April 8, 2015

Trauma Care, Unavailable to Many, Suffers Inconsistent Quality and Inadequate Capacity

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
Female Baby Boomer with Nurse

Nearly 45 million Americans do not have access to a Level I or II trauma center, even though treatment of serious injuries at such a facility can lower the risk of death by 25 percent, according to the Centers for Disease Control and Prevention.

Lack of availability, primarily attributable to distance from the nearest center, is compounded by inconsistent quality and inadequate capacity, notes Kenneth W. Kizer, director of the Institute for Population Health Improvement at the University of California, Davis. Worst, some seriously injured people are not treated at trauma centers even when they are within reach.

So, do we need more trauma centers, better trauma centers or better directions to a trauma center? And what makes a trauma center superior to a standard hospital emergency room?

A trauma center is defined as a specialized treatment center capable of handling the most critical injuries, with specialists available 24 hours a day, seven days a week, state-of-the-art resuscitation rooms and helicopter transport. Orlando Health’s Orlando Regional Medical Center offers the only Level I trauma center in Central Florida.

Speed is critical component of trauma care. The “golden hour” refers to the first 60 minutes after an injury when appropriate intervention can mean the difference between life and death.

Advances in military field surgery have also had a big impact in civilian trauma care. “At no time in history have there been so many promising new treatments as during the global war on terrorism,” said EMS World in a recent issue, citing better tourniquets, devices that stop bleeding – notably QuikCLot Combat Gauze – and procedures developed by the U.S. military as part of its Tactical Combat Casualty Care program.

First responders are seeing success with such new technology as stasis foam, developed by the Pentagon’s Defense Advance Research Projects Agency, which expands rapidly in body cavities where a tourniquet could not be applied, stopping bleeding and hardening into a “cast” that can eventually be removed in the operating room.

Despite recent advances in trauma care, there is room for improvement. Failure to send seriously injured patients to trauma centers is a problem, said Kizer of the Institute for Population Health Improvement.  “Unfortunately, our ability to understand why under-triage occurs so often is hampered by fragmentation in the systems of care, inadequate data management systems and lack of trauma care performance reporting by non-trauma center hospitals.”

Some institutions are exploring how to make their trauma centers more flexible and improve inter-department coordination. Cedars-Sinai hospital in Los Angeles is designing a futuristic operating room and already has developed a simulated version, supported by a Defense Department grant and consultation with military surgical teams in Europe and the U.S.

The very layout of the Cedars-Sinai trauma center operating room is different. The architecture firm CannonDesign created the space to be “endlessly reconfigurable, by implementing a gridded trolley system on the ceiling that allows the surgical lights, equipment booms and the glass walls to be repositioned or removed altogether.” There are color-coded trauma bays and whiteboards to easily access patient information.

The Cedars-Sinai model has cut the time it takes to capture first radiological images by more than 10 percent and the time to draw blood for first lab tests by more than 20 percent. That may not seem like much, but in the world of trauma care, it can the difference between life and death.

April 2, 2015

Major Hospitals Now Offer ‘Complementary and Alternative’ Medicine

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
Female Baby Boomer with Nurse

One of the common misconceptions about alternative medicine is that some mystery herb or invisible energy can replace complex surgery or powerful pharmaceuticals. That misconception has helped spawned two camps: fervent believers and absolute skeptics.

Now major hospitals are narrowing the gap between the believers and nonbelievers by offering complementary and alternative medicine, or CAM, just as more medical schools add CAM to their curricula.

For example, UF Health Cancer Center-Orlando Health hired a clinical psychologist, Diane Robinson PhD, two years ago as program director, integrative medicine/cancer support community. She explains the impetus for adding CAM, saying, “We believe good health should look at the physical, mental and social well-being of the person. It is not just the absence of disease.”

To illustrate the difference, Robinson tells how doctors might approach patients who smoke: “The more traditional approach would be where the doctor just tells you: ‘stop smoking,’ But now we are trying to understand the patient’s habits and behaviors: Why are you smoking? And what techniques can we suggest to help you stop? Or in the case of a patient with frequent infections, a more holistic approach will look at ‘why.’ Is it stress? Is it poor nutrition? If so, what alternative therapies might help the root cause?”

Similarly, UF Health Cancer Center-Orlando Health has been utilizing a more integrative model for oncology, Robinson said. “In no way are we replacing advanced technological solutions like surgery, radiation and chemotherapy. But in the case of cancer, for instance, which is more of a chronic versus acute disease, with ongoing care, long periods of stress, repeat hospital stays, we believe psychosocial supports are important. We also offer alternative ways to alleviate pain and other symptoms.”

U.S. News & World Report reported in 2008 that Children’s Hospital in Chicago has a “healing touch” expert who helps young cancer patients relax and in the hope of speeding their recovery. The Mayo Clinic, the Duke University Medical Center and the University of California in San Francisco all offer massage, acupuncture (to relieve nausea)  and other CAM services.

A 2011 study in the American Medical Association’s American Medical News  says the number of hospitals offering complementary and alternative medical services has tripled since 2000, driven by patient demand.

The National Institutes of Health’s National Center for Complementary and Integrative Medicine  stated in 2007 that nearly 40 percent of Americans use non-vitamin dietary supplements like fish oil or Echinacea as well as CAM therapies including guided imagery – a form of positive visualization –massage acupuncture, meditation, yoga and chiropractic procedures to address back, neck and joint pain.

Kaiser Health News in 2011 reported that Americans spent $33.9 billion on integrative medicine that year, including massage, acupuncture and guided imagery. Pet therapy and music and art therapy also are popular.

Robinson notes that the UF Health Cancer Center-Orlando Health program is based on empirical evidence and that the center does a lot of research on what has been known to work. “We are also starting to gather our own data, and are recording patient feedback,” she said. “We originally took it to our patient advisory council, and nobody even knew these supports were possible.”

UF Health Cancer Center-Orlando Health has taken CAM a step further. Its monthly CAM calendar is packed with events including an informal choir, Tai Qi classes and nutrition seminars. There is an artist-in-residence program, a weekly high tea service and a meditative walking path called The Labyrinth.

“We are the first hospital to embed a full cancer support community, and most of the offerings are free,” Robinson said. “As a matter of fact, our supports are opt-out only. Of course, you don’t have to do any you don’t want to do, but they are all automatically in place as part of your treatment here.”

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