All posts tagged patients

Machias Hospital Expands and Modernizes Emergency Department – WABI

MACHIAS, Maine (WABI) Built over 50 years ago — the Emergency Department at Down East Community Hospital annually treats nine thousand patients — significantly above the capacity it was designed to handle.

Dennis Welsh, President and CEO of Down East Community Hospital says, “This really offers up a lot of space for our patients. Before we were woefully inadequate with regards to space in the E.D. We often had patients lined up in the hallways. It was very busy. We’ve seen continued growth in E.D. services here and I think this will create a completely improved environment for our patients.”

The new Emergency Department has three times the space…and has grown from six beds to nine.

Welsh says, “Hospitals today, a lot of them were built 30, 40, 50 years ago so, when we look at new construction in the new add on it’s up to current times.”

Modern upgrades for the facility include a behavioral health room.

Welsh says, “We have folks coming in for detox or other substance abuse issues, so we’ve created this behavioral health room and it’s really kind of a lock-down room that’s comfortable and quiet. It’s very safe for the patient.”

They also have a negative pressure room for folks with infectious diseases and a new decontamination area.

He says, “They’re large showers that we can put patients in in case of chemical spills or other emergency disasters.”

As the only hospital in a 60-mile radius of Machias, hospital staff say it’s a much needed upgrade for the community.

Kevin McEwan, Chief Nursing Officer says, “We are a very busy community — so there was a demand here in the community to upgrade these services and not have our community drive and hour and a half or two hours to get these services.”

Welsh says, “We have one final phase left. It should be about 4 weeks. We’ll be 100 percent by the end of October and we’ll actually start seeing patients we think early next week in this space.”

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Machias Hospital Expands and Modernizes Emergency Department – WABI

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A View of the Epidemic: At the ER, New Complexities – Valley News

Lebanon Its hard to imagine someone more directly involved in the opioid epidemic through his work than Thomas Trimarco. Hes an emergency medicine physician at Dartmouth-Hitchcock Medical Center, where hes worked since 2012.

Emergency rooms, of course, in some ways serve as one of the front lines in dealing with fallout from the epidemic. Its where opioid users are taken when theyve overdosed. Its also a place where users might go to feign a condition in the hope of securing narcotics.

Dartmouth-Hitchcock officials couldnt readily produce statistics on the number of opioid-related cases it handles in the emergency room, but Trimarco, 37, has no doubt it has increased substantially in the number of people he sees with serious, chronic conditions resulting from intravenous drug use, such as infections of the spine, heart and brain.

Those can lead to significant problems that cant necessarily be taken care of at the smaller, community hospitals, said Trimarco, who also serves as medical director for 27 local emergency medical service agencies. So, weve seen a significant increase in the amount of patients who are being transferred from (other) hospitals that are ending up in our emergency department and in our facility with these more serious, long-term complications.

Such cases were once relatively uncommon, but the amount that were seeing now is very significant. Instead of kind of an interesting, once-in-a-while case, its a pretty common case these days.

While some patients come to the emergency room seeking drugs to feed their habit, Trimarco said DHMC has not seen an increase in such patients recently.

I dont think were known as a candy shop, he said.

Because drug seekers often come in complaining of pain-related conditions, such as those that are commonly treated with opioids, it can sometimes be difficult for providers to determine whether a patient is seeking drugs to feed a habit or is in need of medication to treat an acute medical need, he said.

We like to think the best of patients and surely we will give them the benefit of the doubt, Trimarco said.

His job though is to evaluate a patient to determine what their medical need might be.

Once weve eliminated the acute medical issue that might be going on other than the substance abuse … We try to be upfront and honest about our ability to prescribe (opioids) for chronic pain issues out of the emergency department, he said.

There are times when Trimarco has to speak firmly and bluntly with patients who just want to feed their habit.

Most of the time the overall interaction is reasonable and goes well, he said. But, patients can get upset and angry when they are looking for what they think they need or deserve in coming into the emergency room.

In some cases, patients may become violent, Trimarco said.

Trimarco was assaulted twice while working in an emergency room in Cincinnati, prior to coming to DHMC. In one instance, he was punched in the face, in the other he suffered a broken rib. Though both assaults predated the opioid epidemic, they did involve substance use, he said.

Violence against health-care providers is a problem throughout this system and the nation, he said. Its certainly complicated and, perhaps, increased by the opioid epidemic that were seeing. We are seeing more instances of risk to providers both in the ED as well as in the hospital over the last couple of years.

Health care providers face another danger as a result of the epidemic: toxic substances. Even a trace amount of fentanyl or carfentinal narcotics frequently used by addicts could cause a fatal overdose. Such substances may lurk on patients clothing or belongings when they arrive in the emergency room or when emergency medical personnel arrive on a scene, Trimarco said.

No longer can we just kind of dive in and start treating that patient, he said.

If providers suspect patients may have toxic substances on them, they may need to remove and bag their clothing, or take a shower, Trimarco said.

He and the emergency room staff have to deal with overdoses and medical conditions related to intravenous drug use, but the epidemic has also forced him to question whether the standard emergency-room approach is adequate to the task.

As emergency physicians, were really trained to diagnose and to stabilize the acute medical problem thats in front of us, and once that stabilization is achieved were able to hopefully pass that patient along to another provider that would specialize in the longer term care of whatever the ailment, injury or illness is, Trimarco said.

What weve recognized, though, is the exposure that we have to a patient in the emergency department is sometimes the only chance that the health care system has to access these patients and to offer them this support that they may be in need of.

Aiming to break the cycle of addiction, emergency-room staff have started a peer-recovery coaching program.

We will identify patients who may benefit from this program and well call in a recovery coach to spend some time with that patient and offer some support to that patient, both for their current emergency department visit as well as, hopefully, going forward as they try to deal with the long-term addiction that theyre struggling with, he said.

Shifting to addressing patients longer-term needs, however, has come at a cost. What might previously have been a one- or two-hour visit can sometimes last much longer, which can mean longer waits for other patients, he said.

It does have significant downstream effects for all of the other patients in the community who are coming in for emergency care, but these patients are as important as all of our other patients and we still prioritize them and all of our patients according to severity, said Trimarco.

Providers approach those struggling with substance abuse differently than they did in the past, Trimarco said.

I think we all do a little bit of a better job of recognizing the significant struggle that our patients are having dealing with substance abuse these days, he said. I think the patients are less stigmatized than they have been in the past, perhaps.

In some cases, health-care providers also struggle with substance abuse.

Before coming to D-H, I worked at a hospital and we had a young, tremendously talented nurse in our emergency department that died of an overdose, and so I dont think anybody is immune to this epidemic, he said. You see it in many different ways, both when youre working clinically and … it certainly spills over to our personal side as well.

Its a privilege to be able to see and treat patients in some of the worst times of their (lives), but at the same time that can take a toll on you and you certainly need to find a way to appropriately and positively deal with those stresses to be able to continue to do your job and serve the patients that we try to serve, Trimarco said.

Sometimes you just need a little bit of a breather, he said. A lot of times the issues that we see just constantly remind us of the blessings and the amazing things in our own lives.

Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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A View of the Epidemic: At the ER, New Complexities – Valley News

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Think you need to go to ER? If your insurer doesn’t agree, you could pay – WHAS 11.com

(Photo: Thinkstock / Getty Images, Custom)

(INDYSTAR.com) – Indiana Anthem policyholders may soon discover that what they consider a medical emergency does not necessarily align with what their insurer considers a medical emergency.

Under a new program, Anthem will require Indiana policyholders who seek emergency care for certain nonemergency ailments to foot the emergency room bill. The insurer would still pick up the tab if the patient opted to go to a retail health clinic, urgent care center or doctors office.

Concerns over the high costs of emergency room care, combined with overcrowded emergency rooms, led to the new policy, said company spokesman Tony Felts in an email.

The ultimate goal of this is to encourage more efficient utilization of health care resources, relieve pressure on ERs that are already stretched thin and strengthen the relationship between our members and their primary care doctors, who are in the best position to influence the health of their patients, Felts wrote.

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Emergency room care costs 12 to 18 times as much as a visit to a retail health clinic, eight to 12 times as much as a visit to a doctors office and six to seven times more than an urgent care visit.

While Anthem officials say they have not yet set the date for when the program will begin in Indiana, it is already in place in three other states.

Emergency room doctors and patient advocates decry the new policies, saying they put patients in the uncomfortable position of making critical decisions about their health, when time may be of the essence.

Patients will be too often forced to be their own doctors, said Scott Mulhauser, board member of the advocacy group Consumers for Quality Care. Consumers shouldnt be evaluating their care in these tense moments . You dont want to guess wrong because the consequence can change your life forever.

With the new policy, patients may delay getting care they need, afraid of incurring a hefty bill, said Dr. Chris Burke, a board member of the Indiana American College of Emergency Physicians.

Because many nonemergent conditions present with similar symptoms to emergency ones, identifying the true emergencies can be challenging for a lay person, he added.

The problem is that many diagnoses, their symptoms overlap, and without a thorough evaluation by a physician, you cant tell until that evaluation is complete, said Burke, an emergency room physician with Medical Associates who practices at Community Hospitals East and North. Its wrong to insist that patients should self-diagnose. Most are not able to do that. I think most who come to the emergency department believe that they have a problem.

A patient could misinterpret a bad headache, for instance, as a migraine, failing to recognize it as a stroke that requires emergency care. Or nausea or indigestion could be mistaken for a gastrointestinal condition rather than a heart attack.

If a patient with the same symptoms wrongly concludes a heart attack, the good news that the condition was not more serious could lead to the bad news of being saddled with the full bill for the emergency care.

This past week, the advocacy group sent Indiana Insurance Commissioner Stephen Robertson a letter asking that he reject the policy.

The insurance department conducted a review and decided not to act further, said Jenifer Groth, director of communication and outreach.

“IDOI completed its review and determined the program is not changing any prior coverage and does not constitute a procedural or benefit change,” she wrote in an email. “The program is to make policyholders aware of the process for payment of ER claims by sending information that outlines how coverage of claims will be handled.”

Anthem officials say that they decided to implement the policy after studies showed that about 75 percent of the 6.5 million emergency room visits made by those younger than 65 annually are for conditions that do not actually require immediate medical care.

Four emergency room doctors helped the insurer draw up a list of about 300 medical codes that would be considered nonemergencies, such as suture removal, athletes foot and the common cold, Felts said in an email.

A medical director will review any claim made for care delivered in an emergency room rather than a more appropriate setting. The symptoms that drove the patient to the emergency room also will be taken into account, he said.

Only about 10 percent of all 190,000 emergency room visits in Indiana annually would be reviewed, and likely only about 4 percent would be denied, Felts said.

But according to the companys own research of its policyholders, many patients dont necessarily know where to go for immediate care. About two-thirds go to the emergency room if they are sick and the doctors office is closed. One-quarter think the emergency room is the best place to go no matter their ailment or the time of day.

Half of those surveyed said they knew about retail health clinics and walk-in centers and opt for the emergency room and just under three-quarters of people who have made emergency room visits are familiar with urgent care centers.

While Anthem said that concerns about rising health costs and overcrowding contributed to the development of the new policy, Burke, who has been in practice for three decades, said that this policy will likely have little impact on either of those.

Emergency room care nationwide only accounts for about 2 percent of health costs, he said. While crowded emergency rooms do exist, its often because theres no room in the hospital to admit patients, rather than rampant overuse.

Anthem has already put the program into effect in Kentucky, Missouri and Georgia and could eventually extend it to additional markets. Each state market determines its own list of what will and wont be covered, Felts said. In Indiana about 300 out of 2,000 diagnoses considered to be nonemergencies are included in the new policy.

The policy will not apply to pediatric patients younger than 14, those referred to the emergency room by medical providers, visits made on Sundays or holidays when other clinics and offices are closed and for patients who live farther than 15 miles from an urgent care facility.

Ideally, the new policy will strengthen the relationship between patients and their primary care providers, Felts said in a statement.

[W]e are committed to promoting care delivery in the most appropriate clinical setting; for nonemergent care, generally this is the patients primary care provider, he said. Anthem believes that primary care doctors are in the best position to have a comprehensive view of their patients health status and should be the first medical professional patients see with any non-emergency medical concerns.

But health care advocate Mulhauser said that the policy could actually lead to high health expenditures if people wind up delaying needed care and end up worse off than if they had seen a health professional in a timely fashion.

When time matters and in those crisis situations, you want to feel the comfort of knowing that youre getting best medical care possible and not worrying about whether or not your insurer will cover your visit in a split second, he said. Forcing patients to make their own medical decisions that create incentives for them not to get the care they need can create real problems.”

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and on Facebook.

INDYSTAR.com

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Think you need to go to ER? If your insurer doesn’t agree, you could pay – WHAS 11.com

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Munson Healthcare Cadillac Hospital to Renovate Emergency Room – 9&10 News

The emergency room at Munson Healthcare Cadillac Hospital is getting a major makeover.

The hospital tells us they see almost 100 patients every single day in the ER, and that number is on the rise.

Right now, the ER has 15 rooms with beds.

And since the demand for ER care is rising, they also have two beds in the hallway where the patients have little to no privacy.

We’re up to 27,000 patients per year now, and in order to meet those needs we need a little bit more space, explains Jeremy Carlson, Manager of Emergency Services.

So now they’re doing just that.

Workers are drilling and sawing to create more space for the increasing number of patients Munson is seeing.

Ten years ago we were seeing probably 10,000 fewer patients a year so the design worked really well, Carlson says.

But it’s now time for a renovation.

So they’re re-locating the hallway beds into rooms to give patients more privacy, and theyre adding three extra rooms.

They’re not stopping there, though.

Better patient service means starting at the foundation, so the main staff workspace is getting a makeover too.

I’m excited about the renovation because I think from what the plans look like make its going to make it a more open, smooth space to work in, says ER Technician, Joe Berryhill. Youll be able to see the doc[tors] because there wont be big walls in front of you. So it’s pretty exciting.

Doctor, nurses and technicians will now be able to work side by side.

I think it’s going to help with the communication, Berryhill says. I think it’s going to be a lot [smoother], and in turn that’s going to make us take care of our patients a lot quicker with less obstacles in our way.

This project has been in the works for about a year now, and should be completed by May of 2018.

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Munson Healthcare Cadillac Hospital to Renovate Emergency Room – 9&10 News

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