Innovation for Improved Care
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/ Categories: NEWS, 2019

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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Moving Forward Safely

One of the most frustrating and anxiety-producing traits of our COVID –19 pandemic is how much uncertainty is involved in all aspects of this disease. Symptoms caused by the Coronavirus, age groups affected, the usefulness of medications, anticipated death rate, and the timeline for development of a vaccine are examples of information that sometimes change on a weekly basis.

Vermonters have done a great job of limiting the spread of the virus and protecting our most vulnerable neighbors by following the Governor's "Stay Home, Stay Safe" order over the past few months. Now, we've all been directed to wear masks in public. Both Bennington and Wilmington's Select Boards have passed local mandates requiring masks in public places. Thanks to these efforts—along with distancing, handwashing, and other factors—Vermont is among the states with the fewest number of infections. Continuing each of these important infection-prevention strategies is crucial to returning to a more normal way of life.

As we open up and begin to re-connect, we fully expect to see a rise in COVID –19 cases in Vermont. Thankfully, we have had time to prepare for this increase. We also have adequate PPE, and increased testing will help us gather crucial information for stemming the spread with less disruption to our normal lives.

More than ever, I find it helpful to focus on what we have learned and how it can help us move forward safely. Here is some of what we have learned so far: Most large hospitals, often treating over 1000 COVID patients daily, effectively protected their workers by obsessively following the rules of screening, hygiene, distancing, and masking. Each of these components is designed to work together; Each alone has its inherent limits.

  • Absent quick testing at the workplace, the best screening is asking employees if they have COVID-like symptoms (fever, chills, new cough, shortness of breath, sore throat, loss of taste or smell) and to stay home if they do.
  • Washing our hands (or using sanitizer) after touching well-handled items or visiting populated areas. Washing your hands 10 times daily is not too often.
  • Though an uncovered sneeze or cough can travel farther, 6 feet distancing continues to be the sweet spot for safety.
  • Masks (double layer cotton and surgical) are effective to prevent spreading of large and some small droplets containing virus. They also seem to give some minimal protection to those wearing a mask. Since possibly 40 percent of transmission happens when we do not have symptoms, we wear our masks to protect others and to suppress overall infection rate. They also help many people (not all) to avoid touching their face. The downside is a warm chin; the upside is you may be protecting someone from a significant illness. Masks are not a symbol of government intrusion. Masks are simply a tool to protect others and show empathy.

It is difficult to predict how many COVID-19 infections will occur in our communities in the coming months. What I am certain of is that our choices, on where we go and what we do, often affect the safety of those around us. As we learn to live with this virus in our community, following the recommendation above will help us all.

Marie George, MD, is SVMC’s infectious disease specialist.

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