3 Pages
Preparation
Review the Villa Health Financial Statement Analysisscenario as needed. Conduct general research on the hospital departmentyou have chosen to better understand how it operates, particularly in areas related to its finances.
Scenario
In the weeks after the Villa Health Board meeting, your department is facinga large staffing shortage that has resulted in a significantincrease inovertime costs. Your department needs to address the ensuing budget shortfall and share the plan withsenior leadership.
Instructions
Considering the scenario, create a brief to senior leadership that shares your initial steps for addressing the budget shortfall. In your brief, include the following:
Explain which three financial statements or figures would likely reveal useful insights into the causes or solutions to the problem.
Suggestthree reasonable options for addressing the specified budget shortfall with detail that would inform decision-making.
Justify your choice of the best option by providing an effective analysis of its pros and cons.
Provide reasonable and specific projections of how this action would impact the financial statements or figures you selected in the first bullet point.
“Specific projections” should include the general magnitude and direction of changes and not necessarily specific numbers.
You neednt focus on actual amounts or perform detailed accounting projections;you are merely seeking toprovide insight into areas and magnitude of change (general direction) caused by the action(s).
Financial Statement
Hospital: St. Anthony Medical Center, Vila Health
BALANCE SHEET
2 Years Prior Ending: 6/30
1 Year Prior Ending: 6/30
Current Year Ending: 6/30
ASSETS
CURRENT ASSETS:
Cash
$ 1,587,292
$ (2,464,387)
$ (1,027,622)
Accounts Receivable
$ 46,165,929
$ 39,102,464
$ 32,410,207
Less-Estimated Uncollectable & Allowances
$ 7,428,652
$ 2,038,650
$ 3,891,982
Receivables From Third Party Payors
$ (3,983,360)
$ (3,067,704)
$ (247,989)
Pledges And Other Receivables
$ 3,067,078
$ 1,770,581
$ 1,889,617
Inventory
$ 7,438,974
$ 7,328,984
$ 8,014,988
Prepaid Expenses
$ 982,465
$ 1,230,053
$ 1,301,476
TOTAL CURRENT ASSETS
$ 47,829,726
$ 41,861,341
$ 38,448,695
PROPERTY, PLANT AND EQUIPMENT:
Land
$ 15,239,201
$ 15,239,201
$ 15,239,201
Land Improvements
$ 981,929
$ 1,005,843
$ 1,009,492
Buildings
$ 114,791,925
$ 85,916,245
$ 122,015,477
Fixed Equipment – Building Service
$ 977,950
$ 28,562,665
$ 77,067,373
Fixed Equipment – Other
$ 7,243,962
$ 9,305,052
$ – 0
Equipment
$ 56,465,517
$ 57,547,957
$ – 0
Leasehold Improvements
$ 360,086
$ 425,606
$ 425,606
Construction In Progress
$ 129,971
$ 225,682
$ 1,089,603
TOTAL
$ 196,190,541
$ 198,228,251
$ 216,846,752
Less Accumulated Depreciation
$ 53,467,581
$ 62,102,069
$ 75,384,791
NET PROPERTY, PLANT & EQUIPMENT
$ 142,722,960
$ 136,126,182
$ 141,461,961
INVESTMENTS AND OTHER ASSETS:
Other Investments
$ 1,200,000
$ 1,200,000
$ 1,200,000
TOTAL INVESTMENTS & OTHER ASSETS
$ 1,200,000
$ 1,200,000
$ 1,200,000
INTANGIBLE ASSETS:
Other Intangible Assets
$ 8,136,660
$ 8,785,276
$ 10,135,573
TOTAL INTANGIBLE ASSETS
$ 8,136,660
$ 8,785,276
$ 10,135,573
TOTAL ASSETS
$ 199,889,346
$ 187,972,799
$ 191,246,229
LIABILITIES AND EQUITY
CURRENT LIABILITIES:
Accounts Payable
$ 12,401,459
$ 15,538,863
$ 16,230,075
Accrued Compensation and Related Liabilities
$ 12,314,912
$ 10,399,590
$ 11,777,836
Other Accrued Expenses
$ 2,866,697
$ 2,147,237
$ 1,866,967
Current Maturities of Long Term Debt
$ 106,871
$ 110,036
$ – 0
TOTAL CURRENT LIABILITIES
$ 27,689,939
$ 28,195,726
$ 29,874,878
DEFERRED CREDITS:
Other Deferred Credits
$ 297,706
$ 185,548
$ – 0
TOTAL DEFERRED CREDITS
$ 297,706
$ 185,548
$ – 0
LONG TERM DEBT:
Notes Payable
$ 5,709,416
$ 5,674,827
$ 5,296,930
Notes and Loans Payable to Parent
$ 200,510,267
$ 189,173,761
$ 196,170,117
TOTAL
$ 206,219,683
$ 194,848,588
$ 201,467,047
Less Current Maturities of Long Term Debt
$ 106,871
$ 110,036
$ – 0
TOTAL LONG TERM DEBT
$ 206,112,812
$ 194,738,552
$ 201,467,047
TOTAL LIABILITIES
$ 234,100,457
$ 223,119,826
$ 231,341,925
EQUITY:
Retained Earnings
$ (34,211,111)
$ (35,147,027)
$ (40,095,696)
TOTAL EQUITY
$ (34,211,111)
$ (35,147,027)
$ (40,095,696)
TOTAL LIABILITIES AND FUND BALANCE OR EQUITY
$ 199,889,346
$ 187,972,799
$ 191,246,229
INCOME STATEMENT
2 Years Prior Ending: 6/30
1 Year Prior Ending: 6/30
Current Year Ending: 6/30
OPERATING REVENUE:
Inpatient Revenue
$ 613,250,730
$ 666,080,698
$ 752,813,180
Outpatient Revenue
$ 379,474,731
$ 464,996,793
$ 529,706,918
TOTAL PATIENT SERVICES REVENUE
$ 992,725,461
$ 1,131,077,491
$ 1,282,520,098
DEDUCTIONS FROM REVENUE:
Contractual Adjustments
$ 717,932,468
$ 855,811,021
$ 1,010,760,525
Charity and Uncompensated Care
$ 13,000,000
$ 13,400,000
$ 7,483,718
TOTAL DEDUCTIONS FROM REVENUE
$ 730,932,468
$ 869,211,021
$ 1,018,244,243
NET PATIENT SERVICE REVENUE
$ 261,792,993
$ 261,866,470
$ 264,275,855
OTHER OPERATING REVENUE:
Other Operating Revenue
$ 10,700,496
$ 9,969,048
$ 10,171,428
TOTAL OPERATING REVENUE
$ 272,493,489
$ 271,835,518
$ 274,447,283
OPERATING EXPENSES:
Salaries and Wages
$ 83,640,502
$ 85,864,459
$ 88,523,453
Employee Benefits
$ 23,409,379
$ 25,248,024
$ 25,937,607
Professional Fees
$ 7,771,092
$ 8,144,426
$ 9,613,656
Supplies
$ 45,829,243
$ 47,766,813
$ 46,386,989
Purchased Services – Utilities
$ 2,876,784
$ 3,264,382
$ 3,043,368
Purchased Services – Other
$ 18,060,203
$ 23,072,640
$ 22,184,388
Depreciation
$ 17,664,788
$ 16,910,508
$ 17,408,824
Rentals and Leases
$ 4,457,609
$ 4,505,340
$ 4,866,384
Insurance
$ 4,958,436
$ 5,430,756
$ 5,740,788
License and Taxes
$ 20,456,465
$ 15,984,288
$ 18,828,504
Interest
$ 18,559,323
$ 16,787,580
$ 18,671,136
Provision For Bad Debts
$ 14,054,177
$ 2,564,197
$ – 0
Other Direct Expenses
$ 6,905,494
$ 9,489,283
$ 8,522,136
TOTAL OPERATING EXPENSES
$ 268,643,495
$ 265,032,696
$ 269,727,233
NET OPERATING REVENUE
$ 3,849,994
$ 6,802,822
$ 4,720,050
NET REVENUE BEFORE ITEMS LISTED BELOW
$ 3,849,994
$ 6,802,822
$ 4,720,050
EXTRAORDINARY ITEM
$ (2,600,229)
$ 1,374,000
$ 750,000
NET REVENUE OR (EXPENSE)
$ 1,249,765
$ 8,176,822
$ 5,470,050 1
2
Financial Statement Analysis
Alicia Adelusi
Healthcare Operations Management HSA540
Professor Dr, Lousia Ukochovwera
October 18th, 2022
Financial Statement Analysis
The IT department is responsible for many important functions within Villa Health. It is responsible for maintaining and troubleshooting computer systems, ensuring data security, and providing technological support to hospital staff. As such, it is essential that the IT department run efficiently and effectively in order to best support the hospital’s operation. The study examines a health care scenario to assist gain an appreciation for business realities that are not readily reflected in financial statements. Also, it will assist in crafting and explaining a likely operational question relevant for a department of Villa Health.
The CFO’s question provides an opportunity to review the financial performance of the IT department and consider ways to improve its efficiency and effectiveness. Below are some financial questions that can be asked to assess the IT department’s performance and identify potential improvements: What is the total cost of ownership (TCO) for the IT department? This figure should include all costs associated with running the department, including salaries, benefits, hardware and software expenses. Secondly, how does the IT department’s TCO compare to similar departments in other organizations? If the TCO is significantly higher than peer organizations, this could indicate inefficiency or excessive spending.
Thirdly, what is the return on investment (ROI) for the IT department? This metric measures how much profit or savings the department generates for the organization as a whole. A high ROI indicates that the department is providing good value for its costs. Fourthly, are there any areas where the IT department could be more efficient? For example, are there duplicate processes or redundant data storage solutions that could be streamlined? Lastly, are there any new technologies or solutions that could help improve the performance of the IT department? For example, cloud-based solutions may offer greater flexibility and scalability than traditional on-premises systems.
There are many factors to consider when making decisions about how to allocate resources within a hospital, but one of the most important is the return on investment (ROI) for the IT department. By understanding the ROI for specific IT projects, hospital administrators can make better decisions about which projects are likely to have the greatest impact on patient care and operational success.
The ROI for the IT department in Villa Health hospital is important for several reasons. First, IT systems are critical to the daily operations of a hospital, and efficient IT systems can help hospitals run more smoothly. Second, IT systems can help hospitals save money by automating tasks and improving communication between staff members. Third, IT systems can improve patient care by providing better access to medical records and faster communication between doctors and nurses. For example, consider a hospital that implements an electronic medical records (EMR) system. The EMR system will likely cost the hospital upfront to purchase and implement, but over time it will save the hospital money by reducing paper costs, automating tasks such as billing and scheduling, and improving communication between staff members. In addition, the EMR system will improve patient care by providing doctors and nurses with quick and easy access to medical records.
There are many assumptions that ROI is important for the IT department in a hospital. The main one is that IT can save the hospital money. In other words, IT can be used to reduce costs or generate revenue. For example, if a hospital uses an Electronic Health Record (EHR) system, it can potentially save the hospital money by reducing duplicate tests and procedures, improving patient safety, and reducing paperwork (McHugh, VanDyke, McClelland, & Moss, 2012). Other examples of how IT can save the hospital money include using telemedicine to connect patients with doctors in remote locations, using data analytics to improve operational efficiency, and using automatic bill pay systems to reduce administrative costs.
Another assumption is that IT can improve patient care. For example, EHRs can help doctors and nurses access critical patient information more quickly and easily, which can lead to better patient care. Additionally, telemedicine can help connect patients with specialists who might otherwise be unavailable, and data analytics can be used to identify patterns that could lead to improved patient outcomes.
Finally, assume that IT investments will have a positive return on investment (ROI). That is, for every dollar invested in IT, the hospital will see a greater return in terms of cost savings or revenue generation (Minich-Pourshadi, 2010). While there is no guarantee that every IT investment will have a positive ROI, this assumption provides a good reason for why hospitals should invest in IT initiatives.
In conclusion, the IT department of a health care organization has a lot to consider when it comes to business realities. It must take into account the financial statements of the organization, as well as the operational questions relevant to their department. By doing so, they can ensure that they are providing the best possible service to their clients and patients. The study has explored on the return on investment (ROI) for the IT department such as cost saving through tasks automation. The assumptions identified include enhancement of patient services.
References
McHugh, M., VanDyke, K., McClelland, M., & Moss, D. (2012). Improving patient flow and reducing emergency department crowding: a guide for hospitals.
Minich-Pourshadi, K. (2010). 5 HOSPITAL FINANCE QUESTIONS TO ASK RIGHT NOW.
Brentwood, TN: Health Leaders Media Intelligence Unit.
Miller, L. (2021).
How to improve your hospital’s financial performance. VIE Healthcare Consulting. https://viehealthcare.com/how-to-improve-your-hospitals-financial-performance/
SHOW MORE…
30 assignment 4
Assessment 4 Instructions: Remote Collaboration and Evidence-
Based Care
Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve
the outcomes for the Vila Health patient and examine how remote collaboration provided benefits or challenges to
designing and delivering the care.
Introduction
As technologies and the health care industry continue to evolve, remote care, diagnosis, and collaboration are
becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which
evidence-based models and care can help remote work produce better outcomes will become critical for success.
Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of
institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those
engaging in remote collaboration.
Professional Context
Remote care and diagnosis is a continuing and increasingly important method for nurses to help deliver care to
patients to promote safety and enhance health outcomes. Understanding best EBPs and building competence in
delivering nursing care to remote patients is a key competency for all nurses. Additionally, in some scenarios, while
you may be delivering care in person you may be collaborating with a physician or other team members who are
remote. Understanding the benefits and challenges of interdisciplinary collaboration is vital to developing effective
communication strategies when coordinating care. So, being proficient at communicating and working with remote
health care team members is also critical to delivering quality, evidence-base care.
Scenario
The Vila Health: Remote Collaboration on Evidence-Based Care simulation provide the context for this assessment.
Instructions
Before beginning this assessment, make sure you have worked through the following media:
Vila Health: Remote Collaboration on Evidence-Based Care.
You may wish to review Selecting a model for evidence-based practice changes. [PDF] and Evidence-Based Practice
Models, which help explain the various evidence-based nursing models.
For this assessment, you are a presenter! You will create a 5-10-minute video using Kaltura or similar software. In the
video:
http://media.capella.edu/CourseMedia/nursfp4030element17273/wrapper.asp
https://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf
https://connect.springerpub.com/content/book/978-0-8261-2759-4/back-matter/bmatter1
Propose your evidence-based care plan that you believe will improve the safety and outcomes of the patient
in the Vila Health Remote Collaboration on Evidence-Based Care media scenario. Add your thoughts on what
more could be done for the client and what more information may have been needed.
Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decisions
about the plan you proposed
Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss
strategies you found in the literature or best practices that could help mitigate or overcome one or more of
the collaboration challenges you observed in the scenario.
Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your video.
Discuss why these sources of evidence are credible and relevant. Important: You are required to submit an APA-
formatted reference list of the sources you cited specifically in your video or used to inform your presentation. You
are required to submit a narrative of all your video content to this assessment and to SafeAssign.
The following media is an example learner submission in which the speaker successfully addresses all competencies
in the assessment.
Exemplar Kaltura Reflection.
Please note that the scenario that the speaker discusses in the exemplar is different from the Vila
Health scenario you should be addressing in your video. So, the type of communication expected is
being model, but the details related to the scenario in your submission will be different.
Make sure that your video addresses the following grading criteria:
Propose your own evidence-based care plan to improve the safety and outcomes for a patient based on the
Vila Health Remote Collaboration on Evidence-Care media scenario.
Explain the ways in which you used an EBP model to help develop your plan of care for the client.
Reflect on which evidence you found in your search that was most relevant and useful when making decisions
regarding your care plan.
Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within
the context of a remote team.
Communicate in a professional manner that is easily audible and uses proper grammar, including a reference
list formatted in current APA style.
Refer to Using Kaltura as needed to record and upload your video.
Note: If you require the use of assistive technology or alternative communication methods to participate in this
activity, please contact [emailprotected] to request accommodations. If, for some reason, you are
unable to record a video, please contact your faculty member as soon as possible to explore options for completing
the assessment.
Additional Requirements
Your assessment should meet the following requirements:
Length of video: 5-10 minutes.
References: Cite at least three professional or scholarly sources of evidence to support the assertions you
make in your video. Include additional properly cited references as necessary to support your statements.
APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used
to create and deliver your video. Be sure to format the reference page according to current APA style. Submit
a narrative of all of your video content.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you
complete the final capstone course.
http://media.capella.edu/CourseMedia/nurs-fp4030element17274/wrapper.asp
https://campustools.capella.edu/redirect.aspx?linkid=4533
mailto:[emailprotected]
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course
competencies and scoring guide criteria:
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Reflect on which evidence you collected that was most relevant and useful when making decisions
regarding the care plan.
Competency 3: Apply an evidence-based practice model to address a practice issue.
Explain the ways in which you used the specific evidence-based practice model to help develop the
care plan identifying what interventions would be necessary. This requires a particular evidence-based
model, such as the Johns Hopkins, Iowa, Stetler, or other.
Competency 4: Plan care based on the best available evidence.
Propose your evidence-based care plan to improve the safety and outcomes for the Vila Health patient
with a discussion of new content for the care plan.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
evidence.
Identify benefits and propose strategies to mitigate the challenges of interdisciplinary collaboration to
plan care within the context of a remote team.
Communicate via video with clear sound and light, and include a narrative of video content.
Provide a full reference list that is relevant and evidence-based (published within five years), exhibiting
nearly flawless adherence to APA format.
SCORING GUIDE
Use the scoring guide to understand how your assessment will be evaluated.
VIEW SCORING GUIDE 8
https://courserooma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/220100/Scoring_Guides/a04_scoring_guide.html Remote Collaboration and Evidence-Based Care Scoring Guide
CRITERIA NON-
PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Propose your
evidence-based care
plan to improve the
safety and
outcomes for the
Vila Health patient
with a discussion of
new content for the
care plan.
Does not
propose an
evidence-based
care plan to
improve the
safety and
outcomes for the
Vila Health
patient.
Describes an
evidence-based
care plan, but
the relevance to
the Vila Health
patient or how
the plan would
improve
outcomes is
absent or
unclear.
Proposes your own
evidence-based care plan
to improve the safety and
outcomes for the Vila
Health patient with a
discussion of new content
for the care plan.
Proposes your evidence-
based care plan to improve
the safety and outcomes for
the Vila Health patient with
new content added. Notes
areas in which further
information or data could
have been useful in
developing the plan.
Explain the ways in
which you used the
specific evidence-
based practice
model to help
develop the care
plan, identifying
what interventions
would be necessary.
This requires a
particular evidence-
based model, such
as the Johns
Hopkins, Iowa,
Stetler, or other.
Does not explain
the ways in
which you used
the specific
evidence-based
practice model to
help develop the
care plan,
identifying what
interventions
would be
necessary.
Identifies an
EBP model and
lists the ways in
which you use
the specific
evidence-based
practice model
to help develop
the care plan.
Explains the ways in which
you used the specific
evidence-based practice
model to help develop your
care plan, identifying what
interventions would be
necessary. Uses a
particular evidence-based
model, such as the Johns
Hopkins, Iowa, Stetler, or
other.
Explains the ways in which
you used the specific
evidence-based practice
model to help develop your
care plan. Notes ideas for
how to evaluate the positive
benefits to patient
outcomes.
Reflect on which
evidence you
collected that was
most relevant and
useful when making
decisions regarding
the care plan.
Does not reflect
on which
evidence you
collected that
was most
relevant and
useful when
making decisions
regarding the
care plan.
Lists which
evidence you
collected that
was most
relevant and
useful when
making
decisions
regarding the
care plan.
Reflects on which
evidence you collected that
was most relevant and
useful when making
decisions regarding the
care plan.
Reflects on which evidence
you collected that was most
relevant and useful when
making decisions regarding
the care plan. Discusses the
rationale or criteria that was
used to determine relevance
and usefulness.
Identify benefits and
propose strategies
to mitigate the
challenges of
interdisciplinary
collaboration to plan
care within the
context of a remote
team.
Does not identify
benefits or
propose
strategies to
mitigate the
challenges of
interdisciplinary
collaboration to
plan care within
the context of a
remote team.
Identifies
benefits or
proposes
strategies to
mitigate the
challenges, but
not both, of
interdisciplinary
collaboration to
plan care within
the context of a
remote team.
Identifies benefits and
proposes strategies to
mitigate the challenges of
interdisciplinary
collaboration to plan care
within the context of a
remote team.
Identifies benefits and
proposes strategies to
mitigate the challenges of
interdisciplinary
collaboration to plan care
within the context of a
remote team. Discusses
how interdisciplinary
collaboration could be better
leveraged to improve
outcomes in future care
situations.
CRITERIA NON-
PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Communicate via
video with clear
sound and light, and
include a narrative
of video content.
Does not
communicate
professionally in
a well-organized
presentation and
does not include
a narrative of
video content.
Does not
communicate
via video or
video is difficult
to hear and see,
but does include
a narrative of
video content.
Communicates via video
with clear sound and light
and does include a
narrative of video content.
Communicates via video
with clear sound and light.
Content delivery is focused,
smooth, and well-rehearsed.
Includes a narrative of the
video. Video presentation is
between 5 to 10 minutes.
Provide a full
reference list that is
relevant and
evidence-based
(published within
five years),
exhibiting nearly
flawless adherence
to APA format.
Does not provide
a reference list of
relevant and/or
evidence-based
sources
(published within
five years).
Provides
reference list
that is not
relevant and/or
evidence-based
with several
APA errors.
Provides a reference list
that is relevant and
evidence-based (published
within five years) sources,
exhibiting nearly flawless
adherence to APA format.
The reference list is from
relevant and evidence-
based (published within five
years) sources, exhibiting
flawless adherence to APA
format. Vila Health Activity
Remote Collaboration
and Evidence-Based
Care
Introduction
The Patient Presents
Collaboration Begins
Consulting With the Pediatrician
The Care Plan Continues
Respiratory Therapist Consult on Skype
Conclusion
Introduction
Evidence-based care can be a challenge in any medical situation,
but particular challenges present themselves when care is being
provided remotely. In order to provide quality care to patients
who live in rural settings or have difficulty with transportation to
a care site, health care professionals must sometimes collaborate
with other professionals in different ZIP codes or even time
zones.
In this activity, you will observe how health care
professionals collaborate remotely and virtually to
provide care for a patient in Valley City, North Dakota.
The Patient Presents
Dr. Erica Copeland and Virginia Anderson, a pediatric
nurse, discuss Caitlynn, who came into the ER last night
and has now been admitted to the pediatric unit.
Dr. Copeland starts
the conversation.
Dr. Copeland: Nurse, can you give me an update on
Caitlynn? I know shes two years old and shes been
admitted for pneumonia. Does she have any history of
breathing problems?
Virginia Anderson: Yes, this is her second admission for
pneumonia in the last six months. She had a meconium
ileus at birth.
Dr. Copeland: All right. Is she presenting with any other
symptoms?
Virginia Anderson: She has decreased breath sounds at
the right bases and rhonchi scattered in the upper lobes.
Respirations are 32 and shallow with a temp of 101.
Dr. Copeland: What have we done for her so far?
Virginia Anderson: The respiratory therapist
administered nebulized aerosol and chest physiotherapy.
After the aerosol she had thick secretions.
Dr. Copeland: I see her weight is 20.7 pounds, and
theres been some decreased subcutaneous tissue
observed in her extremities?
Virginia Anderson: Correct. I noticed this too, so she
might have some malabsorption of nutrients.
Dr. Copeland: Have we done a sweat chloride test yet?
Virginia Anderson: Yes, and the results were 65
milliequivalents per liter. Also, the mother reports that
when she kisses her, she tastes salty.
Dr. Copeland: All right. Well, I think its fair to say we
might be dealing with cystic fibrosis here. Lets get her
started on an IV with piperacillin, and keep an eye on her
temperature.
Collaboration Begins
Later, the diagnosis is confirmed: Caitlynn has cystic
fibrosis. Dr. Copeland, Virginia Anderson, and Rebecca
Helgo, the hospitals respiratory therapist have a short
consult, where they realize that Caitlynns care will not be
easy.
Dr. Copeland starts
the conversation.
Dr. Copeland: Lets talk about Caitlynn Bergan. Her
mother, uh, [checks notes] Janice, has been informed of
her diagnosis. I didnt realize this when she first came in,
but she doesnt live in Valley City; shes in McHenry.
Rebecca Helgo: Thats a tough drive during winter.
Theyre over an hour away, arent they?
Dr. Copeland: Thats right. It was a toss-up between
coming here or going to Jamestown, but I guess the
father Doug thought Valley City was the better
choice. Anyway, Ive put her on Pancrease enzymes and
well be recommending a high-protein, extra-calorie diet
along with the fat-soluble vitamins A, D, E, and K. Ill
update her pediatrician on her condition, and order
dornase alfa. Lets see how she does with the breathing
treatments. How are those going?
Rebecca Helgo: Quite well, actually. Shes too young to
get her to do the huff breaths, but were keeping the
secretions thin and manageable with the aerosol
treatments. I am concerned about her day-to-day
treatment, though. Shell be back here with pneumonia if
the parents cant stay on top of that. Shes at risk for
impaired gas exchange and respiratory distress, which
will cause her anxiety and more distress, and thats not
going to help her stay well.
Dr. Copeland: How well do you think the parents will be
able to handle the treatment?
Virginia Anderson: That might get tricky. I gather that
the mother and father are still married but separated.
Well need to make sure that at least one of them gets
the education they need. But they both work, and trips
here arent the easiest choice. We should get a social
services consult to coordinate services and identify some
assistance for the family in McHenry.
Rebecca Helgo: I can do some education here, and then
do a Skype consult with one or both of them once shes
been discharged and is back home.
Dr. Copeland: It sounded like both parents work long
hours. Are you going to be able to schedule times that
work?
Rebecca Helgo: I may have to do some after-hours
appointments. Well have to sort that out.
Virginia Anderson: Shes had one bowel obstruction
already, so I think we need to help them monitor for DIOS
too. Does the pediatricians office have a telemedicine
relationship with us? That might be helpful in preventing
unnecessary trips here.
Dr. Copeland: Lets find out a bit more and see what our
options are.
Consulting With the
Pediatrician
Later that day, Dr. Copeland and Virginia Anderson talk
to Dr. Benjamin, Caitlynns pediatrician, about how his
office can coordinate with the hospital on Caitlynns care.
Dr. Copeland greets
Dr. Benjamin.
Dr. Copeland: Hello, Dr. Benjamin. Im sorry to be
meeting under such circumstances, but I hope we can
work with you to help the Bergans handle Caitlynns care.
On the line with me is Virginia Anderson, the nurse
assigned to Caitlynn while shes here.
Dr. Benjamin: Hello to both of you. Yes, its unfortunate.
This is the first case Ive seen among my own patients.
Dr. Copeland: Are you familiar with the CF protocol?
Dr. Benjamin: I am, but Id love to get any more details
that relate to Caitlynn. Shes done with most of her
immunizations, but shes still needs her HAV and
influenza, of course. Im also not sure where to order
some of the pancreatic enzymes and medications you
listed.
Virginia Anderson: We can help with all that. Do you
have telemedicine access to Valley City?
Dr. Benjamin: No, but we do have it with Cooperstown
Medical Center. We kind of have to in a town of less than
100 people.
Dr. Copeland: We may be able to use Skype on a more
informal basis for consults between us, but it might be
good to get connected with Valley City on your
telemedicine equipment. If the parents bring Caitlynn to
you with symptoms, and youre not sure whether the
hour-long trip is necessary, we can do a telemedicine
appointment and make sure.
Dr. Benjamin: All right. It sounds like we might see them
often initially, and I understand that bowel obstructions
and pneumonia are two possible complications. We can
handle some of those issues here, but assuming they
have trouble during working hours, I assume we can
reach you by phone?
Dr. Copeland: You or your staff can send me a text. If we
need to talk further we can set up a call, but if not, text is
the quickest way to get my attention, and the easiest
way for me to respond between things.
Virginia Anderson: And Im available via text as well if
youre having trouble reaching Dr. Copeland or if its a
question I can field.
The Care Plan Continues
To address some of the questions that came up during
the consult, Virginia meets with Madeline Becker, the
social worker at the clinic in McHenry.
Virginia starts the
conversation.
Virginia Anderson: Hi, Madeline, this is Virginia
Anderson at Valley City Regional Hospital. Im on the line
with Marta Simmons, our social worker here at the
hospital.
Madeline Becker: Hi, both of you.
Marta Simmons: Madeline, were calling because
Virginia is working on a care plan for a child from
McHenry, a Caitlynn Bergan. Shes here after a bout of
pneumonia and shes been diagnosed with cystic fibrosis.
We wanted to talk to you about resources there for some
of the issues the Bergans are going to be dealing with.
Madeline Becker: Of course. I got the documentation you
emailed earlier. Fortunately, the Bergans are both
employed and have good insurance through Dougs new
job. But as you may have heard, he was unemployed for
some time, so money is tighter than it might seem.
Virginia Anderson: Weve talked to Janice and she isnt
sure what her insurance covers as related to the
breathing and other treatments Caitlynn is likely to need.
Madeline Becker: I can do some initial work on that. Ill
need a release from Janice to get detailed information,
but I should be able to get general coverage information.
What other resources might they need? McHenry is
pretty small, as Im sure youre aware.
Marta Simmons: The main issue is going to be the stress
of caring for a child with a chronic illness. Even a group
that helps members deal with grief would be helpful.
Children with CF live much longer than they used to, but
its still a difficult condition.
Madeline Becker: There isnt a group like that here, but
there is one in Sheyenne. I mean, its more for parents in
grief already, parents who have lost a child, but its a
sizable group, relatively speaking. Im sure there will be
some parents who understand what its like to have a
child with a difficult condition.
Virginia Anderson: All right, that helps. Now, were going
to provide as much education as we can before Janice
takes Caitlynn home, but what kind of resources are
there in McHenry? If she doesnt have home Internet
access, does the library offer it? Is there a library?
Madeline Becker: No, the closest library is in
Cooperstown.
Marta Simmons: Well, well talk to the Bergans
pediatrician and see if they might be able to help if they
need materials and cant get them easily at home. This is
progressive and lifelong, and theyre going to need some
support as they learn to deal with it.
Respiratory Therapist Consult
on Skype
A few days after Janice and Caitlynn go back to
McHenry, Janice calls to talk to someone about whether
shes doing Caitlynns chest physiotherapy correctly.
Virginia and Rebecca, the respiratory therapist, call her
back on Skype to answer her questions.
Virginia Anderson
starts the
conversation.
Virginia Anderson: Hi, Janice, thanks for contacting us!
Were getting back to you about Caitlynn. With me on the
line is Rebecca Helgo, the respiratory therapist who
helped you out when you were here.
Rebecca Helgo: Hi, Janice.
Janice: [sounding stressed] Hi.
Virginia Anderson: Janice, how is it going with Caitlynn?
Janice: Well, thats why I called, actually. Not so good. I
mean, not bad, but I guess Im not remembering
everything you told me when we practiced the
physiotherapy, the chest physiotherapy.
Virginia Anderson: Thats okay, Janice. I know this feels
overwhelming. Caitlynns condition is an extensive one,
and were here to help you manage it. Well continue to
be here as youre figuring this out, okay?
Rebecca Helgo: Thats right, Janice. I know youll get the
hang of it, but in the meantime theres a lot to learn. So
you had some questions about the chest physiotherapy?
Whats going on?
Janice: Okay, if you can see on the camera, Caitlynn has
these red marks on her ribs here. Is that a symptom of
something?
Rebecca Helgo: Can you get the camera just a bit closer?
Janice: Hows that?
Rebecca Helgo: Okay, very good. Yes, those look like
marks from the percussion. Are those over her last two
ribs?
Janice: I think so.
Rebecca Helgo: Thats one thing youll have to
remember: You dont want to do the percussion on her
last two ribs on either side, her backbone, or her
breastbone. And when you do it anywhere else, you dont
want to leave red marks. So if you see those, thats a hint
that youre doing the percussion just a bit too hard.
Virginia Anderson: Dont worry, you havent hurt her that
I can see. Plus, youre obviously really staying on top of
things and youre following the recommended treatment
procedures for Caitlynn, and I really want to praise you
for that. So, is she acting like that area is hurting her? Or
can you tell?
Janice: No, it doesnt seem like its hurting her at all.
Rebecca Helgo: She should be fine, then.
Virginia Anderson: And remember, Janice, if you continue
to have trouble with this, weve got other options. Theres
a vest that vibrates the child if percussion isnt getting
the job done. And you wont have to do exactly this
forever. As she gets older and can learn how to do huff
coughs, youll be doing less work and shell be doing
more.
Janice: Okay. Thank you, that makes me feel better. I
couldnt get hold of my pediatrician and I was just getting
worried.
Rebecca Helgo: Good, thats what were here for.
Virginia Anderson: Janice, should we review the signs
and symptoms of respiratory distress? Were happy to go
over anything you need to feel more confident about
monitoring Caitlynn.
Janice: I think I remember those. I feel like I check for
them every hour.
Rebecca Helgo: [chuckles] Thats understandable. Well,
remember to check with Dr. Benjamin or me or Virginia if
you need to.
Conclusion
As you saw in this activity, coordinating care can be a
challenge when the patient lives far from her provider or
when multiple providers are distant from each other.
Many technologies may be necessary in order to provide
quality evidence-based care to patients when care teams
and patients are not in the same location. Nurses and
other health care professionals must find creative
solutions when problems arise, so that care planning for
remote patients is just as comprehensive and outcome-
based as that for patients nearby or on site.
Reflection Questions
As you work on your assignment, consider these
questions:
How was remote collaboration used to improve the
quality and safety of the care being provided in the
scenario?
This question has not been answered yet.
In what ways was evidence-based practice being
effectively applied to help the patient in the
scenario? Were there opportunities for
improvement? If so, what were they?
This question has not been answered yet.
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