Regionalizing Emergency Care Workshop Summary (2010) / Chapter Skim
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2 Emerging Models of Regionalization
2 Emerging Models of Regionalization
Pages 25-36
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From page 25... ...
These conditions include ST-elevation myocardial infarction, out-of-hospital cardiac arrest, acute stroke, and care of seriously ill and injured children. ACUTE STEMI CARE The first panelist was Joseph Ornato, cardiologist and emergency physician from the Virginia Commonwealth University in Richmond.
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From page 26... ...
Now, the American Heart Association -- analogous to the American College of Surgeons in this case -- has helped identify the key components of a successful STEMI system and has launched a nationwide program called "Mission Lifeline." While a successful STEMI system has many similarities with trauma centers and regional systems of trauma care, Ornato continued, "There are also some very harsh differences." Most general medical service hospitals rely upon cardiovascular care to stay alive financially. Therefore, a very important piece of the puzzle has been to ensure that we carve out an important role for medical centers that are not PCI centers -- the functional equivalent of a Level I trauma center.
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From page 27... ...
Pancioli described stroke as a diverse disease process which truly requires a multidisciplinary approach. Even in the case of the simplest stroke, care that is well-coordinated at a local community hospital can make an enormous difference.
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From page 28... ...
Significant research has shown that children do better in regionalized systems of trauma care, especially systems in which there are pediatric trauma centers exclusively committed to caring for children. Because the vast majority of children are seen at the periphery of the hub-and-spoke wheel, we need to ensure that all of the 4,000 emergency departments in this country -- some of which see fewer than 10 children a day -- are prepared for pediatric emergencies.
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From page 29... ...
For example, it might just include adding a set of verification standards and another column for STEMI centers in their Web-based application that tracks the hospitals and their capacity. Ornato added that when new treatments and new hospital product lines arise in this country, you may have a dozen facilities raising their hand -- having never done the therapeutic intervention before -- asserting their right to receive their share of the patients.
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From page 30... ...
Ornato said a study in the journal Circulation illustrated the economic impact for a small community hospital, a medium-sized hospital, and an academic health center if community PCI centers were named, but that hospital was not included as one of them. The dollar losses ranged from about $150,000 per year for the small community hospital (which could be quite significant for a facility that size)
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From page 31... ...
stroke center," he said "is because they're going to lose all the weak-and-dizzies and all the syncopal patients and all the Medicare patients who pay money." He continued, "If there is an economic incentive to do something, suddenly centers will pop up, and without metrics to measure their performance, there will not be a way to cull them back and get them focused back on what they should be doing." He added, "We rely heavily on EMS and whenever we discuss regionalization, we should thank our lucky stars for the prehospital providers who go out there and make really hard decisions in cornfields and intersections with profoundly undifferentiated patients." He emphasized that "we need to educate them, give them good tools, give them feedback based on individual cases, accept overtriage and undertriage, and educate them toward the right level." Bass said that we now have several decades of experience with the trauma triage algorithm for prehospital providers and the Centers for Disease Control and Prevention (CDC) , and others have put as much science into it as we possibly can.
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From page 32... ...
Regionalizing Expertise Michael Sayre, chair of the Emergency Cardiovascular Care Committee for American Heart Association, said he would like to give Pancioli a chance to elaborate on the idea of decentralizing care and regionalizing expertise. Sayre argued that the stroke community has done a much better job than any of the other entities focused on here in spreading their expertise, both physically, by going to the referring hospitals themselves, or virtually through telemedicine.
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From page 33... ...
The Role of Emergency Medical Services Personnel David Stuhlmiller, an emergency physician at Westchester Medical Center in New York, said that most hospitals advertise that they can take care of their communities, and most EMS agencies want to bring community members to their own community hospital. It is familiar to them, but it is not necessarily the best option.
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From page 34... ...
The Uses of Data John Holcomb, former commander of the U.S. Army Institute of Surgical Research and trauma consultant for the Army Surgeon General, asked the members of the panel whether they had all published findings on the quality outcomes in their communities based upon implementation of the systems they had described.
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From page 35... ...
Their major concern was that EMS would preferentially bring STEMI patients with no cardiac arrest to the post-resuscitation center, because it would be perceived as providing better care (however, this has not happened based on objective data review)
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From page 36... ...
6 REGIONALIZING EMERGENCY CARE concept. They don't understand the science behind it, but they understand that they or their loved ones may have a better chance to live under this type of system, because these are perishable skills and you want to be able to go to a place that performs these tasks all the time.
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