Critical Care in Critical Access Hospitals

2015 ◽  
Vol 35 (5) ◽  
pp. 62-67 ◽  
Author(s):  
Teresa J. Seright ◽  
Charlene A. Winters
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Rural Areas ◽  
Tertiary Care ◽  
Safety Net ◽  
The United States ◽  
Infusion Therapy ◽  
Critical Access Hospitals ◽  
Hospital System ◽  
Critical Access Hospital

What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.

A Program to Increase Health Care for Children: The Pediatric Nurse Practitioner Program, by Henry K. Silver, MD, Loretta C. Ford, EdD, and Susan G. Stearly, MS, Pediatrics, 1967;39:756–760

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 245-247
Author(s):  
Robert A. Hoekelman
Keyword(s):  
Health Care ◽  
Nurse Practitioner ◽  
Rural Areas ◽  
The United States ◽  
Optimum Level ◽  
Socioeconomic Groups ◽  
Pediatric Nurse ◽  
Lower Socioeconomic ◽  
Urban And Rural Areas ◽  
Pediatric Nurse Practitioner

The increase in population of the United States is occurring at a much more rapid rate than the increase in medical and nursing personnel available to maintain health services at an optimum level. Unless the pattern of furnishing health care, particularly to lower socioeconomic groups in both urban and rural areas, is drastically improved, these groups will suffer from increasingly inadequate health supervision. This paper describes an educational and training program in pediatrics for professional nurses (the “pediatric nurse practitioner” program), which prepares them to assume an expanded role in providing increased health care for children in areas where there are limited facilities for such care.

Abstract P164: The Impact of the Expanded EVT Window on Acute Stroke Services: A Large Northwest Telestroke Network Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Theodore Lowenkopf ◽  
Leslie Corless ◽  
Elizabeth Baraban
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Treatment Time ◽  
Time Window ◽  
Tertiary Care ◽  
The United States ◽  
Geographic Region ◽  
Anterior Circulation ◽  
Stroke Subtypes ◽  
The Impact

Background: Telestroke has led the technological revolution in providing acute medical services to rural areas in the United States since the beginning of this century. In January 2018 the American Stroke Association made a level IA recommendation to expand the treatment time window for endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from 6 to 24 hours for anterior circulation stroke based on perfusion imaging. Our study is the first to our knowledge to report the effect of the expanded time window on acute stroke consult and treatment volumes in a large rural supporting telestroke network. Methods: Stroke registry data from two tertiary care facilities from a 22 hospital telestroke network supporting a large (> 78,000 mi 2 ) primarily rural Northwest geographic region were used. Data included stroke patients arriving within 24 hours of last known well (LKW) between January 2017 and March 2019. Patients arriving January 2017 to December 2017 were grouped into the PRE-expanded time window and those arriving April 2018 to March 2019 into the POST-expanded time window. Stroke subtypes, transfers, telestroke consults (via phone or video), and EVT treatments were compared across time periods. Analyses were performed using Pearson’s chi square test, corrected for multiple comparisons. Results: A total of 1117 patients arrived with stroke symptoms within 24 hours of LKW, 567 (50.8%) in PRE and 550 (49.2%) in POST-window. The percentage of all stroke subtypes were not significantly different in the PRE and POST patient groups (p=.720). However, the percent of telestroke consults increased by 12.1% from 62.3% to 74.4% (p<.001) but the percent of video consults remained similar (25.9% vs 25.8%). The total number of transfers (142 vs 141) and percentage of transfers among AIS patients (25.0% vs 25.6%) from partner to hub did not change. The percentage of thrombectomies among transfers rose by 8.7% with the expanded time window, but was not statistically significant [p=0.118]. Conclusions: In a large Northwest telestroke rural network the expanded EVT treatment time window led to a marked increase in all telestroke consults but did not impact video consults, transfer, or percentage of patients treated.

scholarly journals Characterizing the Rural Opioid Use Environment in Kentucky Using Google Earth: Virtual Audit

10.2196/14923 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14923 ◽  
Author(s):  
Natalie Danielle Crawford ◽  
Regine Haardöerfer ◽  
Hannah Cooper ◽  
Izraelle McKinnon ◽  
Carla Jones-Harrell ◽  
...  
Keyword(s):  
Health Care ◽  
Land Use ◽  
Substance Use ◽  
Rural Areas ◽  
Physical Environment ◽  
The United States ◽  
Google Earth ◽  
Health Care Facilities ◽  
Opioid Epidemic ◽  
Care Facilities

Background The opioid epidemic has ravaged rural communities in the United States. Despite extensive literature relating the physical environment to substance use in urban areas, little is known about the role of physical environment on the opioid epidemic in rural areas. Objective This study aimed to examine the reliability of Google Earth to collect data on the physical environment related to substance use in rural areas. Methods Systematic virtual audits were performed in 5 rural Kentucky counties using Google Earth between 2017 and 2018 to capture land use, health care facilities, entertainment venues, and businesses. In-person audits were performed for a subset of the census blocks. Results We captured 533 features, most of which were images taken before 2015 (71.8%, 383/533). Reliability between the virtual audits and the gold standard was high for health care facilities (>83%), entertainment venues (>95%), and businesses (>61%) but was poor for land use features (>18%). Reliability between the virtual audit and in-person audit was high for health care facilities (83%) and entertainment venues (62%) but was poor for land use (0%) and businesses (12.5%). Conclusions Poor reliability for land use features may reflect difficulty characterizing features that require judgment or natural changes in the environment that are not reflective of the Google Earth imagery because it was captured several years before the audit was performed. Virtual Google Earth audits were an efficient way to collect rich neighborhood data that are generally not available from other sources. However, these audits should use caution when the images in the observation area are dated.

scholarly journals Region wise referrals to a tertiary care centre: a retrospective analysis

2019 ◽  
Vol 8 (12) ◽  
pp. 4678
Author(s):  
Sirisha Paidi ◽  
Aashritha Thonangi
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Tertiary Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Urban Rural ◽  
King George Hospital ◽  
Tribal Areas

Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.

scholarly journals The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Eric L. Bloomfield
Keyword(s):  
United States ◽  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
Risk Analysis ◽  
Technology Assessment ◽  
The United States ◽  
Electronic Records ◽  
Care Services

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future.

Critical Challenges and Impediments Affecting Rural Physicians During a Public Health Emergency

2012 ◽  
Vol 6 (4) ◽  
pp. 342-348 ◽  
Author(s):  
Gavin J. Putzer ◽  
Mirka Koro-Ljungberg ◽  
R. Paul Duncan
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Associated Factors ◽  
The United States ◽  
Public Health Emergency ◽  
Care Providers ◽  
Rural Physicians

ABSTRACTObjective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.(Disaster Med Public Health Preparedness. 2012;6:342–348)

scholarly journals Palliative care in cardiac intensive care units (CICUs): Insights from the Critical Care Cardiology Trials Network (CCCTN) registry

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Fagundes Junior ◽  
DD Berg ◽  
EA Bohula ◽  
VM Baird-Zars ◽  
J Guo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Tertiary Care ◽  
The United States ◽  
Circulatory Support ◽  
Code Status ◽  
Funding Sources ◽  
Palliative Care Consultation ◽  
End Of Life Decision ◽  
Short Time

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Critical Care Cardiology Trials Network (CCCTN) registry Introduction Palliative care is a practice focused on providing relief of symptoms of illness, while optimizing the quality of life for patients and families. We aimed to quantify palliative care (PC) practices and end-of-life decision-making in critically ill cardiac patients in contemporary CICUs. Methods The CCCTN Registry is a network of tertiary care CICUs in the United States and Canada. Between 2017 and 2020, up to 26 centers contributed an annual 2-month snapshot of all consecutive admissions to the CICU. We captured code status, rates of palliative care consultation, and decisions for comfort measures only (CMO) before all deaths in the CICU.  Results    Of 8231 admissions, 10% ended with death in the CICU and 2.6% were discharges to hospice. Of deceased  patients, 68% were CMO before death. The median age of CMO patients was 70y (25th-75th: 59-78) vs. 67 (56-77) among deaths without CMO. In the CMO group, only 13% were DNR/DNI at admission, and the remainder were full code. Respiratory insufficiency and non-cardiogenic shock were the CICU indications most frequently associated with CMO. The median time from CICU admission to CMO decision was 3.4 days (25th-75th: 1.2-7.7) and was ≥7 days in 27% (Figure). Time from CMO decision to death was &lt;24h in 88%, with a median of 3.8h (25th-75th 1.0-10.3). Before a CMO decision, 73% received mechanical ventilation and 25% mechanical circulatory support. Of total deaths, 34% of intubated patients were palliatively extubated. Formal PC services were engaged in only 28% of deaths. Conclusions In contemporary CICUs, CMO preceded death in 2/3 of cases. The high use of advanced ICU therapies, lengthy times to a CMO decision, and the very short time from CMO to death, highlight a potential opportunity for greater PC consultation, as well as training programs to build skills in PC for practitioners in the CICU. Abstract Figure

scholarly journals Role of the Internet in Solving the Last Mile Problem in Medicine

10.2196/16385 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e16385
Author(s):  
Bradford William Hesse
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Rural Areas ◽  
Task Force ◽  
Digital Health ◽  
The United States ◽  
Good News ◽  
The Internet ◽  
Last Mile ◽  
Last Mile Problem

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the “last mile problem in health care.” In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission’s (FCC’s) Connect2Health Task Force, is the unanticipated emergence of “double burden counties,” ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at “point-of-need,” (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.

scholarly journals Evaluation of maternal mortality and their factors in GMCH, Aurangabad, India

2018 ◽  
Vol 7 (3) ◽  
pp. 879
Author(s):  
Ganesh Balasaheb Bharaswadkar ◽  
Murlidhar L. Kurtadikar
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Community Education ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Maternal Deaths ◽  
Infective Hepatitis

Background: Analysing the factors related to maternal mortality is very important as they reflect the socioeconomic status and health care facility availabilities of the country. This study is aimed to analyse the epidemiological aspects and different causes of maternal death and evaluation of preventable factors and unavoidable factors if any causing maternal death.Methods: The retrospective study was carried out at GMCH, Aurangabad during the period from February 2002 to January 2004. All the data related to epidemiological factors and causes of maternal mortality was recorded and analyzed.Results: There were 33 maternal deaths during the study period. The mean maternal mortality rate was 211 per 1,00,000 total births. Maximum maternal deaths were reported at the age group of 26-30 years (36.1%), in primiparous women (46.8%) and from rural areas (78.38%). Most of the deaths (37.5%) were reported within first 24 hours of hospital admission at postpartum stage (87.5%). 84.37% of maternal deaths were due to direct causes. And toxemia of pregnancy (39.5%) was major direct cause. Anaemia and infective hepatitis constitutes for 9.3% each for the indirect causes maternal death.Conclusion: Most maternal deaths can be preventable by multidisciplinary approaches involving mass community education, improving sanitation, early referrals to tertiary care centres and by providing health care facilities in rural areas.

scholarly journals Transportation and Other Nonfinancial Barriers Among Uninsured Primary Care Patients

2018 ◽  
Vol 5 ◽  
pp. 233339281774968 ◽  
Author(s):  
Akiko Kamimura ◽  
Samin Panahi ◽  
Zobayer Ahmmad ◽  
Mu Pye ◽  
Jeanie Ashby
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Unmet Need ◽  
Care Facility ◽  
Well Being ◽  
Safety Net ◽  
The United States ◽  
Free Clinic ◽  
Transportation Barriers

Introduction: Nonfinancial barriers are frequent causes of unmet need in health-care services. The significance of transportation barriers can weigh more than the issues of access to care. The purpose of this cross-sectional study was to examine transportation and other nonfinancial barriers among low-income uninsured patients of a safety net health-care facility (free clinic). Methods: The survey data were collected from patients aged 18 years and older who spoke English or Spanish at a free clinic, which served uninsured individuals in poverty in the United States. Results: Levels of transportation barriers were associated with levels of other nonfinancial barriers. Higher levels of nonfinancial barriers were associated with elevation in levels of stress and poorer self-rated general health. Higher educational attainment and employment were associated with an increase in other nonfinancial barriers. Conclusion: Focusing only on medical interventions might not be sufficient for the well-being of the underserved populations. Future studies should examine integrative care programs that include medical treatment and social services together and evaluate such programs to improve care for underserved populations.

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