diabetes, asthma, congestive heart failure, or multiple chronic conditions; and/or 3) partnering with community health workers and primary care providers in underserved areas to provide preventive care. 

The UC Davis Institute for Population Health Improvement released a new report this week called ”Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care”.  The report is the one I know about that explores this new and evolving model of healthcare.  The report concludes that expanding the role of paramedics is a promising solution to efficiently increasing access to care, particularly for underserved populations…  and it recommends the development of pilot projects to further refine and evaluate the role of community paramedicine. 

One Valley fire department is exploring its own concept – the Mesa Fire and Medical Department is using a grant from the Centers for Medicare and Medicaid Services to staff mental health and nurse practitioners according to the Arizona Republic last weekend. 

I’ve asked Dr. Bobrow and Terry Mullins to open up dialogue about community paramedicine in Arizona and how it could improve outcomes in a measurable way- and to examine the current scope of practice for EMTs and Paramedics relative to the practice of community paramedicine.  We’ll be asking for interested volunteers from our EMS Council to lead a workgroup of individuals to begin answering the Who, What, Where, When and Why of community paramedicine in Arizona.  Stay tuned.

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.

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.