EMS documentation is important for legal and patient care reasons. It provides an objective written record of the call details, patient's condition and care provided. A PCR should include objective and subjective information and details of patient assessment and treatment. Proper documentation is complete, accurate, legible and avoids personal opinions. Errors can affect patient care and result in legal issues.
Trauma is a leading cause of death worldwide and in the United States. Annually in the US, trauma results in over 179,000 deaths, 60 million injuries, 40 million emergency department visits, and $684 billion in economic costs. The goals of PHTLS are to reduce mortality and morbidity from trauma through providing appropriate prehospital care. It teaches a team-based approach and emphasizes clear communication and documentation. PHTLS is based on current trauma research and aims to teach assessment and treatment principles to enhance critical thinking and patient care.
Scene assessment involves evaluating safety, pre-arrival information, arrival on scene, available resources, and mechanism of injury. The primary assessment evaluates airway, breathing, circulation, disability, and environment/exposure to identify life-threatening conditions. This assessment determines if the patient is sick, not yet sick, or not sick. Based on these assessments, the responder decides if immediate transport is needed, if further assessment is required, how to package the patient, the transport method, and receiving facility.
The document discusses various medicolegal aspects of medical records. It outlines who can label a case as medicolegal, noting the first treating doctor should prepare the report. It also discusses background information on medicolegal case management. The document details what demographic and registration information should be included in medical records for potential future forensic investigations. It lists legal documents that may be required like birth/death certificates and informed consent forms. Finally, it emphasizes the importance of maintaining complete and accurate records signed by doctors for any potential legal claims or indemnity cases.
The secondary assessment completes the full patient evaluation and identifies both life-threatening and non-life threatening injuries. It includes reassessing vital signs, taking a history, conducting a physical exam, monitoring the patient, providing treatment, making transport decisions, communicating with the receiving facility, and documenting findings. For critical patients, the secondary assessment may be abbreviated or postponed to focus on primary assessment and stabilization. The extent of the secondary assessment depends on the situation and patient condition.
Regulatory bodies and legal aspects in nursingJenita John
This document discusses various regulatory bodies and legal aspects related to nursing. It provides information on international agencies like the International Council of Nurses (ICN) and the American Nurses Association (ANA). For India, it discusses regulatory bodies like the Indian Nursing Council, Trained Nurses Association of India, and State Nursing Councils. It also covers legal aspects nurses need to be aware of like informed consent, negligence, malpractice, and more. Common acts of negligence are discussed for different specialty areas like medical-surgical, obstetrics, psychiatry, and more.
The document provides information on medical records including what they are, their components, functions of the medical record department, and processes for receiving, retrieving, completing, and releasing medical records. Some key points:
- Medical records chronicle a patient's medical history and care, including notes, test results, reports, and other documentation entered by healthcare professionals over time.
- Records are used for documenting treatment, communication between providers, collecting health statistics, and legal/insurance matters.
- The medical record department is responsible for filing, retrieving, completing, coding, and evaluating medical records as well as compiling statistics.
- Strict processes are followed for receiving records at discharge or death, retrieving records for care or authorized
Medical Legal Power Point- Nancy Carolinedjorgenmorris
This document discusses medical, legal, and ethical issues relevant to paramedics. It covers topics like consent, privacy, scope of practice, mandatory reporting, and transportation of patients. The key points are that paramedics must understand medical ethics and follow all relevant laws to avoid civil or criminal liability. They are responsible for keeping patient information confidential according to HIPAA and transporting patients appropriately.
EMS documentation is important for legal and patient care reasons. It provides an objective written record of the call details, patient's condition and care provided. A PCR should include objective and subjective information and details of patient assessment and treatment. Proper documentation is complete, accurate, legible and avoids personal opinions. Errors can affect patient care and result in legal issues.
Trauma is a leading cause of death worldwide and in the United States. Annually in the US, trauma results in over 179,000 deaths, 60 million injuries, 40 million emergency department visits, and $684 billion in economic costs. The goals of PHTLS are to reduce mortality and morbidity from trauma through providing appropriate prehospital care. It teaches a team-based approach and emphasizes clear communication and documentation. PHTLS is based on current trauma research and aims to teach assessment and treatment principles to enhance critical thinking and patient care.
Scene assessment involves evaluating safety, pre-arrival information, arrival on scene, available resources, and mechanism of injury. The primary assessment evaluates airway, breathing, circulation, disability, and environment/exposure to identify life-threatening conditions. This assessment determines if the patient is sick, not yet sick, or not sick. Based on these assessments, the responder decides if immediate transport is needed, if further assessment is required, how to package the patient, the transport method, and receiving facility.
The document discusses various medicolegal aspects of medical records. It outlines who can label a case as medicolegal, noting the first treating doctor should prepare the report. It also discusses background information on medicolegal case management. The document details what demographic and registration information should be included in medical records for potential future forensic investigations. It lists legal documents that may be required like birth/death certificates and informed consent forms. Finally, it emphasizes the importance of maintaining complete and accurate records signed by doctors for any potential legal claims or indemnity cases.
The secondary assessment completes the full patient evaluation and identifies both life-threatening and non-life threatening injuries. It includes reassessing vital signs, taking a history, conducting a physical exam, monitoring the patient, providing treatment, making transport decisions, communicating with the receiving facility, and documenting findings. For critical patients, the secondary assessment may be abbreviated or postponed to focus on primary assessment and stabilization. The extent of the secondary assessment depends on the situation and patient condition.
Regulatory bodies and legal aspects in nursingJenita John
This document discusses various regulatory bodies and legal aspects related to nursing. It provides information on international agencies like the International Council of Nurses (ICN) and the American Nurses Association (ANA). For India, it discusses regulatory bodies like the Indian Nursing Council, Trained Nurses Association of India, and State Nursing Councils. It also covers legal aspects nurses need to be aware of like informed consent, negligence, malpractice, and more. Common acts of negligence are discussed for different specialty areas like medical-surgical, obstetrics, psychiatry, and more.
The document provides information on medical records including what they are, their components, functions of the medical record department, and processes for receiving, retrieving, completing, and releasing medical records. Some key points:
- Medical records chronicle a patient's medical history and care, including notes, test results, reports, and other documentation entered by healthcare professionals over time.
- Records are used for documenting treatment, communication between providers, collecting health statistics, and legal/insurance matters.
- The medical record department is responsible for filing, retrieving, completing, coding, and evaluating medical records as well as compiling statistics.
- Strict processes are followed for receiving records at discharge or death, retrieving records for care or authorized
Medical Legal Power Point- Nancy Carolinedjorgenmorris
This document discusses medical, legal, and ethical issues relevant to paramedics. It covers topics like consent, privacy, scope of practice, mandatory reporting, and transportation of patients. The key points are that paramedics must understand medical ethics and follow all relevant laws to avoid civil or criminal liability. They are responsible for keeping patient information confidential according to HIPAA and transporting patients appropriately.
Legal issues regularly arise in emergency medicine. Doctors have a duty of care to provide treatment that is in the patient's best interests and of an appropriate standard. Valid consent requires the patient be competent, receive full disclosure of risks/benefits, and freely agree to treatment. Doctors must assess a patient's capacity to consent using functional tests of their understanding. Privacy and confidentiality principles also apply but have exceptions like mandatory reporting. Proper documentation is important to demonstrate reasonable care was provided to avoid negligence claims.
- Paramedics must understand and follow medical ethics and laws to avoid civil and criminal liability. They are bound by professional ethics to do no harm, act in good faith, and act in the patient's best interest. EMS research presents ethical issues regarding informed consent.
- The legal system includes federal and state laws, with two types of law - civil and criminal. Lawsuits against paramedics usually involve negligence claims. Paramedics are subject to their state's medical practice act and scope of practice. Patient privacy is protected by HIPAA.
- Paramedics must obtain consent, honor patient refusals and autonomy when possible, and understand decision-making capacity, especially for minors. They must
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Nurses working in hospitals have important legal responsibilities when caring for patients. Nurses are responsible for patient care but sometimes feel frightened by complex medical issues or have inadequate knowledge. They need additional training through their curriculum and refresher courses. Hospital administrators must ensure nurses are properly trained to care for patients safely and in accordance with the law.
Dr. Ravi R Kasliwal’s personality is truly multifaceted- his list of honors is testimony of this. His passion for developing and applying non-invasive techniques for early detection and prevention of coronary artery diseases is exemplary.
The document discusses several issues related to management in Pakistan's health sector. It notes that healthcare management has not been recognized as a specialty in Pakistan despite being established as such globally. It highlights problems like lack of resources, outdated training approaches, and appointing non-professionals to management roles. The document advocates treating healthcare management as a distinct specialty requiring dedicated professional training and management teams to help improve Pakistan's health services and outcomes.
This document discusses medical ethics as they relate to otorhinolaryngology (ENT). It outlines several key principles of medical ethics including putting patient interests first, treating patients with respect and honesty, maintaining confidentiality, and obtaining informed consent. It also discusses some specific ethical issues that ENT doctors may face, such as discussing cancer diagnoses and treatment options sensitively, handling congenital abnormalities compassionately, and serving as expert witnesses objectively. Overall, the document emphasizes that ENT doctors must practice with competence, integrity and with the well-being of patients as the top priority.
This document summarizes a study on conductive-insulator composites conducted by Iliya Tsvibel and Denis Teitelbaum. The study used atomic force microscopy to analyze the fractal dimension of percolation networks in carbon black polymer composites and investigate the electro-thermal switching effect. It also used Kelvin probe microscopy to examine charging effects in silicon/silicon dioxide composites. The results provide insight into percolation and conductivity properties near the percolation threshold for these materials.
Rayne is a timid girl who is packing for a trip with her mother. At school, Rayne sits alone drawing while her classmates play around her. Rayne finds an unusual ring in the woods and puts it on, causing her to disappear.
Part of team of 5 UIUC students in a case study to create a campaign for Plantlink, a startup, to gain awareness and increase sales. We were required to present a brand proposal to the founders of Plantlink create a 30 page portfolio and a 10 minute presentation summarizing our strategy and tactics.
The shot list describes scenes that will be filmed for a project titled "The Ruin's Mist". It involves a mother brushing her daughter Rayne's hair while laughing, Rayne drawing alone in a loud classroom and finding a ring in the woods. The shots range from extreme close-ups to establishing shots and include different camera movements, angles, and focuses to capture these moments between Rayne and her surroundings.
The survey responses provided insights into the target audience for a short film:
- The audience is primarily young adults aged 14-56 living in the London area of England.
- The audience has a even split of males and females.
- Most watch 1-3 hours of short films per week, primarily accessing them via the internet.
- The audience has varying preferences on genres and themes, with some preferring mainstream genres like action and comedy while others prefer independent or socially-focused films.
- There is a general lack of awareness of short filmmakers and titles among the audience. Increased advertising and accessibility of short films could help engage more mainstream viewers.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
El documento anuncia los Premios Goya que se celebrarán el 8 de febrero de 2016 en Madrid. Se nombrará a Dani Rovira como el nuevo presentador. Habrá categorías como Mejor Actriz, Mejor Actor, Mejor Película, Mejor Dirección y Mejores Efectos Especiales. Se mencionan posibles nominados para cada categoría.
Servant leadership is a leadership philosophy in which the main goal of the leader is to serve. The document discusses the concept of servant leadership and was written by Adedayo Azeez Ruben on January 20, 2016. While leadership typically involves the exertion of power by a leader over those they lead, the core concept of servant leadership is the reversal of that, with the leader acting as a servant to the group.
Testing AngularJS Workshop Codemotion 2015 Sam LeachSam Leach
This document provides an agenda for an AngularJS testing workshop taking place in Madrid on November 27-28, 2015. The workshop lasts 105 minutes and includes an introduction, installation instructions, a demonstration of ngMock functions for testing, a break, a demonstration of HTTP calls, and a session on controllers. It also includes biographical information about the instructor, Sam Leach, and an advertisement for a full-stack internship at Fuelling that involves Android, iOS, web, backend, cloud and DevOps work either remotely or in Holland.
Target audience research shows that while there was only one fantasy film in the top 10 films of 2015, Cinderella grossing $201 million, Harry Potter films dominated the top 10 with 5 films, showing fantasy appeals to many people. Adding thriller elements to films can make them appeal to a broader, more mainstream audience as Titanic, a thriller/suspense, was the highest grossing film of all time. The fantasy/thriller film Ghost from 1990 had mainstream appeal, grossing $218 million, but that genre is no longer as popular. Current box office data shows thrillers and fantasies remain popular with mainstream audiences.
Kasus pembunuhan berencana yang dilakukan oleh siswa SD di Depok karena perebutan HP. Korban ditusuk berkali-kali oleh pelaku di tempat sepi yang sudah direncanakan sebelumnya, kemudian mayat dibuang di selokan. Pelaku diduga memiliki tingkah kriminal berulang kali.
1. The document discusses the author's experience with native iOS development and introduces React Native as a way to write mobile apps using JavaScript instead of Objective-C or Swift.
2. It provides an overview of how React Native works by using JavaScriptCore and Node.js to render components while allowing developers to use familiar Flexbox syntax for layouts instead of Autolayout.
3. The author demonstrates how to install React Native, create a basic app, add components and styles, and use tools like the Inspector and Perf Monitor.
This document discusses P-wave morphology and its relationship to various cardiac rhythms. It begins by defining the P-wave and establishing criteria for normal P-wave characteristics. It then explores how deviations from these criteria can indicate conditions like atrial enlargement or ectopic rhythms. Specific arrhythmias like atrial fibrillation, flutter, sinus arrest and junctional rhythms are examined in terms of their P-wave patterns. The document emphasizes analyzing P-waves to help identify the origin of the cardiac rhythm and any underlying conduction abnormalities.
Legal issues regularly arise in emergency medicine. Doctors have a duty of care to provide treatment that is in the patient's best interests and of an appropriate standard. Valid consent requires the patient be competent, receive full disclosure of risks/benefits, and freely agree to treatment. Doctors must assess a patient's capacity to consent using functional tests of their understanding. Privacy and confidentiality principles also apply but have exceptions like mandatory reporting. Proper documentation is important to demonstrate reasonable care was provided to avoid negligence claims.
- Paramedics must understand and follow medical ethics and laws to avoid civil and criminal liability. They are bound by professional ethics to do no harm, act in good faith, and act in the patient's best interest. EMS research presents ethical issues regarding informed consent.
- The legal system includes federal and state laws, with two types of law - civil and criminal. Lawsuits against paramedics usually involve negligence claims. Paramedics are subject to their state's medical practice act and scope of practice. Patient privacy is protected by HIPAA.
- Paramedics must obtain consent, honor patient refusals and autonomy when possible, and understand decision-making capacity, especially for minors. They must
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Nurses working in hospitals have important legal responsibilities when caring for patients. Nurses are responsible for patient care but sometimes feel frightened by complex medical issues or have inadequate knowledge. They need additional training through their curriculum and refresher courses. Hospital administrators must ensure nurses are properly trained to care for patients safely and in accordance with the law.
Dr. Ravi R Kasliwal’s personality is truly multifaceted- his list of honors is testimony of this. His passion for developing and applying non-invasive techniques for early detection and prevention of coronary artery diseases is exemplary.
The document discusses several issues related to management in Pakistan's health sector. It notes that healthcare management has not been recognized as a specialty in Pakistan despite being established as such globally. It highlights problems like lack of resources, outdated training approaches, and appointing non-professionals to management roles. The document advocates treating healthcare management as a distinct specialty requiring dedicated professional training and management teams to help improve Pakistan's health services and outcomes.
This document discusses medical ethics as they relate to otorhinolaryngology (ENT). It outlines several key principles of medical ethics including putting patient interests first, treating patients with respect and honesty, maintaining confidentiality, and obtaining informed consent. It also discusses some specific ethical issues that ENT doctors may face, such as discussing cancer diagnoses and treatment options sensitively, handling congenital abnormalities compassionately, and serving as expert witnesses objectively. Overall, the document emphasizes that ENT doctors must practice with competence, integrity and with the well-being of patients as the top priority.
This document summarizes a study on conductive-insulator composites conducted by Iliya Tsvibel and Denis Teitelbaum. The study used atomic force microscopy to analyze the fractal dimension of percolation networks in carbon black polymer composites and investigate the electro-thermal switching effect. It also used Kelvin probe microscopy to examine charging effects in silicon/silicon dioxide composites. The results provide insight into percolation and conductivity properties near the percolation threshold for these materials.
Rayne is a timid girl who is packing for a trip with her mother. At school, Rayne sits alone drawing while her classmates play around her. Rayne finds an unusual ring in the woods and puts it on, causing her to disappear.
Part of team of 5 UIUC students in a case study to create a campaign for Plantlink, a startup, to gain awareness and increase sales. We were required to present a brand proposal to the founders of Plantlink create a 30 page portfolio and a 10 minute presentation summarizing our strategy and tactics.
The shot list describes scenes that will be filmed for a project titled "The Ruin's Mist". It involves a mother brushing her daughter Rayne's hair while laughing, Rayne drawing alone in a loud classroom and finding a ring in the woods. The shots range from extreme close-ups to establishing shots and include different camera movements, angles, and focuses to capture these moments between Rayne and her surroundings.
The survey responses provided insights into the target audience for a short film:
- The audience is primarily young adults aged 14-56 living in the London area of England.
- The audience has a even split of males and females.
- Most watch 1-3 hours of short films per week, primarily accessing them via the internet.
- The audience has varying preferences on genres and themes, with some preferring mainstream genres like action and comedy while others prefer independent or socially-focused films.
- There is a general lack of awareness of short filmmakers and titles among the audience. Increased advertising and accessibility of short films could help engage more mainstream viewers.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
El documento anuncia los Premios Goya que se celebrarán el 8 de febrero de 2016 en Madrid. Se nombrará a Dani Rovira como el nuevo presentador. Habrá categorías como Mejor Actriz, Mejor Actor, Mejor Película, Mejor Dirección y Mejores Efectos Especiales. Se mencionan posibles nominados para cada categoría.
Servant leadership is a leadership philosophy in which the main goal of the leader is to serve. The document discusses the concept of servant leadership and was written by Adedayo Azeez Ruben on January 20, 2016. While leadership typically involves the exertion of power by a leader over those they lead, the core concept of servant leadership is the reversal of that, with the leader acting as a servant to the group.
Testing AngularJS Workshop Codemotion 2015 Sam LeachSam Leach
This document provides an agenda for an AngularJS testing workshop taking place in Madrid on November 27-28, 2015. The workshop lasts 105 minutes and includes an introduction, installation instructions, a demonstration of ngMock functions for testing, a break, a demonstration of HTTP calls, and a session on controllers. It also includes biographical information about the instructor, Sam Leach, and an advertisement for a full-stack internship at Fuelling that involves Android, iOS, web, backend, cloud and DevOps work either remotely or in Holland.
Target audience research shows that while there was only one fantasy film in the top 10 films of 2015, Cinderella grossing $201 million, Harry Potter films dominated the top 10 with 5 films, showing fantasy appeals to many people. Adding thriller elements to films can make them appeal to a broader, more mainstream audience as Titanic, a thriller/suspense, was the highest grossing film of all time. The fantasy/thriller film Ghost from 1990 had mainstream appeal, grossing $218 million, but that genre is no longer as popular. Current box office data shows thrillers and fantasies remain popular with mainstream audiences.
Kasus pembunuhan berencana yang dilakukan oleh siswa SD di Depok karena perebutan HP. Korban ditusuk berkali-kali oleh pelaku di tempat sepi yang sudah direncanakan sebelumnya, kemudian mayat dibuang di selokan. Pelaku diduga memiliki tingkah kriminal berulang kali.
1. The document discusses the author's experience with native iOS development and introduces React Native as a way to write mobile apps using JavaScript instead of Objective-C or Swift.
2. It provides an overview of how React Native works by using JavaScriptCore and Node.js to render components while allowing developers to use familiar Flexbox syntax for layouts instead of Autolayout.
3. The author demonstrates how to install React Native, create a basic app, add components and styles, and use tools like the Inspector and Perf Monitor.
This document discusses P-wave morphology and its relationship to various cardiac rhythms. It begins by defining the P-wave and establishing criteria for normal P-wave characteristics. It then explores how deviations from these criteria can indicate conditions like atrial enlargement or ectopic rhythms. Specific arrhythmias like atrial fibrillation, flutter, sinus arrest and junctional rhythms are examined in terms of their P-wave patterns. The document emphasizes analyzing P-waves to help identify the origin of the cardiac rhythm and any underlying conduction abnormalities.
Leadership austin presentation chenven april 24 2015_ppAnnieAustin
Norman Chenven, founder and CEO of Austin Regional Clinic, presented on healthcare costs and reforms to the Leadership Austin program. Austin Regional Clinic serves over 350,000 patients across 21 locations with 1,750 employees including 335 physicians. Chenven discussed the unsustainable growth of healthcare costs, key provisions and uncertainties of the Affordable Care Act, and strategies to shift payments from fee-for-service to models emphasizing quality and value through accountable care organizations and medical homes.
Leadership austin presentation chenven april 24 2015_pdfAnnieAustin
The document discusses healthcare costs and reforms in the United States. It provides an overview of Austin Regional Clinic, including the number of patients, locations, physicians, and specialties. It then discusses various challenges facing the US healthcare system like the costs as a percentage of GDP, the Affordable Care Act, deficits, uninsured Americans, increasing costs, and sustainability issues. Alternative payment models like accountable care organizations and medical homes are presented as ways to better manage costs for high-risk populations through care coordination and preventive care. The challenges of transitioning payments from fee-for-service to these alternative models is also noted.
This document discusses medical errors and increasing patient safety. It summarizes several studies that found medical errors are common, with rates of adverse events from around 3-17% of hospital admissions. Errors result in tens of thousands of unnecessary deaths annually. Most errors are due to cognitive mistakes and "system" failures rather than individual negligence. To improve safety, the document argues we must think of errors as systems failures and implement strategies like checklists, standardized procedures, training, and a culture where safety is a top priority and errors are reported to fix underlying issues rather than blame individuals.
Developing Networks of Care through Long Term Conditions Year of Care Commissioning & Long Term Conditions Improvement Programmes
Bev Matthews
Programme Lead for Long Term Conditions @Bev_J_Matthews
Presentation from the Tackling Long Term Conditions conference on 29 October 2014
The document discusses health management information systems and hospital information systems. It defines key terms like system, health system, information, and health information system. It explains that the goal of a health information system is to improve actions and decision making at all levels of the health system by generating relevant information. It outlines some common issues with current health MIS like irrelevant data, poor quality, and lack of timely reporting. It also discusses important components and characteristics of an effective health information system.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
This document discusses strategies to ensure the safety and wellness of paramedics and their patients. It addresses key threats like motor vehicle crashes, back injuries, and disease transmission. It emphasizes the importance of proper lifting techniques, infection control, health and wellness, and stress management for paramedic safety. For patient safety, it highlights risks of improper transfer or communication, medication errors, airway issues, and ambulance crashes. The document stresses the legal and ethical responsibilities of paramedics to adhere to standards of care, patient rights, and reporting requirements. Finally, it provides an overview of cellular metabolism and the importance of maintaining cellular integrity in emergency medical treatment.
This document discusses various topics related to paramedic safety and patient care. It addresses actual safety threats to paramedics such as motor vehicle crashes and back injuries. It provides recommendations for injury prevention including proper lifting techniques and seatbelt usage. The document also discusses ensuring patient safety by preventing medical errors, effective communication during patient handoffs, and following standard precautions. Legal issues related to the paramedic scope of practice and a paramedic's responsibilities are also reviewed.
Urgent care clinics and emergency departments provide similar services like extended hours, treatment for all ages, diagnostic testing, and coordination of care. However, they differ in important ways. Urgent care clinics are best for non-emergent care and offer low-cost, high-efficiency treatment, while emergency departments are intended for true medical emergencies and acute issues that could threaten life or limb. It is important for patients to educate themselves on when to use urgent care versus an emergency room in order to receive the right treatment in the right setting. Conditions that generally require emergency care include chest pain, difficulty breathing, severe abdominal pain, injuries, and other issues listed. With guidance and knowledge of options, patients can make
This document discusses the use of a mobile app called drGrouper for public health management and data collection in Romania. It provides usage statistics for the app, including over 310 active users who have grouped over 2600 patient cases. The document analyzes the most frequent medical diagnosis-related groups from 2015 data and presents details on several example cases like average length of stay and patient demographics. It concludes that while the available data is limited, this app provides the first publicly available health data in Romania and serves as a proof of concept that can be expanded further with more users and improved data systems.
The who, what, where, why and how of end-of-life care. A continuing education webinar presented by VITAS Healthcare on March 15, 2018. For more information or future webinars, please visit: https://www.vitas.com/partners/continuing-education
- The document discusses how artificial intelligence can enable earlier and safer medicine.
- It provides background on the author and their expertise in biomedical informatics and roles as editor-in-chief of several academic journals.
- Key applications of AI in healthcare discussed include using machine learning on large medical datasets to detect suspicious moles earlier, reduce medication errors, and more accurately predict cancer occurrence up to 12 months in advance.
- The author argues that AI has the potential to transform medicine by enabling more preventive and earlier detection approaches compared to traditional reactive healthcare models.
Re-Imagining Psychiatric Care - Presentation (1).pptxAfifaKhan62
The document discusses the growing need for mental health services in America and challenges facing clinics in meeting this demand. It notes that 1 in 5 adults experience mental illness while access to services remains limited. Clinics struggle with high psychiatrist turnover and inconsistent care. Current trends include increasing demand, regulatory complexity, and a shortage of qualified clinicians. While telepsychiatry offers solutions like improved access and recruitment, the behavioral health workforce faces critical challenges in meeting population needs as mental health needs are expected to rise dramatically in coming decades. Telepsychiatry models show promise but continued innovation is still needed to close gaps in psychiatric care.
Re-Imagining Psychiatric Care - Presentation (1).pptxAshfaqul Tanim
The document discusses the growing need for mental health services in America and challenges facing clinics in meeting this demand. It notes that 1 in 5 adults experience mental illness while access to services remains limited. Current industry trends include increasing demand, regulatory complexity, and a shortage of qualified clinicians. While telepsychiatry offers benefits like improved access and work-life balance for providers, recruiting psychiatrists remains difficult for clinics. The adoption of telepsychiatry aims to help address workforce shortages and access barriers to better serve populations in need of mental healthcare.
Putting it all together: Personalized care for cancer survivors Carevive
This document discusses barriers to quality cancer survivorship care and potential solutions. It notes that there are over 13 million cancer survivors in the US who face long-term effects of treatment and prevalent unmet needs. The Institute of Medicine recommends that survivors receive a comprehensive treatment summary and care plan. However, creating these plans can be time-consuming. New technologies like the On Q Health system aim to generate personalized care plans more efficiently based on patient-reported outcomes and guidelines. The system covers symptoms, surveillance, late effects and aims to improve quality and coordination of care across the cancer journey.
Medico Legal implication of medical records-IndiaSrishti Bhardwaj
Medico legal liabilities related to patient records,
Medical Record committee and role of committee Hospital Utilization
Bed turnover ratio,
Average length of stay,
Death rate,
Bed occupancy rate
Unit 4- BVUCHMSR Portion (Sem-3)
The Inland Counties Emergency Medical Agency (ICEMA) is responsible for coordinating emergency medical services and trauma care across San Bernardino and Riverside counties. ICEMA designates trauma centers, hospitals, and EMS providers and ensures an effective emergency response system. During disasters, all hospitals may receive trauma patients through medical mutual aid agreements within and across counties and states. Trauma centers play an important role but the system is scalable to handle surge from any size incident.
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
Predicting cancer patients’ quality of life: an analysis of the relationship ...Kerry Sheppard
This document summarizes a study that used data from the Cancer 2015 cohort to analyze the relationship between cancer patients' quality of life (measured by EQ-5D utility scores), treatment regimens, and time. The study found that chemotherapy and radiotherapy had the largest negative effects on quality of life scores, particularly in the 1-2 months after treatment. Surgery had a smaller effect. Baseline quality of life was the strongest predictor of follow-up quality of life. The results provide insights into how different cancer treatments impact patients' quality of life over time.
This document outlines the Missouri Foundation for Child Abuse Prevention's 2013-2014 media activity plan. It details four prevention campaigns focused on never leaving children unattended in vehicles, shaken baby syndrome, parenting with patience, and strengthening families. It also outlines three donor campaigns. The foundation's media mix includes radio, print, online, and cable TV advertising statewide and in targeted areas to promote these campaigns and increase donations.
This document announces an annual education law and policy training event for advocates working with students and families in South Carolina. The training will provide information on legal tools and programmatic supports available to help students achieve academic success. Specific sessions will cover school finance, special education law, bullying, charter schools, and other educational resources. The event is on March 9, 2012 from 9:00 am to 4:15 pm at Mashburn Construction Company in Columbia, South Carolina.
Quarterly scans by internal IT staff
External: Annual scans by external vendor
Patches/Updates: Patches and updates applied within 30 days
Penetration Testing: Annual external penetration testing
Monitoring: Network and systems monitored 24/7 by IT staff
Incident Response: Formal incident response plan and team
Logging/Auditing: Critical systems and firewalls centrally logged
Change Management: Formal change control process for systems
Business Continuity: Documented business continuity and disaster recovery plans tested annually
Learfield Communications provides marketing, communications, and media services for organizations through online and traditional methods. They offer long-term strategies and daily support such as social media implementation, videos, podcasts, and content production. Hiring Learfield saves expenses compared to managing an in-house team and provides expertise tailored to each organization's objectives and budget.
Learfield InterAction will establish an online brand and identity for MO Healthy Births through social media platforms like Facebook and YouTube. They will launch a YouTube video series called "MomTalk" consisting of 9 videos total across 3 series to educate females ages 18-34 on healthy lifestyles and caring for their bodies. Additionally, they will develop a Facebook advertising campaign and keep social media content fresh with regular weekly updates focused on health news, questions from fans, discussions, tips, and facts. The goal is to attract more social media followers and build an online community around the MO Healthy Births brand.
This document provides guidance to help chronic condition self-management education programs achieve long-term sustainability. It discusses 10 key planning areas that programs should consider when developing a Growth Action Plan: revenue, marketing, referral networks, competition, service operations, evaluation, organizational support, community support, advocacy, and resource linkages. The goal is to help programs strategize to create the necessary infrastructure and community support needed for sustainable operations over the long run.
This document discusses services provided by Learfield InterAction related to social networking, website development, multimedia production, and mobile marketing. For social networking, they offer strategy development, content management, and customization of Facebook pages. For multimedia production, they create online experiences like videos and podcasts. For website development, they assist with setup, content production, and management. For mobile marketing, they offer apps, QR codes, and location-based services. Examples of past projects include Facebook ad campaigns and videos showcasing soybean farmers.
RN-BSN Rural Nurse Initiative for Missouri learfield
The document discusses challenges facing rural health and strategies of the UMKC Rural Nurse Initiative to address them. Rural areas have worse health outcomes due to lower access to care and resources. The initiative aims to increase the number of rural nurses through an online RN-BSN program that incorporates rural health concepts, provides technology support, and uses virtual practicums with rural and urban student collaboration on community health projects. Graduates gain skills to improve rural health outcomes through expanded nursing roles, teamwork, and application of technology and evidence-based practice.
The Flex Program provides cost-based reimbursement for critical access hospitals (CAHs) through two components: state rural health plans and CAH certification. Originally, the program aimed to develop rural health networks and improve quality of care. Over time, more hospitals were certified as CAHs. Currently, CAHs make up 26% of community hospitals and 66% of rural hospitals. Quality reporting through measures like pneumonia and heart failure processes of care is increasing for CAHs.
This document provides guidance on writing grants for rural programs. It discusses why organizations should pursue grant funding and covers key aspects of developing a successful grant application such as conducting needs assessments, organizing teams, developing budgets and timelines, evaluating proposed projects, and finding potential funding sources. The document emphasizes clearly articulating the problem, proposed solution, and impact of funded projects and engaging stakeholders throughout the process. Overall, it aims to equip rural organizations with best practices for securing needed grant money to support their work.
The document discusses leadership and vision. It defines two types of leaders - those with power and authority defined by their title, and those who inspire others through their vision and beliefs. True leadership requires having a vision and inspiring others to believe in that vision. The document outlines five competencies of leadership - modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart. It emphasizes that leaders must live according to the values and principles they espouse, enlist others to support their vision, take risks and learn from failures, empower others, and recognize contributions. Hiring and attracting people based on shared beliefs and values is key to effective leadership.
The document provides biographical notes on several speakers at the Rural Hospital Conference at the Inn at Grand Glaize on June 2, 2011. It summarizes the professional backgrounds and experiences of Rae Lee, Nancie McAnaugh, Jeff Tindle, Paul David Moore, Clark Conover, Dorothy Andrae, Nancy Fredrich, Aileen Kelley, Michelle Cahow, Pam Karr, Karen Clover, Lisa Twidwell, Missy Sutton, Bob Copeland, Teryl Eisinger, and Stephanie Hansen.
This document discusses electronic medication reconciliation at Phelps County Regional Medical Center. It provides screenshots of the electronic medication reconciliation process when a patient presents to the emergency department, is admitted to the hospital floor, is transferred within the hospital, and at discharge. It notes the challenges of medication reconciliation including a patient's ability to recall their medications, language barriers, stress of transitions of care, and ensuring accurate and complete medication histories. It also discusses a new challenge of transitioning to an electronic health record for medication reconciliation and the complexity and compliance needed to use the electronic system efficiently.
CCMH implemented an electronic medical record (EMR) system from Cerner in September 2010 to improve patient care, comply with government incentives, and modernize their outdated system. They chose Cerner due to its experience, certification for meaningful use incentives, and software as a service model which reduced IT costs and responsibilities. While implementation challenges included changing staff workflows and technology skills, benefits included improved quality of care, operational efficiencies from reduced paperwork and faster access to records, and participation in meaningful use attestation programs.
The document is a self-assessment tool created by the National Rural Health Resource Center for health information technology (HIT) networks to evaluate their organizational strengths and weaknesses. The tool consists of 25 statements across 7 sections that represent key components for a successful HIT network, including leadership, strategic planning, network members, evaluation, workforce and technology, processes, and impact. Network leaders can use the tool to identify areas for improvement by indicating on a scale of 1 to 5 how well each statement reflects their current position. The tool is intended to help HIT networks target their technical assistance needs to move faster in building their network capabilities.
MO HIT Assistance Center Rural Hospital presentationlearfield
The document summarizes the services provided by a Regional Extension Center (REC) in Missouri to assist healthcare providers with adopting and using electronic health records (EHRs). The REC provides technical assistance, training, and guidance to help providers select and implement EHR systems, redesign workflows to optimize EHR use, and achieve meaningful use incentives. It has helped over 1,100 primary care providers and 55 rural hospitals to date. Key services include vendor selection, implementation support, workflow redesign, user training, and helping providers meet meaningful use criteria.
This document summarizes the results of a SCIP/HF Project at Primaris. It discusses measures related to heart failure, infections, blood clots, and best practices implemented around continuing medications, flagging patients in medical records, automatic stop alerts for antibiotics, and VTE risk assessment alerts. The project involved focused metric review, providing performance feedback to physicians, identifying documentation issues, promoting awareness, and enlisting physician champions. Physician report cards and unit competition were used to encourage quality improvement.
Citizens Memorial Healthcare developed a medication reconciliation process across multiple departments and sites of care. An action plan established teams to map current medication reconciliation workflows and identify weaknesses. Staff received education on the new process, which focused on stopping the practice of automatically resuming all medications and improving electronic listing and reconciliation of medications during transfers. The process was initially rolled out in the Emergency Department and then to other areas over time. Participation in a national collaboration helped identify additional issues like lack of reconciliation during transfers. Ongoing efforts aim to strengthen the process through continued education, community outreach, and use of the electronic medical record.
Citizens Memorial Healthcare developed a medication reconciliation process across multiple departments and business units from 2008-2010. Key steps included establishing multidisciplinary teams to map out current medication reconciliation workflows, identify weaknesses, and design improvements. The initial process focused on education of clinical staff and a standardized approach to medication reconciliation at admission, discharge, and transfer. Over time the process was expanded and refined, including rolling out new electronic tools, ongoing education, and participation in a national collaboration to further enhance the medication reconciliation process system-wide. Lessons learned highlighted the importance of an accurate and accessible "source of truth" for medications, as well as ensuring all parts of the process are completed to avoid potential errors.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Main Java[All of the Base Concepts}.docxadhitya5119
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Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
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How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
3. Right Care. Right Place. Right Time.
The End Goal:
360/365 Emergency Medical Care System
4. Right Care. Right Place. Right Time.
Meeting Purpose
• TCD System Review
– Background
– Overview of Proposed Missouri Regulations
• Rural Hospital and CAH Roles in the TCD System
• Next Steps
• Questions
6. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis System
Matters:
Leading causes of death in Missouri
1st
Heart Disease, including ST-Elevation
Myocardial Infarction (STEMI)
3rd
Stroke
1st
/4th
/5th
Trauma-injury-accidents, motor vehicle
accidents, suicide, homicide, other;
Leading cause of YPLL
7. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis
Matters: STEMI
• Heart disease, including STEMI, is the leading cause
death in this state.
• In 2004, Missouri’s heart disease death rate was 13.5
percent higher than the national rate.
• Missouri was in the bottom ten (45 out of 52) in
coronary heart disease death rates.
• The prevalence of heart disease was higher than the
national average
– Missouri ranked 9th among the 50 states in heart disease
prevalence in 2005.
• . Rosamond, W, Flegal K, Furie, K, et.al. Heart Disease and Stroke 2008 Update: A report from the
American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;
117; e25-el46; Epub 2007 December 17;
http://circahajournals.org/cgi/content/full/117/4/e25. Retrieved June 24, 2008.
• . MO BRFSS 2005
8. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis
Matters: STEMI
STEMI
• Shorter time from door-to-balloon (PCI) - lower risk of
mortality
– Moving towards first medical contact to balloon
• Symptom onset to treatment time greater than 4 hours
independent predictor of one-year mortality
• Faster treatment and lower in-hospital mortality
associated with hospital “specialization” and emphasis
on PCI as principal mode of reperfusion
Prompt treatment reduces death and disability.
9. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis
Matters: Stroke
STROKE
• Stroke is the third leading cause of death in the state.
• In 2004, Missouri’s stroke death rate was 11 percent higher than
the national rate.
• Missouri ranked low (40 out of 52) in the comparison of stroke
death rate between states.
• Missouri was ranked 7th
in stroke prevalence.
• 15-30% will be disabled (leading cause of disability)
• 20% require institutionalization first 3 months post-stroke
• Only a small percent of ischemic stroke patients get definitive care
within the 3 hour window recommended.
Prompt treatment reduces death and disability.
10. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis
Matters: Stroke
STROKE
• t-PA Treatment within 180 minutes from symptom
onset:
- Better odds of improvement at 24 hours
- Improved 3-month outcome
• Patients treated after 180 minutes
- Poorer outcomes
- More hemorrhages
Prompt treatment reduces death and disability.
11. Right Care. Right Place. Right Time.
Why Time Critical Diagnosis
Matters: Trauma
TRAUMA
• Trauma is the first, fourth or fifth leading cause of death in
Missouri depending on group
• It is the most frequent cause of visits to the emergency
department, causing more than half a million visits in 2006
• Missouri death rates for unintentional injuries increased 25%
between 1991 and 2006
• Missouri death rates for accidental injuries, suicides, falls and
MVC’s exceed national rates
• There are gaps, particularly in rural areas, for timely access to
trauma care
Prompt treatment reduces death and disability.
12. Right Care. Right Place. Right Time.
Using Trauma System as a Model
Trauma System:
• Improves Patient Outcomes and Saves Lives
- 50% reduction in preventable death rate after
implementation
- Decrease in cases of sub-optimal care from 32% to 3%
• Improves Hospital Outcomes
- Better outcomes compared to voluntary system
- Cost Savings through more efficient use of resources
• Improves Regional Outcomes
- Regional system accommodates regional and local
variations
13. Right Care. Right Place. Right Time.
Missouri’s Goals
–Reduce incidence and severity of
injury, stroke, and STEMI
–Improve access into the system
–Improve outcomes of those injured
or suffering stroke and STEMI
–Improve system evaluation and
QA/QI/PI Processes
14. Right Care. Right Place. Right Time.
Missouri’s Key Guiding Principles
–Patient centered care
–Evidence-based system design
–Population-based approach
–Evaluation mechanism
15. Right Care. Right Place. Right Time.
TCD System Goal
Prompt treatment reduces death and disability.
16. Right Care. Right Place. Right Time.
Developing the System:
August 2008: TCD Stroke/STEMI Task Force
compiled formal recommendations
Sept.’08-Present: TCD Trauma Task Force convened for
compiling recommendations
2008-Present: Stroke and STEMI Implementation groups
meeting regularly and compiling standards for stroke
and STEMI center designation and EMS
Implementation: Progress and Goals
18. Right Care. Right Place. Right Time.
Legislative Synopsis:
2008: House Bill 1790 enabling reform passed
unanimously by the Missouri Assembly and
signed into law
RSMo 190-100 Definitions
RSMo 190.200 Public Information & Education
RSMo 190.241 Center Designation
RSMo 190.243 Transportation to Centers
Implementation: Progress and Goals
19. Right Care. Right Place. Right Time.
Missouri Regulations
1. Law authorizes DHSS to promulgate
regulations
2. Inclusive process for drafting
regulations
3. DHSS submits as “Proposed Rules”
– Office of the Secretary of State and
– Joint Committee on Administrative Rules
1. Public Comment Period
2. Final Rules
20. Right Care. Right Place. Right Time.
Missouri Regulations
Both Stroke & STEMI
Four Levels of Center Designation
Level I Functions as resource center within region
Level II Provide care to high volumes of stroke and
STEMI patients
Level III Access into system in non-metropolitan areas,
more limited resources and generally refer to
higher level center
Level IV Access in rural areas, stabilize and prepare for
rapid transfer to higher level of care
21. Right Care. Right Place. Right Time.
Missouri Regulations
Both Stroke & STEMI
• Voluntary process
• Stroke/STEMI Program-24/7 (all levels)
– Medical Director
– Program Manager/Coordinator
• Staff meet and maintain core requirements to
provide care
• One-call activation protocol
• Transfer – network agreements
22. Right Care. Right Place. Right Time.
Missouri Regulations
Both Stroke & STEMI
• Data submission for statewide registry
• Performance improvement and patient
safety requirements
• Public education to promote prevention
and signs and symptoms awareness
23. Right Care. Right Place. Right Time.
Missouri Regulations
STEMI Center Stipulations
Level I Level II
PCI Receiving Center PCI Receiving Center
24. Right Care. Right Place. Right Time.
Missouri Regulations
STEMI Center Stipulations
Level III Level IV
Lytic Center
some PCI capability
“Drip and Ship”
25. Right Care. Right Place. Right Time.
Missouri Regulations
CMEs-STEMI
Level I Level II Level III Level IV
Medical
Director-
10 hrs/yr 10 hrs/yr 8 hrs/every other yr
Call
Roster
10 hrs/yr 10 hrs/yr 8 hrs/every other yr
ED
Doctor
4 hrs/yr 6 hrs/every other yr
26. Right Care. Right Place. Right Time.
Missouri Regulations
Continuing Education-STEMI
Level I Level II Level III Level IV
Manager 10 hrs/yr 8 hrs/yr 8 hrs every other yr.
ED RN 4 hrs/yr 4 hrs/yr 6 hrs every other year
ICU RN 8 hrs/yr Not
required
STEMI
Unit RN
8 hrs/yr (I, II) and 8 hrs/every
other year (III)
Not
required
27. Right Care. Right Place. Right Time.
Missouri Regulations
Stroke Center Stipulations
Level I Level II
Align with comprehensive
stroke center standards
•Align with The Joint
Commission-Primary
Stroke Centers standards
28. Right Care. Right Place. Right Time.
Missouri Regulations
Stroke Center Stipulations
Level III Level IV
“Drip and Ship” Rapid Entry into the
System
29. Right Care. Right Place. Right Time.
Missouri Regulations
CMEs-Stroke
Level I Level II Level III Level IV
Medical
Director-
12 hrs/yr 8 hrs/yr
8
hrs every other yr.
And 6 hrs every other
yr.
Call
Roster
10 hrs/yr 8 hrs/yr
ED
Doctor
4 hrs/yr 4 hrs/yr
30. Right Care. Right Place. Right Time.
Missouri Regulations
Continuing Education-Stroke
Level I Level II Level III Level IV
Manager 10 hrs/yr 8 hrs/yr
8 hrs
every other yr. and 6
hrs every other yrED RN 4 hrs/yr 4 hrs/yr
ICU RN 10 hrs/yr 8 hrs/yr Not required
Stroke
Unit RN
10 hrs/yr 8 hrs/yr Not required (8 hrs for
III’s that will keep pts.
under supervised
relationship with a II or II)
31. Right Care. Right Place. Right Time.
Missouri Regulations
Trauma
• Level IV Trauma Center regulations under
development
•Survey sent to CAH
• Update old trauma regulations
• Update pediatric trauma regulations
• Transport under discussion
• Injury Specific triage/transfer guidelines under
development
• Other
32. Right Care. Right Place. Right Time.
Missouri Regulations
STEMI and Stroke Patient Transport
• STEMI patient classification
• STEMI patient transport
• Stroke patient classification
• Stroke Patient Transport
33. Right Care. Right Place. Right Time.
Missouri Regulations
Regional Plans
Regional or community based
plans for transporting trauma,
STEMI or stroke patients may be
submitted to DHSS. 190.200
RSMo but not required
34. Right Care. Right Place. Right Time.
Rural and CAH’s in the TCD
System
35. Right Care. Right Place. Right Time.
Rural and CAH’s
• Stroke Regulation Review
• STEMI Regulation Review
• We will develop guidelines for
Rural and Critical Access
Hospitals and receiving
hospitals
37. Right Care. Right Place. Right Time.
1. Work group compiling plan and materials
2. Launch public education campaign
– TCD System/9-1-1
– Signs and symptoms and importance of
calling 911
Next Steps
Public Education
38. Right Care. Right Place. Right Time.
1. Professional education planning (Fall-2009
through Summer-2010)
2. Convene Professional Education work group
(Fall 2010)
3. Conduct professional education (Begin mid-
2011)
Next Steps
Professional Education
39. Right Care. Right Place. Right Time.
Next Steps
Tracking Progress
Create evaluation mechanism to track
progress and outcomes
40. Right Care. Right Place. Right Time.
1. Review existing data system
– CDC Info Aid
– MU Health Informatics
1. Convene quality assurance work group (late
2010)
– Define data points (benchmarks, PI, indicators, outcomes)
– Review existing systems for collection
– Compile plan to populate state Stroke and STEMI registry
without creating burden for reporters
1. Implement plan
– Update state database and reporting methodologies
– Training
– Compile reports to support PI/Quality Assurance
– Regional Processes
Next Steps
Quality Assurance
41. Right Care. Right Place. Right Time.
1. DHSS creates application—filed as part of
regulations
2. Once regulations effective, hospitals may submit
application (similar to trauma center application
and review process currently in place)
3. DHSS conducts review
4. DHSS approves designation for those that meet
standards
Next Steps
Center Application
42. Right Care. Right Place. Right Time.
The End Goal:
360/365 Emergency Medical Care System
44. Right Care. Right Place. Right Time.
Contact Information
• Dr. Samar Muzaffar
– samar.muzaffar@dhss.mo.gov
• Cindy Gillam
– cindy.gillam@dhss.mo.gov
• Website
– www.dhss.mo.gov; go to Time Critical Diagnosis
System
Editor's Notes
Welcome—Local person can begin—welcome group.
Introductions
Identify those that are from the region
Explain that the colors reflect the colors that are in each of the 6 respective regions.
Meeting Schedule
Jefferson City September 29Central
KirksvilleOctober 5Central
Cape GiradeauSeptember 30Southeast
St. LouisOctober 1East Central
Kansas CityOctober 6Kansas City and Northwest
SpringfieldOctober 7Southwest
The End Goal is this:
An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.
Stroke, STEMI and trauma are all time critical diagnoses.
Tag line reference- Right Care at the Right Place at the Right Time
Table of contents
The magnitude of the time critical diagnoses clearly warrant attention
The FACT SHEET in your packets also outlines some other noteworthy facts about these conditions.
Luckily, we have an existing model – the Trauma model saves lives by making sure that patients in need of acute trauma care get to the right facility as quickly as possible.
And it’s a proven model. The trauma system saves lives, improves patient outcomes, creates efficiencies and cost savings, and allows for regional and local variations.
Need to update
Transition to DHSS staff
Fall meetings are at the tail-end of the drafting process. Have had over 20 statewide meetings/conference calls and now conducting meetings to provide overview to interested health care community.
We need your feedback. Welcome your input at this stage.
These Regulations to be written
- The designation process will identify hospital’s levels within stroke and STEMI. The requirements for designation have been developed by the TCD team and will be approved as part of the regulations.
EMS and hospital personnel will all be included in the professional education program.
A public education plan will be developed in 2010 – will likely include media outreach and speaking engagements.
The End Goal is this:
An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.
The End Goal is this:
An integrated emergency medical care system that broadens the trauma system approach and perspective to improve injury prevention efforts, patient care throughout this circle, and ultimately, to improve patient outcomes across the state of Missouri.