Doctor's Corner - Current News

Quality Pentagon

Since HCA and HealthONE are hospital companies, the quality measures we are most familiar with (such as preventing MRSA infections, ensuring prescription safety, and minimizing post-operative infections) apply to inpatient medicine. Quality of patient care in outpatient practices is stressed, but many of the national standards are limited to primary care and the compliance with preventive strategies. While those are very important, primary care is a small fraction of our employed medical group, and quality of care is only a part of the total quality picture.

The entire Quality Pentagon presents a better “picture” of what it means to address quality in the outpatient setting. It starts with physician leadership. This includes the newly formed HCAPS Physician Quality Council, our new group of five medical directors, and the physicians in each practice that now includes 25 specialties. They not only drive quality of care in every specialty, but also patient safety. The Safety Pyramid was recently communicated to all clinics in an effort to increase awareness of the importance of recognizing and reporting not only incidents, but also near misses. The more we know about near misses the better we can improve upon procedures and share best practices.

The key to employee safety is in prevention. The credo is to prevent any adverse health consequences arising from employment. Personal protection in the handling of chemical hazards, biological fluids and needles is continually stressed by our safety experts. In the event of exposures or injuries, it is important to immediately report the event and seek treatment at one of the seven occupational medicine clinics. New this year: our employee health medical director now provides leadership to the entire Continental Division, as do all of the medical directors. A point of reemphasis this year will be in the goal to completely eliminate the requests for and the dispensing of “curbside prescriptions” (physicians writing prescriptions for co-workers with whom they have no doctor-patient relationship).

Finally…Value. We want to attract new patients and retain current ones because we offer them superior value over our competitors. That is, they get the highest quality of care in the safest environment while we as providers demonstrate that we are paying attention to their cost of health care, and we will make efforts to minimize it. All of us at HealthONE either provide service to the patients, or provide service to those who do. When that service is superb, our patients will recognize the value when they come to see us .

-Alan Burgess, MD, CMO

What’s New for the Injured Employee

Occupational medicine is a unique medical specialty for one reason: its practitioners serve two masters. The prevention, diagnosing, and treating workplace injuries and illnesses requires working for employers (who fund the system and may require assistance in injury or exposure prevention at the worksite), and the employee (who need expert medical management to maximize the ability to return to full function as soon as possible).

HealthONE in conjunction with Colorado Rehabilitation and Occupational Medicine has joined forces to pilot an integrated approach to patient care in the Aurora area. Combining primary occupational medicine doctors who excel at injury treatment and case management with experts in the rehabilitation of complex cases is just the first step. What’s been enhanced is preventive medicine services, expert causality analysis, early identification of complex cases, and “interventional care with a conscience”.

It is well understood that good general health of employees translates into fewer injuries and decreased overall health care costs. In addition to on-site lectures from experts in preventive health, HealthONE is expanding its “H2U” program to Denver employers, creatively called H2U@work. The goal is to assess the health risk of employees and implement strategies to “reach the hard to reach”: motivate those at high risk to choose healthier lifestyles.

One “bug” in the workers compensation system is that interventional treatments, such as injections, are reimbursed well by the health plans and tend to get over-utilized. These treatments are cutting edge and very useful when medically indicated, but strict utilization and effectiveness controls we believe will sharply reduce costs while still allowing selected patients the benefits of the procedures. Hence the name, interventional care with a conscience.

We expect that integrating prevention, injury management, and expert rehabilitation of complex cases will result in improved patient outcomes at a lower cost. In effect, we are attempting to bring occupational medicine back to its roots.

For more information about the HealthONE Occupational Medicine Clinics, please visit our website at www.healthoneclinics.com

Alan W. Burgess, MD
Chief Medical Officer
HealthONE Clinic Services

Hypothermia is defined as a lowering of body temperature below 95 degrees. This can be caused by any situation of rapid body heat low. Even though a healthy person can increase heat production by six times with cold exposure, a wind of 30mph will increase heat loss by five times. Also, not wearing proper clothing - for actual or potential weather conditions - can quickly cause trouble; if a hat is not is worn, one-half of the body’s heat production can be lost through the head at an outside temperature of just 39 degrees. Wet clothes can increase heat loss twenty times.

Several factors aggravate hypothermia. Alcohol increases heat loss, and is a very common cause of hypothermia. Smoking pollutes the body with over 10% carbon monoxide, which increases the fatality rate in victims by decreasing tissue tolerance for cold. Exhaustion impairs heat production, since shivering produces great amounts of heat.

When body temperature goes below 90 degrees, it no longer can maintain heat production so further cooling happens rapidly. This is associated with depression and decreased judgement and coordination. The mortality rate is 20% with body temperatures in the 80s, over 50% in the 70s. First aid should be to stop heat loss by removing wet clothing, removing from wind, insulate from cold ground, and covering head and body with blankets. Share body heat inside of a sleeping bag, and if conscious, provide warm liquids. Arrange immediate transportation to a hospital.

Frostbite becomes a risk to exposed skin when the temperature drops below 20 degrees, and a serious risk below zero. Good defenses include, appropriate protection for hands, feet and face, as well as periodic re-warming. If frostbite occurs, protect the part (without trying to thaw it) while transporting to emergency room.

Chronic illness, such as heart disease, asthma, diabetes, and circulatory diseases can be exacerbated by cold exposure. These illnesses decrease adaptability to cold and other outdoor stresses such as altitude. Age extremes (over 70 and under 3 years) can be problem for the same reason. Malnutrition markedly impairs cold tolerance, and a starving person can become fatally hypothermic at room temperature.

Is there a cold weather limit to being outside? Assuming no wind and you are dry, a person can work and play for extended periods in almost any temperature.

• Continual activity (but not to the point of sweating) helps maintain heat production while staying dry.
• Layered, loose clothing which can be removed or added with good head and hand protection are important.
• Stay near a warming area.
• Most importantly, assume the worst. Weather changes quickly, especially in Colorado. Even if you only plan to drive to work, be sure hats, gloves, boots, and a coat are in your car all winter. You can almost bet your car will decide to break down during the worst possible weather with the least help around.

Altitude Illness

Altitude sickness is a brain malfunction which can occur at altitudes above 8,500 feet. Symptoms always include headache and nausea, but can progress to vomiting and loss of mental concentration. Some people are more susceptible than others, but it can happen to anyone if their behavior pushes their tolerance for altitude beyond their limit. Those behaviors are lack of acclimatization, rapid ascents, over-exertion (relative to conditioning level), dehydration, and alcohol consumption. So, the immediate treatment is rest and fluids. Then moving to a lower altitude rapidly resolves the problem. Sometimes, medical evaluation and treatment is required.

Summer Safety – Heat

With summer fast approaching, it is important to be aware of body overheating and proper hydration. With the proper clothing, humans can tolerate a 140 degree span in outdoor temperatures (from -20° to +120°). However, our body temperature only does well over a 14 degree span (between 90° – 104°). By 107 degrees, coma is impending and 109° can be fatal - only 10 degrees from normal!

So, our body’s cooling system is crucial to survival. Since exercising muscle can increase energy consumption by 20 times (75% of which is converted to heat), the cooling efficiency must be at 100% to keep the body temperature at a normal 99 degrees.

The following can interfere with the cooling system: dehydration, improper clothing, sun exposure, certain medications, poor conditioning/acclimatization, and over-exertion.

Remember to maintain hydration, especially during exercise. Sixty-four ounces of water daily is normal, but in Colorado’s high altitude, our bodies may require much more. And, alcohol in any form is dehydrating.

If you experience lethargy, confusion, and nausea, you should urgently seek water, rest, shade, fans, and water sprays. Dry skin, delirium, vomiting, and fever make heat illness a 911 medical emergency.

About Dr. Alan Burgess:

Doctors Corner is authored each month by Alan Burgess, MD, Chief Medical Officer for HealthONE Clinic Services. Dr. Burgess has practiced in healthcare for over 25 years in both private practice and various staff, advisor and director positions for organizations including, Xcel Energy, HealthMark , Frontier Airlines, and Presbyterian St. Luke’s Medical Center.

Dr. Burgess studied at the University of Illinois, Chicago and is American Board of Internal Medicine certified. He has earned Level II Workers’ Compensation certification, and is a certified Medical Review Officer.

His special areas of interest include Corporate Medicine, Occupational Health and Safety, Drug Testing, Preventive Medicine and health promotion in all areas of medical care from primary care to safety and industrial health.