LACONIA — With about one-fifth of Medicare patients readmitted to hospitals within 30 days, Lakes Region General Hospital has embarked on a program to reduce preventable readmissions. Since starting Project BOOST five years ago, the hospital has seen about a 20 percent decrease in preventable re-hospitalizations.
The program was one of four initiatives designed to improve quality of care and make it easier for patients to get the care they need in the most suitable treatment setting which were outlined to a gathering of LRGHealthcare's corporators at the organization's annual meeting Wednesday evening at Church Landing at Mill Falls in Meredith.
Gloria Thorington, director of Medical Safety and Healthcare Quality Management for LRGH, said the hospital was one of 24 nationally chosen to launch the BOOST program which aims to reduce 30-day readmissions rates, provide a higher degree of patient satisfaction about their care, and improve the flow of information between the hospital and a patient's regular doctor or specialist. The program also aims to identify the needs of hospital patients considered high-risk, and that greater effort is made to educate the patients and their families about care after they leave the hospital.
In addition to being dangerous to patients, readmissions are costly. A New England Journal of Medicine study found that unplanned readmissions cost Medicare $17.4 billion annually.
Thorington said that under BOOST — Better Outcomes for Older Adults through Safer Transitions — patients are told what risks they need to be aware of when they leave the hospital. In addition the hospital ensures the patient has a scheduled follow-up appointment with their primary care physician within seven days of leaving the hospital, and prior to discharge hospital personnel collaborate with other community health agencies to ensure the patient receives any needed support services. As part of this follow-up, every discharged patient gets a call from a nurse within 48 hours of leaving the hospital, who will ask them how they are doing and if they are having any problems.
Another program focuses on the high-risk chronically ill. It features what LRGH calls embedded care coordinators who regularly touch base with patients and medical practitioners. The embedded care coordinators work with the patients for the first 30 days after they leave the hospital. Because these patients are often on dozens of medications, Karen Davis, LRGH clinical process specialist, said the coordinators sometimes arrange for these patients to have medications delivered to them if they cannot get to a pharmacy themselves and have no family or friends to can do so. This program has cut down on emergency room visits, Davis noted.
Another program which aims to help reduce the unnecessary emergency room use is the Patient Navigator Program.
Margaret McLean, a nurse practioner at LRGH, said the purpose of the program is to get people to go to a doctor's office rather than going to the emergency room.
McLean, who works in the emergency room, sees those who other emergency room personnel have determined do not require urgent treatment. McLean and her colleagues work with these patients get them an appointment with their regular doctor, or find a doctor they can see if they do not already have a doctor of their own.
McLean said that since implementing the Patient Navigator Program at LRGH, statistics show that out of a group of 826 patients, 653 were referred to the program because they did not need to be in the emergency room.
Unlike the other two programs which deal heavily with older patients, McLean said that many of the patients she sees are between the ages of 18 and 45. Many of them do not have any insurance.
For many years now LRGHealthcare's Medication Connection has helped certain patients obtain medications they could not otherwise afford. The company helps qualified patients navigate the medication assistance programs offered by the various pharmaceutical companies.
Marge Kearns, who as vice president of clinical support services heads LRGHealthcare's pharmacies, said Medication Connection currently serves 329 clients in 35 Lakes Region communities. She said that in the last fiscal year alone the program had dispensed $1.8 million in medications to needy patients.
Without directly addressing the BOOST program, Kearns underscored its importance when she said, "The riskiest part of patient care is transition."
NOTES: There was special recognition for Suzanne Stiles, LRGHealthcare's vice president for Administrative and Support Services, who has announced her decision to retire in June. In honoring Stiles, company President Tom Clairmont recognized her work as director of Human Resources at Franklin Regional Hospital before FRH merged with LRGHealthcare, and then her work with the larger organization for the past 12 years. Clairmont praised her for carrying out her duties with dignity. "She the V.P. of class," he said. . . . . . The annual meeting also honored Christine Dzujna for her work on behalf of Franklin Regional Hospital. Dzujna helped to revive the FRH Auxiliary and has worked on a wide variety of auxiliary programs. In recognition she was honored with the Sally Proctor Award. . . . . . The annual Rhoda Ladd award was presented to Nancy Paterno of Gilford, who has been active in the LRGH Auxiliary for many years, and has headed the organization for the past four.
Last Updated on Friday, 04 April 2014 12:25
LACONIA — The skirmishing among members of the Belknap County Convention reached the Belknap County Superior Court yesterday, when Judge James D. O'Neill, III heard the suit brought against Rep. Colette Worsman (R-Meredith), the chairman of the Belknap County Convention, for permitting a member to participate by telephone in what proved a critical vote.
After a hearing that lasted about 45 minutes O'Neill said he would take the matter, together with a motion to dismiss filed by Worman's attorney, under advisement.
The vote was taken when the convention, then wrestling with the 2014 county budget, met in the midst of a heavy snowstorm on February 18, which delayed the assembly of a quorum until three-quarters of an hour past the appointed time of 5 p.m. Only 13 of the 18 members were present when the meeting was convened. Prior to convening the meeting Worsman arranged for Rep. Guy Comtois (R-Barnstead), who was tending to a failing roof, to participate by telephone. When the meeting opened, Worsman explained Comtois would participate by telephone, an instrument was placed on the table and she spoke with him to confirm their connection.
Rep. Beth Arsenault (D-Laconia) offered a motion to adopt the commission's budget, which was second by Rep. Lisa DiMartino (D-Gilford). The members in the room divided seven-to-six in favor of the motion, but Comtois, participating by telephone, voted against and the motion failed. Two weeks later, on March 4, the normal convention majority adopted its own version of the county budget.
Meanwhile, on March 3, the five Democrats filed suit, charging that Worsman violated the provisions of the Right-to-Know Law bearing on members participating by telephone. The Democrats noted that the statute authorizes but does not require the convention to allow one or more members to participate by "electronic means" and claimed that the decision properly rested with the convention, not the chair. Moreover, they charge that no notice was given to the convention that Comtois would be permitted to participate by telephone nor was the reason he could not be physically present recorded in the minutes as the statute requires. Finally, contrary to the law, Comtois failed to identify anyone else present at the location from which he was participating.
Consequently, the Democrats, concluding that Rep. Comtois's vote was "unlawful," asked the court to set it aside, overturn the vote of convention rejecting the commission's budget, and set aside the vote of March 4 adopting the convention's budget.
Representing the Democrats, Rep. David Huot (D-Laconia), told the court yesterday that the issue hinged on the authority of convention to permit a member to participate by telephone. The statute reads that "a public body may, but is not required to, allow one or more members of the body to participate in a meeting by electronic or other means of communication." He said that Worsman failed to put the question to the convention, which did not consider or discuss Comtois's participation.
Attorney Barton Mayer, representing Worsman, countered that the statute does not suggest the convention must expressly "permit" or "authorize" a member to participate by electronic means. Noting that public bodies like the convention adopt their own rules, he said that the county convention is governed by the chair, subject to the will of the majority. For example, Mayer recalled that earlier on the evening of February 18 Worsman proposed recessing the meeting because of the weather only to be overruled. He said that no one objected either when Worsman announced Comtois would participate by telephone or after he cast his vote and the tally was taken.
The statute, Mayer continued, reads "allow," and asked "was he allowed to participate?" He answered "no doubt, no dispute. He voted. No dispute." Mayer said that the video tape recorded a member saying he was not aware the convention had adopted a rule allowing a member to vote by "proxy." Calling the remark "an invitation to object," Mayer repeated that no one objected.
Mayer noted that by voting to adopting the 2014 county budget on March 4, the convention confirmed the legitimacy of the vote rejecting the commission's recommended budget on February 18. To overturn that vote the court would have to find that Comtois was not allowed to participate, for which there is no evidence. Moreover, Mayer explained that the court could set aside the action of the convention but not the vote of one of its members. Since the convention took no action on February 18, he said the issue was moot.
"This a political question brought to this court," Mayer told the judge.
Finally, to underscore his argument, Mayer cited the New Hampshire Supreme Court, which held that "Although interested parties are entitled to object to any error they perceive in governmental proceedings . . . they are not entitled to take later advantage of error they could have discovered or chose to ignore at the very moment when it could have been corrected."
Last Updated on Thursday, 17 April 2014 12:06
LACONIA — A man police describe as transient is in police custody and is charged with one count of receiving stolen property and one count of forgery.
City police said Stephen Donahue, 27, was in Franklin when he was spotted by one of their patrol officers who knew Laconia had two separate warrants outstanding for his arrest.
Donahue appeared in the 4th Circuit Court, Laconia Division Friday morning and was ordered held on $5,000 cash-only bail.
According to affidavits filed with the court, Donahue allegedly stole an antique gun June 15, 2013 that was at a booth at the Antique Center in downtown Laconia. The owner of the gun — a .50 caliber Connecticut Valley Arms black powder pistol — told police he had brought the gun in to one of the dealers to have him look at it.
The owner said his friend wasn't at his booth so he left it in an open case. The booth operator called the victim at 4 p.m. to ask him if he had left the gun there and if so where did he put it.
She reviewed the video surveillance and learned a man had taken it but she didn't know his name. The owner reported the theft three days later.
Police reviewed the logs of a local pawn shop and realized a similar gun had been pawned there on the same day as the theft. Police asked the pawn shop owner to set it aside because they had reason to think it was stolen.
When the victim provided the serial number of the gun to police it matched the one on the gun at the pawn shop and it was confiscated. Pawn shop records allegedly showed the person who sold it was Donahue.
In the matter of forgery, police responded on August 10 to a reported break in. Two days later the officer learned the some checks from the victim's checkbook were missing and had been cashed a Meredith Village Savings Bank.
The MVSB security officer verified the stolen checks were cashed and the teller had gotten a driver's license from the man who cashed them and it belonged to Donahue.
Since the bank reimbursed the victims, that makes it the real victims of forgery.
Donahue was also scheduled to plead guilty to a drug charge in the Belknap County Superior Court yesterday however his appearance was postponed.
As of Friday night, Donahue was in the Belknap County House of Corrections.
Last Updated on Friday, 04 April 2014 11:58
LACONIA — Fire Chief Ken Erickson said yesterday that his decision to retire the department's Dive Team reflected the changed circumstances of the unit, while emphasizing that the capacity of the department to respond to emergencies on water and ice remained undiminished.
The Dive Team was begun, inspired and led by firefighter Mark Miller, who drowned beneath the ice off Weirs Beach while training on March 11, 2004. Erickson said that he delayed his announcement until after the department marked the tenth anniversary of Miller's passing and speaking with his widow Gayle and Cynthia Makris, whose father Peter was the team's leading patron.
Last year, when Municipal Resources, Inc. undertook an analysis of the operations and staffing of the Fire Department, included among its recommendations was a suggestion that the department reconsider the Dive Team and concentrate its resources on its most essential functions and responsibilities. "I had been thinking about it before the report," Erickson said, "but that focused my attention."
Erickson said that with Miller's leadership and inspiration the team numbered nine fully certified divers, trained in underwater rescue and recovery as well as to dive underneath a frozen surface, and a full complement of tenders to assist them. However, since then the number has dwindled with retirements, injuries and aging . "We're running short of qualified divers," he said. He explained that for one diver to enter the water safely, at least a second diver and tender in support are required.
Moreover, Erickson said that experience cast doubt on the role of the Dive Team. "We had a couple of drownings," he noted, "but by the time we could get a diver in the water, we weren't going to rescue anybody." He recalled that several years ago, when a swimmer drowned off Bond Beach, Firefighter Mike Shastany raced from his home, donned his mask and flippers and recovered the lifeless body. "We still have that capability," Erickson said, adding that in any event the recovery of victims of drowning is the responsibility of the New Hampshire Fish & Game Department.
He said that the Dive Team spent more time seeking to recover evidence for the Police Department than engaged in underwater rescues.
However, Erickson stressed that the department has the personnel and equipment to respond to emergencies on the water and ice. The fleet consists of two inflatables, one of 15 feet at Central Station and another of 21 feet at The Weirs, the Fire/Rescue Boat bearing Miller's name and a 21-foot center console craft on loan from New Hampshire Marine Patrol. With one at the Water Street boat launch, another at the Laconia Water Works and a third at The Weirs, Erickson said that the department is positioned to respond quickly on all the lakes as well as the Winnipesaukee River.
"The Dive Team was a relatively small component of our water rescue capability," he said. "We are still the first responders and we have the training and the boats to do the job."
The equipment and operations of the Dive Team were financed entirely by private donations to the Life Saving Fund, which was established in 2004. Erickson said that the fund will remain in place to support the department's marine operations as well as the Laconia CERT (Community Emergency Response Team) and Veterans Count, an affiliate of the Easter Seals program.
Last Updated on Friday, 04 April 2014 11:38
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