Archive for the ‘Critical Access Hospitals’ Category

Hospital Participates in County-wide Ebola Drill
—Posted Friday, November 21st, 2014 at 2:12 pm— « »

Demonstration of use of Personal Protective Equipment (PPE)

During Thursday’s county-wide Ebola drill, MCDH Housekeeper Rosa Ramos demonstrates the personal protection equipment (PPE) that would be used to keep Hospital staff safe from viral contamination in the event of the arrival of an actual Ebola patient. In addition, a respiratory hood would be added to ensure a fresh air supply.

Fort Bragg, California – November 21, 2014 — “Patient arrives at the Emergency Room; temperature 102.3◦ F, with nausea, vomiting, abdominal pain. . . .” This scenario happens hundreds of times a year at the hospital.  However, this could be something much more serious than a case of the flu. Ebola Virus Disease (EVD) can present in much the same way. For that reason, Mendocino Coast District Hospital participated in the Mendocino County 2014 Statewide Medical and Health Functional Exercise.

During the exercise, Dr. Keith Curtis, an Emergency Medicine physician, nursing staff, and clerical support staff were challenged with an unannounced visit Thursday, November 20, from a person posing as a patient suffering symptoms of Ebola infection. Dr. Curtis and the nurses rapidly identified the serious condition of the mock patient by evaluating the patient’s recent travel history to Liberia in West Africa and the array of symptoms that were reported to the registration clerk. The nurse activated the Hospital Incident Command System, bringing all departments to high alert. The doctor notified the Mendocino County Public Health Department (MCPHD), Hospital Infection Control, and the Infectious Disease resource physician. The patient was directed to a safe location outside the ER, away from other patients. The nurse put on personal protective equipment (PPE) then guided the patient to a special isolation room where there would be no exposure to other patients or staff.

The Departmental Operations Center at MCPHD rapidly responded with a report that a specially designated ambulance was on the way to pick up the patient and transport her to the nearest Ebola treatment center.

The Hospital management team participated in the drill to study and improve the Hospital’s level of preparedness. Staff participation and enthusiasm was impressive! Specific steps to improve communication were identified. The Hospital Incident Command staff drilled on working with County Medical and Health Operational Area Program staff to requisition critical equipment and supplies of PPE. Volunteers from a number of departments are currently signing up for training in putting on and removing the personal protective equipment needed for this level of care.

As a result of this exercise, the Hospital will have an improved Ebola care plan to identify, isolate, notify appropriate agencies, and transfer the patient to the appropriate facility for care. The goals of the exercise were to have the patient cared for and staff able to safely return to their work, both of which were successfully met.

–Emmet O’Connell, MCDH Laboratory Manager and Infection Control Officer

Challenges Ahead for MCDH — and All Hospitals — Under Healthcare Reform
—Posted Friday, May 2nd, 2014 at 8:54 am— « »

Patricia Darland

Patricia Darland

More than 60 people attended last night’s Mendocino Coast Health Care District Board presentation to help the public better understand challenges ahead for MCDH under healthcare reform.

Among the attendees were Fort Bragg City Manager Linda Ruffing, Council Members Heidi Kraut and Doug Hammerstrom and County Supervisor Dan Gjerde.

The presentation was led by Board Chair Patricia Jauregui-Darland and Board Treasurer Sean Hogan.

With reform’s triple aim of achieving “Better Health, Better Care and Lower Cost”, there will be more emphasis on keeping patients well and out of the hospital, and financial consequences for hospitals not meeting government-set mandates and goals, Darland told the audience, while Hogan covered the financial impact of reduced insurance and government reimbursements.

Hogan said, “people tell us all the time that we should run the hospital like a business” which he said is a good goal, but difficult when dozens of federal and state agencies monitor and dictate how the hospital must operate. He presented a slide showing a maze of governmental agencies that oversee all aspects of hospital operations. Darland emphasized that the whole community will need to get involved to help people stay healthy and out of the hospital.

In the near future, she noted, the focus will be on providing outpatient services, teaching patients to care for themselves and keeping people in their homes rather than the hospital.


Medicare and Medicaid Funding for Hospitals Jeopardized in Federal Debt Ceiling Debate
—Posted Thursday, July 14th, 2011 at 8:09 pm— « »

Gina and Shelly

MCDH Nurses Jeanna and Shelley

You may be wondering if the struggle that is currently going on in Washington, D.C. over the decreasing the Nation’s debt will have an effect on health care in our local area.  We are all watching as both sides of Congress appear to agree that taking action to raise the Federal Debt Ceiling before the August 2 deadline is imperative.  We have been told that failure to raise the Debt Ceiling would push the U.S. into default on it’s existing financial obligations, which according to experts would have a catastrophic effect on our economy.  The answer to the question, “will the Debt Ceiling struggle affect us locally?”  is probably yes, given the fact that Medicare and Medicaid (known as Medi-Cal in California) comprise 20% of all Federal spending.

Earlier this week a list of 27 specific health care cuts were released by a “Deficit Reduction Group” led by Vice President Joe Biden.  On the list is $14 billion in savings (over 10 years) for “Reform Rural Hospital Programs (Medicare).”  Very few people outside of the Deficit Reduction Group know for sure what is included in that $14 billion cut.  (more…)

JAMA Article on Quality of Care in Critical Access Hospitals
—Posted Tuesday, July 5th, 2011 at 5:48 pm— « »

MCDH Front Entrance

Tomorrow a Nationally respected Medical Journal (the Journal of the American Medical Association) is issuing a report on “Quality of Care and Patient Outcomes in Critical Access Hospitals.”  The report uses a scientific approach to determining if there is a difference between critical access hospitals (CAHs, such as Mendocino Coast District Hospital) and non-Critical Access Hospitals when it comes to quality.  The report provides evidence that when looking at Nationally recognized hospital quality data, that critical access hospitals consistently come in with lower quality scores than non-critical access hospitals.   I have 2 reactions to the report.  First, I think that the report misses the boat by not recognizing that there are some fundamental differences between CAH hospitals and non-CAH hospitals.  The most major difference is that the CAHs exist in smaller rural markets with much less availability of physicians, specialist physicians and advanced clinical capabilities (such as cardiac catheterization labs).  Also, critical access hospitals are focused on keeping only those patients that can be treated safely in a smaller hospitals and transfering the more acutely ill patients to larger hospitals.  In the JAMA study, patients that were transfered to a larger hospital were excluded from some of the analysis.  So my first reaction is that quality in critical access hospitals needs to be measured differently than quality in urban hospitals.  My second reaction is that our hospital, Mendocino Coast District Hospital, compares very well to the National database that the JAMA article uses.   The data that they are using is available to anybody with a computer and internet access.  It’s available on a website called “Hospital Compare” on the Medicare site,   We have an ICU here, which is a big advantage for a critical access hospital (only 30% of them do, according to the report).  And in the areas of “processes of care” and “clinical outcomes” we compare pretty well.  In those 2 areas on the Medicare Hospital Compare website, we report and we consistently show as being comparable to larger hospitals.  The one caveat that I would point out is that, due to our low numbers, many of our scores have a footnote number 1.  Footnote number 1 says “the number of cases is too small to be sure how well a hospital is performing.”  So, in other words, even though the report says that our numbers are good, it is also saying that small numbers are unreliable.

My conclusions from reading the JAMA article are that (1) there needs to be more study on what constitutes high quality in critical access hospitals and (2) Mendocino Coast District Hospital is doing all of the right things to ensure that we are providing a high quality of care here on the Mendocino Coast.