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February 23, 2012 Ambulatory Care

Outpatient

Same day, patients dont stay overnight Every doctors office is an ambulatory care center

OT, LPT, Speech, Psych, Rehab include both Inpatient and Outpatient depending

Homecare

Visiting nurses Privately owned business Provide nurses for patients who are home bound

EMSS Emergency Medicine Services System

The system that we know as the emergency room All hospitals have it Where most impatient come in Important department for administration

If you were asked to put together an emergency room what would be included?

Comes from the EMSS Act of 1973o Legislation from Congress that dictated what needs to be there

First person you see in an Emergency Room is a Trauma Nurseo Perform Triage

Nonurgent the person is not in a life or death situation. Dependant on vital signs and other behaviors

Urgent patient is not in a life or death situation but still important EmergentPatient is in a life or death situation and needs to be stabilized ASAP

Labor is emergent but also dependant on how far dilated One of the biggest problems in ER is the backlog, where patients are seen later than they should be.

o This is because emergency rooms are overcrowded.o Because Emergency rooms are overcrowded they created the Emergi-Center

Self standing In this case only the nonurgent and Urgent patients are seen here, thus hospitals are better able

to control Emergent patients.

1. Must have adequate labor forcea. Must have enough people workingb. Scheduling is importantc. Emergency Medicine Doctors

2. Everyone working in ER must be trained and able to do CPR and use a Defibrillator.3. Must be connected to a 911 system.4. Must be connected to a transportation system.

a. Volunteer serviceb. Fire department paidc. Private ambulance service

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5. Must have proper facilitiesa. Equipment, updated hospital, beds

6. Must have at least one CCUa. Where most critical care patients can be taken

7. Must be connected to a Public Safety Unita. Police + Fire

8. Must get community feedback at least once a year and do something about it.a. Focus groups

9. Obligated as a hospital to educate about what happens in the ER10.Accessibility

a. Must be open 24/7b. Not allowed to turn away any patient

i. Especially if the hospital is using Government money.ii. Whether the patient can pay or not

11.Transferring Patientsa. Stabilizing the patient

i. No longer in danger of losing their lifeb. Critical vs. Stablec. If patient is stabilized they are allowed to leave this hospital and go to another and ambulance must be

able to do this.

12.Every ER must keep every patient report and must be kept in the same way Standardizeda. Must be able to transfer information to another hospital

13.Disaster Linkagea. Hospitals must work togetherb. Could not say no to patients and must take every patient in.c. Mutual Aid Agreement

i. Municipalities must help with each other1. Cheltenham must help Abington

14.Must be evaluated at least once a year.1966 National Safety Highway Act

Out of this came the seat belt law and the speed limit law Before 1966 there was no speed limit Today speed limit on a highway is 65 mph and it used to be 55 mph. 1976 is when they made it mandatory to wear seat belts Physicians now are responsible to ask if the child wears their seat belt and that they wear a bicycle helmet

1973 Emergency Medical Services Act

EMT One of the most well trained Emergency Practitioners

Sometimes has more scope than a nurse EMTs are now able to start Emergency Care as soon as they see the patient

o Allowed to cut them open if they have to.o EMT would call in as they see the patient explain vital signs, etc.

Educationo 185 Hours Standard Course makes them an EMT

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o +81 Hours makes them an EMTA.o +81 Hours makes them an EMTBo +1000 Hours makes them an EMT Paramedic

Highest amount of scope next to a doctor. Ally to Emergency Services

February 28, 2012 Continuum of Long Term Care

Long Term Care caring for a person who has lost or never had the ability to care for themselves in terms of health,

personal care socialization, housing, accessibility, due to a physical or mental illness.

Focus primarily on elderly Includes babies born Stroke patients They need a caregiverOccupational Therapy Activities of Daily Living

1. Home/ Apartment living independently2. Retirement Living people have stopped working, have a simpler lifestyle and in this community everything is

done for them.

3. Assisted Living medical help is available on premises. Caregiver comes to work.4. Special Care

a. Nursing Home privately owned business with beds and roomsi. Can be characterized by beds

ii. Fully staffed clinical care giversiii. Have become very selective

1. Thus some patients arent able to have access & other methods (below) needed to beinvented.

b. Adult Day Care a bus picks up patient takes them to a center where they are well taken care of and wilbe dropped off home later. Family must pay for this program.

c.