Fall, 99
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2000 JCAHO Workshops
The Arkansas Hospital Association will sponsor in 2000 the following workshops offered by the Joint Commission on Accreditation of Healthcare Organizations. All three workshops will be presented in Little Rock.

January 28
Performance Measurement & Performance Improvement in all Home Care and Hospice Organizations
(Addresses JCAHO 1999-2000 accreditation standards for IOP and related standards; leadership role in selecting an approach to process improvement, setting priorities, and creating a corporate culture; quality improvement tools and measurement techniques; and performance measurement requirements of the JCAHO ORYX initiative.)

March 31
Team Approach to Conducting a Root Cause Analysis
(Participants will utilize case studies and tools during hands-on practice sessions to conduct a root cause analysis.)

August 10
Hospital Accreditation Standards and Survey Process: The Advanced Course
(Addresses survey process and standards including: standards that most frequently receive "Type I" recommendations; highlights of changes in standards and survey process for the upcoming year; strategies for successful survey outcome; and "scoring changes" that can impact your organization's accreditation score.)

Arkansas Tobacco Money Timeframe
A task force of 20 members of the Arkansas House of Representatives began meeting in August to decide on plans for both receiving the state's $1.62 billion tobacco settlement money and spending it. At the same time, they were faced with questions about when the state's share will be available.

According to the Arkansas Attorney General's office, in order for any state to begin receiving its share of the settlement funds, it must achieve a status called "state specific finality" (SSF). Forty-two states have achieved that status. Arkansas is not among those states, although it has about $20 million in escrow for 1998.

If Arkansas obtains the SSF status by June 30, 2000, it will be eligible to begin receiving money the next day, July 1. The single obstruction to Arkansas getting its SSF is a disagreement between the state and a California law firm that says it has a contract with former state Attorney General Winston Bryant entitling it to a substantial percentage of the state's share as legal fees.

Current Attorney General Mark Pryor is contesting the alleged contract, meaning a final decision will probably come through the courts. If the dispute is not settled in or out of court by next June 30, receipt of the money will be delayed until a final decision is made.

Transitioning for Patient Discharge
According to the Picker Institute of Boston, Massachusetts, patients report significant dissatisfaction with the discharge process. Picker research finds that patients leave the hospital not understanding their medications or the side effects to watch out for, lacking knowledge of danger signals and without knowing when they can resume usual activities.

Improving the discharge experience for patients is everyone's job. Improvements may require systematic, multi-level process changes that involve various departments and providers or may be the result of a few simple interventions. A study done by Brigham and Women's Hospital and Harvard Community Health Plan, for example, found that a patient's discharge experience can be improved by clarifying who is responsible for making the decisions and follow-up care.

Other simple strategies may include involving family members more directly, or reducing the amount of time a patient must wait for such things as an escort to the lobby or for their medications. It is also important to patients that their primary physician is informed about their hospitalizations so they can transition smoothly from the hospital to the community.

Other suggestions:

  • Use pre-hospital telephone calls to identify post-hospital needs and concerns.
  • Increase patient responsibility to closely mimic the "real world"
  • Telephone patients after discharge to provide education and support
  • Offer a telephone information service to answer questions and provide information about community resources.
  • Use volunteers or home health aides to facilitate the transition to home.
  • Share clinical pathways with patients as part of pre-admission work-up so they know exactly what to expect.

New Information Available on Prospective Employees
Arkansas Act 1474 of 1999, the Quality in Hiring Act, enables employers to receive accurate and reliable job performance information about prospective employees. Under the act, current or former employers will be immune from any civil liability for either the disclosure of employment history, or any consequences that arise from the disclosure of employment history; unless generally the employee can prove that the information disclosed was false and the employer knew it was false. Now, employers may disclose the following information:

  • Date and duration of employment
  • Current pay rate and wage history
  • Job description and duties
  • The last written performance evaluation prepared before the date of the request
  • Attendance information
  • Results of drug and alcohol tests administered within one year before the request
  • Threats of violence, harassing acts, or threatening behavior related to the workplace or directed at another employee
  • Whether the employee was voluntarily or involuntarily separated from employment and the reasons for the separation
  • Whether the employee is eligible for rehire

Employment applications should include a consent form, which is separate from the application. The consent form should state the following information:

I, (applicant) give consent to any and all prior employers to provide information with regard to my employment with prior employers to (prospective employer).

The consent must be signed and dated by the applicant. The consent is valid for the length of time that the application is considered active by the prospective employer, but no longer than six months.

For a copy of Act 1474, go to www.arkhospitals.org. Click "Governmental Issues" and, then "Arkansas General Assembly, January 1999." Under "view act," enter "1474" and click on "submit."

National Healthcare Spending Projections
A new report by the Health Care Financing Administration (HCFA) projects that national healthcare spending will grow over the next eight years more slowly than originally thought. The new projections by HCFA's Office of the Actuary says spending will increase at a 6.5% rate between 1997 and 2007. Last year the office projected growth for the period at 7% per year.

The downward revision reflects slower-than-expected Medicare spending in 1998 and slower projected growth in both private and Medicare spending in the latter five years of the projection period. By 2008, total national healthcare spending will double to $2.2 trillion, representing 16.2% of the nation's Gross Domestic Product, according to the report, which will be published in the July/August 1999 summer issue of Health Affairs.

HCFA actuaries project faster growth in private spending due to sharper increases in private health insurance costs next year and a continued upward spiral in prescription drug costs. Medicare spending should ease overall growth. The revised projections show those expenses growing at a 4.5% clip between 1997 and 2000, down from the previous estimate of a 5.1% annual growth rate.

JCAHO, Health Department Meet
Act 506 of 1999 provides for the voluntary substitution of hospital surveys conducted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for surveys conducted by the Arkansas Department of Health (ADH). In other words, JCAHO-accredited facilities may elect to avoid a duplicative regulatory survey by the ADH.

To help ensure a smooth transition for hospitals that choose this survey option, representatives of the Joint Commission met recently with the full survey team of the ADH to discuss the survey process and how the new arrangement will benefit hospitals in the state.

The JCAHO team provided details about the organization's standards and survey process; surveyor education and training; accreditation categories, policies, and procedures; continuous survey readiness program; public release of information; publications; and information about their Web site, www.jcaho.org.

Access Arkansas Data Via Internet
Since 1993, the Arkansas Hospital Association has published the quarterly magazine, Arkansas Hospitals. In each of those years, the summer issue of the magazine has been dedicated to information about the state's hospitals. That is true of the Summer 1999 issue, which was distributed in July.

Because the summer magazine contains a wide array of general information, comparative data, and statistics about Arkansas' hospitals, it has historically been one of the most requested of all AHA publications. The complete set of information is now available via the AHA's Web site.

The site includes tables and charts showing hospital utilization trends, financial indicators, state-by-state comparisons of hospital costs and charges and selected indicators per 1,000 population. It also shows which hospitals are members of larger systems, both for-profit and not-for-profit, and gives a brief synopsis of services available in each AHA-member hospital.

To find the information on the Web site, go to www.arkhospitals.org, click on "publications," then click on "Arkansas Hospitals Magazine Archive," and choose "Summer 1999." Questions should be directed to Paul Cunningham at (501) 224-7878.

HMO Pulling Medicare Plans
Several of the largest Medicare health maintenance organizations (HMOs) in the U.S. issued announcements June 30 and July 1 that they will pull their plans from select Medicare markets, effective January 1, 2000. Altogether, nearly 100 plans are set to pull out of the Medicare program or reduce the size of their service area. The Pullouts will affect about 325,000 Medicare beneficiaries, according to figures published July 15 by the health Care Financing Administration. Two thousand of the beneficiaries live in Arkansas.

Karen Ignagni, president of the American Association of Health Plans, said all 6.2 million Medicare managed care beneficiaries will be impacted by the loss of available HMOs through a combination of premium increases and benefit reductions, and that 79,000 enrollees in managed care plans will be forced back into Medicare's fee-for-service program. According to Ignagni, the pullouts are caused by three factors: insufficient Medicare managed care payments, added regulatory burdens and increasing provider costs.

Plane Crash Tests Skills of Local EMS Providers
By Natalie Gardner

Getting a call in the middle of the night is not unusual for an emergency room physician. So, when Dr. Marvin Leibovich, medical director of the emergency department at Baptist Medical Center, got a call late June 1, he wasn't expecting what he heard on the other end of the line.

"The hospital called me--I had already gone to bed and was asleep-- just to let me know our internal disaster plan, a Red Alert, had been issued. There had been a crash out at the airport and they were expecting multiple casualties."

While Dr. Leibovich was getting ready to go to Baptist, he received another call from the Little Rock Police Department. Dr. Leibovich, also a Little Rock police officer, was asked to come to the scene and help with the many seriously injured.

Even though Dr. Leibovich has been involved with many disasters through the years, including January's tragic tornado [in Little Rock and the surrounding area], he wasn't ready for what he saw at the Little Rock National Airport.

American Airlines Flight 1420 crashed during a severe thunderstorm. Broken in half, the jet slid off the runway toward the Arkansas River. The crash killed 11 and seriously injured several.

"When I got there, there was already a sea of red lights from rescue personnel," Dr. Leibovich said. "The plane was off the approach way of the runway, badly mangled and broken in sections. There was a fire that had just been extinguished. All around were these colored tarps, signifying the different levels of injuries."

Although most of the seriously injured passengers had been triaged and evaluated when Dr. Leibovich arrived, rescue personnel continued searching the site looking for any passengers that might have been ejected from the plane.

"There was an excellent lighting system in the plane, but if you stepped a few feet away from the plane, you were in total darkness," he said. "That and the torrential downpour made it difficult."

Dr. Leibovich helped with the 40-50 people with minor injuries. They were quickly taken to nearby hospitals.

Lessons Learned
Planning was the key to successful implementation of the disaster plan. Working together, hospital staff, police, firefighters and paramedics got injured passengers the help they needed quickly, Dr. Leibovich said. "We could learn a lot from the lessons of this tragedy," he said. "Had it not been for planning, things could have been a whole lot worse."

Quicker notification about the disaster to emergency medical service providers and area hospitals could have assisted emergency response, Dr. Leibovich said. "But overall, things were handled very well, and there were no lives lost because of a delay," he said.

Preparing for Disaster
Little Rock's last plane crash occurred almost 10 years ago when an Eastman Kodak corporate jet crashed with seven on board. Yet, American Airlines flight 1420 had 139 passengers. Even so, healthcare providers and rescue personnel were ready.

The airport is required to schedule a disaster drill very three years, which includes participation from city EMS providers. Area hospitals are required by their certifying agencies to conduct internal disaster drills twice a year.

"Fortunately, all hospitals implemented their internal disaster plans," Dr. Leibovich said. "At our hospital, there was an excellent response. Trauma surgeons were all in, orthopedic surgeons were here waiting on patients, and we had excellent response by emergency nursing staff. Administration was extremely supportive of us. And talking with other hospitals and physicians, they all had a good exercise.

"It was very fortunate, in this particular aircraft accident, that there had been a degree of deceleration before impact occurred. Had that impact occurred initially, most of the people would have died in that crash. We were very fortunate, that unlike other crashes with 75 or so critical patients, we didn't have that many and we were able to keep up with the injuries."

Reprinted from the Journal of the Arkansas Medical Society, July 1999

Little Rock Hospitals Respond Following Crash
Once again, Arkansas hospitals and the people who work in them were called on to provide care in a time of tragedy, and once more they responded quickly and professionally when the call came, just before midnight June 1.

This time, the hospitals were in Little Rock and North Little Rock and the tragedy was the first-ever commercial airline accident to occur at the Little Rock National Airport. Within minutes after American Airlines Flight 1420 crashed and burned when landing at the airport, area hospitals had implemented their external disaster plans.

Codes and alerts were issued and call-trees activated; emergency teams - surgeons, emergency physicians, residents, nurses, and all the necessary support staff - began assembling at the hospitals to meet incoming ambulances, just as they've practiced time after time over the years. Inside, rooms were prepared and supplies that might be needed were brought into the hospitals' emergency areas.

The routine was the same as for other disasters, which, in Arkansas, are normally caused by severe weather. But, according to Dr. Carolyn Haynes, a physician at University Hospital, the types of injuries were different. Haynes said the injuries more closely resembled a massive high-speed car accident.

Eighty-six of the 145 passengers and crew who were aboard the aircraft were transported for emergency care to Arkansas Children's Hospital, Arkansas Heart Hospital, Baptist Medical Center, Baptist Memorial Medical Center, St. Vincent Infirmary Medical Center, Southwest Regional Medical Center, and University Hospital.

At the hospitals, the patients were triaged to identify the nature and seriousness of their injuries, prioritized and routed to physicians who assessed and treated their injuries, which ranged from broken bones to major chest and head trauma. Most of the injured were treated and released, but 34 patients were admitted to the hospitals, including two passengers who suffered burn injuries. Eleven people died from injuries suffered in the accident.
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