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innovaTeam

New Carseat Recommendations

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The American Academy of Pediatrics (AAP) has published new car seat safety guidelines as of August 30, 2018.  They have updated their recommendations to state that children should remain rear-facing until they reach the highest weight or height (whichever they reach first) for their seat.  Previously the AAP recommended rear-facing until at least age 2, but with these new guidelines, many children can and should remain rear facing much longer.

You may be wondering – why is rear-facing important?  Infants and toddlers have heads of disproportionate weight to the rest of their body.  Rear facing seats help to better cradle the head during a crash, therefore protecting the neck and spine from injury.  Neck and spine injuries are some of the most devastating and heart-breaking injuries we care for in the emergency department.

As Emergency Physicians, we are thrilled with these new recommendations.  Car accidents remain a major cause of death and disability for children under age 15 and this evidence-based policy recommendation guides parents in proper restraint use to protect their child. Please check your specific seat for the height and weight limits for rear-facing installation.

The National Highway Traffic Safety Association has published guidelines, recommendations and can even help set up an installation inspection.   See their website for further information.

https://www.nhtsa.gov/equipment/car-seats-and-booster-seats#install-inspection

EpiPen Shortages

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Drug shortages are affecting our patients and providers on a daily basis.  One of the most concerning recent shortages is the limited availability of the Epi-Pen, a home device used to deliver epinephrine to patients with life-threatening allergic reactions (anaphylaxis). 1-2% of the population will develop anaphylaxis in their lifetime.  Anaphylaxis is a complicated reaction leading to mast cell release, airway swelling, and can cause cardiopulmonary arrest.  Epinephrine is the treatment of choice.

The development of epinephrine auto-injectors has allowed patients with a history of anaphylaxis to initiate immediate life-saving treatment in cases of repeat events.  Patients are provided with prescriptions for epinephrine auto-injectors to carry with with them at all times.  Patients benefit from having multiple auto-injectors to keep at home, school, work, and daycare.

In order to manage this dangerous shortage, the FDA has extended the expiration date of some of the pens (regular Epi-pens, not the Jrs) by up to 4 months.  Patients can check the FDA website to verify the lot number on their pen.  Patients should not throw away their pens until they check the website to see if the expiration date has changed and also verify that the pharmacy can refill them.  Some schools and daycares are still refusing to use expired pens even with this FDA announcement due to liability concerns.

FDA page to check pens:

https://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm563360.htm

There are now additional auto-injectors available – Adrenaclick or Auvi-Q – both are FDA approved epinephrine devices but the have a different delivery system so patients will need to read the instructions carefully and train themselves before they need to use them. Patients should check with their pharmacy to determine what they have in stock and what their insurance will cover.

Rural Emergency Care

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Approximately 60 million Americans live in rural communities across the United States.  When it comes to health care, they face unique challenges compared to patients who live in urban communities.  There are far fewer physicians, both primary care and specialists, and patients must travel further distances to get to physicians and hospitals.  There are also proportionately more severe auto accidents and trauma related deaths despite the overall lower population. In the current economic environment, many rural hospitals have been forced to close labor and delivery units – meaning that pregnant women must now travel even further for care.

Innova Emergency Medical Associates helps hospitals tackle the difficult problems of physician recruitment and Emergency Department quality.  We are drawn to the numerous benefits of practicing medicine ruraly – especially the relationship that forms between the physician and the members of the hospital staff, our patients and the community as a whole.  We wanted to create a way to recruit highly qualified, board certified Emergency Medicine physicians to provide world-class care to areas that had struggled with either staffing or quality in their Emergency Department – and it has been a huge success!

Our hospitals have been shocked by our ability to change the culture of their Emergency Department and take the quality of care delivered to new heights.  Our physicians are dedicated to patient safety, ED throughput, and provide outstanding patient care.

Innova | A Brief Case Study

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Here at Innova, patient safety is our top priority.  We know that long waits and high left without being seen (LWBS) rates put patients at risk – and we work diligently to maintain outstanding performance in these metrics.  We recently acquired a hospital contract at a site that sees approximately 12,000 patients per year. The Emergency Department layout is ideal with plenty of space to accommodate the volume, but when our partnership began, the Door to Provider times and LWBS numbers were unacceptably high.   

An astonishing 9.6% of the patients were leaving without ever being seen.  Patients were languishing in the waiting room with average wait times of nearly 1 hour.  The general culture was that nothing could be done.

Within 60 days, our average wait time dropped by 60% to just 20 minutes.  The LWBS rate fell from 9.6% to <2% (an 80% improvement) and patient satisfaction scores have skyrocketed.  

Contact us if you are interested in learning more about how Innova partners with hospitals to deliver world-class care to patients!

Innova Joins Catalyst HTI

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DENVER—August 2nd, 2018— Innova Emergency Medical Associates announced today that they are relocating their national headquarters to Catalyst HTI in Denver, CO.  The team at Innova searched for a community where their own penchant for innovation could collide with other leaders looking to reimagine healthcare.  In fact, Innova’s longtime tagline “Emergency Care Reimagined” perfectly matches the culture of innovation at Catalyst.

Innova’s Founder and CEO, Dr. Steve Sherick stated that “Since 2011 we’ve been working tirelessly to improve the quality of emergency care in hospitals across the US through cutting edge care and employee ownership and our move into Catalyst represents the next step in our journey.  Our providers live across the country from California to New York, and our partner hospitals span from Arizona to Indiana and many states in between, but our home base is in the great health innovation community of Denver.”

Innova was founded in 2011 with the idea that all patients deserve the best in patient care, and that it was possible to do so while treating patients, providers and partner hospitals with the utmost respect.  Innova provides emergency department provider staffing across the Intermountain West and Midwest, specializing in rural emergency departments.  Innova is proud to have an exclusively employee-owned structure that creates a level of true investment by the employees into a company which believes that you work hard when you work, and enjoy your life and family beyond your dreams when you’re not working.

Catalyst HTI is a health care industry ecosystem putting together some of the most forward-thinking minds in the field, under one roof.  Catalyst President Mike Biselli said that “Having Innova join us at Catalyst is an honor and a critical part of our ecosystem, as the team they have represents the future of health care, especially the future for our health care providers.”

***Innova will be having an open house in their office on the 3rd floor (Suite 320) of Catalyst (3513 Brighton Blvd., Denver, CO 80216) from 1-3PM on August 21st.  Please come by and meet the team and learn more about how Innova plans to be an ever-bigger part of the ecosystem at-large.

Access to Care in Rural Communities

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One of the biggest challenges facing our rural communities is access to care.

In the last 8 years, 5% of rural hospitals have closed their doors, leaving their communities with no access to emergency care and many more hospitals continue to struggle to keep their doors open.

Additionally, one of the major tragedies in access to care has been the closing of labor and delivery units in a large number of rural hospitals.

Here at Innova, we were very glad to see a recent article in the New York Times highlighting access to care issues for rural communities.  This article focuses on both lack of obstetrical care as well as lack of Emergency Services available to a large percentage of rural patients.  Click here to read the full text.

Senator Cory Gardner hears about opioid solutions

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ALAMOSA — Meeting with staff and guests at SLV Health in Alamosa on Thursday, U.S. Senator Cory Gardner said he wanted to hear what is happening locally with the opioid crisis and how his office might be able to help.

“This is an incredible challenge,” Gardner said. “This is a significant public health crisis.”

Gardner spoke about two pieces of legislation designed to help deal with this crisis. The Comprehensive Addiction and Recovery Act, which has received more than a billion dollars in the past year and recently $500 million more, provides funding for prevention, education and other efforts such as promoting better tracking in an effort to eliminate “pill mills” that have overprescribed opiates.

The 21st Century Cures Act facilitates faster Food and Drug Administration (FDA) approvals of opioid treatments such as a new injectable medication introduced by Indivior that lasts for a 30-day period and helps prevent relapses.

Gardner (R) and Senator Michael Bennet (D) have also introduced SB2516, the Alternatives to Opioids (ALTO) “to get our hands around this crisis,” he said. It would direct the Secretary of Health and Human Services to conduct a demonstration program to test alternative pain protocols to reduce opioid use in emergency departments.

Also present on Thursday, Dr. Brian Shiozawa, regional director for Region 8 of the U.S. Department of Health and Human Services, which includes Colorado, said dealing with the opioid problem is the department’s number-one priority.

SLV Health CEO Konnie Martin said funding has made its way to the San Luis Valley “in very small doses” so far.

SLV Health is already implementing its own ALTO project, which is ready to become operational by May 1.

Martin and others in the room talked about measures SLV Health and its affiliates in the Valley have taken and are taking to reduce opioid use and provide alternatives to it.

Efforts include pain management contracts for patients with chronic pain, for example, and the hospital staff has updated those to make them more easily understandable for patients, SLV Health Emergency Room physician Dr. Megan Koenig said.

To make sure pain prescriptions are taken properly, those receiving such prescriptions must sign contracts that include such provisions as no refills for stolen or lost medication and urine tests before refills to make sure the person receiving the prescription is the one using it.

As part of its ALTO project SLV Health providers also recommend non-medication pain treatments such as physical therapy and acupuncture, pain management groups and referrals for other services such as behavioral health services. SLV Health also has strict internal security and monitoring for medications, Martin explained.

Koenig further described SLV Health’s ALTO project and acknowledged that while opioid prescriptions could not be entirely avoided there are other options to providing pain relief for patients. She said all departments have been cooperative, from the pharmacy to the emergency department, and providers themselves are re-educating themselves on alternatives to prescribing pain medications. She said there are four or five steps a provider must go through before writing an opioid prescription. One of those, for example, is checking the Prescription Drug Monitoring Program (PDMP), a database of patients’ prescription history. Access to PDMP is restricted, and the system is not nationwide yet.

Dr. Koenig said she wished she could access records nationwide, especially since she is seeing more patients that have moved here from other places.

She and Martin said PDMP is also limited to patient history, not provider history, so they could not find out if a provider was aggressively prescribing medications, for example.

Dr. Koenig stressed the importance of providing alternatives to patients.

“There are a lot of resources,” she said.

Dr. Donna Nelson, who attended Thursday’s gathering by phone, is a physician with the emergency department at SLV Health Conejos County Hospital. She is getting an ALTO program going there as well, and the staff is receptive to it. She added that they had already been limiting narcotics in the emergency department there for five or six years.

Senator Gardner asked Dr. Nelson where people are getting prescription drugs if the hospitals are not prescribing them as much. She said in the Valley there are still a lot of purchases on the street, although she did not know where the supply was coming from.

When the senator asked about heroin, Dr. Nelson said heroin has been prominent in the Valley for several years now.

“I couldn’t tell you where they are getting it,” she said. “It’s just as common as methamphetamines. I assume it’s very easy to get on the street because everybody’s using it.”

She said sometimes she also sees patients who overdose on heroin, and their drug screens come back positive for fentanyl, which is sometimes mixed with heroin and other drugs like cocaine.

Dr. Koenig added unfortunately this is all too common and that doctors know when a new drug supply has hit the Valley because they see patients with reactions to the new mixtures.

When asked about emergency and long-term substance abuse treatments, Dr. Koenig said many police are carrying Narconon; three providers are giving Suboxone with the goal of every clinic having at least one provider who can provide it; and a SHARRP (San Luis Valley Health Access Risk Reduction Project) clinic now offers services every Wednesday morning including a needle exchange.

Audrey Reich Loy, who directs SLV Health’s Primary Care Clinical Operations, added that there is also a methadone clinic here.

She said SLV Health can provide some outpatient treatment on a limited basis and she would like to see that expanded.

Loy said inpatient treatment is limited.

Dr. Nelson added that at the Conejos Hospital staff refer patients to groups like Narcotics Anonymous and Alcoholics Anonymous, and several of the AA meetings here also welcome those suffering from other addictions besides alcohol.

Donna Wehe, SLV Health director of communications, added that another treatment tool being implemented here is the LEAD (Law Enforcement Assisted Diversion) program that will assist defendants with options and resources other than incarceration.

Senator Gardner asked about marijuana in relationship to opioids. Kelly Gallegos, administrator for the SLV Health Conejos County Hospital, said that while some have said marijuana is the answer to the opioid problem, providers have found the opposite to be true. She said marijuana has contributed to the problem.

Martin added that too often people who have relocated here to be closer to legal marijuana have brought a myriad of other problems with them, and they have not been contributing members of the society.

“It stresses our system, and it stresses our community,” she said.

Dr. Koenig said there are patients who receive some benefit from marijuana use and are not abusing it.

Gardner asked SLV Health Interim Chief Medical Officer Dr. David Geiger, a surgeon, what legislation he would like to see at the federal level, whether it would mean more money or other resources. Geiger said money is always helpful, but the key is education regarding alternatives.

Loy added that another solution is to deal with the poverty that exists in many of the communities where people have turned to drugs.

Martin said, “This problem is huge … but the only way you are going to solve it is a piece at a time.”

It is like a puzzle, she said, where one piece at a time can be put in place to solve the bigger picture problem. She said SLV Health has shifted resources to make it a priority to implement the ALTO project.

Caption: Senator Cory Gardner, right, speaks with staff and guests at SLV Health on Thursday. At left is SLV Health CEO Konnie Martin, and center is Dr. Brian Shiozawa, regional director for Region 8 of the U.S. Department of Health and Human Services.

https://alamosanews.com/article/senator-hears-about-opioid-solutions