Special Interests

EMSPC and UCHealth Partnership Improves Sepsis Bundle Compliance and Patient-Centered Outcomes

When the Centers for Medicare and Medicaid Services released its sepsis guidelines for hospitals EMSPC faced a daunting challenge.  As the medical provider responsible for over 200,000 emergency department patient visits per year and the medical oversight entity for almost 50 pre-hospital services it was clear that a multi-faceted approach to meeting this new healthcare reality was needed if we were to continue to provide the excellent care that our patients threatened with sepsis deserve.  Sepsis is a potentially life-threatening condition affecting many thousands of patients per year at UCHealth and many more nationwide.  Prompt recognition and treatment are essential to provide the best possible outcome as the condition continues to inflict a high morbidity and mortality on patients.  The CMS guidelines have mandated a quality reporting program to track such metrics as time to antibiotics, fluid resuscitation, laboratory evaluation, and patient re-assessment, among others.  To succeed with this challenge a system-wide collaborative multi-disciplinary approach was needed bringing in all of the vital patient-care partners.  This involved hospital administration, nursing leadership, laboratory, information technology, and pharmacy.  Examples of EMSPC’s unique and active role in helping provide the solution to bundle compliance and improving mortality are below.

• • • • Active partnership with a clinical nurse specialist to gather and review data
      • Monthly educational communication to emergency medicine providers 
      • Collaboration with UCHealth to provide sepsis education system-wide to providers
      • Pharmacy protocol changes to reduce barriers to timely antibiotic administration
      • Grand Rounds sepsis education provided to medical staff 
      • IT changes to catch fallouts on repeat lactate
      • Focus on patient safety to minimize fluid overload while at the same time meeting the CMS measures
      • Ongoing compliance data monitoring and feedback
      • Collaboration with UCHealth Virtual Health Center to passively monitor patients, both ED, and inpatient 

Through an active partnership with UCHealth, EMSPC has improved CMS sepsis significantly.  Active monitoring of fallouts, provider feedback, areas of improvement, patient safety, and ongoing education are just some of the ways we have helped to optimize patient care.   Healthcare is a changing and dynamic field and as the quality of care is increasingly linked to facility reimbursement EMSPC stands ready to partner with you to provide innovative and patient-centered improvements in sepsis care.

An Emergency Department is a complex organism, and it takes a lot of coordination to keep it running optimally. Through our dedication to improving department operations, EMSPC strives to excel at performance. We understand that patients do not come to the Emergency Department to see a registration clerk and sit in a waiting room. They come to see a provider and to find answers.  That is why we have an average door to physician time of 4 minutes for our busy Level 1 Trauma Center (Memorial Central) that sees over 100,000 patients per year. Performance like this is unmatched in our country or anywhere, and this is only one example of the way we have used metrics analytics to improve the care we deliver. We consider our performance metrics and our approach to continuous improvement unparalleled, and we challenge ourselves to constantly search for and develop new opportunities in care delivery.

To that end, we strive to take control of the metrics that we are able to influence in order to maximize efficiency and the patient experience.  We work tirelessly with our partners in nursing, other medical specialties, ancillary services, and hospital leadership to create the most efficient, best patient-centered care possible.  We push other providers, departments, and services to match our high standards of care delivery.  We have been able to work directly with third-party payers including Medicaid to develop novel site-specific rewards for performance, care, and cost containment.  We integrate multiple data collection methods to monitor care and provider performance to search for opportunities for improvement at the individual level as well as provide systemic approaches to best practices. 

This approach is shared throughout all of our facilities, from the Level 1 Trauma Center to our smaller hospitals and free-standing emergency departments. At our smaller facilities, the patients benefit from our group taking our workflow, practices, and experience with us when we work there, keeping our patient care consistent even within the confines of having more limited resources. 

 “I have never seen groups come together so well, across different service lines, with one goal in mind: improving patient care. We brainstorm, we analyze data, we innovate. New ideas are conceived, and then taken to every available staff member to help implement.”

– Dr. Sean Donahue, Memorial Central ED Medical Director

The Sexual Assault Nurse Examiner (SANE) program for sexual assault victims in El Paso and Teller counties began at Memorial Hospital in 1995. As the program grew, it was recognized that other victims of abuse were also in need of medical forensic care. This program then expanded to become the Forensic Nurse Examiner (FNE) Program in 2007 to include care for intimate partner violence, elder abuse, strangulation, child abuse, trauma and human trafficking. The program saw 2125 (656 pediatric, 1469 adult) patients in 2019. 

As physicians in the emergency department, we work closely with our forensic nurses and they are present to consult on all of our patients with concern for violence. They are present in the emergency department 24-7. We are thankful to have this incredible resource at our hospital as they are an invaluable part of our emergency department. They work with law enforcement and multiple local agencies to offer services to victims of violence. The FNE program is also in many community agencies such as the local colleges and high schools to provide education. 

Memorial Hospital has also led the statewide Sexual Assault Forensic Examiner (SAFE) Project for over five years. In this program, Memorial Hospital routinely educates other nurses in the medical forensic examination via didactic coursework, as well as live clinical skills lab training. Our program offers a clinical preceptorship to local and outlying communities providing hands-on patient care experiences. 

The FNE Program is involved in several research projects. The team is in the fourth year as a participant in the Women’s Health Study, which is looking at the healing process of victims of sexual assault. This team is also the pilot site for a rapid DNA study, decreasing the analysis time of sexual assault evidence kits from months to hours. They are spearheading a new research project on living victims of strangulation.

In the Emergency Department, some of our most important colleagues and allies are our pre-hospital providers. Paramedics and EMTs are often our patient’s first point of contact with the healthcare system, and their information-gathering and initiation of treatment are vital to our patient’s success. All of our providers value working with our EMS colleagues, but for many of our physicians, pre-hospital care is a passion.

Among others, these physicians include:

Dr Jeremy DeWall
Dr. DeWall is the Chief Executive Officer of Wilderness and Emergency Care Consulting, PLLC in Woodland Park, CO. He is the dedicated Medical Director for over 23 EMS services ranging from EMS education services, tactical EMS services, and urban and wilderness services throughout the Pikes Peak and southeastern Colorado region. These agencies include Manitou Springs Fire Department, Crystal Park Fire Department, Pikes Peak Community College, Ute Pass Regional Health Services District, Custer County Search and Rescue, Newmont Cripple Creek – Victor Gold Mine Rescue, Pikes Peak Medical Task Force, and Teller County Emergency Medical Services (including 18+ Fire, EMS, Law Enforcement, Dispatch, and Wilderness based services). The area of Emergency Medical Services that Dr. DeWall covers encompasses transport times up to 2-3 hours in addition to urban-level transport times. Overall, these areas include over 2000+ ground-transport square miles of urban, rural, frontier, and wilderness environments. These services involve levels of care form Emergency Medical Responder through Advanced Life Support, Critical Care Medicine, Austere Environment Medicine, Mine Rescue, and Community Paramedicine/Mobile Integrated Health. He is also Vice-President of the National Association of EMS Physicians Colorado Chapter as well as Regional Medical Director for Plains to Peaks RETAC. He is one of the first physicians to be Board-Certified in Emergency Medical Services through the American Board of Emergency Medicine.

Dr Matt Angelidis
Dr. Angelidis is a member of the El Paso County EMS Medical Director Committee, and is the Medical Director for the Plains to Peaks RETAC participating in the development, implementation, training/education, and quality assurance for pre-hospital providers across the Plains to Peaks Region. He also serves as the Medical Director for UCHealth’s Center for EMS Excellence, which strives to improve patient outcomes in the communities that it serves. The Center for EMS Excellence provides current and future EMS providers and EMS agencies with the resources needed to excel in their roles. For the EMS providers, we offer a broad range of initial and continuing education classes designed to bring them into the profession, and then to continually excel once they are in the field. The Center for EMS Excellence works with over 40 affiliated EMS agencies in 7 counties across the Pikes Peak Region. We provide comprehensive medical direction and support services for these agencies including protocol development and review, quality improvement/assurance support, provider skills testing, continuing education, and mentorship.

Dr David Steinbruner
Dr. Steinbruner is the co-medical director of Colorado Springs Fire Department and American Medical Response. He also serves as the medical director of Ambulanz, Limon Ambulance, and other rural agencies.

Dr. Kate Steinberg
Dr. Steinberg is the medical director for EMS is Peyton, Calhan, and Elbert.

There is never an end to a physician’s training and education. While all healthcare providers are dedicated to lifetime learning, it is also important to have a process to continue to assess each provider’s performance after formal training ends. This is why some of our physicians also dedicate time to peer review. Two of these physicians include Dr. George Hertner and Dr. Les Moats. Dr. Hertner has been the Chairman of the UCHealth Memorial Multi-Specialty Committee since 2011, overseeing the peer review process for over 1300 physicians and advanced practice providers, and has also assisted other facilities and groups across the country with their peer review and credentialing process. He also serves on the Claims Committee for COPIC, a medical liability insurance company, and has served in the capacity of an expert in legal cases.  Dr. Moats participates in peer review with MD-Review, with a specialty in critical care and psychiatric cases. Both these physicians have stated that they value peer review not only because it helps the physicians being reviewed, but also because they find it so personally educational.

“[Peer review cases] keep me on my toes; I always learn something.”
– Dr. Les Moats

“I believe the peer review process to be an incredible asset to providing patient-centered care. It is instrumental in identifying individual and system issues with a goal to improve quality and safety in delivering care.”
– Dr. George Hertner

Several of our physicians have additional training and certification in Hyperbaric Oxygen Therapy (HBO). This is a therapy that involves a patient being treated in a chamber with significantly increased air pressure, to increase the body’s ability to absorb oxygen. Conditions treated with this therapy include non-healing wounds, radiation cystitis, and side effects of radiation therapy, among others.

As health professionals at Emergency Medical Specialists, we strive to provide financial assistance to local students in the health field. To this end, Dr. Clark Brewer initiated the EMS Scholarship Fund program in 2018. This program provides funds for books as well as performance-based rewards to EMTs who are continuing their education with the goal of becoming a nurse, advanced practice provider, or physician. We hope that this will help to foster their academic success and will also encourage a high level of performance in the future of healthcare in our community.

EMSPC physicians are leading clinical educators in the Southern Colorado Region. Our clinical educators hold Clinical Faculty Appointments with the University of Colorado School of Medicine, Peak Vista Family Practice Residency, and Rocky Vista School of Osteopathic Medicine. We teach as part of the regional medical campus of CU, and we are recognized as a top medical school nationally for Emergency Medicine education. Our clinical educators are proud of our outstanding educational outcomes in medical education and graduate medical education. Click the links below to learn more.

CU Anschutz – Colorado Springs Branch

Kaplan

EMSPC understands the challenges of practicing emergency medicine during a time of epidemic levels of physician burnout.   We are leading efforts to promote professional satisfaction and career longevity.  Our commitment to physician well-being includes leadership on the UCHealth Southern Region Physician Wellness Committee, ongoing sabbatical program, PRN peer to peer support and individual resilience programming.  We support a culture of wellness through new partner mentorship and opportunities to promote social connectedness.  We support individual professional fulfillment through opportunities for professional development as part of our level one trauma program, as well as opportunities to pursue niche aspects of medicine like hyperbaric medicine, rehab medicine, wilderness medicine, and the other special interests included on this page.  We give back to our community through a scholarship program and nationally recognized trauma outreach program to local elementary schools.