Februari 15, 2017
♪ >> on "health matters," television for life, a high school football player is airlifted to the hospital after a hit on the field knocks him out. >> it could have been so much worse.
>> go inside the newest chopper at northwest medstar and see how technology is saving lives. >> it's been a very exciting time in the development of emergency medicine. >> from urgent care to the e.r., experience the fast-paced world of modern emergency medicine.
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i'm your host teresa lukens. according to the cdc, emergency departments across the country see more than 136 million people each year. it's a specialized certainly in emergency medicine and one that a lot of people are fascinated by.
also urgent care is another specialty and we will break down both of those today with our group of panelists who we assembled to talk about emergency care and urgent care and also e.m.t.s. so with us tonight is heather healy is the director of
nursing and the director of six urgent care clinics for rockwood health system. dan getz is the medical director for the providence sacred heart emergency department. shaun pitts is an advanced emergency medical technician and instructor for inland northwest
health services. tamara brining works in the emergency department at valley hospital where she is one of the assistant medical directors. thank you all for being here tonight. this is a great topic, and one we really haven't explored, and
it's very specialized. it's very different. i think fascinating to a lot of people and often one that they don't know about until they have to use one of your services. so let's talk, first, about emergency care, dan. and what we're talking about
when we are talking about the emergency room and the unique features to the emergency room and why we go there, and what is offered. >> sure. emergency medicine is a fairly unique specialty in that we are really the first line of care
for life threatening or potentially immediately disabling illness. so if you see that ambulance is driving by, usually they are coming to see one of our local e.r.s with pretty sick people. and there's a lot of confusion on what warrants and e.d. visit,
but anything that's life threatening or disabling, we tend to get them. we have broken ankles and urgent cares where a person who presents with a complaint that may not be appropriate for their setting but they will send it to the emergency department.
>> that's a great way to bring you in, heather to talk more about the urgent care facilities. we are seeing a lot of them now in spokane, which is a good thing. why do we go to urgent care as opposed to maybe going to the
emergency room? >> it's a great access point during the week, during the day if you can't get in with your primary care and you have cold, flu-like symptoms, a chest cold, the flu bug that's going around right now. it's -- so it's not the urgent
and immediate, really life altering that dan was talking about. some of the quick illnesses in the urgent care, we can do, you know, ankles and sprains and strains, that type of thing. but it's some very quick, colds, flus, and then we just kind of
assess. if we do feel like maybe you needed an e.r., then we absolutely send to the e.r.s in the area, rockwood valley, and then providence if needed. >> and the idea being that i can just walk in and get that care that i need if my physician is
not available. you are probably fairly busy on the weekends also? >> yes, we have our weekends and saturday and sundays, those are times when people can't get into primary care but they are sick. they need to get in. they want to get healthier and
get back to work. and so saturdays and sundays are busy, especially with all the sports going on. we will get kiddos there. we have sports physicals. we can take care of that. so some wellness things too. so that's good.
>> mm-hmm. >> and shaun, your crews are first on the scene as the e.m.t.s and so you are there to do that first assessment. to get them to one of the talk about your role and the larger role that e.m.t.s play. >> absolutely.
so we -- you call 911 and we are who shows up, a mix of e.m. t.s and some areas advanced e.m.t.s and others offer paramedicine. most of all of the patients we are taking from their home to an emergency department facility. every once in a while, we get
someone who has an urgent care facility that we are taking into the emergency department, whether it was something that was a little more critical than the patient thought or the nursing staff decided it would need to be handled on the e.d. side of things.
we transport them in and get them taken care of by the different e.r. facilities. >> and some facilities indicator to seniors and children's hospital with a trauma unit. so talk about how we're addressing those unique needs of the patients and not just kind
of a cattle call, so to speak. >> yes, that's true. we have kind of -- each different -- each institution that we have in spokane has a certain, you know, level of specialty, whether it be the sacred heart children's hospital.
we focus more on some geriatric approach from valley hospital's standpoint, being a geriatric friendly e.d. urgent care, you see all walks, of course. you have young, old, doesn't -- all age ranges. there are some specialty e.d.s
as well, even outside of our local community as well that focus on subspecialty neurology, et cetera, that kind of thing. i think we are probably all the emergency departments in our surrounding area, spokane specifically, can tailor, you know, to anyone who walks
through the door or gets brought in through the ambulance door. >> so kind of take us through that process, especially where you cater to seniors. why is it unique for them? >> so for seniors, specifically, one of the focuses that we took was being able to have a
comfortable, easy access, accessible environment. so essentially that easier parking. so bringing a parking spot closer to the door. because it's a big deal to get from that car to the front door in some cases.
we have thicker mattress stretchers. so essentially we added more padding. so you don't feel -- you don't feel the stretcher as much while you are sitting there getting your care. so little things that make the
difference. >> and dan, we often say on the show with a lot of our docs that children aren't just small adults. they have special needs and that's where children's hospital, sacred heart children's hospital comes into
may with the only area trauma unit for kids. >> yes, it's -- the way we set up our pediatric emergency department, it's for the most part staffed by emergency medicine physicians, fellowship training and pediatric care. it's definitely a very different
specialty from general emergency medicine and a very unique practice. they do a very good job providing care to very, very sick children. that's one of the challenges when you have a children's hospital, you deal with the
pediatric population with some very serious illnesses and we have children coming from the seattle area to receive care in spokane. so all of the equipment is geared towards children. it's child-sized so to speak? >> yes, even the way you walk in
there, there's a tremendously big fish tank and video games and we try to make it as comfortable as we can for the children, as well as the families. it's an entirely different waiting room from our adult waiting room.
thanks to a large donation, there was a new pediatric emergency department that's beautiful and comfortable for children and their families. >> shaun, is that an automatic for the e.m.t.s to know which facility to use? i'm fascinated by that process?
we all have policies and procedures that we determine on the scene if it's a pediatric patient, then we will be headed down to see people at sacred heart. different levels of care, which it's a cardiac patient, and what hospital they are supposed to go
to or a stroke patient, utilizing those. and spokane county and other agencies like them have protocols set up that we can use as guidelines of where to go and one thing that we have always utilized is an online medical direction, where we can pick up
our cell phones or radios and contact an e.r. physicians, these are our patient's symptoms, would you like them to be seen at your facility or another facility. most of the time, most of our patients, one of our first questions is what hospital would
you like to be seen at? and those patients determine where they are going to go. and we try to follow those wishes until there's something that's specialized and absolutely needed. >> when someone picks up the phone to call 911 and they need
assistance, when does an ambulance arrive and when does a fire aid car arrives? how is that determined? >> if this area if you call 911 and you are requesting a medical need, the fire department around here is staffed with e.m.t.s and paramedics and so you will
get a fire response, whether it's an engine or something along those lines, and then an ambulance responds. and so most places especially in the city of spokane and the spokane county area, you get both the fire department and the ambulance area.
we are all pretty used to working together, and, again, just depends where you live whether the fire department has a paramedics or just a paramedic on an ambulance. that paramedic level is what we strive to get to our community, as quick as possible, because of
their scope of practice. and heather, more people are using urgent care which is a good thing and with the health insurance changes you are seeing more patients at your clinics. what would you like those people to know that maybe haven't set foot in an urgent care facility
before they arrive. what do they need to know, for instance, about their insurance or what they need to bring and the type of doctor and nurses that they are going to see? >> so in our urgent cares, we are staffed by physicians, nurse practitioners, physician's
assistants and so they could see all three of the provider type. we have r.n.s and medical assistants and so they see the whole gamut. one really, really, really important thing is their medication list. because if they have come to
urgent care for the very first time, either they are rockwood patients or they are providence patients or they are just moving through, because they are visiting family for a function or whatever, we don't have any of their health records on file. and so we need to know what
medications they are taking so that we can treat them properly, prevent more illness because we use meds that didn't match or allergies. so if they had a med list, if they had a list of some of their chronic conditions, that's helpful so that we can kind of
narrow it down and speed up their care. we would like to get them in and out quickly. >> i can see how that would be a challenge because essentially you are seeing this doctor probably for first time. >> yes.
>> if i have been to an urgent care, and i need to go back at some point, is it important to go to the same one? >> in our system, all six are connected. so helps with the connection with the computer systems and the medical record.
if you went to one rockwood in our or began facility or rockwood at liberty lake, those medical records would be so it doesn't matter which urgent care you go to, we would have that data. >> i'm hearing a lot about customer service and the fact
that there as a lot -- a lot of thought be put into making sure the patient is comfortable, making sure you see them comfortable. you have a 30 minute or less policy. >> we have a plaque about that. >> yeah.
>> so essentially we pledge to see the patient within 30 minutes upon arrival in the department. now, when you first come, in you are greeted by a greeter, obviously. if you need something emergently, it happens
emergently. but as a provider we staff nurse practitioners at the front of the department. so we can get a look at them within that 30-minute time frame to decide what do we have to do? do we need to expedite the care and figure out what we need to
do for their stay at the emergency department and figure out the best way to get them through and what they need. it helps us to expedite their care overall. >> typically how many staff are on? is there a busy time?
do you have more people overnight or on weekends or in the summer months when we tend to see more injuries? >> some of our busiest months with trauma seasons, with the way spokane has grown, there's really no slow time in the we finished last year seeing
82,000 patients in the emergency department of the sacred heart and we are on pace to see close to 100,000 this year. so it really -- you really build from probably 2 p.m. to 1 a.m. and then it slows down a little bit, but it's -- it's very busy the whole time.
we have a similar approach where we use nurse practitioners and physician assistants in triage, we call it a provider in triage program to get the patients seen more expediently on the very high volume days which is saturday, sunday and monday and we will expand that probably to
every day of the week because we are running out of real estate when we are dealing with the patient volumes but the customer satisfaction and our patients are our customers are coming to the forefront of emergency medicine. actually in 2016o early 2017,
they are going to be rolling out e.d. caps which is hospitals will be reimbursed and part of the medicare d.r.g. money based on patient satisfaction surveys. so it's really one of those things where it used to be, you come into an emergency department who knows how your
experience was. you will get a tremendously large bill, and thanks, have a nice day. well, now patients have a chance to contribute back, and if they had a bad experience, we need to know about it. >> hmm.
what are some of the challenges that you are facing? >> well, i think expectations and this is, i think, a huge question in the minds of people when they come into the i almost wish we could name it what it ain't department. i have a patient come in and
they will be in the emergency department for three and a half hours and order a battery of tests and they will come with abdominal pain and i will tell them i don't know what the abdominal pain is. it's not life threatening or appenditis, but i tell them that
no news is good news from the so if we can sell them some reassurance and realize that you don't have a life threatening or potentially disabling condition and you are stable to follow up with your primary care condition for further testing, that's the value of the emergency
but if we do find something, we are equipped to handle that but we are set to look for a very small spectrum of illness that can potentially kill you. if we don't find that, that's a good thing for people. >> is that some of the challenges that you face with
urgent care? >> we do that. i think people will see a health system name and then they will go this no matter what. and so we'll have people come into the urgent care that have had, you know, the classic chest pain signs, you know, pressure,
radiating up my jaw and down my arm, and they just see rockwood or they see providence and that's where they go, and that's really not the best care for them, because we can't get to the -- those are the ones that might cause a death. so we need to get them to the ex
e.r. as fast as we can. we call our e.m.s. team and they get them there quick. the patients are scared in an emergency and all that they know is i go to rockwood or i go to providence and i want to see my doc, but i can't. so i'm going to go to the next
best thing. and so they see the name and they go right in. so we have highly trained staff that can triage that patient and figure out is this the right place? or is the e.r. the right place? and sometimes e.r.s will do
the reverse and they will figure out, you are a level five or a level one and then they help to triage and get the right care for the right thing. >> that's what's frustrating for patients too. when they walk into a busy waiting room and they see 20
patients and they keep seeing people coming past them into the they get frustrated. i have been here two hours and that patient just walked in. but what she alluded to was the triage criteria. if someone potentials with potentially more serious
complaint we expedite them back as quickly as possible. i don't think people always reallyize that the ambulance is coming through the back door at a steady clip. last i saw statistically about 80% of all ambulance traffic goes to sacred heart.
so we have a steady stream of ambulances. sometimes 60 ambulances a day which comes through the back door, which makes it harder for people to come through the front door. >> i think that's why it's essential that we now have the
providers in kind of the front of the department as well, because, you know when you are looking at prime real estate for sick, sick patients if you can see someone quickly, that doesn't require a bed, that can stay upright and get their treatment quickly, then i think
that's worth its weight in gold, because then, you know, they don't have to stay for prolonged, you know, workup. and the patient that needs the bed can get to the bed faster, and get what they need. so i think that's a big -- i think that's a big drive with
some of the programs that we have institutes, at both of our e.d.s. >> a lot of in-pro process waiting. that's the name of the game. and when you walk through the front door. when you walk into our lobby,
even if we can't get a bed back for you, if we can get in front of a provider and start care and get your workup are going that maybe potentially hour and a half that you waited is getting an hour and a half and disposition home, and that's where the value add is for the
patient. >> we have a caller coming in from spokane. this is kathy. >> caller: good evening. >> thank you so much for calling. do you have a question for our panel?
>> caller: yes, i just want to know, like, when you go -- i recently went to an urgent care, and -- because i had fallen, and there was a doctor that, you know, talked to me, and i got x-rays and stuff. and then this was a different doctor that read the x-rays.
so i wanted to know -- and that doctor was not a provider in my insurance. so i wanted to know, like, as a patient coming in, what questions do we have to ask? do we have to ask, like, if the doctor that's going to be seeing us is in our network and the
doctor that reads the x-rays is that a different network? does this make sense? >> yes, i think it, does kathy, and heather, can you take that? >> yes, i think it's an excellent question, and one of the topics we haven't really touched on is how insurance
dictates where you go to what urgent care you go to what emergency room you go to. and in terms of the radiologist. so in the rockwood urgent care system, we do take the radiology logical films and then a radiologist does the confirmation film, which would
be the same in the emergency rooms, and that radiologist is partnered with rockwood, and so if the insurance worked for rockwood, you know, we're not -- we don't always know that the radiologist will be the insurance carrier. so we do check on the insurance
for the emergency room visit or the urgent care visit, but some of the ancillary services, it's not always 100% that we know all of your parts and pieces to the and i think what's really challenging is there's so many divisions with the different insurance companies and so they
will cover this or they will pay for this, but they won't pay for that. and that's insurance a. and insurance b is going to do it a little bit different. insurance c does it a little bit different. and so on our end, that is hard
sometimes for our reception staff and for our medical staff. so what we do, our primary objective is we want to get you in. we want to get you taken care of and we want to get the medications and things that you need.
and then that other financial part is that back end. so for the caller's question, it's great to look through your benefit package and figure it out, which hospital do they want you to go to, which emergency room do they want you to go to, which urgent care do they want
you to go to and then do they really place it out specifically on which lab, which radiology? and that can help, but that's data that the patient needs to come in with them for us. >> again, good information to have along with that medication list.
these are things that you should be preparing before you have the emergency and before you become sick. >> yes, it's great to have in your wallet or your purse. >> that's great. i want to bring in another piece of the puzzle when it comes to
emergency care. we have seen spokane's emergency rooms and urgent care are ready at a moment's notice to provide life-saving medical assistance. one key to that success is northwest medstar which uses helicopters to transport
patients. with a service area that reaches into four states, northwest medstar covers a lot of ground and transports a lot of >> hundreds every year. >> but dr. james nania, medical director for medstar, is quick to point out, it's not about the
numbers. it's about the people. >> you just have to meet one person that wasn't going to be there next christmas, wasn't gonna make their birthday, wasn't gonna see their first kid born, and see that they are alive by virtue of what is being
done here, and that's why i am a fan. it is miracles. >> those miracles happen high in the sky at speeds of 140 miles an hour and in some pretty tight quarters. here ems personnel have access to tools once reserved for
hospital staff. >> the monitors are much more sophisticated. maybe only 20 years ago, you couldn't do an ekg to look for a heart attack till they got to the hospital. >> the added technology and training mean dr. nania's team
cannot only treat, but prevent some common killers. >> we are able now to stop strokes sometimes. we are able to stop heart attacks sometimes. >> it's that combination of speed and expertise that give patients a fighting chance.
patients like maxwell mielke. >> i was playing a football game at lakeside high school, running the football, and i ended up getting helmet-to-helmet contact and ended up going in and out of consciousness, ended up a having a fracture of the skull and bleeding of the brain.
>> maxwell was airlifted by northwest medstar. the medical treatment he received en route and at the hospital made all the thanks to them, i'm pretty much a normal human being. >> medstar operates from six sites in eastern washington and
montana. ready to go 24/7. an investment in critical care that is paying off one call at time. >> it's the best. >> and dan, talk about this medstar unit. these are incredible flying mini
hospitals in essence. >> yeah, they are amazing. they are flying i.c.u.s and the staff that work on them are incredible. they are taking patients from the middle of nowhere out on the highways and scooping them up and protecting their airway and
guarding their cervical spine and stabilizing them en route to get them in a hospital setting. it's an amazing technology and something that's advanced the emergency medicine over the past 20 years. historically if you were out in the middle of nowhere, you would
go to a critical access hospital that would not be equipped to deal with the level of injuries you have. and now we can get you to a trauma center and from a trauma surgeon and emergency medicine specialist. it's pretty amazing.
>> we live in an area where you are 20 minutes from being in a rural area. we have lots of small towns, and now they also even offer that yearly payment service, which we have seen a lot of people end up using otherwise that can be a pretty expensive ride to the
>> it can be. >> absolutely, but well worth it also. talk about the technology that's inside medstar. well, the mobile i.c.u. units whether they are going by air or ground, they have pretty much everything you would in an
i.c.u., they have advanced pumps and things to deliver life saving medications if they need it. they have advanced airway supplies if they need to intubate you or protect your airway. they have pretty much everything
in the i.c.u., pretty nice amount of medications if your heart needs some medications. >> are these physicians on board. >> for the most part, no, they are not, they are r.n., former i.c.u. r.n.s that are trained for transport.
there are some places where they will have physicians on e.m.s. teams but i don't believe spokane is using that. >> pretty amazing that we have that here at our disposal, again. just kind of goes to what spokane has to offer in mode
sin, and -- medicine and, again, taking you inside the emergency rooms and the urgent care facilities here on "health matters" tonight. shaun, let's talk about cpr. there was just a story out of everett, where two teenaged girls just completed their cpr
class at high school. they were at a restaurant and a gentleman was having an incident. and those two girls who had just completed that cpr class pulled him out of his pickup and performed cpr and most likely saved his life.
pretty amazing stuff. but a lot of people are still hesitant to learn cpr or to use >> yes, absolutely. and one of the things that we are doing around this area is working on teaching what's called hands only cpr which takes out the mouth-to-mouth
piece. >> is that why people were hesitant? >> i think that was the biggest problem. they were concerned about whether it was disease prevention or transfer of diseases or not knowing, maybe
not doing it correctly. there's a couple of different agencies around here that do do hands only cpr classes. there's a couple of groups, i know, one of the doctors from providence does a group for the high schools and the meads school district and district 81,
where the seniors are getting taught cpr, which is pretty impressive. we always get the phone calls of how young can i have my son or daughter learn to do cpr. we are basically tell people if they are strong enough to push on someone's chest, we can teach
them how to do cpr. we don't have to teach the mouth-to-mouth piece or the pulse check piece. if the person doesn't look like they have signs of life and then teaching them how to do chest compression. one the big new things here in
the spokane area is the pulse point app. it's an app that goes on your phone that notifies you as a public service person anybody can download it. it notifies of you a cardiac arrest nearby in a public venue and recently here in spokane,
they did have the first confirmed save -- the app is based out of california and the first confirmed save was here in spokane, washington. that individual was -- his story was sent all around the nation, and talked about that story, but anybody can download it and it's
just getting cpr by bystanders quicker. one of the biggest things we deal with in the ambulance that we can't control is the amount of time it takes us to get to the rural area. the ambulance company that i work for, best case scenario,
inside town, we can be there in 10 to 15 minutes. worst case scenario we cover 720 square miles and so it could be 45 minutes to 50 minutes before you get an ambulance. and so getting bystanders there quicker that can do cpr is a pretty important piece.
>> and the hands only piece is just as effective as the old cpr that some of us learned many years ago. the american heart association says that the circulation is the most important part. circulating that to your heart and vital organs.
>> so how young can you be to learn this technique. >> we have seen kids as young as 11 or 12 that can push down on the chest and we are glad to teach them cpr and get them out there. in the unique circumstances they can do it effectively.
>> are you seeing more family members that bring in patients into the emergency room that have performed cpr and saved lives. >> we had a few. that's what saved them. >> that's pretty exciting. and the hands only?
>> hands only. mm-hmm. because they weren't actually trained, the few cases that we had when i was on shift. >> i know there used to be a fear that you could hurt somebody with cpr. >> well, probably a little bit,
but for the good of them. >> for the good. yeah, you have to press them pretty hard and i think the benefit also of taking these type of classes, they train you on the use of the automated external defibrillators and they save lives and teaching the
public how to utilize those. it's making a huge impact on people that have witnessed cardiac arrest. >> and i think the thing for the public to remember and this might sound crass, but they are dead. so you can't hurt them.
you can only save them. >> i have never heard it quite that way and i think you make an excellent point. >> let's take another phone call. we have tina from spokane. good evening, tina. >> caller: hi, this is tina.
i have a couple of questions about emergency services here in >> caller: i have been an r.n. for 44 years and i have worked here at a local e.r. and also at an local ambulatory care office, and i have concerns about e.r. accessibility. i had a knee replacement about
four years ago, and i had absolute excellent care. the following year, my husband had some issues that required a cat scan and they discovered that he had a tumor in his pancreas. and he was treated absolutely with excellence at cancer care
northwest with the scans and the whiffle procedure but afterwards he was in the hospital for a month. he had major complications. his -- his oncologist surgeon called sacred heart and said this is -- this guy is coming this is what's going on.
he needs to be seen. and we literally sat in the e.r. for five hours. i went up to them and asked is there a place he can actually lay down? he was propped in a chair with his feet on another chair, barely able to do anything.
and having e.r. experience in the past, which isn't that updated now, i was very, very frustrated with the way he was treated, the lack of response to getting him in a room, and the fact that the oncology physician had called in and said, this needs to be dealt with.
and i just don't feel we were adequately addressed. i think we were put off, and he was out in the waiting area for a minimum of four to five hours without -- you know, with all of that other contagious stuff going on. >> all right.
thank you, tina. would anyone like to address -- it was obviously, she was very frustrated by that process. we hate to have people wait. and, you know, a couple of things that maybe would have prevented that wait is that on kohlists could have always --
oncologists could have directly admitted him to the hospital if they thought he needed to be hospitalized. maybe he didn't need to go to the e.r. in the first place and just have one of the medical physicians upstairs care for him.
secondly, we don't keep people out there on purpose. we have high acuity. we have to deal with the ill people that we have. five hours is an extensive wait and i hate to hear numbers like that's by no means the norm and there's no lobby that is a
comfortable setting for somebody that's hurting. you know, it's an unfortunate experience when people do go to the emergency departments. departments there's the potential that we will be waiting a fair amount of time if they don't require
aggressive care immediately. we will take care of those people ahead of them that do. >> is there anything she could have maybe done differently in that situation not knowing the full storey? >> it's really tough, and that's one thing as an emergency
department we are striving to improve. and what dan speaks of with regards to communicating with your physician or your oncologist, or someone to advocate on your behalf. it may save you a trip into the emergency department, not to
turn business away but at the same time to get him the care that he needs more expeditiously. it might be in his best to have your provider speak on your behalf. but other than that, no, i don't think there's anything he or she
could have done differently. it's just the way that the current system works with when you have someone who you are actively resuscitating in the back or an ambulance that, you know, you brought in somebody that you are resuscitating there and you can't physically get out
to the see the patient or get them back into a bed. i think that's why we are constantly trying to make small improvements every day to expedite and kind of prevent that from happening those five-hour waits. >> that's the rationale behind
the urgent care opening. we are trying to drive those who don't require emergency care to urgent care. people who require advanced care have an easier time getting access to that. >> it is pretty amazing the levels of care we have starting
with the first responders and then having access now to urgent care and emergency room or your own physicians. so we really do have the different levels, so to speak, that you just need to target and snow what's best for your situation or have the doctors
assess that and let you know what is best for that situation. so we are fortunate. >> providence is rolling out telemedicine now to the area. so if you have pink eye or if you have a cough, you can take a picture of what is bothering you and for $35, they will take care
of that via a teleconsult. so you don't have to leave your own home. i think what you will see now with cough, the landscape of medicine is really shifting towards more accessible medicine that still has good quality but for cheaper.
and if we can keep people in their own home, they don't need to get in their car and drive to an urgent care, that will save money for the system and they should still have pretty quality care. >> how much networking is going on between the facilities and
these different levels of care? are there -- are there ways you get together and put your heads together to try and address those customer issues? >> i think quite a bit. i know for us, we meet with the management for our emergency rooms and our system every
quarter. and then we have the physicians that community back and forth. we actually just met with some of the community boardses with it, and wanting to make sure that we didn't just look at the emergency room for disaster planning but looked at the
urgent cares as well. we are starting to do a lot more community awareness, community benefit, community relationships to make sure that we are meeting the need of the area. so being new in town, i feel like we are doing quite a bit to start to build those
relationships and community with all -- communicate with all the different entities. it starts with e. m.s. and then they go to the e.r. or it start starts with the urgent care and then e.m.s. to get them to the hospital. >> all the pieces have to fit
together. >> we can't do it alone. we can't do it in a silo. for the best patient care and to make the time smaller for hike the caller who had the long wait, we are trying to really streamline it and like dan said, have the patients go to the
right level of care, to get it into faster. >> mm-hmm and also be prepared if we were to have some sort of large-scale disaster. i know there's a lot of readiness drills that spokane does, along with fire and the facilities that we provide, and
to be ready for a situation should something come up. how often do you do those? >> with the ebola scare, we had them pretty regularly. yeah. that was probably the most recent with the influenza season that we had.
we had some drilling there. but disaster preparedness courses are pretty routine through emergency departments. we work closely with the e.m.s. community, organizing those drills as well, because you are kind of it. you have someone that comes in
and they have been exposed to a chemical or they have an infectious exposure, that's where they are going through is the emergency department and trying to make sure that people that they are not walking through a waiting room full of folks.
>> you have to be ready for just about anything. >> decontamination rooms and a special way to triage. yes, we do that quite regularly. we have dan. good evening, dan. thank you for taking my call. >> well, thank you for waiting.
>> caller: i have a question about the consistent care program and how the emergency rooms in the state of washington just about all of them, are going to the consistent care program. how do they get away with the lifetime of profiling the sick
and the disabled, a lifetime sense that can never be removed, and that discriminates against the disabled that have chronic problems and need the emergency room on a regular basis. i want to know what your feelings are about that and how i go about getting myself off
the consistent care list. >> i'm not familiar with the >> i can -- i'm very familiar with it. so the consistent care program, when we look at the amount of money we have to deliver healthcare across the country, it's not getting any bigger and
we have more patients and expanding wax we have done is we have identified people who are frequent utilizers of emergency services, and when we identify those people, we go through their visits, do a case review with two physicians. usually the primary care
physician of that patient and see if they are appropriate uses of emergency department. the average bill is $1,200. so every time, a $1,200 bill is engendered. it's not designed to keep those people out of the emergency if they have an issue that we
feel requires emergency room. the consistent care has created a resource for patients that are identified as high utilizers to get care through their primary care physicians. a lot of it was done to crack down on narcotic prescriptions across the street.
spokane county has one of the highest death rates secondary to overdose from prescription narcotics anywhere in the country. and so what we found is that people we are going to e.r.s to obtain these prescriptions, selling them on the street, and
this program started darin neven, working with some people in olympia and got this program up and running. we identified people who were using the emergency department 60 times a year. do the math, 60 times a year at $1,200 for the minimal cost.
it wasn't fair to the system. when we get the consistent care, we get them enrolled. for the gentleman's question, i feel terrible that he feels like he was discriminated against but we want you to have access to the care that you need that is, one, cost effective and two,
very high quality care and if you do have an emergent complaint. come to the e.r. if we feel it doesn't feel like you require emergent care, we will get you seen at 8:00 in the morning. we have social workers that help
out with these folks. that's a drift of medicine in general and we have so many different issues that we deal with in our community that funnel into the emergency department because it's the only place open at 3 a.m. so we have been creating
alliances with the community detox and mental health facilities so we can expedite people who have mental health and that's the game of medicine unfortunately and this gentlemen's issue that we are trying to be creative in how do we provide high quality care
that is more on par with what the rest of the world is spending. >> can he get off the list once he's been put on the list? >> yes, you can. >> do you ask to be taken off a list? how does that --
>> what is the procedure? >> it takes almost as much time and communication with the physician, and the hospital. it is a very extensive process. it involves case management. we have case managers at our hospital as well as i'm sure providence, that work on that
with us, with all the patients that are on this program. because it is so extensive. because it's taken very seriously. it's something that's not taken lightly. it's not something that someone comes in five times and it gets
turned on. it doesn't happen that easily. you can get off the list. it just takes work. it takes a little effort. >> and the state tracks it. so there's a -- the e.d., the emergency department information exchange will track visits
throughout the state. so when i have a patient that shows up, i get a fax from e.d. that says this patient has been seen in nine different e.r.s across the state in the last three months and what we are linking right now to these e.d. faxes are access to the
washington state prescription monitoring program. we will know in a patient has been prescribed narcotics in olympia or kennewick, and so the consistent care program, it shouldn't have a derogatory connotation. it's a good program for patients
would require higher level or more frequent levels of care. i don't know if there's truly a way to get out of it. it's not designed to discriminate. it's to create an extra level of network for that patient to get care expedited.
if they don't need it at 2 a.m., then we will get it for them later that day. >> i think one of the things we talked so much today about the right care at the right location. and this is just before that. so this is the right care in
primary care. and so if you have pulmonary disease or heart disease or diabetes, you know, 9 -- the e.r. or the urgent care, you know, their purpose is for those life threatening diseases or life threatening issues, and we want your chronic illness, your
asthma, pulmonary issues, heart failure, we want them done in the primary care for your doc and your team to know what your medicines are, what did we do last. it didn't work. so let's try this. if we -- if we e.r. shop, then
we don't have that history. and so the best thing for the patient is to have that primary care provider and across the country, they have the patient centered medical home and the idea is that you have a medical home and then you go to the right care at the right time for
the right thing. and so i think that's a little bit of what we are talking and that's what that program does. it says, the right place for the right care at the right time. >> very well said. let's take another phone call. don from calgary, good evening,
don. i just have a general question for your panel. i wondered what they thought of the concept of patients of a certain age group going to baby aspirin in their pocket and if they have chest pain to take it. it might save their life.
thank you, don. so one of the things that we do here in spokane is our 911 dispatchers are trained to give some over-the-phone instructions and that's one of the things that's being done is the possibility of asking the right questions when the caller
reports that so and so is having chest pain or whatever their complaint might be. what they then do is ask a series of questions and then if they do have that aspirin available in their home, giving them the aspirin. they teach cpr guidelines over
the phone. there's ways of, you know is there epinephrine in the house/do they have known allergies? so our dispatchers are addressing that to hopefully provide for some better care before it takes us time to get
and so, i know one of the things is pushing is for the use of aspirin when it comes to carback. cardiacs. you see the commercials and the bear. i think it is a good tool, as long as there's definitely some
instances where you wouldn't want to give that aspirin. for the most part, i think if it's deemed under those circumstances that's absolutely a good idea. >> that's so fascinating. what other types of maybe basic first aid do you advise people
to know about, say, and we are coming up on the summer months. we talked a little bit about this before the show started tonight, but, for instance, how do i know if my child has a fracture? and you know, some of those things, bee stings are going to
become prominent. tick bites, those sorts of things. what can we arm ourselves with before we make the phone call or while we are making the phone call and before emergency teams get there? >> i think the best thing is
most of those first aid kits that you would get at walmart, you know, it's one of those you get what you pay for so if it's a $5 or $6 first aid kit, it will have band-aid and gauze. the more you spend on the first aid, you will get some different splints or a bee sting kit and
some of those things. one of the big things we push for is just the education side. inhs teaches first aid and cpr that combines the two classes and teaches very, very basic first aid maneuvers whether it's using a magazine to splint a possible broken arm or leg.
we talk about tourniquet use that's big in emergency medicine when it comes to stopping bleeding, especially if you are out in the rural area and a chain saw incident or some sort of laceration that causes life threatening bleeding. one of the things we are
teaching is the use of tourniquets. first aid kits that have bee sting kits and things along those lines are good. you know, the only downfall if it's a known allergy and you don't have that epinephrine pen, you won't find an epi pen inside
one of those kits. that needs to be prescribed to you from a facility. i think the education side is the biggest piece of getting out there and they are usually pretty low cost programs that we teach it in the area and they can come to us and help with
that thinking outside the box when it comes to treating some pretty serious injuries. >> do you advise at all going to the internet for any of that? are there any websites that can help or would you rather see them take one of the classes? >> i definitely would always
recommend a credible source. the internet is filled with credible sources and non-credible sources. you know, one of the things we see on the ambulance is if someone looks up their symptom on some sort of web-based diagnostic and it's either
cancer or runny nose. it ranges in severity. american heart association is always a good tool. they do first aid things along those lines but i think education from a credible source, i think could definitely be recommended.
>> okay. very good. diane, good evening. >> caller: hello. >> hello. >> caller: yes, i do. and thank you all so much for spending the time with us. i was wondering historically
emergency rooms have been used for the homeless people as their first base of care, and the under employed where they don't have any insurance, and this is the first place they come to is the emergency room. is that seeing any kind of lessening effect now that we
have the a.c.a. and more people hopefully being insured? how is that going as far as the emergency rooms? >> that's an interesting point. >> i would say, yes. i think we are starting to see some improvements with regards to people having coverage.
we also have more programs within our hospital to get people enrolled in coverage and i'm sure providence does and so does rockwood. it really helps the patient get on to a program, and i think we have seen an increase in covered folks that come in through the
door, but also those that aren't, they are getting access to care. and access to coverage for the care that they have been given. so i think there has been a positive. >> it's going to be an uphill battle.
>> i mean, the apple care is great and we have an expanded insured patient population. the problem that we have is there's a large lack of primary care providers in the area. that's one of the big pushes to have these medical schools open in spokane and heavily recruit
primary care doctors. if you are under insured or uninsured the emergency department is really your only option. it's an expensive option. so just like rockwood is doing, providence has been very aggressive at finding expanded
ways of keeping people in our community in the right direction for primary care and hopefully it gets better as we get more primary care physicians in the area. the last statistic, there's a shortage of 35,000 primary care physicians across the united
states, and if you look at how long it takes to make a primary care doctor, it's going to be a while to fill that. i think that's why nurse practitioners and physician assistants extend that and you can have them running their own clinic and providing good
primary care and filling that gap. we have another phone call coming in from ron here in good evening, ron. i wanted to call in and say that dr. goetz would not remember me, but i remember him. i was operated on in phoenix in
early february, and i got home here, and what had a happened was they had to drill a hole in my skull, the size of a 50-cent >> i remember you! >> and it got quite infected. >> oh, boy. >> it was really quite a i found out later, it was spinal
fluid coming out of the hole and, you got me in and dr. carlson did a great job. had to take all the hardware out of my head, but i'm doing great. >> that's wonderful to hear. >> ron, thank you so much for your call. that's very nice of you to call
in and i'm sure that touched dr. getz tonight also. thank you. and we're glad that you are doing better. >> say hi to your wife. >> you probably get that quite often. >> that's why we do this.
it's phenomenally rewarding. i get cookies baked, you know, dropped off and i do eat them. it's a good idea. and lots of thank you cards and that's the rewarding part. hey, you did make a big ifference and i think pep people historically think that
emergency people don't do anything. but for the small group, we do a lot. >> it's a special type of breed. it's a special type of doctor to do what you do and see the patients that all of you see on a daily basis.
you know, why did you choose emergency medicine? >> well, i think it was a mix i love the pace of it, and i like that sense of never knowing what comes through the door. i think that's -- we tend to be a little bit frenetic in our pace when we approach things.
i come in for a 9 or 10 hour shift and i blink and it's over. i might have had a cup of coffee, and no lunch and used the bathroom once but it's wonderful. we use scribes in our emergency department would actually do all of the note taking.
i don't have to carry a pen in any longer. and these are all gifted college students and the first emergency shift they work. and their feet work and they are hungry. and when they see what comes through the doors and they say i
want to be an emergency room doctor. i have been doing it almost ten years, post residency and every day i go to work, i enjoy doing >> i bet the same can be fed for all of you -- stead for all of. >> you i think emergency medicine chose in a sense when i
rotated through the department. something spoke to me. it's never a dull moment and it's gratifying at the end of the day. you feel like you have done a good job for your community and like people calling in and, you know, letting you know or seeing
that person in the grocery store would wasn't able to walk two months earlier who is now up and around buying their apples. >> or maybe recognizes you or -- >> or vice versa. >> you see a lot of patients. >> you might recognize them. there are a lot of rewards.
>> even for me, i do mostly administration, but i stay clinical as a nurse practitioner in the urgent cares because you can't step away from that patient all the time. you still need that patient focus and that patient care and it keeps you kind of centered
and grounded. so absolutely. >> and shaun, what do you say to those maybe teenagers that are considering e.m.s., becoming ane.m.t. what do you tell them about your patient for this side of >> my definite side is the
people. i love interacing with the it's like -- dr. getz said, it's never the same two days in a row. you can see the same patient two days in a row and it will be it's by far the most rewarding job i ever had.
it definitely does something to you. there's definitely the losses that affect you in a certain way, but we see a lot kind of like dr. getz was saying where we see transport a patient and we don't get a lot of after news about them.
we drop them off at a hospital and we pass the care off to them but we don't hear how they do t is a pretty as manying amazing where they stop back by and they bring cookies an doughnuts and cakes and pies and all kinds of things and thank you cards. we have a wall up in deer park
with all the thank you cards and that's by far the most rewarding. that beats anything about this job. and that's my drive towards it and i think that's what we try to pass on to other people, all the students who go through our
there's days where you are woken up, you are trying to sleep or trying to have dinner and it pays off at the end of it. >> i'm hearing too, we are down to just a few minutes left in the show. but i'm hearing a lot of with the apps that you talked about,
shaun, and the technology that's coming into place with people being able to send pictures and photos in and do that through the computer, what's on the horizon for emergency medicine? what are we looking at? because it's ever changing. always something different.
what are we going to see in the near future when it comes to >> i think you touched on it with the telemedicine. that's the talk as of late with regards to kind of next level of patient care without having to actually leave your home. for some of those things that
can be managed that way. i think that's definitely on the horizon. >> i think consolidated care networks is going to be the big i think the days of having the primary care doctor with the shop on the corner. we are looking at ways to
deliver centralized care to make it easy for patients and avoid excess visits that were not required. aggressive with that in trying to find ways to deliver, consolidated care to cut down on over treatment or over utilization of resources that
aren't needed and i think that's why we have moved towards electronic medication records and that i can pull up the medical record of a providence patient who was seen by their primary care patient two days ago. and i'm not flying blind.
i'm not ordering a $1,200 test that was ordered two days ago. i think consolidated care is part of the future. >> it was a wonderful discussion. thank you so much for sharing your thoughts and your wisdom and knowledge with us this
evening. that will do it for "health matters." i thank everyone who called in with a yes. -- with a question. we hope you'll join us on may 21st when our topic will be rural medicine.
until then, thanks, for watching. i'm teresa lukens. good night. closed caption productions ccproductions.com 602-456-0977 >> i really liked the idea of being part of providence, where if i have a question, if there's something that i'm concerned
about, i can always call a i'm dr. anna barber, and i chose providence because here, i can help children thrive and reach their highest potential.
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