By Dan Barber
Public Affairs Officer
Robert E. Bush Naval Hospital
Patients of the Robert E. Bush Naval Hospital have now been cared for in its clinics using the Medical Home Team model for more than a year now.
The patient-centered method of delivering health care has been instituted in most military medical care treatment facilities and many civilian medical practices over the past couple of years.
This hospital’s model, which was begun last year, assigned primary care staff to Blue Team, Gold Team and Pediatrics, and enrolled TRICARE Prime patients to each team. This allows patients to see the same team each time they come in for an appointment. This replaced the prior concept of having patients assigned to a single Primary Care Manager. Patients at the Naval Hospital now have an entire team of health care professionals made up of physicians, physician assistants, Certified Nurse Practitioners, Registered Nurses, Licensed Vocational Nurses and Corpsman who are dedicated to providing their assigned patients with the best possible health care management.
Specialty care by one of the hospital’s network health care providers has and will remain unchanged in the near future, but, work is underway at the hospital to try to bring more specialty services ‘in-house’ with additional staff, training or “circuit rider” specialists from San Diego or Camp Pendleton seeing patients here instead of making patients travel some distance for care.
Also, the hospital disestablished “Central Appointments” last year to allow the staff of the Medical Home Teams to speak directly to patients calling in to request appointments. In many cases with this change, patients have been able to book a same day appointment, or to speak with a team member to receive an answer to a simple health care question. The phone number has remained unchanged, patients can still call 760-830-2752 and they will be directed to their assigned team.
Another patient pleaser the hospital has just initiated is posting the available open appointments each work day on the hospital’s Facebook page. Normally this posting will be listed by 7:15 a.m., to allow the patients to see what is available. “If the caller misses the opportunity to book one of these appointments, they still will be able to talk to a team member who will do their best to help them ,” said Commander Lisa Morris, Director of Medical Services of the hospital. “We want our patients to be satisfied with their care, but we also want to deliver that care safely. With that in mind we will always strive to say ‘yes’ to our patients when we can,” she added. To check out the hospital’s Facebook page visit:
http://www.facebook.com/pages/Naval-Hospital-Twentynine-Palms/83701100741#
In addition, the hospital signed up for a secure computer based communications tool last year called Relay Health where patients can access their medical team from home…to email their provider, request an appointment, cancel an appointment , request a prescription renewal or find out the results of lab tests. To sign up visit: https://app.relayhealth.com/Registration.aspx and follow registration directions.
“We have found that the Medical Home Team method of patient-centered care provides our customers with more access to primary care and it allows longer appointments so our providers are able to meet most if not all of our patients health care needs during one visit,” said Morris.
The purpose of the Robert E. Bush Naval hospital is to care for the Marines, Sailors, and families of the Marine Corps Air Ground Combat Center and to keep its promise of care to the military retirees and families in the surrounding communities of the Morongo Basin. “The reason we are here is to care for our patients,” said Morris.
Tuesday, May 22, 2012
Thursday, April 26, 2012
The Hospital Emergency Medicine Department is a Busy Place
By Dan Barber
Public Affairs Officer
Robert E. Bush Naval Hospital
One of the important benefits of serving in the U.S. Military is the health care provided to active duty service members and their families as well as eligible military retirees and their families.
Here at the Marine Corps Air Ground Combat Center the Robert E. Bush Naval Hospital provides an Emergency Medicine Department staffed with highly trained individuals. “The Emergency Medicine Department employs a mix of both military and civilian staff,” said Commander Raul Carrillo, a Nurse Corps Officer and Department Head for the Emergency Medicine Department. “All are highly trained, with all the physicians being board certified in Emergency Medicine. Both the civilian and military nurses are registered nurses and are also trained in Emergency Medicine. The corpsmen also receive specialized training to work in the department,” he added.
A typical 12 hour shift in the hospital’s Emergency Medicine Department (EMD) is staffed with one certified emergency medicine physician, two registered nurses and two corpsmen. Others can be called in as needed.
To operate the Emergency Medicine Department twenty-four hours a day, 365 day a year takes a staff of 14 emergency medicine physicians, 12 registered nurses, 10 corpsmen and 2 clerks. The physicians and nurses are a mix of both military and civilian personnel.
The definition of emergent care is the threat to life, limb or eyesight… that could be a threat to your life, a fractured bone or an injury to your eye.
The hospital’s EMD should never be treated as a walk-in clinic; however, no one is ever turned away from receiving care.
“I would highly encourage patients get seen by their Primary Care Manager (PCM), if possible. Here at the hospital we have established a Patient Centered Medical Home with the philosophy that the PCM who is assigned to the patient is responsible for providing their medical care needs. The Patient Centered Medical Home has been established in Pediatrics, Gold Team, and Blue Teams only. If their provider is on leave, TAD or ill, then their Medical Home Team, regardless of who they see for care can see any other provider on their team,” said Carrillo. “There are times when patients cannot come in during clinic hours for care then yes, they will be seen in the Emergency Medicine Department,” he added. But Carrillo pointed out that patients need to keep in mind “we are an Emergency Medicine Department and we always take the sickest first, and everyone else will be prioritized for care.” Sometimes patients may have a wait between 2 to 4 hours… depending on multiple factors to include patient acuity, patient census, ambulance arrivals, and critical care transport coordination to higher levels of care.
According to Carrillo patients arriving at the EMD by ambulance are always seen first. “I would highly encourage patients to keep in mind that if they are calling for an ambulance to make sure it is a life threatening emergency. The use of Emergency Services shouldn’t be used at the whim of making a trip to the ER… if you have shortness of breath, if you have chest pain and you perceive it as a life threatening illness, then yes I would encourage you to call 911,” said Carrillo. “If a patient comes in by ambulance and it isn’t a life threatening illness or injury you will essentially have taken one ambulance out of service,” said Carrillo. “There are only two ambulances on base, and if one is responding then that ambulance is off line when it could be responding to a true emergency on base,” Carrillo added.
According to Carrillo the best times to be seen in the ER, if needed, are pretty much anytime of the day on Tuesdays through Thursdays. He pointed out that off payday weekends, the day prior and after a holiday and military special liberties are busy times in the EMD.
Patients coming into the Emergency Medicine Department need to check in at the window in the Emergency Medicine Department Waiting area. If there is no one at the window because they are busy in the back, then there is a button that can be pushed and someone will respond.
Once a patient is checked in, they will be called for triage by a Registered Nurse. The patient will be assessed and assigned an appropriate triage category of 1 through 5, known as the Emergency Severity Index. The number assignment is based on age, chief complaint, history of present illness, and vital signs upon presentation.
Number one category is a life threatening injury or illness, in most cases a one is assigned when a person has stopped breathing or their heart has stopped. A number one can also be assigned for mental illness for a patient who is actively suicidal or homicidal with altered mental status. A level 2 or 3 patient may be someone with shortness of breath or chest pain. “In the cases of one through 3 we would provide immediate care,” said Carrillo. According to Carrillo a level four patient is someone who may have a sprained ankle or sustained some orthopedic injury but is not a life or limb threatening injury. A level five category would be someone with an upper respiratory infection with no fever and they have had these symptoms greater than 48 hours. “This system allows us to prioritize patients in the order that they will be taken care of,” said Carrillo.
“Sometimes there are delays in the Emergency Department because our staff is working on a critical patient that requires a more comprehensive evaluation and they need to be stabilized so they can be transported by ambulance or flown out by air transportation. Our role in the Emergency Medicine Department is to stabilize patients, and we do have a mix of different patients with different triage categories and based on the number of staff, we do the best we can to expedite care so we can get patients feeling better and discharged, transported or admitted as soon a possible,” said Carrillo. The EMD has the capacity to call in a back-up provider if there is greater than 4 hour wait, a level one category patient that results in greater than 4 hour wait in the EMD, and patient surges from a single incident (e.g. vehicle roll-over) that overburdens resources and staffing.
The typical time a patient will spend in the Emergency Room here at the hospital for a non urgent problem is around 2-hours. “We are a nine-bed emergency department with patients suffering from various illnesses or injuries. Some patients require more care than others and keep in mind that we have one provider on duty with two registered nurses and two corpsmen. When patients come in the ED during busy times they can expect a longer wait to be seen and possibly a longer disposition time before they can be discharged,” said Carrillo.
Patients requiring medical advice can call TRICARE Online at 1-800- or Military One Source at 1-800-342-9647. A consultant is available 24/7. The National Suicide Prevention Hotline is at 1-800-273-TALK (8255). Another option is to contact the Naval Hospital Quarterdeck at (760)830-2190. A physician or Nurse Practitioner is available from 1600-0700 to answer any questions. Emergency Medicine Providers can treat most acute illnesses or injuries, but the Emergency Medicine Department is not a patient’s Primary Care Manager. If the Emergency Medicine Provider recommends a patient to have a follow-up appointment within 24-48 hours, the department will have a copy of the Emergency Treatment Record available for clinic staff to pick-up the following morning. The clinic will contact the patient to schedule a date and time for an appointment. If the Emergency Medicine Department recommends follow-up as needed, the patient is required to call the clinic or use Relay Health in contacting the clinic for a requested appointment. “There seems to be some confusion for the patient when told to follow up with their primary care provider and they show up without making an appointment,” said Carrillo. The Naval Hospital is a small community-type hospital where most specialty care is referred out. “We have a small Emergency Medicine Department,” said Carrillo. The Department has a small waiting room. When people come in with an upper respiratory infection, everything is done to prevent the spread of illnesses. “We do provide masks to prevent the spread of illness and we advise patients with chicken pox or any skin infection to inform our check-in staff so they can isolate them from other patients in the waiting area to minimize exposure,” said Carrillo.
The Emergency waiting area of any hospital is not a very comfortable place for someone with a cold or flu to be waiting for care, and it can prove hazardous for someone with a reduced immune system, or a newborn waiting to see an Emergency Medicine provider. All efforts are made to triage and deliver care to patients in a timely fashion.
Routine or acute appointments can be made at the Robert E. Bush Naval Hospital, and even in many cases a same day appointment can be scheduled with your Primary Care Manager by calling 760-830-2752. Patients enrolled to the Naval Hospital Twentynine Palms Patient Centered Medical Home Pediatrics, Gold Team, or Blue Teams can sign up for Relay Health at www.relayhealth.com.
Tuesday, April 17, 2012
Deny Mosquitoes a Breeding Pool
By Lt. Shelley Griffith, MPH, RS
Robert E. Bush Naval Hospital
Summer is fast approaching and with it come the mosquitoes that accompany our outdoor activities.
There are ways you can prevent these bugs from flying away with your outdoor barbeque happiness. Simple things in the yard can have standing water. Mosquitoes need water to make more little mosquitoes.
Take a look around the outside of your home and notice what has water sitting in it. Think of ways to provide drainage to those items to get the water out. Properly dispose of old tires so they don’t become a hatchery for new mosquitoes. Potted plants need to have proper drainage to maintain a healthy plant and to prevent standing water. These are just a couple of simple tips that may help to make your summer more enjoyable.
Another way to plan outdoor activities is to understand that mosquitoes like to come out at dawn and dusk, just when it is warming up or cooling down here in the desert. Try to plan activities to end before the sun starts to go down. Protection from mosquitoes also can be accomplished by wearing long sleeves and jeans with covered shoes. This will prevent being bitten by a mosquito. Bug spray, zappers, and insecticide are also a choice, but it may be a smelly one.
If you would like to find more simple tips for enjoying summer activities just look at cdc.gov and epa.gov for more fun ways to stay healthy this summer.
Robert E. Bush Naval Hospital
Summer is fast approaching and with it come the mosquitoes that accompany our outdoor activities.
There are ways you can prevent these bugs from flying away with your outdoor barbeque happiness. Simple things in the yard can have standing water. Mosquitoes need water to make more little mosquitoes.
Take a look around the outside of your home and notice what has water sitting in it. Think of ways to provide drainage to those items to get the water out. Properly dispose of old tires so they don’t become a hatchery for new mosquitoes. Potted plants need to have proper drainage to maintain a healthy plant and to prevent standing water. These are just a couple of simple tips that may help to make your summer more enjoyable.
Another way to plan outdoor activities is to understand that mosquitoes like to come out at dawn and dusk, just when it is warming up or cooling down here in the desert. Try to plan activities to end before the sun starts to go down. Protection from mosquitoes also can be accomplished by wearing long sleeves and jeans with covered shoes. This will prevent being bitten by a mosquito. Bug spray, zappers, and insecticide are also a choice, but it may be a smelly one.
If you would like to find more simple tips for enjoying summer activities just look at cdc.gov and epa.gov for more fun ways to stay healthy this summer.
Monday, March 12, 2012
‘Desert Beginnings’ Delivers Babies and Safe Care
By Dan Barber
Public Affairs Officer
Robert E. Bush Naval Hospital
The Robert E. Bush Naval Hospital first opened the doors to its remodeled Labor, Delivery, Recovery and Postpartum (LDRP) care units in the Maternal Infant Nursing Department (MIND) in the summer of 2003… at the time it was one of Navy Medicine’s “Family-Centered” health care initiatives underway. The hospital decided to call the new LDRP units “Desert Beginnings.”
Since that time, more than 4,000 babies have been born at the Desert Beginnings unit… and since 2008 the trend in the numbers of births have steadily been increasing averaging more than 500 births each year. In calendar year 2011 the hospital delivered a record 631 babies.
The LDRP rooms were designed to provide the safe delivery and medical care for the Mothers and newborns, then converting into a large comfortable room for recovery and postpartum care with enough room for family visitors. A chair in the room can be converted into a bed for Dad if he chooses to spend the night.
After the birth of the baby the hospital’s galley (Navy terminology for food services) provides a special menu where Mom’s can order room service.
And if the case arises for the need of an emergency C-Section, the operating room is always ready and seconds away, by design, from the LDRP.
In addition, the Maternal Infant Nursing Department has a professional staff on hand for teaching new Mom’s the benefit of breastfeeding the newborn.
The Robert E. Bush Naval Hospital is the only hospital in San Bernardino County and one of only 40 hospitals in the entire state of California which has been designated as a “UNICEF Baby-Friendly” hospital. When the hospital first received this designation in 2003 there were less than 40 Baby-Friendly hospitals in the United States.
“The safe delivery and care of the new Mom and baby is number one concern in the Maternal Infant Nursing Department,” said Lt. Cmdr. Joanne Costello, Department Head of the MIND.
“We understand that young women want to deliver their baby just as soon as possible. We understand that nine months can seem like an eternity while being uncomfortable, but we don’t encourage early induction of labor before 39 weeks without it being a medical necessity,” said Costello.
There have been young women coming into the LDRP and demanding that their labor be induced and when denied they leave and visit a civilian medical facility to have labor induced. This action can bring harm to the baby and Mom.
“Some early deliveries are necessary because of maternal diabetes or hypertension that could harm either the mother or child,” said Costello.
According to an article published in the San Bernardino Sun at the end of January of this year, “potential complications of early delivery range from breathing and feeding problems to blood infections for the baby. Also, inducing labor before 39 weeks may double some women’s chances of needing a C-section, when this happens Moms also face a greater chance of complications from that procedure.” Costello added, “Delivery between 39 and 41 weeks is best.”
“Medicine has improved the survivability of premature babies, but we should never take a chance in harming an infant by intentionally bringing them into the world before they are ready,” said Costello.
Public Affairs Officer
Robert E. Bush Naval Hospital
The Robert E. Bush Naval Hospital first opened the doors to its remodeled Labor, Delivery, Recovery and Postpartum (LDRP) care units in the Maternal Infant Nursing Department (MIND) in the summer of 2003… at the time it was one of Navy Medicine’s “Family-Centered” health care initiatives underway. The hospital decided to call the new LDRP units “Desert Beginnings.”
Since that time, more than 4,000 babies have been born at the Desert Beginnings unit… and since 2008 the trend in the numbers of births have steadily been increasing averaging more than 500 births each year. In calendar year 2011 the hospital delivered a record 631 babies.
The LDRP rooms were designed to provide the safe delivery and medical care for the Mothers and newborns, then converting into a large comfortable room for recovery and postpartum care with enough room for family visitors. A chair in the room can be converted into a bed for Dad if he chooses to spend the night.
After the birth of the baby the hospital’s galley (Navy terminology for food services) provides a special menu where Mom’s can order room service.
And if the case arises for the need of an emergency C-Section, the operating room is always ready and seconds away, by design, from the LDRP.
In addition, the Maternal Infant Nursing Department has a professional staff on hand for teaching new Mom’s the benefit of breastfeeding the newborn.
The Robert E. Bush Naval Hospital is the only hospital in San Bernardino County and one of only 40 hospitals in the entire state of California which has been designated as a “UNICEF Baby-Friendly” hospital. When the hospital first received this designation in 2003 there were less than 40 Baby-Friendly hospitals in the United States.
“The safe delivery and care of the new Mom and baby is number one concern in the Maternal Infant Nursing Department,” said Lt. Cmdr. Joanne Costello, Department Head of the MIND.
“We understand that young women want to deliver their baby just as soon as possible. We understand that nine months can seem like an eternity while being uncomfortable, but we don’t encourage early induction of labor before 39 weeks without it being a medical necessity,” said Costello.
There have been young women coming into the LDRP and demanding that their labor be induced and when denied they leave and visit a civilian medical facility to have labor induced. This action can bring harm to the baby and Mom.
“Some early deliveries are necessary because of maternal diabetes or hypertension that could harm either the mother or child,” said Costello.
According to an article published in the San Bernardino Sun at the end of January of this year, “potential complications of early delivery range from breathing and feeding problems to blood infections for the baby. Also, inducing labor before 39 weeks may double some women’s chances of needing a C-section, when this happens Moms also face a greater chance of complications from that procedure.” Costello added, “Delivery between 39 and 41 weeks is best.”
“Medicine has improved the survivability of premature babies, but we should never take a chance in harming an infant by intentionally bringing them into the world before they are ready,” said Costello.
Thursday, February 2, 2012
Why Walking Can Help Your Heart
By Shari Lopatin
TriWest Healthcare Alliance
Regular walking can reduce your chances of heart problems by about 30 percent, according to Harvard Health Publications.
Those results came from the analysis of 18 studies between 1970 and 2007. Study participants who walked 5.5 miles each week began showing benefits to the heart. And the more they walked, the greater the benefits.
So, just how can walking help you live healthier this year?
Heart Health Benefits of Walking
While countless activities are available to try—such as cycling or yoga—walking has the lowest drop-out rate, said Health Coach Meghean Cook of TriWest Healthcare Alliance.
Regular walking will:
Lower your risk of heart disease
Improve your blood pressure and blood sugar levels
Lower your bad (LDL) cholesterol, while raising your good (HDL) cholesterol
Help maintain your weight
Lower the risk of obesity
Reduce your risk of type 2 diabetes
In addition, did you know walking fast 35 minutes a day, five days a week, will make you feel better if you’re depressed?
A Harvard Health study published in 2005 proved such activity had a significant influence on mild to moderate depression. If walking five days a week is too often, you can substitute it for 60 minutes a day, just three times a week, for the same results.
Start a Walking Club!
If you’re tired of walking alone, or need new motivation to get up and move, why not start your own walking club?
The American Heart Association will “walk” you through the steps at www.mywalkingclub.org.
If you’re not up for starting your own, you can also browse nearby clubs based on your zip code. Walking clubs aren’t only a positive way to improve your health, but help those around you. They can also develop into a great social bonding experience with new or existing friends.
Want more healthy living tips? Visit TriWest’s Healthy Living Portal at www.triwest.com/HealthyLiving.
TriWest Healthcare Alliance
Regular walking can reduce your chances of heart problems by about 30 percent, according to Harvard Health Publications.
Those results came from the analysis of 18 studies between 1970 and 2007. Study participants who walked 5.5 miles each week began showing benefits to the heart. And the more they walked, the greater the benefits.
So, just how can walking help you live healthier this year?
Heart Health Benefits of Walking
While countless activities are available to try—such as cycling or yoga—walking has the lowest drop-out rate, said Health Coach Meghean Cook of TriWest Healthcare Alliance.
Regular walking will:
Lower your risk of heart disease
Improve your blood pressure and blood sugar levels
Lower your bad (LDL) cholesterol, while raising your good (HDL) cholesterol
Help maintain your weight
Lower the risk of obesity
Reduce your risk of type 2 diabetes
In addition, did you know walking fast 35 minutes a day, five days a week, will make you feel better if you’re depressed?
A Harvard Health study published in 2005 proved such activity had a significant influence on mild to moderate depression. If walking five days a week is too often, you can substitute it for 60 minutes a day, just three times a week, for the same results.
Start a Walking Club!
If you’re tired of walking alone, or need new motivation to get up and move, why not start your own walking club?
The American Heart Association will “walk” you through the steps at www.mywalkingclub.org.
If you’re not up for starting your own, you can also browse nearby clubs based on your zip code. Walking clubs aren’t only a positive way to improve your health, but help those around you. They can also develop into a great social bonding experience with new or existing friends.
Want more healthy living tips? Visit TriWest’s Healthy Living Portal at www.triwest.com/HealthyLiving.
Thursday, January 5, 2012
Joint Commission, MEDIG Seeks Information
The Joint Commission and the Navy Medical Inspector General (MEDINSGEN) will conduct an accreditation survey of Naval Hospital Twentynine Palms from 10 January 2012 to 13 January 2012.
The purpose of the survey will be to evaluate the organization's compliance with nationally established Joint Commission and United States Navy standards. The survey results will be used to determine whether, and the conditions under which accreditation should be awarded the organization.
Joint Commission standards deal with organizational quality of care issues and the safety of the environment in which care is provided. Anyone believing that he or she has pertinent and valid information about such matters may request a public information interview with the Joint Commission's field representatives at the time of survey. Information presented at the interview will be carefully evaluated for relevance to the accreditation process. Requests for a public information interview must be made in writing and should be sent to the Joint Commission no later than five working days before the survey begins. The requests must also indicate the nature of the information to be provided at the interview. Such requests should be addressed to:
Division of Accreditation Operations
Account Representative
Joint Commission One Renaissance Boulevard
Oakbrook Terrace, IL 60181
The Joint Commission will acknowledge such request in writing by telephone and will inform the organization of the request for any interview. The organization will, in turn, notify the interviewee of the date, time, and place of the meeting.
Patients and staff members may contact a Joint Commission surveyor during this survey and request a public information interview. The Joint Commission survey team will be located in Classroom 4, lower level, phone 760-830-2121. Concerns may also be brought to the attention of the Medical Inspector General (MEDINSGEN) by calling the MEDINSGEN Hotline at 1-800-637-6175, DSN 295-9019 or via e-mail at
While here they will be located in Room H104, phone 760-830-2738
This notice is posted in accordance with the Joint Commission's requirements and may not be removed before the survey is completed.
Date Posted: 05 January 2012
This notice is posted in accordance with the Joint Commission's requirements and may not be removed before the survey is completed.
Date Posted: 05 January 2012
Tuesday, December 27, 2011
Naval Hospital Operating Room "Goes Green"
Last month, the Operating Room (OR) at Robert E. Bush Naval Hospital in Twentynine Palms, Calif., began a new environmentally friendly program in their quest for efficiency.
Typically a single surgical case generates a considerable amount of waste because most of the items used for a procedure are disposable. All items needed for a particular case are put together by a Custom Pack manufacturer such as Cardinal Health in what are referred as Custom Surgical Packs.
In order to reduce the waste from these disposable pack contents, reusable surgical items are being used to replace many of the items found in these packs. In view of this, a coordinated effort to substitute as many disposable products as possible for reusable items was initiated by Lt. Cmdr. Brian Parton in March of 2010, and finally implemented in last month.
With the help of the Materials Management Department staff, the OR implemented the use of reusable surgical gowns, towels, basins, and various drapes from SRI Surgical in combination with smaller, more efficient surgical packs from Cardinal Health. The new items that were substituted will help the command reduce surgical waste generation by approximately 13,000 pounds per year at no additional cost.
The process was not as easy as first envisioned. Since Naval Hospital Twentynine Palms is the first Department of Defense (DoD) facility in the country to fully implement the use of hybrid packs, there were several hurdles to overcome. SRI did not have a Distribution and Pricing Agreement (DAPA) in place, so they utilized their partnership with Cardinal Health to add reusable items to Cardinal's DAPA. In addition, the typical three year contract obligation that SRI utilizes was modified in order to satisfy the requirements of the DoD.
After finalizing the custom pack modifications, determining the delivery and pickup schedule, updating the Defense Medical Logistics Standard Support (DMLSS) supply ordering system, and training staff on proper care and use, the new "Green" items were finally used in surgery. The Army and Air Force are also looking into implementing this program at some of their facilities. Their conversions should be smoother thanks to lessons learned between Twentynine Palms, SRI, and Cardinal Health.
Ensign Jenna Dimaggio of the Maternal Infant Nursing Department is currently exploring the potential use of SRI's reusable items in for their patients as well. Single pull items are also being implemented to minimize the use of disposable gowns and accessories when items that exceed the pack contents are required.
Other initiatives that have been implemented in the Operating Room over the past year include the installation of LED surgical lights in all OR Rooms that reduce energy demand by 40 percent, a new instrument washer that is expected to reduce water consumption by 100,000 gallons per year, the utilization of reprocessed devices from Stryker (Ascent) expected to generate savings in excess of $30,000 dollars, and filterless instrument sterilization containers that reduce waste generation and provide increased infection control measures.
By embracing ideas new ideas, researching innovations, and implementing various process improvement initiatives, the Operating Room staff has exemplified environmental awareness and best business practices within the workplace. They have found ways to reuse surgical items, reduce unnecessary waste, and upgrade equipment, all with the purpose to be more environmentally conscious and to contain costs within Navy Medicine, while still providing the best possible care for patients.
Typically a single surgical case generates a considerable amount of waste because most of the items used for a procedure are disposable. All items needed for a particular case are put together by a Custom Pack manufacturer such as Cardinal Health in what are referred as Custom Surgical Packs.
In order to reduce the waste from these disposable pack contents, reusable surgical items are being used to replace many of the items found in these packs. In view of this, a coordinated effort to substitute as many disposable products as possible for reusable items was initiated by Lt. Cmdr. Brian Parton in March of 2010, and finally implemented in last month.
With the help of the Materials Management Department staff, the OR implemented the use of reusable surgical gowns, towels, basins, and various drapes from SRI Surgical in combination with smaller, more efficient surgical packs from Cardinal Health. The new items that were substituted will help the command reduce surgical waste generation by approximately 13,000 pounds per year at no additional cost.
The process was not as easy as first envisioned. Since Naval Hospital Twentynine Palms is the first Department of Defense (DoD) facility in the country to fully implement the use of hybrid packs, there were several hurdles to overcome. SRI did not have a Distribution and Pricing Agreement (DAPA) in place, so they utilized their partnership with Cardinal Health to add reusable items to Cardinal's DAPA. In addition, the typical three year contract obligation that SRI utilizes was modified in order to satisfy the requirements of the DoD.
After finalizing the custom pack modifications, determining the delivery and pickup schedule, updating the Defense Medical Logistics Standard Support (DMLSS) supply ordering system, and training staff on proper care and use, the new "Green" items were finally used in surgery. The Army and Air Force are also looking into implementing this program at some of their facilities. Their conversions should be smoother thanks to lessons learned between Twentynine Palms, SRI, and Cardinal Health.
Ensign Jenna Dimaggio of the Maternal Infant Nursing Department is currently exploring the potential use of SRI's reusable items in for their patients as well. Single pull items are also being implemented to minimize the use of disposable gowns and accessories when items that exceed the pack contents are required.
Other initiatives that have been implemented in the Operating Room over the past year include the installation of LED surgical lights in all OR Rooms that reduce energy demand by 40 percent, a new instrument washer that is expected to reduce water consumption by 100,000 gallons per year, the utilization of reprocessed devices from Stryker (Ascent) expected to generate savings in excess of $30,000 dollars, and filterless instrument sterilization containers that reduce waste generation and provide increased infection control measures.
By embracing ideas new ideas, researching innovations, and implementing various process improvement initiatives, the Operating Room staff has exemplified environmental awareness and best business practices within the workplace. They have found ways to reuse surgical items, reduce unnecessary waste, and upgrade equipment, all with the purpose to be more environmentally conscious and to contain costs within Navy Medicine, while still providing the best possible care for patients.
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