EmCare’s Genesis Cup Honors Innovation, Creativity in Healthcare

Posted on Wed, Apr 06, 2016
EmCare’s Genesis Cup Honors Innovation, Creativity in Healthcare

An innovative collaboration between emergency department (ED) physicians and anesthesiologists to effectively manage pain experienced by patients presenting with hip injuries has won this year’s EmCare Genesis Cup. The initiative was implemented at Los Alamitos Medical Center in Los Alamitos, California. The Genesis Cup is an award for healthcare innovation presented each year by EmCare, a leading national physician practice management company.
EmCare Anesthesia Services Regional Medical Director Jonathan Maskin, M.D., M.B.A. presented an overview of the initiative – Fascia-Iliaca Compartment Block in the Emergency Department (FICB) – on behalf of the multi-disciplinary team led by EmCare-affiliated physicians Kirsten Calder, M.D., FACEP, Chair and Medical Director, Department of Emergency Medicine, Los Alamitos Medical Center and Chris Tomongin, M.D., FACEP, Regional Medical Director with EmCare’s West Division and Chief of EmCare Services for Los Alamitos Medical Center and Lakewood Regional Medical Center. Other members of the team included: Kelvin Nguyen, M.D.; Gary Lau, M.D.; Harry Jung, M.D.; Dragos Diaconescu, M.D.; Directors of Clinical Services Sue Kirk, RN and Donna Greenhalgh, RN; Reba Reed, RN, Director of Practice Improvement and Melissa O'Guinn, Project Manager.
"The realization of the FICB initiative was accomplished collaboratively, between the Los Alamitos Anesthesia and Emergency Departments,” said Chris Tomongin, M.D. “By introducing proven anesthesia techniques and bringing them to the front lines of the emergency department, emergency physicians are now better equipped to provide pain relief effectively and with less harmful side effects.  This project would not be realized without the leadership of Dr. Kirsten Calder and the participation of the Los Alamitos emergency department physicians in recognizing a need to improve patient care for those who suffer from hip pain after a devastating fracture."
“This initiative was truly patient-centered,” said Tom Carpenter, M.D., the Divisional Medical Director – Anesthesia, who introduced the project to the team. “Emergency management of the severe pain associated with hip injuries has traditionally been based on the use of systemic opioids. The FICB ultrasound guided nerve block process produces superb pain relief without narcotic demand in addition to skeletal muscle relaxation required for dislocation reductions. Complications are rare. As a result of these benefits, the FICB nerve block procedure is uniquely well-suited to application in the emergency setting.”
Critical to the success of the initiative was the spirit of collaboration between emergency department physicians and anesthesiologists at the hospital. They jointly developed a protocol to be followed for patients presenting to the emergency department with hip injuries. The protocol included the following steps:

  • Nursing staff immediately notifies the ED physician of a newly-arrived suspected hip fracture.
  • Traditional approach to severe pain management would be used if appropriate to prevent any delays in providing pain control pending the FICB.
  • ED physician decides on appropriate use of FICB after reviewing imaging studies of the injured hip area.
  • ED physician decides to contact the in-house anesthesiologist to assist the ED physician with administering the FICB. The goal is to have ED physicians trained to perform the block independently.
  • FICB supplies stocked in ED kits or tackle box formats.
  • Patient data entered into specifically designed Qualitick program after FICB completed to monitor success of procedure.
  • Director of Clinical Services responsible for aggregation and presentation of quality reports on FICB.
Dr. Calder states, “I believe this is one of the finest examples of the benefits I’ve seen in working with EmCare and its integrated services.  Because EmCare has both emergency medicine and anesthesia services at my hospital, it’s easy to build relationships and mutual trust.  The success of this program speaks volumes to how we are able to work together to improve patient care.”
“To date, 14 FICBs have been performed at Los Alamitos Medical Center,” said Paul Silka, M.D., FACEP, Chief Executive Officer, EmCare West Division. “All procedures have demonstrated superior pain relief, reduction in narcotic utilization and zero complications. This is truly a testament to the leadership of Drs. Calder and Tomongin.”  
While this is occurring at Los Alamitos Medical Center, Amy Axberg, M.D., FACEP and Mara Windsor, D.O., FACEP at HonorHealth JCL MC Level I Trauma Center in Phoenix are working on a parallel project in collaboration with Trauma Services and Orthopedics to expedite the care of patients with femur fractures by creating a Fracture Alert protocol. The patients who qualify for this protocol will have an Ultrasound-Guided Continuous Fascia-Illiaca Nerve Block with catheter placement for continuous infusion of ropivacaine for pain control. This continuous infusion can be used preoperatively, intraoperatively and postoperatively.
The ultimate goal is to train our ED physicians in this procedure so that they can provide timely and effective care to decrease pain in this increasing population of patients. The participants are completing a research project to evaluate the results relative to intended outcomes which would be decreased pain, improved ED throughput, decreased hospital length of stay, improved sensorium and decreased complications from standard analgesia medications. They will standardize the protocol with intentions to take it to all HonorHealth hospitals. Though it may sound challenging they feel that all emergency medicine physicians can accomplish this in their hospitals with persistence, political grace and passion for patient improvement.
Based on these outstanding results, the initiative has been introduced to Lakewood Regional Medical Center in Lakewood, CA, and Corona Regional Medical Center in Corona, CA, with further plans. Dr. Maskin stated “This is a giant step in EmCare’s overall goal of working towards pain-optimization in the emergency department. Every patient deserves to have their unique pain issues innovatively addressed. By leveraging our knowledge and creativity across specialties, we believe there to be multiple future opportunities for us to improve our patients’ emergency department experience.”
EmCare designed The Genesis Cup program to recognize and celebrate the creativity and innovation of everyday physicians as part of the company’s never-ending pursuit to improve the delivery of patient care. In addition to recognizing the inventor/innovator, The Genesis Cup recognizes those involved in the initiative, including the emergency department, radiology department, hospitalist team, anesthesia team and the regional office in supporting such endeavors. The award was presented at EmCare’s Leadership Conference held at The Wynn in Las Vegas, NV, March 14-16.

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