The Key to Combat Readiness Is a Strong Military–Civilian Partnership

2021 ◽  
Author(s):  
Matthew S Sussman ◽  
Emily L Ryon ◽  
Eva M Urrechaga ◽  
Alessia C Cioci ◽  
Tyler J Herrington ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Hospital Admissions ◽  
Physician Assistants ◽  
Military Hospital ◽  
Optimal Care ◽  
Perioperative Nurses ◽  
Team Members ◽  
Licensed Practical Nurse ◽  
Certified Registered Nurse Anesthetists ◽  
Combat Readiness

ABSTRACT Introduction In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST. We test the hypothesis that the clinical experience of non-physician FRST members varies between active duty (AD) and Army reservists (AR). Methods Over a 3-year period, all FRSTs were surveyed at one civilian center. Results Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P < .001). These differences persisted across all specialties, including perioperative nurses, certified registered nurse anesthetists, operating room (OR) techs, critical-care nurses, emergency room (ER) nurses, licensed practical nurse (LPN), and combat medics. Conclusions This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers.

scholarly journals The Challenging but Imperative Path to Monoclonal Antibody Use Against COVID-19 for a Small Overseas Military Hospital

2021 ◽  
Author(s):  
Spencer Shirk ◽  
Danielle Kerr ◽  
Crystal Saraceni ◽  
Garret Hand ◽  
Michael Terrenzi ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Lessons Learned ◽  
Military Hospital ◽  
Clinical Criteria ◽  
Fda Approval ◽  
Life Saving ◽  
Set Up ◽  
Naval Hospital

ABSTRACT Upon the U.S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U.S. Naval Hospital Rota, Spain (USNH Rota) requested and received a limited number of doses. Concurrently, our host nation, which previously had reported the highest number of daily deaths from COVID-19, was deep within a second wave of infections, increasing hospital admissions, near intensive care unit capacity, and deaths. As USNH Rota was not normally equipped for the complex infusion center required to effectively deliver the monoclonal antibody, we coordinated a multi-directorate and multidisciplinary effort in order to set up an infusion room that could be dedicated to help with our fight against COVID. Identifying a physician team lead, with subject matter experts from nursing, pharmacy, facilities, and enlisted corpsmen, our team carefully ensured that all requisite steps were set up in advance in order to be able to identify the appropriate patients proactively and treat them safely with the infusion that has been clinically proven to decrease hospital admissions and mortality. Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.

Enhancing the professional dignity of midwives: A phenomenological study

2017 ◽  
Vol 26 (4) ◽  
pp. 1062-1074 ◽  
Author(s):  
Christelle Froneman ◽  
Neltjie C van Wyk ◽  
Ramadimetja S Mogale
Keyword(s):  
Research Design ◽  
Phenomenological Study ◽  
Tertiary Hospital ◽  
Ethical Considerations ◽  
Optimal Care ◽  
Team Members ◽  
University Of Pretoria ◽  
Phenomenological Research Design ◽  
The University ◽  
Depth Interviews

Background: When midwives are not treated with respect and their professional competencies are not recognised, their professional dignity is violated. Objective: This study explored and described how the professional dignity of midwives in the selected hospital can be enhanced based on their experiences. Research design: A descriptive phenomenological research design was used with in-depth interviews conducted with 15 purposely selected midwives. Ethical considerations: The Faculty of Health Sciences Research Ethics Committee of the University of Pretoria approved the study. The research was conducted in an academic tertiary hospital with voluntary participants. Findings: To dignify midwives it is essential to enhance the following: ‘to acknowledge the capabilities of midwives’, ‘to appreciate interventions of midwives’, ‘to perceive midwives as equal health team members’, ‘to invest in midwives’, ‘to enhance collegiality’, ‘to be cared for by management’ and ‘to create conducive environments’. Conclusion: The professional dignity of midwives is determined by their own perspectives of the contribution that they make to the optimal care of patients, the respect that they get from others and the support that hospital management gives them. With support and care, midwives’ professional dignity is enhanced. Midwives will strive to render excellent services as well as increasing their commitment.

Organization and Structure of the Cardiothoracic Intensive Care Unit

2015 ◽  
pp. 86-104
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽  
2017 ◽  
pp. 709-727
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Venereal Disease in Vietnam: Clinical Experience at a Major Military Hospital

1974 ◽  
Vol 139 (5) ◽  
pp. 374-379 ◽  
Author(s):  
Stephen R. Shapiro ◽  
Louis C. Breschi
Keyword(s):  
Clinical Experience ◽  
Venereal Disease ◽  
Military Hospital

Louisa Garrett Anderson (1873–1943), surgeon and suffragette

2008 ◽  
Vol 16 (4) ◽  
pp. 205-214 ◽  
Author(s):  
Jennian F Geddes
Keyword(s):  
Clinical Experience ◽  
Public Affairs ◽  
Military Hospital ◽  
Press Coverage ◽  
Military Hospitals ◽  
Women Doctors ◽  
The Public ◽  
High Profile ◽  
Army Hospital ◽  
Woman Doctor

Louisa Garrett Anderson, daughter of Britain's first woman doctor, has been largely forgotten today despite the fact that her contribution to the women's movement was as great as that of her mother. Recognized by her contemporaries as an important figure in the suffrage campaign, Anderson chose to lend her support through high-profile action, being one of the few women doctors in her generation who risked their professional as well as their personal reputation in the fight for women's rights by becoming a suffragette – in her case, even going so far as to spend a month in prison for breaking a window on a demonstration. On the outbreak of war, with only the clinical experience she had gained as outpatient surgeon in a women's hospital, Anderson established a series of women-run military hospitals where she was a Chief Surgeon. The most successful was the Endell Street Military Hospital in London, funded by the Royal Army Medical Corps and the only army hospital ever to be run and staffed entirely by women. Believing that a doctor had an obligation to take a lead in public affairs, Anderson continued campaigning for women's issues in the unlikely setting of Endell Street, ensuring that their activities remained in the public eye through constant press coverage. Anderson's achievement was that her work played no small part in expunging the stigma of the militant years in the eyes of the public and – more importantly – was largely instrumental in putting women doctors on equal terms with their male colleagues.

scholarly journals Arthroplasty implants and materials: Cost awareness and value perception

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255061
Author(s):  
Mursal Gardezi ◽  
Taylor D. Ottesen ◽  
Vineet Tyagi ◽  
Josiah J. Z. Sherman ◽  
Jonathan N. Grauer ◽  
...  
Keyword(s):  
Registered Nurses ◽  
Physician Assistants ◽  
The United States ◽  
Relative Cost ◽  
Clinical Value ◽  
Team Members ◽  
Value Perception ◽  
Knowledge Deficit ◽  
Willingness To Use ◽  
Cost Differences

Arthroplasty procedures are commonly performed and contribute to healthcare expenditures seen in the United States. Surgical team members may make selections among implants and materials without always knowing their relative cost. The current study reports on a survey aimed to investigate the perceptions of an academic group about the relative cost and value of commonly used operating room implants and materials related to joint arthroplasty cases using 10 matched pairs of items. Of the 124 persons eligible to take the survey, 102 responded (response rate of 82.3%) including attendings, fellows, residents, physician assistants (PAs), advanced practice registered nurses (APRNs) and registered nurses (RNs). On average for the ten pairs of items, the more expensive items were correctly selected by 90.2+/-13.9% (mean+/- standard deviation) of respondents with a range from 54.9% to 100%. Of note, the cost differences were significantly overestimated for 8/10 item pairs. The majority of respondents perceived the more expensive item as the item with the higher clinical value for 9/10 item pairs. Most arthroplasty attendings (91.3%) indicated willingness to use the less expensive item of two similar items. Nonetheless, 17.9% of fellows, residents, PAs, APRNs and RNs indicated that they would not feel comfortable suggesting using the less expensive item. Although attending arthroplasty surgeons stated a desire to consider costs, a knowledge deficit with regards to identifying the extent of cost differences was identified, and a significant portion of the surgical support team reported being hesitant to suggest less expensive options.

Studying and Supporting Collaborative Care Processes

2005 ◽  
Vol 49 (11) ◽  
pp. 1074-1078 ◽  
Author(s):  
Cynthia Dominguez ◽  
Paul Uhlig ◽  
Jeff Brown ◽  
Systems Safety Group ◽  
Olga Gurevich ◽  
...  
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Collaborative Care ◽  
Physician Assistants ◽  
Ongoing Research ◽  
Team Members ◽  
Hospital Units ◽  
Post Surgery ◽  
Care Processes ◽  
Shared Goal

In patient care today, teams of practitioners from various disciplines must coordinate their efforts in order to deliver care successfully. Frontline nurses and physicians must interact with social workers, therapists, physician assistants, nurse practitioners, and others to develop and carry out coordinated plans of care. Also, clinical team members must communicate with patients and their families in language that can be understood and acted upon. In support of these goals, JCAHO standards require patient care to be planned and provided in an interdisciplinary, collaborative manner. As hospital units develop processes for collaborative care in complex environments such as post-surgery and critical care units, it is important to understand what constitutes success for these processes and how they can be enabled and supported. This report documents a series of field visits and simulations designed to observe, videotape, and interview collaborative care team members, patients, and family members engaged in varying forms of collaborative practice. This ongoing research is being conducted by a multi-disciplinary team of medical and social scientists with a shared goal of studying and supporting collaborative care processes.

Interdisciplinary Approach to the Management of Intestinal Transplant Recipients: Evaluation, Discharge, and Lifetime Management

2005 ◽  
Vol 15 (1) ◽  
pp. 54-59
Author(s):  
Kate Samela ◽  
Erin Fennelly ◽  
Mary Brosnan ◽  
Jill Robinson
Keyword(s):  
Intestinal Failure ◽  
Interdisciplinary Approach ◽  
Open Communication ◽  
Optimal Care ◽  
Team Members ◽  
Close Relationship ◽  
Transplant Team ◽  
Intestinal Transplant

Patients suffering from intestinal failure present unique and difficult challenges to the transplant team. Augmenting the need for interdisciplinary teamwork is the higher incidence of death on the intestinal transplant waiting list. Successful management of this population requires an interdisciplinary approach at each stage of care, beginning with evaluation and continuing through discharge and lifetime management. A close relationship between patients, their caregivers, and all members of the transplant team is an essential component to successful lifetime management. Open communication between team members and unlimited accessibility to each other enables work flow to be managed efficiently, and enables the provision of optimal care. In this article, we describe the functions of the nonphysician clinical personnel needed to manage the intestinal transplant patient—beginning at the evaluation through lifetime follow-up care. The goal of each professional is the same: to restore the patient to the best quality of life possible.

Reducing ED visits by “closing the loop” for symptomatic patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 100-100
Author(s):  
Edward Arrowsmith ◽  
Lenes Suits ◽  
Bertrand Marquess Anz ◽  
Gina Geren ◽  
Leslie Vasta ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Resource Constraints ◽  
Low Cost ◽  
New Technology ◽  
Data Access ◽  
Care Team ◽  
Telephone Triage ◽  
Team Members ◽  
Ed Visits

100 Background: Improving the value provided to patients and payers in our system of cancer care relies on reduction of avoidable hospital and emergency department (ED) utilization. Furthermore, recent payer pressures on community oncology practices (COPs) have resulted in an increased focus on improving care coordination (CC) under strict resource constraints. As part of the ASCO Quality Training Program, we tested several low-cost CC interventions, leveraging workflow redesign, already employed care team members, and technology already implemented, to reduce ED visits (EDV) in a single large COP clinic where more than 3,200 cancer patients were treated during 2016. Methods: Baseline EDV rates were obtained through nurse chart review during Jan.-Jun. 2016. The following CC interventions were implemented: Initiated after hours call process with access to EMR and patient access to bidirectional real-time messaging with care team members; Implemented new in-office process to “close the loop” on patient evaluations by creating follow up guidelines for symptomatic telephone triage and in-clinic patient evaluations; Implemented a standard 48 hour follow up process for all EDV and hospital admissions; Increased patient awareness of telephone triage services during and after clinic hours by: augmenting new patient education by staff, developing a magnetic reminder to call the office for non-emergent and emergency situations, and instructions for use of afterhours call system. Nurse chart reviews were conducted throughout implementation to observe effects of new CC processes on EDV. Results: We observed a 30% reduction in EDV from baseline measurement. No new FTEs added and no new technology licenses acquired for this initiative. Conclusions: Low-cost CC interventions can be implemented in COPs to avoid ED utilization. Limitations of this analysis included manual chart abstraction that could not account for EDV outside the partnering health system, illustrating data access for hospital utilization remains a major challenge for quality improvement efforts for COPs. Additional challenges have been experienced in expanding these process improvements from a single large clinic to the broader Tennessee Oncology network of more than 30 clinics.

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