Methodist Richardson Medical Center (MRMC) and the Richardson Fire Department (RFD) were recognized by the American Heart Association for having the fastest total combined patient treatment time for cardiac events for the first quarter of 2011 for the state of Texas.
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
Patient satisfaction with the care and clinical staff at the Long Beach Emergency Department stands at among the highest recorded when compared to other emergency departments nationwide, according to HealthStream®.
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
Patient satisfaction with the care and clinical staff at the Long Beach Emergency Department stands at among the highest recorded when compared to other emergency departments nationwide, according to HealthStream®.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
How one Hospital Shaved Off 88 Minutes from their ALOSEmCare
With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.
PowerPoint: Practical Approaches to Improving Patient Pre-Op PreparationEmCare
Michael Hicks, MD, MBA, FACHE, CEO of EmCare Anesthesia, and Lisa Kerich, PA-C, VP of Operations for EmCare Anesthesia, provide expert advice for improving the performance of your O.R. through an integrated, collaborative approach. Learn how Pre-Anesthesia Testing (PAT) clinics are being used successfully to improve patient readiness, surgeon satisfaction and financial performance.
Originally presented Sept. 17, 2015, as a webinar in partnership with Becker's Hospital Review.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
CPR for Family Members and Caregivers of At-Risk PatientsDavid Hiltz
Half of all cardiac arrest victims were previously identified as at-risk. 80% of cardiac arrests occur in and around the home. Why aren't we training the caregivers and family members?
Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from our patients. In this #ACEP13 presentation, Dr. Jensen gives practical tips to improve your patients' ED experience.
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
Magnet recognition is the highest award a hospital can receive for outstanding nursing services, by creating an environment that attracts and rewards outstanding nurses.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
How one Hospital Shaved Off 88 Minutes from their ALOSEmCare
With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.
PowerPoint: Practical Approaches to Improving Patient Pre-Op PreparationEmCare
Michael Hicks, MD, MBA, FACHE, CEO of EmCare Anesthesia, and Lisa Kerich, PA-C, VP of Operations for EmCare Anesthesia, provide expert advice for improving the performance of your O.R. through an integrated, collaborative approach. Learn how Pre-Anesthesia Testing (PAT) clinics are being used successfully to improve patient readiness, surgeon satisfaction and financial performance.
Originally presented Sept. 17, 2015, as a webinar in partnership with Becker's Hospital Review.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
CPR for Family Members and Caregivers of At-Risk PatientsDavid Hiltz
Half of all cardiac arrest victims were previously identified as at-risk. 80% of cardiac arrests occur in and around the home. Why aren't we training the caregivers and family members?
Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from our patients. In this #ACEP13 presentation, Dr. Jensen gives practical tips to improve your patients' ED experience.
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
Magnet recognition is the highest award a hospital can receive for outstanding nursing services, by creating an environment that attracts and rewards outstanding nurses.
James I. Merlino is acolorectal surgeon and thechief exper.docxvrickens
James I. Merlino is a
colorectal surgeon and the
chief experience officer at
the Cleveland Clinic.
Ananth Raman is the UPS
Foundation Professor of
Business Logistics at Harvard
Business School.
HEALTH CARE'S
SERVICE FANATICS
How the Cleveland Clinic leaped to
the top of patient-satisfaction surveys
by James I. Merlino and Ananth Raman
THE CLEVELAND CLINIC has long had a reputation for medical excel-
lence and for holding dov în costs. But in 2009 Delos "Toby" Cos-
grove, the CEO, examined its performance relative to that of other
hospitals and admitted to himself that inpatients did not think
much of their experience at its flagship medical center or its eight
community hospitals—and decided something had to be done.
Over the next three years the Clinic transformed itself. Its overall
ranking in the Centers for Medicare & Medicaid Services (CMS) sur-
vey of patient satisfaction jumped from about average to among the
top 8% of the roughly 4,600 hospitals included. Hospital executives
from all over the world now flock to Cleveland to study the Clinic's
practices and to leam how it changed.
The Clinic's journey also holds lessons for organizations outside
health care—ones that until now have not had to compete by cre-
ating a superior experience for customers. Such enterprises often
have workforces that were not hired with customer satisfaction in
mind. Can they improve the customer experience without jeopar-
dizing their traditional strengths? The Clinic's success suggests that
they can.
The Cleveland Clinic's transformation involved actions any
organization can take. Cosgrove made improving the patient ex-
perience a strategic priority, ultimately appointing James Merlino,
a prominent colorectal surgeon (and a coauthor of this piece), to
io8 Harvard Business Review May 2013
n
HEALTH CARE'S SERVICE FANATICS
lead the efiFort. By spelling out the problems in a sys-
tematic, sustained fashion. Merlino got everyone in
the enterprise—including physicians who thought
that only medical outcomes mattered—to recognize
that patient dissatisfaction was a significant issue
and that all employees, even administrators and
janitors, were "caregivers" who should play a role in
fixing it. By conducting surveys and studies and so-
liciting patients' input, the Clinic developed a deep
understanding of patients' needs. It gave MerUno a
dedicated staff and an ample budget with which to
change mind-sets, develop and implement processes,
create metrics, aind monitor performance so that the
organization could continually improve. And it com-
municated intensively with prospective patients to
set realistic expectations for what their time in the
hospital would be like.
These steps were not rocket science, but they
changed the organization very quickly. What's more,
fears expressed by some physicians that the initia-
tive might conflict with efforts to maintain high qual-
ity and safety standards and to further reduce costs
turned out to be unfounded. Du ...
The Healthcare Team as the Healthcare Provider: A Different View of the Patie...guesta14581
Presentation to the Ohio State Society of Medical Assistant's annual convention about the Patient Centered Medical Home and the role of the medical assistant
Report TemplateREPORT COVER PAGE (1 page; not included in 25pa.docxsodhi3
Report Template
REPORT COVER PAGE (1 page; not included in 25page limit)
EXECUTIVE SUMMARY (1 page; not included in 25page limit)
INTRODUCTION (1 page)
MedStar Washington Hospital Center is a not-for-profit, 926-bed, major teaching and research hospital in the nation’s capital. The Hospital Center is among the 100 largest hospitals in the nation,* and is renowned for handling the Washington region’s most complex cases. U.S.News & World Report consistently ranks the Hospital Center’s cardiology and heart surgery program as one of the nation's best; it’s the only hospital in the Washington metropolitan area to earn a national ranking for heart care in FY 2015. A long-standing leader in cardiovascular care, MedStar Washington Hospital Center is home to MedStar Heart & Vascular Institute, which formed a first-of-its kind clinical and research alliance with Cleveland Clinic Heart & Vascular Institute in 2013. The Hospital Center operates the Washington region’s first Comprehensive Stroke Center and the District’s only Cardiac Ventricular Assist Device program, both certified by The Joint Commission. The hospital is also home to MedSTAR, a nationally-verified level I trauma center with a state-of-the-art fleet of helicopters and ambulances, and also operates the region’s only adult Burn Center.
MedStar Health combines the best aspects of academic medicine, research and innovation with a complete spectrum of clinical services to advance patient care. As the largest healthcare provider in Maryland and the Washington, D.C., region, MedStar Health’s 10 hospitals, the MedStar Health Research Institute and a comprehensive scope of health-related organizations are recognized regionally and nationally for excellence in medical care. MedStar Health has one of the largest graduate medical education programs in the country, training 1,100 medical residents annually, and is the medical education and clinical partner of Georgetown University. MedStar Health is a $5 billion, not-for-profit, regional healthcare system based in Columbia, Maryland, and one of the largest employers in the region. Our 31,000 associates and 4,700 affiliated physicians support MedStar Health’s patient-first philosophy that combines care, compassion and clinical excellence with an emphasis on customer service.
MedStar Washington Hospital Center: FY 2013 - FY 2015 STATISTICS
Description
FY 2015
FY 2014
FY 2013
Inpatient admissions
38,156
39,598
42,412
Outpatient visits
389,535
384,112
398,058
Cardiovascular admissions
7,368
7,844
8,828
Cardiac surgeries
1,694
1,707
1,623
Heart transplants
16
9
12
Ventricular assist device procedures
75
61
45
Inpatient surgeries
11,948
11,752
12,068
Outpatient surgeries
11,139
11,335
11,739
Robotic surgeries
TBD
353
364
New cancer cases diagnosed
2,189
2,350
2,400
Cancer admissions
1,815
2,046
2,262
Outpatient cancer visits
68,853
72,082
77,152
Outpatient visits in the Center for Breast Health
19,143
19,947
19,447
Kidney transplants
51
79
...
The Future of OB Hospitalist Programs: The Unexpected DeliverablesEmCare
You might expect that with an OB hospitalist onsite 24/7, hospitals are better equipped to manage obstetric and gynecologic care and emergencies, providing the ultimate in patient safety while reducing liability and risk. That’s true. But there are unexpected benefits as well.
Wayne L. Farley, Jr., D.O., FACOG, presents “The Future of OB Hospitalist Programs: The Unexpected Deliverables.” This webinar was September 21, 2016, hosted by Becker’s Hospital Review.
Alexander Strachan, Jr., MD, MBA, and Asim Usman, MD, of EmCare Hospital Medicine, discuss bundled payments for care improvement (BPCI) and how hospitalists are leading the charge.
Originally presented May 4, 2016, as a webinar in partnership with Becker's Hospital Review.
Efficiency in the emergency department is always at the forefront of the minds of hospital leaders -- and for good reason. The infographic below reveals the true cost of inefficiency in the emergency department when it comes to patients who leave without treatment (LWOT) and why hospitals can't afford to leave this issue unaddressed.
OPERATIONAL INTEGRATION: CREATING A HIGH-PERFORMING HEALTHCARE ORGANIZATIONEmCare
What strategies are in your arsenal to combat and conquer the thorny challenges
of healthcare reform? Reducing costs? Improving quality, productivity and efficiency? Redesigning processes? Improving the patient experience? Transforming your organization from one that delivers episodic sick care to one that nurtures wellness and personal responsibility is daunting, but absolutely necessary. While consultants
have prospered by touting the “solution-of-the-day,” a handful of approaches have gained traction. One of those is clinical integration.
Learn how a shift in processes, leadership and culture to an integrated solution can put your hospital on track to achieve improved clinical outcomes, metrics and patient experiences, each of which can have a potentially dramatic financial impact.
Proven Techniques to Boost Lean Implementation in Your Emergency DepartmentEmCare
Six facilities of a national hospital chain located in the Southeast United States teamed up with EmCare® to review recent best practice publications, incorporate individual ideas, implement changes, modify processes and develop a standard best practice recommendation for efficient, quality ED care. The main goal was to satisfy the patient’s primary need in presenting to an ED – the desire to see a physician as soon as possible.
The concepts herein have been proven to work in various size and volume EDs. The following chart outlines the descriptions of the six facilities involved in this effort.
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
Fast and Efficient Practice: The Emergency Department Clinician on the Emerge...EmCare
Patient safety and satisfaction are the focus
within any emergency department. To streamline
navigation on the ED autobahn, i.e., flow, and
thus accomplish these goals most efficiently
can be accomplished by the consideration of
several factors and the application of several
key techniques.
This Genesis Cup 2012 runner-up presentation by Medical Director, Harry "Tripp" Wingate, MD and Shayne Middleton, RN, RDCS describes the process used at EMH ED to “flip” the complaint to compliment ratio – a crude measure of customer service performance in a rural ED. The presentation details steps from training on AIDET to the key issues in providing effective feedback to ED staff. Special emphasis is given to the tricky issue of email communication and compliance with HIPAA. New web-based tools (WinZip.com and MyFax.com) for safe email communication are introduced to the audience with comments on benefits and usage.
In 2011, we took it upon ourselves to break down our patient care and examine it from the time the patient arrived (regardless of method) to the time they departed (again, regardless of method). Over the next year, we developed and implemented an end-to-end strategy of patient care and flow, where all decisions were under the scrutiny of what was deemed to be ‘patient-centric’. This process of self-improvement led us to develop a scalable, replicable template for hospitals of all shapes and sizes. Too often, patient flow hurdles and patient care problems are addressed solely through the vantage of individual departments at the expense of efficiency. Our presentation is the result of a personal, real-time experience.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Learn how Methodist Richardson Achieved Fastest Total Patient Treatment Time for Cardiac Events
1. Collaboration Between the ED and the Local
Fire Department Improves Results, Saves Lives
An EmCare® Case Study
Methodist Richardson Medical Center
Richardson, Texas
4. 2
Introduction
Methodist Richardson Medical Center (MRMC), a non-profit hospital
in Richardson, Texas, has offered compassionate medical, surgical and
behavioral health services for more than 40 years. MRMC has received
numerous recognitions and accreditations, including:
• Sleep Disorders Center accredited by American Academy of Sleep
Medicine
• Cancer Center accredited by American College of Surgeons
Commission on Cancer
• Advanced Primary Stroke Center designation by American Stroke
Association
And, recently, the EmCare-affiliated emergency department at MRMC
in Richardson, Texas became one of only a few in the Dallas area to be
named a Cycle III Chest Pain Center and Heart Failure Center- the highest
level of accreditation by the Society of Chest Pain Centers.
Challenge
Every day in Dallas County, approximately 30 people suffer a heart attack
and depend on the seamless delivery of emergency medical services to
increase their chances of survival and quality of life. Cardiovascular disease
is the number one killer of all Americans and current survival rates in
Dallas County are lower than the national average. Response times vary
across hospital systems and EMS providers, and that critical time can mean
the differences between life, death and permanent disability.
“It is the time of reduced blood flow to the heart that counts, not just
the time the patient arrives at the hospital,”says Dr. Nhan Nguyen,
interventional cardiologist and medical director of Cardiology at MRMC.
The hospital had two goals: to improve results for those who suffered
heart attacks in the region and to earn accreditation as a Chest Pain Center
and Heart Failure Center. To achieve this status, hospitals must meet or
exceed a comprehensive set of stringent heart failure care criteria and
undergo an on-site evaluation by members of the Society of Chest Pain
Centers review team.
Solution
To ensure the medical center met the survey criteria, Dr. Elizabeth Fagan,
EmCare Regional Medical Director, and Medical Director Dr. Brian Kenjarski
Every day in Dallas
County, approximately
30 people suffer a heart
attack and depend on
the seamless delivery
of emergency medical
services to increase their
chances of survival and
quality of life.
5. 3
The hospital works closely
with Richardson Fire
Department to improve
emergency services to the
surrounding community.
partnered with all of the hospital departments involved in the care of
heart failure patients and standardized order sets to ensure appropriate
treatment and documentation. The medical center also developed risk
stratification tools to ensure patients are appropriately placed in either an
observation bed or inpatient bed.
“The survey is very intense as the survey team evaluates every facet of
your program,”said Dr. Fagan, who has also served as the emergency
department medical director at MRMC. The survey included a review
of the medical center’s involvement in EMS education, ED evaluation
and treatment, inpatient care, discharge planning, patient education,
community outreach, process improvement and other areas.
Through a multi-million dollar grant initiative between the American
Heart Association (AHA) and W.W. Caruth, Jr. Foundation, efforts are being
made to streamline protocols between participating hospitals and EMS
agencies in a collaborative effort to reduce response times, increase action
and coordinate data transfer. Every second counts and critical seconds are
gained when effective coordination occurs.
As part of the efforts to prepare for the survey and to improve emergency
services to the surrounding community, the hospital worked closely
with the Richardson Fire Department. Dr. Fagan stated that, in this case,
working with local EMS providers was crucial to meeting evaluation
criteria.“Partnering with EMS allowed us to educate all providers who take
part in the care of our community’s heart failure patients, from 9-1-1 call
to discharge,”she said.
Results
In February 2011, the EmCare-affiliated emergency department at
Methodist Richardson Medical Center received Heart Failure Accreditation
from the Society of Chest Pain Centers. It is the twenty-sixth facility in the
United States and the first in Dallas to receive the certification.
On Wednesday, August 24th Methodist Richardson Medical Center and
the Richardson Fire Department were recognized for having the fastest
total combined patient treatment time for data submitted to the AHA
Dallas Caruth Initiative during 1st Quarter, 2011.
Specific initiatives of the program include convening EMS and hospital
emergency providers to regionally standardize emergency heart attack
treatment and transport protocols, report and share patient care and
quality improvement data, increase professional education standards and
6. 4
eliminate equipment gaps so all EMS providers can identify suspected
heart attack patients in the field and transmit to the hospital for expedited
transport and treatment.
Dr. Fagan believes the certification should provide benefits to both
the medical center and the patients for whom care is provided.“Early
identification, prompt treatment and aggressive patient education will
improve the care we can provide to our patients and decrease their
readmission rate,”she said.
The process is relatively simple:
• The patient is picked up by an ambulance to be taken to the hospital
• Richardson EMS personnel evaluate the patient and if STEMI presents,
they field-activate the cath lab
• Upon arrival at the hospital, the patient is taken through the ER where
emergency medicine physicians can treat the patient on the way to the
cath lab if needed
• In the cath lab, cardiologist and hospital team perform a heart
catheterization and place a stent in the patient’s blocked artery
• Once the patient has been catheterized, he or she is moved to a
hospital room until discharge
“Patients who recognize heart attack symptoms and quickly call 911 can
be treated through a coordinated effort between EMS and healthcare
providers,”states Dr. Elizabeth Fagan. She continues,“The national goal is
a response time of less than 90 minutes from the time the patient arrives
at the hospital (door) to the time the blocked artery is open (balloon).
Methodist Richardson Medical Center has met that goal 100 percent of the
time for nearly three years. For the previous six quarters‘door to balloon’
time average was only 59 minutes.”
EmCare focuses on helping each hospital partner with efficiency,
quality and patient satisfaction. In short, EmCare is making health
care work better.™
A Case Sample
A 66 year old male experienced and recognized the symptoms associated
with a cardiac event and, through a series of controlled coordination
between the patient, the EMS and hospital staff, symptom onset through
arterial reperfusion (SOAR) was reduced to 43 minutes. This is a significant
reduction in response time when compared to the median reported
EmCare focuses on helping
each hospital partner with
efficiency, quality and
patient satisfaction.
7. 5
response times in Texas of 171 minutes, or just under three hours. The
timeline of events is listed below (some times are approximates):
12:20 pm: A 66 year old male experienced chest pain doing yard
12:28 pm: Patient dials 911
12:33 pm: Richardson Fire Department EMS arrives on scene
12:40 pm: ECG completed and cardiac cath lab was activated
from field
12:45 pm: Patient arrives at ER; cardiologist conducted another
12-Lead ECG at the door
12:57 pm: Patient arrives in cardiac cath lab
1:03 pm: Artery opened, blood flow restored to heart
About EmCare®
EmCare is the leader in physician servicesTM
serving more than 500 hospitals
nationwide. Founded nearly 40 years ago, today the company handles
more than nine million patient encounters annually. The integrated
company consists of four service lines including emergency medicine,
hospital medicine, anesthesiology and radiology/teleradiology. The
company is focused on:
• Leadership
• Delivering high quality clinical care
• Improving performance metrics
• Achieving superior patient and staff satisfaction
• Managing costs
For more information on how EmCare can help your hospital strengthen
its emergency medicine practice, feel free to visit us online at
www.EmCare.com. Following the link“Solutions for Hospitals”will offer
more information on the services EmCare’s other specialty divisions–
Hospital Medicine, Anesthesiology and Radiology / Teleradiology – can
provide.You may also contact a business development representative
directly at (877) 416-8079.