Network Brings Better, More Efficient Care to Cardiac Patients in 68 Counties
by Candi Helseth
Since Lincoln Medical, a county hospital in Fayetteville, Tenn., joined the Saint Thomas Chest Pain Network, it has been able to expedite treatment for cardiac patients.
The Saint Thomas Chest Pain Network, which serves patients in 68 counties in central Tennessee and southern Kentucky, is proving that small, rural hospitals can achieve great things when everyone works together. In January the Chest Pain Network received $24,000 as one of six finalists for the Monroe E. Trout Premier Cares Award, which spotlights innovative programs that help medically underserved communities.
Better than awards, though, is the fact that 15 rural network hospitals have achieved Chest Pain Center Accreditation through the nationally recognized Society of Chest Pain Centers.
Saint Thomas data demonstrates that patients are seeking help faster, seeing an ER physician earlier, and, when necessary, transferred more efficiently to a tertiary center. Moving patients in remote areas into and through a system quickly and efficiently is critical to saving more lives, according to network education.
Saint Thomas Chest Pain Network is part of the Saint Thomas Health Regional Network under the umbrella of Saint Thomas Health, a nonprofit, faith-based health care system in Tennessee.
The Chest Pain Network (CPN) provides training and resources to rural EMS services and hospitals to improve early recognition, diagnosis and treatment for patients exhibiting signs and symptoms of Acute Coronary Syndrome (ACS). The CPN formed in 2006, and expanded in 2008 to include stroke and heart failure protocols. To date, eight rural hospitals have met the stroke network requirements and three have established heart failure outreach clinics.
“A lot of what we’ve accomplished with the training is speed, which is monumental when time is of the utmost importance,” said Debbie Yorba, emergency director at Lincoln Medical Center in Fayetteville, Tenn.
A team from Lincoln Medical examines a cardiac patient.
“Now we know within the first 10 minutes if the patients’ symptoms are cardiac related and if so, we know what direction to go with that patient.”
Lincoln Medical, a county hospital with outreach to 33,000 residents, is accredited in chest pain and stroke categories. Given the hospital’s size and limited specialized staff, Yorba was skeptical that Lincoln Medical could achieve chest pain accreditation when it joined the network in 2007. Today Yorba is one of the network’s biggest advocates.
Patients who can be treated appropriately at Lincoln Medical appreciate being able to stay closer to home, she said. Patients having a heart attack at admission are transferred using CPN’s One-Call system, which Yorba said greatly expedites the transfer process. If extreme weather delays EMS arrival, staff can appropriately monitor and medicate the patient until a helicopter arrives.
Saint Thomas CPN members know that a large percentage of their patients are at-risk. Rural populations, particularly those in the South and Appalachian region, experience risk factors that contribute to increased rates of heart disease and cardiac-related deaths, according to Rural Healthy People 2010. In 2009, Tennessee was ranked 46th in the nation for heart disease and 42nd in the nation for stroke. Kentucky is ranked 41st in the nation for health disease and 37th for stroke.
“Quality outcomes require seamless coordination between multidisciplinary providers such as the dispatch, a local hospital, EMS and Air Medical Services in order to save heart muscle,” said Ranee Curtis, executive director of Saint Thomas Health Network Services. “Crucial to our success are activities that provide uniform training to health care providers, regardless of where they live and work in the region. Standardizing protocols across urban tertiary facilities and small rural hospitals creates opportunity for a higher quality of patient care, and equally importantly, creates a culture of trust and respect between providers.”
According to Curtis, unnecessary patient transfers have dramatically declined as rural facilities’ comfort levels improve and education has provided greater understanding of which patients can be appropriately cared for in the rural environment. Door-to-Balloon Time has decreased by 48 percent at the Saint Thomas Hospital tertiary center; the other two tertiary centers have also noted decreases.
“Successfully treating heart disease and stroke symptoms begins by increasing public awareness,” Curtis added. “Community education has centered on risk factors and symptoms—as well as the importance of calling 9-1-1. Mock community drills have put all segments of the care plan into practice, from the initial 9-1-1 call to patient transfers to a tertiary care facility.”
Yorba said public drills helped the community better understand the importance of recognizing symptoms and seeking treatment earlier. Quarterly drills have enhanced speedy responses as hospital departments and the EMS work together to streamline care.
“There is no doubt that being in the Saint Thomas Chest Pain Network has made a difference for us and our patients,” Yorba said. “Our physicians and staff got on-site training and education so we are using the same protocols that patients would get at a Saint Thomas Health facility. We’ve also benefited from the involvement of these other rural facilities because we talk to each other, learn from each other and check results against each other.”
CPN has served more than 15,000 patients from nearly 1,000 zip codes. A data registry developed specifically for the network includes over 200 metrics for program evaluation and quality improvement.
Five Health Resources and Services Administration (HRSA) grants of approximately $2.1 million, along with organizational funding, have assisted network expenses. Grants include two Rural Network Development awards, a Rural Outreach award, a Rural Access to Emergency Devices award and a Rural Health Workforce Development award.
To learn more, contact Program Development Coordinator Audrey Daniel at Audrey.Daniel@stthomas.org.
AROUND THE COUNTRY
Marshfield Telehealth Program Reaches Rural Kidney Patients in Northern Wisconsin
by Candi Helseth
A physician with Marshfield Clinic examines a patient in a rural Wisconsin location via computer monitor.
For rural people diagnosed with end-stage renal disease, access to treatment often depends on whether they have the financial means and transportation access to travel long distances. Since most patients with end-stage renal disease are elderly, and many reside in skilled nursing facilities, long transports are often impossible. As a result, many go without any care for their chronic, advancing disease. For such patients, telehealth services can be a godsend.
Marshfield Clinic in Marshfield, Wis., is providing that kind of care, in addition to other telehealth services in advanced specialties that are practically non-existent in rural areas. Its renal disease telehealth program serves low-income, mostly disabled, nursing home residents living in five rural north central Wisconsin counties where travel to specialists can involve a distance of up to 600 miles.
Marshfield Clinic TeleHealth (MCT) also provides services for patients in earlier stages of renal disease who travel to their local clinic for care. Marshfield nephrologists use telehealth to work with freestanding or hospital-based dialysis units in the rural regions, greatly reducing transport time for patients who are on regular dialysis.
“Ninety percent of this service area is rural, covering somewhere around 250,000 miles,” said Nina M. Antoniotti, director of telehealth. “We have five nephrologists that work with patients out in those rural areas. Until we began the service, for the most part, patients were simply going without care. They had to drive long distances to get care and weather can often prevent them from making it to an appointment. If they missed, there was a long wait to get in again. Telehealth has definitely improved access and made it possible for these patients to get the care they need.”
Since its inception in 1997, MCT has grown to include 54 locations including rural clinics, rural nursing homes, Head Start centers and an Indian Health Center, in addition to two hospitals. MCT also offers other highly specialized services including Burn Management, Cardiology, Clinical Psychology, Diabetes Management, Gerontology, Psychiatry and Wound Therapy. Geriatrics, pediatrics and special needs patients are primary populations for outreach. MCT serves about 15,000 patients annually.
“We have patients who see a clinician in Denver because he’s the only one in that specialty,” Antoniotti said. “Our local communities really want telehealth services. For many of their residents, the difference in care is simple: drive 200 miles in the middle of winter for a 15-minute cardiology visit or drive two minutes across town to the local primary clinic. Talk to your neighbor at the reception desk, feel comfortable with a nurse you already know, and be back home in less than an hour.”
In addition to improving patient health care, MCT stabilizes rural community economies and proves that telehealth can be a sustainable program, Antoniotti added. Initiated in December 1997 with a Rural Telemedicine Grant from the Office of Rural Health Policy, the grant proposal proposed seven telehealth services. Within two years, MCT had 15 telehealth services. In 2000, the Office for the Advancement of Telehealth, provided a grant to expand the program and service area. Since then, MCT operations have not relied on grant funding.
“Many programs begun with grants aren’t able to sustain themselves after the three-year grant is up,” Antoniotti said. “We believe we have a moral obligation that if we start telehealth services in a remote community, we can’t pull those services out. We have a business approach to be sure that necessary service is going to continue. We do continue to apply for and get grants on a regular basis that we use as venture capital money, but we no longer use any grant funding for operations.”
The MCT consortium of health care partners funds operation costs. For more information about the program, contact Antoniotti at email@example.com.