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The Hospitalized Officer Protect Your Investment Sarah Mildred Gamble, DO Police Surgeon / Greenwich Police Department / Greenwich / CT Clinical Instructor-

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Presentation on theme: "The Hospitalized Officer Protect Your Investment Sarah Mildred Gamble, DO Police Surgeon / Greenwich Police Department / Greenwich / CT Clinical Instructor-"— Presentation transcript:

1 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

2 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

3 Disclosures None

4 Objectives HIPAA Review US Hospitals = Danger Zones Why LEO’s get Hospitalized Top 3 Hospital Dangers Officer/Family Support Liaison Chief Prevention Strategies

5 HIPPA Health Insurance Portability & Accountability Act –Privacy –Security

6 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

7 HIPAA Privacy Electronic / Written / Oral Information 12 national priority purposes allowing disclosure of medical information

8 Oops, My Bad… HIPAA applies to: Doctors Health Insurance Companies Health Care Clearing House

9 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)

10 Doc to Brass… Judicial & Administrative Proceedings Order from court / administrative tribunal Subpoena To protect the health and safety of inmates

11 But if I Know… Cocaine/heroin/PCP Contagious Multiple (vs. 1 st ) DUI’s Homicidal Uncontrolled medical issue: –diabetes –seizures –bleeding/clotting disorder

12 Just the Facts Ma’am Minimum Necessary To accomplish the intended purpose of the use/disclosure/request Not the whole record

13 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

14 Health is Wealth Open the discussion This is first generation to DIE before parents

15 Extrapolate This… LEO’s Illness/Injury Ill/Injured LEO’s get Hospitalized Hospitalized LEO’s get Complications Complications Delay Discharge Bad Discharge leads to Poor Follow Up Poor Follow Up causes improper RTW RTW Without Education

16 LEO’s have Significantly Higher… Stress Levels PTSD / Depression Suicide Rates Divorce On the Job Injury & Chronic Disease

17 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

18 Cold Hard Facts Your LEO’s get INJURED Your LEO’s are OBESE Your LEO’s get CHRONIC DISEASE

19 Physical Deconditioning Hurts! Pursuit Issues Effecting Arrest Sprains and Strains

20 Obesity Hurts! #1 Cause: back injury / all cause injury Degenerative Joint Disease / Arthritis

21 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

22 Chronic Disease CAD Diabetes Type II High Blood Pressure High Cholesterol COPD / Asthma

23 1/3 of All Cause Mortality Tobacco Abuse Physical Inactivity Poor Eating Habits Obesity Alcohol Abuse Stress

24 Injured/Ill LEO Must Go… Off to the Hospital Vulnerable / Unprotected In Danger

25 Top 3 Hospital Dangers Hospital Acquired Infections Wrong Drug / Wrong Dose No Planned Follow Up

26 Hospital Danger #1 Hospital Acquired Infections Skin / Soft Tissue Blood Urine C. difficile Diarrhea Ventilator

27 Hospital Danger #2 Medication Error Wrong Medication Wrong Dose

28 Hospital Danger #3 Poor / No Discharge Plan No scheduled follow up Poor pain management Prescription compliance

29 Break the Cycle! LEO’s Illness/Injury Ill/Injured LEO’s get Hospitalized Hospitalized LEO’s get Liaison Liaison provides 2 and 3 Intervention Mitigates Complications No Complications + Liaison Timely/Proper Discharge RTW With Illness/Injury Education

30 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

31 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

32 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

33 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 1 st year follow up- doing great!

34 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

35 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

36 Chief Then Please… Be Responsible and Educate Direct the Health Care Keep them out of Danger!

37 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

38 Healthy Cops Are Productive Cops!

39 What Are You Waiting For? Shoulder / Hip / Knee Replacement Spinal Disc Herniation Degenerative Joint Disease Stroke / Heart Attack Morbid Obesity SUPER Morbid Obesity

40 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

41 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

42 Areas for Future Research Department Specific Data Unit Specific Data

43 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 JOEM, 51(6):700-707, June 2009. 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

44 Contact Me 203-962-1009 office 11 Bruce Place / Greenwich / CT / 06830

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