Innovation for Improved Care
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Innovation for Improved Care

In the fourth quarter of 2018, just 3 months, United Counseling Service completed 294 crisis evaluations on children with psychological distress who were patients in the Emergency Department at Southwestern Vermont Medical Center (SVMC). To maintain their safety, the children are asked to change into a gown. Their personal belongings are removed. The experience can further traumatize those who are already having emotional and behavioral difficulty. After all of that, 82 percent were released to their homes.

Staff at SVMC and United Counseling Service recognized that the Emergency Department is not the ideal place to care for patients with these symptoms. They created the UCS/SVMC Youth Psychiatric Urgent Care Model and applied for a $125,000 grant from OneCare Vermont to fund the project.

More than 30 applications were submitted, and just three projects we awarded funds to implement their ideas. The funds established and staffed a Youth Psychiatric Urgent Care Center, a home-like environment stocked with kid-friendly activities. The Center partnered with a single referring site, as a test, and has been accepting patients since September.

In the past, staff at the site would have called the police or 9-1-1 for a child experiencing a psychiatric event. The child would have been brought to the Emergency Department. Now, instead, the site calls the Center. From there, the child can be treated by UCS’s specialists and, in the greatest number of circumstances, make a plan to return home.

“The new way of handling these cases is better for children and families, because the treatment matches their needs more closely,” said Jill Maynard, RN, BSN, CEN, SANE, director of Emergency Nursing at SVMC and one of the authors of the project.  “In addition, it improves care for all by making better use of the Emergency Department, freeing it up for patients who need the type of care it is equipped to provide.”

“Children who are seen in Emergency departments for a mental health concern are often traumatized by the very intervention we provide,” said Lorna Mattern, executive director of United Counseling Service. “We are now able to provide the right care in a therapeutic environment that improves outcomes for children and reduces cost.”

If found to be feasible, the program will become permanent and expand to additional referral sites. One day, the originators of the program would like to replicate the it to serve adults as well.

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Six Questions with the Medical Director of SVMC Orthopedics

Dr. Michaela Schneiderbauer, medical director of orthopedics and orthopedic surgeon, answers six questions about getting orthopedic care right now.

1. What types of patients are you able to treat right now?

We are happy to see patients with all sorts of conditions returning to the practice for care. Patients have heard that the Governor has lifted restrictions for elective procedures, and they are ready to investigate their options for joint pain relief. Plus, the weather is getting nice again, so people are active outside. We've seen an increase in injuries related to outdoor activity, too.


2. Are you seeing patients remotely via telemedicine?

Yes. We offer telemedicine, and we use it a lot. Of course, there are limitations for those that need an X-ray or a physical exam. But telemedicine is a great option for initial visits when we need to collect patients' health history and for follow-ups.


3. How has care in the office changed over the past several months?

Patients will notice that we have gone beyond all of the Centers for Disease Control and Vermont Department of Health recommendations for office visits. All of our staff are wearing masks and shields or goggles, and patients are expected to wear a cloth face covering when they come in. In addition, we are making efforts to limit the number of people in our waiting rooms and office at any one time. For example, part of the check-in process now happens on the phone, instead of in person.


4. How is preparing for a surgery and recovering from a surgery different since COVID-19 became a concern?

Like for office visits, our pre-surgery processes have all been ramped up well beyond the state and national recommendations designed to decrease risk of contracting COVID-19. A few days before the surgery, we test patients for COVID-19 and ask them to self-quarantine until their procedure. The patient arrives to the hospital in their own cloth face covering. Visitors are limited. After the procedure, we provide patients with an app that allows them to note their temperature and any type of respiratory symptoms for a few weeks. If any of the information falls outside the norm, a nurse gives the patient a call. These are all examples of ways we are going beyond our very high infection-prevention standards to ensure safety for patients, their families, and our staff.


5. What would you like to share with people who postponed a joint replacement or other orthopedic care because of COVID-19?

Here in Vermont cases of COVID-19 cases have been relatively low. The Governor has given his approval by lifting restrictions for elective procedures, even those requiring an overnight hospital stay. SVMC started with an exceptionally low rate of hospital-acquired infections and added many extra precautions on top of that. We have the attitude that it is definitely safe to resume care both surgeries and other types of orthopedic care.


6. What are the greatest risks and rewards related to having orthopedic care now?

From our position as one of the safest hospitals in one of the safest states, the risks of contracting COVID-19 and other illnesses during a procedure or other care are very low. Many patients know this. They are coming in for their procedures and joint replacements. Many of them will recover and be active again in time to really enjoy this summer. That’s our goal: to help every patient resolve their orthopedic issues so that they can get back to doing the things they love.

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