Upload
vicky
View
50
Download
1
Tags:
Embed Size (px)
DESCRIPTION
The Hospitalized Officer. Protect Your Investment. Sarah Mildred Gamble, DO Police Surgeon / Greenwich Police Department / Greenwich / CT Clinical Instructor- Columbia University College of Physicians and Surgeons, NY, NY. Me. Board Certified Internal Medicine Physician - PowerPoint PPT Presentation
Citation preview
The Hospitalized Officer
Protect Your Investment
Sarah Mildred Gamble, DO
Police Surgeon / Greenwich Police Department / Greenwich / CT
Clinical Instructor- Columbia University College of Physicians and Surgeons, NY, NY
Me
• Board Certified Internal Medicine Physician• Police Surgeon- Greenwich, CT• Exclusive hospitalized patient care• Clinical Instructor for Internal Medicine-
Columbia University College of Physicians and Surgeons- NY, NY
Wife of S.W.A.T/S.R.U Officer
Disclosures
None
Objectives
• HIPAA Review• US Hospitals = Danger Zones• Why LEO’s get Hospitalized• Top 3 Hospital Dangers• Officer/Family Support Liaison • Chief Prevention Strategies
HIPPA
• Health Insurance Portability & Accountability Act
– Privacy– Security
Office of Civil Rights
• Enforce HIPAA Privacy– Protects individually identifiable health information
• Security Rule – National standard for electronic health information
• Confidentiality Provisions Patient Safety Rule – Protect identifiable information – Analyze patient safety events
HIPAA Privacy
• Electronic / Written / Oral Information
• 12 national priority purposes allowing disclosure of medical information
Oops, My Bad…
HIPAA applies to:
Doctors
Health Insurance Companies
Health Care Clearing House
Doc to Brass…
• Serious Threat to Health or Safety
• Prevent/lessen serious and imminent threat to a person/public
• Made to someone they believe can prevent/lessen the threat (Brass)
Doc to Brass…
• Judicial & Administrative Proceedings
• Order from court / administrative tribunal
• Subpoena
• To protect the health and safety of inmates
But if I Know…
• Cocaine/heroin/PCP • Contagious• Multiple (vs. 1st) DUI’s• Homicidal• Uncontrolled medical issue:
– diabetes – seizures – bleeding/clotting disorder
Just the Facts Ma’am
• Minimum Necessary
• To accomplish the intended purpose of the use/disclosure/request
• Not the whole record
GINA
• Genetic Information Nondiscrimination Act• Acquisition of employee genetic information• Unlawful• If you already have it
– Keep it separate – Not in regular accessible employee file
Health is Wealth
• Open the discussion
• This is first generation to DIE before parents
Extrapolate This…
LEO’s Illness/Injury
Poor Follow Up causes improper RTW
RTW Without Education
Ill/Injured LEO’sget Hospitalized
Hospitalized LEO’sget Complications
Complications Delay Discharge
Bad Dischargeleads to Poor Follow Up
LEO’s have Significantly Higher…
• Stress Levels• PTSD / Depression• Suicide Rates• Divorce
On the Job Injury
&
Chronic Disease
How Was GPD Last Year?
• Muscle/Bone (sprains/strains): – 54% – 90% while on the job
• Trauma: – 36%– 93% while on the job
• Atherosclerotic Disease: – 10%– 50% while on the job
Cold Hard Facts
• Your LEO’s get INJURED
• Your LEO’s are OBESE
• Your LEO’s get CHRONIC DISEASE
Physical Deconditioning Hurts!
• Pursuit Issues• Effecting Arrest• Sprains and Strains
Obesity Hurts!
• #1 Cause: back injury / all cause injury
• Degenerative Joint Disease / Arthritis
Chronic Disease Hurts!
• Incidence is on the rise 50%
• Using up – Medical benefits – Sick time / personal day / vacation time– Short term disability claims – Long term disability claims– Early retirement– Early pension
Chronic Disease
• CAD• Diabetes Type II• High Blood Pressure• High Cholesterol• COPD / Asthma
1/3 of All Cause Mortality
Tobacco Abuse
Physical Inactivity
Poor Eating Habits
Obesity
Alcohol Abuse
Stress
Injured/Ill LEO Must Go…
• Off to the Hospital
• Vulnerable / Unprotected
• In Danger
Top 3 Hospital Dangers
• Hospital Acquired Infections
• Wrong Drug / Wrong Dose
• No Planned Follow Up
Hospital Danger #1
Hospital Acquired Infections
Skin / Soft Tissue
Blood
Urine
C. difficile Diarrhea
Ventilator
Hospital Danger #2
Medication Error
Wrong Medication
Wrong Dose
Hospital Danger #3
Poor / No Discharge Plan
No scheduled follow up
Poor pain management
Prescription compliance
Break the Cycle!
LEO’s Illness/Injury
No Complications + LiaisonTimely/Proper Discharge
RTW With Illness/InjuryEducation
Ill/Injured LEO’sget Hospitalized
Hospitalized LEO’sget Liaison
Liaison provides2 and 3
Intervention
Intervention Mitigates Complications
Officer/Family Support Liaison
• Role is to standardize the process and improve care rendered
• Must have some medical knowledge
• PS/Occ Health/PA/NP/RN
Liaison Responsibilities
• Admission• Daily visits- communication• Educate LEO/Family (hand washing/meds/find a PMD)
• Discharge Planning• Weekly contact LEO on sick leave/light duty • Once LEO Full Duty… Can sign off case
No Liaison
• 55yo LEO no PMD to follow department physical results for 20 years
• Lost consciousness on patrol• Admitted: BS critical high, kidney failure, almost
complete vision loss• Contracted blood infection from central line• Prolonged stay for 2 weeks• Poor discharge- no PMD, blind,3 flights of stairs,
didn’t fill meds• END RESULT: Disability, dialysis, almost dead
With Liaison
• 26yo LEO emergency sx aggressive spinal tumor• Speak with NES / ONC day of admission• Translate to LEO and family progress/diagnosis• Tumor Board organized to discuss case• Second opinion arranged • NES no ins on follow up / assisted with billing• Narcotic management, physical therapy compliance,
light duty, full duty• 1st year follow up- doing great!
Liaison Leads Return to Work Program
• Within 7 days of discharge• Not if contagious or open wounds• Specific light duty for recovering LEO• For Patrol (SWAT/SRU stricter guidelines)• Narcotic Use Agreement• Establish PMD / Follow Up• Medication Compliance• Physical / Occupational Therapy Compliance
The Bottom Line is…
• Standardize care: policy and procedure• Human capital: investment to be managed• Money for REACTIVE CARE
– Barriers to health / Worsen clinical outcomes
• Money for PROACTIVE CARE– Educate– Diagnose early– High quality care
Chief Then Please…
• Be Responsible and Educate• Direct the Health Care• Keep them out of Danger!
Non Hospitalized LEO
• Physically fit: appropriate physical activity
• No tobacco / illicit drugs
• Preventative health
• Psychologically handle highly demanding job
• Safe and healthy work environment
• Respond positively to changes
Healthy Cops
Are Productive Cops!
What Are You Waiting For?
• Shoulder / Hip / Knee Replacement• Spinal Disc Herniation• Degenerative Joint Disease• Stroke / Heart Attack• Morbid Obesity• SUPER Morbid Obesity
Summary of Main Points
• LEO’s have high rates of Illness/Injury• Ill/Injured LEO’s go to the Hospital• Hospitals = DANGER• Officer/Family Support Liaison protects your
investment from Danger• Simple low cost education/screening breaks
the cycle
Our Team
• Contact # provided memo/email quarterly• Desk sergeant / dispatchers • 24 hour answering service• Email accounts- urgent vs. routine• Facebook- weekly health updates• Contact WITHIN department• Captain Hero
Areas for Future Research
• Department Specific Data• Unit Specific Data
References
• Violanti et al, BCOPS, Ann Epidemiol. Vol 16 no 2, Feb 2006• Kunen et al, JOEM, vol 51, no 9, Sept 2009• Stuart, COP, vol 21, no 5, Sept 2008• Loeppke et al, JOEM, vol 51, no 4, April 2009• Franke et al JOEM, 52(5):561-565, May 2010• www.healthypeople.gov• www.cdc.gov• www.fbi.gov• www.leoka.org• JOEM, 51(6):700-707, June 2009.• www.businessgrouphealth.org• US Department of Labor-Bureau of Labor Statistics. Occupational
Outlook Handbook, 2008-09 Edition • US Department of Labor-Bureau of Labor Statistics. Police and
Detectives. Washington, DC; 2008-2009 Edition • Ramey et al, AAOHN, vol 57, no 11 nov 2009• Franke et al, JOEM, vol 40, no 5, May 1998
Contact Me
• 203-962-1009 office
• 11 Bruce Place / Greenwich / CT / 06830
• www.PrecinctMedicine.com