Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

These Rural Athletes Will Soon Have Concussion Care Close to Home

12/28/2016 2:46:34 PM | 0 comments

boy at concussion clinicHigh school sports bring fun and excitement to small town America. But when a player sustains a concussion on a rural field or court, things can escalate quickly.
 
Concussion symptoms can be subtle. They can also be deadly if athletes return to the field too soon. And unfortunately, most concussion specialists practice in urban areas. As a result, rural families often travel long distances for care.
 
But that doesn't always have to be the case.
 
CEP America and Mercy Medical Center Roseburg are working together to build a comprehensive concussion clinic in the rural enclave of southwestern Oregon. In today's post, we'll talk about the need for this service and our vision for the program.
 

A Real Head Shaker

 
Our ED at Mercy Medical Center Roseburg in Douglas County is nothing if not rural. In fact, we're the only ED for 40 miles. Our catchment area includes about 100,000 people and 15 high schools.
 
Most of our concussion patients are teens and young adults. We see a big peak in concussion-related visits on Friday nights after high school football games.
 
In that regard, we're pretty typical. Research suggests that 5 to 10 percent of athletes will suffer a concussion in a given sports season. Symptoms can last 8 to 12 weeks — or even longer in a minority of cases.
 
Unfortunately, we've realized that for many of our patients, there's no clear care plan or path to recovery after the ED.
 

No Direction Home

 
Like kids everywhere, our concussion patients just want to get back to school and sports. But the timing can be tricky.
 
Kids who return to play before their brain injury has healed are at risk for second impact syndrome, which can be fatal or cause permanent disability. So they need expert guidance to know what's safe.
 
But in many cases, there's no expert to be found. The job of managing concussion care often falls on primary care providers who are poorly equipped for the task. Because symptoms can be subtle, the American Academy of Pediatrics warns providers against clearing kids to return to sports unless the provider is specifically trained in concussion care. And many simply lack the training.
 
Another issue is that some concussion patients need several assessments and services — everything from counseling to vestibular (balance) therapy to cognitive rehabilitation. While many of these resources are available in Roseburg, they're scattered around the community and don't typically coordinate their efforts.
 
Families who can't access the right services close to home often end up traveling an hour north to Eugene. That's a significant burden on injured kids and their worried parents. And during football and basketball season, it can mean braving some nasty Oregon weather.
 
So as providers, we saw a huge need for more comprehensive, coordinated concussion care. And then an opportunity arose.
 

Our Wish Is Granted

 
During CEP America's 2015 Partnership Meeting, an annual gathering of providers as well as nurses and administrators, we learned about CEP's Innovation Grants. These awards support joint quality improvement projects between CEP and our client hospitals. We wondered if a concussion program might be a good fit.
 
Sadly, right after the meeting, our community was devastated by the tragic Umpqua Community College shooting. There was so much heartache and suffering around us. We felt especially moved to do something positive for our community.
 
We proposed the idea to our hospital CNO Debbie Boswell, RN; our CEP Regional Director Wade Fox, DO; and Tuan Phan, MD, a CEP Partner with clinical interests in concussion. All were enthusiastic about the program and agreed to support our application.
 
For real-world guidance on shaping the program, Wade Fox introduced us to Julie Dever, the athletic director at Roseburg High School. Talk about busy. She not only ran her own athletics program, she consulted with coaches at 15 other schools around the region. She confirmed that concussions were a frequent topic of concern, and that the need for more resources was huge.
 
So our initial idea — the one we wrote into the grant — was to provide an education and awareness program to support local coaches.
 
Well, wouldn't you know it? We were awarded the grant at about the same time our state began mandating Heads Up Football© certification for football coaches. (They also have training requirements for coaches of other sports.)
 
Don't get us wrong. We were thrilled by this news. And now we had to figure out a new way to use our award. (Tip number one for future grant winners: go into the process with a vision but also an open mind!)
 
To get the ball rolling again, we held a multidisciplinary retreat with participants from CEP, the hospital, and the community. Together, we identified gaps in local concussion care. And a new idea began to take shape: a comprehensive concussion clinic.
 

Innovating — Fast

 
One thing the retreat showed us was how many resources we really did have available in our community.
 
There was a pediatrician with concussion training who had closed his private practice and left to work for the hospital. We also had one thinly stretched sports medicine physician in the area who nevertheless expressed interest in collaborating with us. Mercy Medical Center ran a comprehensive therapy program, including cognitive and vestibular rehabilitation. And we had several ED providers trained in ImPACT®, a well-validated neurocognitive test for concussion.
 
We decided that our first task would be to create a multidisciplinary network of professionals qualified to treat concussions. Key elements would include:
 
  • A medical director to provide clinical leadership and oversight
  • CEP emergency providers to examine and assess patients
  • Providers of speech therapy, vestibular training, counseling, athletic training, and more to treat and manage patients
  • A partner organization (most likely located in Eugene) to provide tertiary services like neuropsychiatry for patients who needed them
 
Our next goal is to regularly bring our concussion network together in one place. Mercy Medical Center generously committed to provide clinical space and staffing for the project. Once we're up and running, this will give us a place to not only see patients but to collaborate on individual care plans and coordinate care.
 
Our goal is to hold a soft opening of our clinic next spring in which we offer neurocognitive testing for high school athletes. If an athlete later suffers a concussion, this baseline assessment will help us monitor progress and guide return-to-play decisions.
 
If everything goes well, we hope to have our full clinic up and running once or twice when football season starts next fall. In addition, several of our providers are enthusiastic about providing concussion education to parents, athletes, and coaches.
 
As ED providers who are committed to our beautiful community, we're gratified by the excitement this idea has generated. We look forward to working more closely with Mercy Roseburg, our local provider network, area coaches and athletic directors, and of course our wonderful patients and families.
 
To learn more about CEP America's commitment to collaboration, innovation, and leadership, visit www.cepamerica.com.


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