2004-2005 Mini-Grant Award Projects

Eagle River Memorial Hospital
Eagle River, Wisconsin

Palliative Care Program

The original need for a palliative care program was determined several years ago when the hospital case management department became aware that patients were being discharged into a hospice program and dying within a few days. Further investigation revealed that the discharge plan for patients who were terminally ill or had a chronic long term disease were very extensive and time consuming, and could not be accomplished or arranged by the time the patient was discharged from the hospital. Readmissions often occurred due to the inability of patient and caregiver to manage at home. This led to the formation of the Eagle River Area Palliative Care Coalition. Subsequent actions included a community needs assessment and the palliative care outreach program began accepting referrals. It quickly became evident that a real need existed for this program, and that the palliative care outreach coordinator could not meet the increasing needs of the program. It was at this time the coalition began to discuss the idea of a volunteer program to assist in palliative care outreach.

The Palliative Care Program has many components. The palliative care coordinator works as the inpatient hospital social worker and, with the utilization nursing case manager, coordinates discharge planning for hospital patients. The case management department is involved with looking at hospital utilization of patients with chronic disease; i.e., readmissions, emergency room visits and length of stay. It is believed the Palliative Care Program will influence the number of days in the hospital by addressing advance care planning and advance directives, so that patients will be better prepared to make decisions regarding placement, services and life sustaining treatments. The volunteer program will support the hospital palliative care efforts in three ways. 1) Promoting more healthy long-term care given at home by providing volunteer respite services to patients and care givers; 2) Increasing the number and quality of advance care planning documents in the community by volunteers providing Respecting Choices Advance Care Planning Workshops; and 3) Increase public awareness and education regarding end of life care through a resource library to be organized and maintained through volunteers.

For more information contact Lisa Becker.

Moundview Memorial Hospital and Clinics
Friendship, Wisconsin

Moundview Memorial Telehealth Program

Moundview Memorial Hospital and Clinics (MMHC) serves an area of the state designated as a Medically Underserved Area and a Health Professional Shortage Area. MMHC is the only hospital in Adams County and serves residents in three counties. Community Programs provides services to frail elderly through its Long Term Support Program. Some of these services include supportive home care, nursing care, service coordination, and provision of medical and pharmaceutical supplies. Adams County Department of Aging currently supplies services such as Meals on Wheels, Elder Abuse Services, and a variety of other services for the senior population.

Each of these organizations has been working independently to address the growing demand of healthcare for the elderly population. The overall goal of the Telehealth Program is to develop and implement a program that increases the access to quality healthcare for the elderly through collaborative efforts of these three organizations. Moundview Home Health will be the leading partner in this collaboration, and will be responsible for training, monitoring, and responding to telehealth participants.

This telehealth program targets the disease management of chronic illnesses such as congestive heart failure and diabetes. The program will use a combination of videophones and peripheral devices with data transmission to be utilized for interaction with patients in their home. This funding will allow for better utilization of scarce nursing resources by serving more patients within their homes without increasing staff. Benefits to the rural Adams County patient will include increased access to care, reduced cost due to less ER visits and hospitalizations, and empowerment to manage their own health. Collaboration with Community Programs would enhance both agencies’ services, and assist with marketing telehealth to Adams County residents while improving the quality of life for those that remain in their home. Community Programs will provide staff (certified social workers and a RN) to be members of the telehealth workgroup and to provide a candidate for a telehealth monitor from their program. Moundview Home Health will be responsible for monitoring each patient assigned to a monitor and for reporting to physicians when indicated and requested.

For more information contact Linda Charles.

Osceola Medical Center
Osceola, Wisconsin

On Track – Health Lifestyle Management Program

The Osceola Medical Center, St. Croix Regional Medical Center, and the Wild River YMCA are collaborating in an effort to establish a model healthy lifestyle management program. Funds will be used to plan and implement a program to include a monitored, supervised exercise program and education in healthy lifestyle choices for people diagnosed with obesity, diabetes, or hypertension.

The need for a program was first determined by a physician who was unable to find a monitored, supervised exercise program for his patients that was both convenient and provided an educational component regarding healthy lifestyle choices. His greatest concern was to find services for his overweight/obese, diabetic, and hypertensive patients. He found most of his patients were not comfortable exercising in a normal unsupervised fitness environment and that many often needed monitoring. The goal of the program is to provide opportunities for healthy lifestyle changes for targeted populations. Implementation of a one 12 week program of monitored exercise will be conducted for each of three participating groups including diabetic, overweight/obese, and hypertensive participants with measurable outcomes of improved exercise tolerance, blood pressure, blood sugar, and/or decreased body weight. Also, all program participants will be educated on healthy lifestyles, including specific disease management, nutrition, risk factors, exercise, and warning signs/symptoms. Progress reports of participants will be prepared and sent to their physician monthly. Protocols will be established and fitness staff trained to recognize inappropriate response to exercise and how to respond to potential emergent situations prior to the initiation of the program. The success of this program will provide a foundation for future program expansion to include other diagnoses such as arthritis, congestive heart disease, post cardiac angioplasty, post cardiac valve replacement, fibromyalgia, or other conditions no yet identified.

For more information contact Sue Gerlach.

Riverside Medical Center, Inc.
Waupaca, Wisconsin

Healthy Lifestyle Campaign

It has long been recognized that unhealthy lifestyle choices contribute to increased morbidity and mortality from diseases. The goal of the Healthy Lifestyles Campaign is to increase community awareness regarding the impact of lifestyle on health and to provide programs and services that are accessible and support healthy lifestyle behaviors. This project represents a collaborative effort of Riverside Medical Center, The Waupaca County Tobacco Free Coalition, and The Waupaca County Nutrition and Activity Coalition.

Key components of the campaign include the following:

Media strategies that increase community awareness. The community will learn about their county health assessment data, recommendations for healthy lifestyle behaviors aimed at improving outcomes, and services offered throughout the year designed to support healthy lifestyle changes.

Regularly scheduled health screening services. To screen for and identify persons with elevated blood pressure and provide ongoing monitoring for persons with existing high blood pressure. To offer coronary heart disease risk assessment profiles to all program participants. To offer strategies for controlling blood pressure such as exercise, dietician visits, healthy living classes and cardiac rehabilitation.

Health lifestyles classes. Smoking Cessation class, Healthy Eating Class and Stress Management and Relaxation class will be offered by Riverside Medical Center throughout the campaign year.

All community members will have access to an up-to-date local hike/bike map that highlights and supports exercise and a healthy lifestyle.

For more information contact Marci Reynolds.

Wisconsin Comprehensive Advanced Life Support (WI CALS)

Wisconsin CALS

The Emergency Services Integration Committee of Luther-Midelfort-May Consortium was established in the fall of 2001 and involved five hospitals in five counties in the North/Northwest Regional Trauma Advisory region. These hospitals included Barron, Bloomer, Osseo, Menomonie, and Luther Hospital Eau Claire, the latter having a level II trauma designation. The Committee recognized reluctance on the part of rural emergency room providers to stay current or update their skills to reflect the standard of practice in meeting the needs of emergency patients. Some physicians working in the rural areas indicated a choice of no longer providing emergency services if required to stay certified in all courses. The rural emergency department is a necessity for the populations that do not have initial access to tertiary centers.

The mission of WI CALS is to improve patient care through the advanced education of rural healthcare providers. The goals of WI CALS are to improve patient care by:

presenting an educational experience in advanced life support that encompasses all critical areas of emergency care specific to rural settings;

developing a team approach to patient management including physicians, RNs, LPNs, PAs, NPs, CRNAs and pre-hospital providers;

providing information and practice in a variety of instructional formats to allow for self-directed learning and to provide a balance of cognitive, affective and psychomotor skills;

providing the opportunity for improved patient outcomes in rural emergency settings.

The objective measure of success will be providing two WI CALS provider courses for rural healthcare providers in western Wisconsin. These courses will be completed in 2005. There will be a plan for the continued offering and expansion of course availability to other rural areas of Wisconsin. An additional goal is to identify and obtain statistics on trauma care morbidity and mortality in rural Wisconsin, to trend the impact of WI CALS education on the clinical outcomes for patients.

For more information contact Lynn Hunt.

St. Joseph’s Community Health Services
Hillsboro, Wisconsin

Diabetes Self Management Education Program

Data shows that the St. Joseph’s service area (with Vernon County as a focus) has a slightly higher than average inpatient stay when diabetes is the reason for hospitalization. Although the hospital consistently provides medication teaching to the insulin-dependent diabetic in the inpatient setting, extensive diabetes management training is difficult due to staffing and time constraints from short stays and increased patient acuity. Many times the diabetes is a secondary, not primary diagnosis. This means that the focus is on the treatment of the primary condition and hospital stays are relatively short. The end result is that opportunities to teach self management during hospitalization may be lost. The need for a formal diabetes self-management program has been an identified concern among staff for a number of years. A diabetes self management program, with an identified diabetes expert, would provide better transition from inpatient to outpatient care, and allow for vital case management and education.

A logical next step in making a diabetes self-management program possible is to hire a designated diabetes educator, begin educational support of patients and staff, and develop the policies necessary to direct efforts in formal diabetes education. The objective of the program is to prevent the serious complications of diabetes through surveillance of measures of glycemic control, individual and group education activities, and provision of anticipatory guidance for provider and patient as they work together to manage the disease.

For more information contact Cheryl Vulstek.

Memorial Hospital of Lafayette County
Darlington, Wisconsin

Supportive Home Visitation Program

Memorial Hospital of Lafayette County is located in Darlington, Wisconsin, and is the only hospital in the county. In January 2000, the UW-Extension Family Living Programs initiated a new program entitled “New Beginnings” offered to all mothers giving birth at Memorial Hospital. This program offers prenatal education and support in addition to home visitation following birth. In the first year of the program, 100% of the mothers participated in the prenatal portion of the program with only six opting out of the program after delivery. The second year of the program, services were extended to parents giving birth at the Monroe Clinic. Now in its fifth year, the program has proven to be an excellent program for first time parents. However, parents who had been in the program for their first child are not participating with the birth of additional children. To meet the needs of these parents, additional resources need to be developed around the issue of siblings.

Funds from this grant will be used to expand the home visitation program. This includes offering the New Beginnings program to births of Lafayette County citizens occurring at St. Clare Hospital in Monroe, Wisconsin, enabling the program to serve another 50% of Lafayette County births. It is hoped that the program could be expanded to include one new area hospital annually. Some of the enhancements will include continued prenatal counseling, post-delivery in-home visits and/or telephone calls during the first year, providing support for child-parent interactions in the way of parenting skills, child development, and child health, breastfeeding support and timely immunizations. Services will be culturally competent as Lafayette has large Hispanic and Amish populations. For example, presentations planned for the general population will be presented in English and Spanish, with Spanish-speaking individuals available to facilitate the presentation. A midwife serving the Amish communities will be partnered for purposes of liaison and education.

For more information contact Sherry Kudronowicz.

Sacred Heart – Saint Mary’s Hospitals
Tomahawk, Wisconsin

Implementation of a Paramedic Program

Lincoln County EMS (LCEMS) – Tomahawk Division is an emergency medical services department based at Sacred Heart Hospital. It is an organization consisting of two ambulances with 3 EMT-Paramedics, 8 EMT-IV Technicians, and 7 EMT Basic Technicians. LCEMS provides inter-facility transfer services and 911 emergency responses to the northern half of Lincoln County and southern parts of Oneida County, totaling 400 square miles and incorporating nearly 11,000 permanent residents. Due to the transient nature of the seasonal tourist economy, the service population swells to nearly 40,000 at various times throughout the year. (In 2003 there were 896 calls for service.) An across-the-board review of 911 and non-emergency calls over the past three years indicated that an average minimum of 33% of patient calls for service would have directly benefited from the Advanced Life Support (ALS) skills that paramedic-level ambulance response would provide. Based upon this information, it was determined that the citizens of Lincoln County would greatly benefit from the advanced level of care provided by the EMT-Paramedic. It is the goal of LCEMS to reduce mortality and morbidity in serious medical and trauma situations, and to improve patient outcomes by providing advanced level as pre-hospital care.

The Lincoln County EMS requested funds to develop and implement a paramedic level service upgrade in their service area. Implementation of the paramedic program is being conducted through the certification criteria set for by the State of Wisconsin, Bureau of Emergency Medical Services. Grant funds will primarily be used for continued training of EMS staff in ACLS, PALS, NALS, as well as paramedic refresher training and additional equipment.

For further information contact Dean Goulet.

The Richland Hospital, Inc.
Richland Center, Wisconsin

Providing Care to Patients with Alzheimer’s Dementia

The Richland Hospital, Inc., located in Richland Center, Wisconsin, serves the population of Richland County and portions of five contiguous counties. This hospital serves a population that is approximately 70% elderly. A little over one year ago, hospital administrators were notified that two new facilities were being planned in the community specializing in the care of patients with Alzheimer’s Disease or Dementia. There are already several facilities providing services to local elderly and/or Alzheimer’s type patients who admit patients to Richland Hospital as the need arises. With the likelihood of two more facilities admitting patients to this hospital, patient safety and staff competence to handle an increased Alzheimer’s Dementia population were identified as concerns. Funds from this grant will be used to begin assessment and planning for ways to provide care to patients with Alzheimer’s Dementia in a “Best Practices” type setting within an acute care environment. This includes staff education and training, consultation to determine short term and long term equipment needs and care unit configurations, and site visits to select facilities. The goal is to identify ways of improving patient safety during any episode of care; provide staff with communication and re-direction skills necessary for care of these patients; development of a specialized care plan for Alzheimer’s patients; provide care that preserves the dignity of each patient.

For further information contact Cynthia Chicker.

Cumberland Memorial Hospital & Extended Care Unit, Inc.
Cumberland, Wisconsin

Comprehensive Advanced Life Support (CALS) Training Program

Cumberland Memorial Hospital and Extended Care Unit, Inc. (CMH-ECU) provides comprehensive health services to families in the rural Cumberland area. It is a Critical Access Hospital with an attached 50-bed long-term care unit, behavioral health clinic, and senior housing apartments. CMH-ECU operates a 24-hour per day ambulance service staffed by EMT-1s. It serves a rural area of 300 square miles with a population of 11, 300 individuals in Barron and Polk counties. This number increases dramatically in the summer due to the influx of summer residents and tourists. The 24-hour emergency room is staffed each day by a registered nurse and on-call Family Practice medical doctor. Of the 2,992 emergency room visits in 2004, 450 resulted in inpatient admissions and 187 were transferred to specialized care centers. Staff at this center does not have immediate access to on-site specialists and advanced diagnostic technologies. Although different advanced life support courses have been development to keep health care providers up-to-date in treatment of critically ill or injured patients, it is difficult for these providers to attain and maintain certification in all courses.

The CALS training program has been specifically designed for rural providers that work in settings where care must be provided to patients with undifferentiated medical emergencies without the luxury of on-site special assistance. CMH-ECU currently has one emergency room staff nurse and one family practice physician who attended a CALS course. The need to train all of their health care providers is critical to the health of this rural community. Funds from this grant will be used to cover CALS course and lab tuitions for its 15 Registered Nurses and four Family Practice Physicians who staff the emergency room.

For further information contact Mary Jean Jergenson.

Tomah Memorial Hospital
Tomah, Wisconsin

Expanded Prevention and Intervention Program

Tomah Memorial Hospital is located in Southwestern Wisconsin and serves the residents of Monroe County. The Tomah Memorial Hospital Community Outreach Program will use funds from this grant to expand the Prevention and Intervention Program. This program was established in 1996 and is committed to the enhancement of the physical and emotional well being of the community through education. This is a multifaceted program utilizing a team approach to help prevent obesity and heart disease, and to intervene as a community in the event of sudden cardiac arrest. The original need for this program was determined when statistical data indicated that Monroe County fell into a region with the highest rate of obesity; 40% of adults over the age of 18 were estimated to be overweight.

The program has made tremendous strides in the community through its quarterly business and industry meetings, and monthly wellness programs at Cardinal IG, Cardinal TG and Ocean Spray. In addition, the program offers certified babysitting classes, CPR, first aid and Automated External Defibrillator (AED) courses. Although Tomah Memorial Hospital has made a positive impact in community health since the initiation of this program, it believes it can do more. Therefore, funds will be used to expand this program with the following goals:

Ensure that all of the agencies and organizations in the community with AEDs are in compliance with recommended guidelines for a successful corporate/community AED program.

Offer adult CPR and AED awareness training to area worksites reaching a minimum of 920 individuals

Educate all fifth grade students and their families in the Tomah Area School District on the benefit and importance of a healthy diet and active lifestyle.

For further information contact LuAnn Fowler.