Plan for Providing Care Change Log 2014 SECTION CHANGE RESPONSIBLE PERSON WEEKEND AND

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1 Trauma Services Plan for Providing Care Change Log SCOPE OF SERVICE: Cabell Huntington Hospital (CHH) is a jointly designated Level II Trauma Center and operates as such under the rules and regulations of the WV Trauma and Emergency Medical System. CHH Trauma Center is verified by the American College of Surgeons Committee on Trauma (ACS-COT) as a Level II Trauma Center. The Trauma Services Director along with the Trauma Medical Director prepares the facility for continued designation/verification as a Level II Trauma Center. CHH trauma obtains re-designation every three years by the State Trauma and Emergency Medical System and reverification by the American College of Surgeons Committee on Trauma. Jenny Murray Pain Management Center Perinatal Center Trauma patients are identified per established protocols and service area. The Trauma Response Team consists of multiple disciplines that are available 24 hours per day to provide care for the neonate through elderly geriatric populations. The Trauma Services Director oversees the Performance Improvement activities, structures loop closure event resolution in collaboration with the Trauma Medical Director, Adult and Pediatric Multidisciplinary Trauma Program Performance Committee, Adult and Pediatric Multidisciplinary Trauma Peer Review Committee, and other departments affected. The Trauma Services Director presides over weekly trauma and orthotrauma rounds, which involves the trauma medical director, trauma nurse practitioner, surgery/orthopaedic resident physicians as well as ancillary departments including but not limited to Nursing, Dietetics, Rehabilitation, Respiratory Therapy, Clinical Resource Management and Clinical Pharmacy. CHH Trauma is active in lobbying for statewide safety initiatives such as motorcycle helmets, bicycle helmets, ATV safety, smart phones hands free calling and no texting while operating a motor vehicle. The CHHPMC is open Monday through Friday 8:00 A.M. to 5:00 P.M. For any problems that occur after hours, the physician may be contacted at A specialized facility established for the purpose of providing prenatal pregnancy related diagnosis and follow up for pregnant women child bearing age. Patients are referred from physicians offices and clinics throughout West Virginia, Ohio and Kentucky. Two pperinatologists, registered nurses and ultrasonographers, and front office staff provide a team approach to addressing a wide range of services. Christiann Kuhner Annette Cartwright

2 Page 2 of 11 The Perinatal Center provides consultation and ongoing management of normal and high risk pregnancies. Perinatology consultations include preconceptual, genetic, as well as a variety of maternal and fetal conditions. Pastoral Care Physician consultations include pre-conceptual, genetic, and a variety of maternal and fetal conditions. The Department of Pastoral Care (chaplains) offers spiritual care to patients, families, and staff of Cabell Huntington Hospital. Full-time and contract Chaplains provide (24 hour/7 days a week) spiritual care to all traumas, codes, deaths, pre-surgical patients, inpatients & families, and support in the Emergency Department. The department (chaplain) provides weekly pastoral care at Riverpark Hospital, a psychiatric facility, to provide spirituality groups, spiritual counseling, consultation to staff, and worship services for patients. The CHH Counseling Center and EAP (Employee Assistance Program) provides over 5300 counseling sessions annually to hospital personnel and the general public. Individuals and families meet with counselors to discuss a variety of problems such as depression, grief, marital difficulties, childhood trauma, low self-esteem, spiritual confusion or conflicts, etc. In addition, the center employs a psychologist that is qualified to test for ADHD, IQ, Aspergers, and other cognitive disorders. Counselors are licensed by the state, participate in annual CEUs, and are supervised in weekly case conferences. Members of the department hold membership on the local Organ Donation Committee, Bioethics Committee, and Ministerial Groups. The Department of Pastoral Care (chaplains) offers spiritual care to patients, families, and staff of Cabell Huntington Hospital. Full-time and contract Chaplains provide (24 hour/7 days a week) spiritual care to all traumas, codes, deaths, pre-surgical patients, inpatients & families, and support in the Emergency Department. The department (chaplains) provides weekly pastoral care at Riverpark Christie Eastman

3 Page 3 of 11 Hospital, a psychiatric facility, to provide spirituality groups, spiritual counseling, consultation to staff, and worship services for patients. The CHH Counseling Center and EAP (Employee Assistance Program) provides over 6,200 counseling sessions annually to hospital personnel and the general public. Individuals, couples, and families meet with counselors to discuss a variety of problems including depression, anxiety, grief, marital difficulties, childhood trauma, post-traumatic stress, low self-esteem, work stress, interpersonal conflicts, and spiritual confusion. In addition, the center employs a psychologist that is qualified to test for ADHD, IQ, Autism spectrum disorders, and other cognitive disorders. Our psychotherapists maintain professional standards and continuing education for licensure with their respective licensing boards, and are supervised by their clinical supervisors and/or in biweekly case conference. Surgery Center and Center for Surgical Weight Loss Members of the department hold memberships on the local Organ Donation Committee, Bioethics Committee, as well as various professional organizations including the American Counseling Association, American Association for Christian Counselors, International Center for Excellence in Emotionally Focused Therapy, American Psychological Association, and others. Cabell Huntington Hospital Surgery Center is a multi-specialty surgery center with four operating rooms and one endoscopy suite. We provide surgical care to patient s age 3months full term infants and one year old premature infants to the elderly and all socioeconomic groups. A broad range of surgical services is provided including Orthopedic, General, GYN, Ophthalmology, Podiatry, Plastic, ENT, GU, GI, Dental, Pain Management, and Urology. Anesthesia services include General, Regional, Spinal, Monitored Anesthesia Care (MAC) and Conscious Sedation provided by nursing staff. All nurses are required to be ACLS certified, PACU RN s are required to have PALS certification. An anesthesiologist supervises the CRNAs at a ratio of 1 Anesthesiologist to 4 CRNA s. The Anesthesiologist remains in the building until the last patient is discharged from the PACU. The staff consists of Registered Nurses, technicians and other ancillary personnel.. Our hours of operation are from 6:00 a.m. to 5:00 p.m., Mon through Friday or till the last patient Tabitha Bremer

4 Page 4 of 11 is discharged from PACU. Rehabilitation Medicine Services Cabell Huntington Hospital Surgery Center is a multi-specialty surgery center with four operating rooms and one endoscopy suite. Surgical care is provided to infants as young as three months (full-term) or 12 months (premature) to geriatrics and of all socioeconomic groups. A broad range of surgical services is provided including Orthopedic, General, GYN, Ophthalmology, Podiatry, Plastic, ENT, GU, GI, Dental, Pain Management, and Urology. Anesthesia services include general, regional, spinal, and monitored anesthesia care (MAC), and conscious sedation provided by nursing staff. All staff nurses are required to be ACLS certified. Additionally, recovery room nurses are required to have PALS certification. An anesthesiologist supervises the CRNA to a ratio of 1 anesthesiologist to 4 CRNAs. An anesthesiologist is to remain in the building until the last patient is discharged. The staff consists of registered nurses, surgical technicians, and other ancillary personnel. The surgery center is operational from 6:00 a.m. to 5:00 p.m., Monday through Friday, or until the last patient has been discharged. Three outpatient facilities, Balance Center and SMART Center & Proctorville Medical Center offer a range of services. Aquatic Therapy is provided at the Huntington YMCA OT also addresses hand and upper extremity treatment, lympedema, pelvic floor weakness, use of adaptive equipment; energy conservation, splinting, positioning, functional capacity assessments, balance assessments and treatment. Marshall Health Provider Based Clinic Services at the Proctorville Medical Center include Physical Therapy.

5 Page 5 of 11 Marshall Cardiology Marshall Cardiology is located on the fourth floor of the Ora Erma Byrd Clinical Center and provides complete adult cardiology services. Staffed with Board Certified Cardiology physicians, Marshall Cardiology is led by Marc A. Studeny, MD Department Chairman. Marshall Cardiology operates form 8AM 4:30PM Monday through Friday. Marshall Cardiology offers a range of on-site cardiac testing including: Stress Testing Echocardiograms Carotid Ultrasound Ankle Brachial Index (ABI) Cardiac CT The following job titles are found in the Marshall Cardiology Clinic: 2. RN 3. Licensed Practical Nurse 4. Medical Assistant 5. Receptionist Marshall Family Medicine At Marshall Family Medicine, we provide comprehensive primary care to patients of all ages, from infants to the elderly. We offer a patient-centered medical home for their continuing health care needs, while integrating elements of wellness and disease prevention for ongoing health. Our physicians have training and personal interests in a wide variety of specialty areas, such as travel medicine, sports injuries, obstetrics and cosmetic procedures. Additionally, we have physicians who are authorized Civil Surgeons by the United States Citizenship and Immigration Services to evaluate individuals applying for permanent residency in the United States. Our Division of Occupational, Environmental and Disability Medicine is staffed by specially-trained and certified physicians to provide the full gamut of services, including Independent Medical Examinations, acute workplace injuries and chronic complications of job-related injuries. Our offices are located at the Marshall University Medical Center. Hours of

6 Page 6 of 11 operation are Monday Friday from 8:00 a.m. to 8:00 p.m. Marshall Internal Medicine The following job titles are found in Marshall Family Medicine: Physician Nurse Practitioner Physician Assistant Resident Physicians Registered Nurse Medical Assistant Pre-cert/Auth Staff Patient Service Representative Patient Care Coordinator Marshall Internal Medicine is located at the Erma Ora Byrd Clinical Center, th Street, Huntington, West Virginia. Appointments are offered by all sections and a walk-in clinic is available Monday through Friday, 8:00 a.m. to 4:30 p.m. The department s board certified and board eligible faculty physicians, resident physicians, and non-physician providers provide care for a variety of medical conditions, from the simple to the complex, for the prevention and treatment of disease in adults ages 18 and older. Primary care is provided by the section of General Internal Medicine. Specialty care is provided by the following sections: Endocrinology Gastroenterology Geriatrics Infectious Diseases Pulmonology Rheumatology The Hanshaw Geriatric Center is located within the department of Internal Medicine and provides specialized care for dementia and Alzheimer s disease, including offering a driving assessment clinic. A certified social worker supports the Geriatric Center as well as the rest of the department s patients by helping to identify support services in the community and beyond. The Bruce S. Chertow Diabetes Center in the department is staffed by two certified diabetes educators and a nutritionist who specialize in diabetes education and nutritional counseling.

7 Page 7 of 11 The following job titles are found in Marshall Internal Medicine: 2. Physician Assistant 3. Nurse Practitioner 4. Resident Physician 5. Registered Nurse 6. Licensed Practical Nurse 7. Medical Assistant 8. Social Worker 9. Certified Diabetes Educator 10. Nutritionist 11. Patient Care Coordinator 12. Patient Service Representative 13. Health Information Representative Marshall Orthopaedics Marshall Orthopaedics treats patients who present with a wide range of acute and chronic medical conditions. Staffed with physicians and midlevel providers, Marshall Orthopaedics provides care to patients of all ages. Marshall Orthopaedics is open during standard business hours, Monday through Friday, and is accepting new patients. Marshall Orthopaedics is staffed by fourteen attending physicians, two physician assistants, one nurse practitioner and fifteen resident physicians. The office is headed by Department Chairman, Ali Oliashirazi, M.D. The clinic specializes in the complete spectrum of orthopaedic care, including the following: Joint Replacement Sports Medicine Trauma General Orthopaedics Pediatrics Hand and Upper Extremity Foot and Ankle. Same day appointments are available via a Walk-In Clinic for urgent orthopaedic needs. The following job titles are found at Marshall Orthopaedics:

8 Page 8 of Nurse Practitioner 3. Physician Assistant 4. Medical Assistant 5. Clerk 6. Referral 7. Receptionist 8. Licensed Practical Nurse 9. Operator 10. Ortho Tech 11. Resident Coordinator 12. Secretary 13. Registered Nurse 14. Office Manager 15. Department Administrator Marshall Pediatrics Marshall Pediatrics provides comprehensive medical care to patients from birth through college. Marshall Pediatrics has four locations: a) 1600 Medical Center Drive, Huntington; b) rd Avenue, Huntington; c) 5170 US Route 60 East, Huntington; d) 179 Station Place, Hurricane. These locations are open Monday through Friday 8:00 a.m. to 4:30 p.m. and are accepting new patients. Same day appointments are available. Marshall Pediatrics NowCare is open seven days a week, Monday through Friday 1:00 p.m. to 8:30 p.m. and Saturday and Sunday 9:00 a.m. to 2:30 p.m. The NowCare is also located at 5170 US Route 60 East, Huntington. The following job titles are found at Marshall Pediatrics: 2. Medical Assistant 3. Administrative Assistant 4. Patient Service Representative 5. Patient Accounting 6. Resident Coordinator 7. Licensed Practical Nurse 8. Registered Nurse 9. Office Manager 10. Department Administrator Marshall Surgery Marshall Surgery is led by Chairman David Denning, MD. The office is open 8:00am to 4:30pm, Monday Friday. The Department treats patients for a variety of surgical needs. Our board certified surgeons perform a vast array of surgical services, including but not limited to: routine/screening

9 Page 9 of 11 colonoscopies, minimally invasive surgery, trauma surgery, vascular surgery, thoracic surgery, bariatric surgery, and pediatric surgery. Marshall Oral and Maxillofacial Surgery Marshall Obstetrics and Gynecology The following job titles are found in Marshall Surgery: 2. Nurse practitioner 3. Nursing Supervisor 4. Billing Supervisor 5. Front Desk Supervisor 6. RN 7. LPN 8. Patient Service Representative 9. Patient Account Representative Marshall Oral & Maxillofacial Surgery is led by Raj Khanna, DMD, MD and is open 8:00am to 4:30pm, Monday Friday. The office offers a full range of Oral and Maxillofacial services: general oral surgery, wisdom teeth extractions, dental implants, anesthesia services, facial trauma/reconstruction and cancer(s) of the mouth. The following job titles are found in Marshall Oral & Maxillofacial Surgery: 2. RN 3. LPN 4. Oral Surgery Assistant 5. Patient Service Representative Marshall Obstetrics and Gynecology specializes in caring for normal and problem pregnancies and provide preconception and prenatal care in a friendly, family-oriented environment. The Department offers complete range of general gynecologic services including screening examinations and disease prevention, evaluation and management of reproductive problems for women from adolescence through menopause. The department is led by Chairman David Jude, MD and is comprised of 4 divisions: Gynecologic Oncology Maternal-Fetal Medicine Reproductive Endocrinology and Infertility

10 Page 10 of 11 Urogynecology Marshall Psychiatry and Behavioral Medicine Marshall Neuroscience The following job titles are found in Marshall Oral & Maxillofacial Surgery: 2. RN 3. LPN 4. Oral Surgery Assistant 5. Patient Service Representative Marshall Psychiatry and Behavioral Medicine is located at th Street, Huntington WV and is open Monday through Friday from 8:00 5:00. Treatment is provided for mood, thought, and anxiety disorders, autism spectrum disorders, ADHD and disruptive behavior, and cognitive illnesses including memory care and dementia.patient care services include: Adult Psychiatry Services Child & Adolescent Psychiatry Services Geriatric Psychiatry Services Autism Evaluation & Treatment Bariatric Care Clinic Developmental Delay Eating Disorders Electroconvulsive Therapy Memory Disorder & Dementia Clinic Mood Care Clinic Psycho-Educational Testing Psychological Evaluation for Long-term Opiate Screening Psychological Pre-surgical Evaluations Psychological Testing for Adults and Children Psychotherapy and Counseling Services - Adult and Child Substance Use Disorders / Addiction Marshall Neurosurgery is staffed by the board-certified physicians, Anthony Alberico, M.D., Chairman, Rida Mazagri, M.D., Terrence Julien, M.D., Robert Marsh, M.D. and Paul Muizelaar, M.D, and John Cornell, MD, perioperative specialist. These physicians are assisted by Destiny Day, FNP, Deborah Allen, PA, Cameo Hehe, PA and Suzanne Spooner,

11 Page 11 of 11 FNP. The Cabell Huntington Hospital Back and Spine Center, located within the department, provides additional support and education to patients with back and spine disorders. The office is open from 8-4:30 PM, Monday Friday and specializes in many medical conditions including but not limited to metastatic and primary brain tumors, back and spine disorders, movement disorders, hydrocephalus, nerve compression, and carpal tunnel for adults and children. These physicians also provide neurosurgery trauma coverage for Cabell Huntington Hospital. Marshall Neurology is staffed by Paul Ferguson, M.D., Mary Payne, M.D., Justin Nolte, M.D., Sona Shah, M.D., Samrina Hanif, M.D., and Paul Knowles, M.D. all of which are board-certified in Neurology. Additionally, Dr. Payne and Dr. Knowles are fellowship-trained pediatric neurologists. Dr. Shah is also board-certified in Epilepsy Monitoring, Neurophysiology, and Neuromuscular Medicine. Dr. Hanif is also boardcertified in Epilepsy Monitoring. Dr. Nolte is also fellowship-trained in stroke. These neurologists are assisted by Jennifer Fields, NP, and Kelly Johnson, NP. Additionally, the Cabell Huntington Hospital Neurophysiology Lab, located within the department, provides state of the art technology and certified technicians to assist our neurologists in performing nerve conduction studies, ambulatory EEGs and long term monitoring EEGs. The office is open from 8-4:30 and specializes in many medical conditions including but not limited to neuropathy, dementia, epilepsy/seizures, headaches, MS, movement disorders, and stroke.