CREST:CREST: Regional OverviewRegional Overview

DHMC Service AreaDHMC Service Area

►►Working together, the regionWorking together, the region’’s community s community hospitals, Critical Access hospitals, and hospitals, Critical Access hospitals, and DHMC strive to offer Level 1 trauma DHMC strive to offer Level 1 trauma services and the specialized services of a services and the specialized services of a teaching hospital to nearly 2 million people teaching hospital to nearly 2 million people scattered across 16,000 square miles of scattered across 16,000 square miles of northern New England. northern New England.

Background/NeedBackground/Need

►►2/3 of NH and VT pop. live in rural areas 2/3 of NH and VT pop. live in rural areas representing 84% of the land mass representing 84% of the land mass

►►Rural residents: significantly older, poorer, Rural residents: significantly older, poorer, & less educated than non& less educated than non--rural residents. rural residents.

►►InjuryInjury--related death rates: 40 percent related death rates: 40 percent higher in rural populations than in urban higher in rural populations than in urban populations populations

►►More than half (55%) of all EMS runs in the More than half (55%) of all EMS runs in the states are to rural areasstates are to rural areas

Background/NeedBackground/Need

►►Average EMS response time for the most Average EMS response time for the most rural tier in NH was 77% longer than in the rural tier in NH was 77% longer than in the nonnon--rural areas. rural areas.

►►Problems cited with transfer process: Problems cited with transfer process: delays, inefficient/inconsistent process, poor delays, inefficient/inconsistent process, poor communication.communication.

Background/NeedBackground/Need

GeographyGeography

►►Mountain rangesMountain ranges►►RiversRivers►►WeatherWeather

RuralityRurality of NH and VTof NH and VT

Admissions by regionAdmissions by region

DHMC service areaDHMC service area

DHMCDHMC

►►DHMC is the stateDHMC is the state’’s only academic medical s only academic medical center and only level 1 trauma center.center and only level 1 trauma center.

►►DHMC offers almost all areas of specialty DHMC offers almost all areas of specialty care and includes a childrencare and includes a children’’s hospital and s hospital and cancer center.cancer center.

►►2 full2 full--time transport helicopters (Dartmouthtime transport helicopters (Dartmouth-- Hitchcock Advanced Response Team Hitchcock Advanced Response Team -- ‘‘DHARTDHART’’) serve NH and parts of VT, ME, ) serve NH and parts of VT, ME, NY. NY.

DHMCDHMC

►►DHMCDHMC’’ss Emergency Department: Emergency Department:

~ 30,000 patients/year~ 30,000 patients/year

~3,000 ED to ED transfers/year~3,000 ED to ED transfers/year

►► Admits via Emergency Department: 6000 Admits via Emergency Department: 6000 patients/year patients/year

DHMC dataDHMC data

►► DHART Air helicopter service: 1068 DHART Air helicopter service: 1068 transportstransports

~900 being transfers from referring ~900 being transfers from referring facilitiesfacilities

►► 1200 trauma admissions 1200 trauma admissions ~65 percent were inter~65 percent were inter--facility facility

transfers transfers

10

20

30

40

50

Flight/Ground TimesFlight/Ground Times

145

120

75

40

75

65

Air

Ground

FacilityType of Hospital County & State

Total Transfers to DHMC

Phase 1DHMC AMC Grafton, NHNew London Hospital Critical Access Merrimack, NH 604Upper Conn Valley Hosp Critical Access Coos, NH 399Weeks Memorial Hospital Critical Access Coos, NH 548

Phase 2Littleton Hospital Critical Access Grafton, NH 418Northeastern Vermont Reg Hosp Critical Access Caledonia, VT 865Cottage Hospital Critical Access Grafton, NH 431Valley Regional Hosp Ed Critical Access Sullivan, NH 811Alice Peck Day Critical Access Grafton, NH 291Gifford Med Ctr Critical Access Orange, VT 527Mount Ascutney Hospital Critical Access Windsor, VT 401VA Medical Center Windsor, VT 443

Phase 3Androscoggin Valley Hosp Critical Access Coos, NH 416North Country Hosp Critical Access Orleans, VT 884Memorial Hospital Critical Access Carroll, NH 95Central Vt Med Ctr Community Washington, VT 707Grace Cottage Hospital Critical Access Windham, VT 100Lakes Reg General Hosp Community Belknap, NH 639Franklin Regional Hosp Critical Access Merrimack, NH 175Speare Mem Hospital Critical Access Grafton, NH 449Rutland Regional Med Ctr Community Rutland, VT 762Springfield Hosp Community Windsor, VT 1254Brattlebor Memorial Hospital Community Windham, VT 766Cheshire Med Center Community Cheshire, NH 1356Monadnock Comm Hosp Critical Access Hillsborough, NH 326

Phase 4Concord Hospital Community Merrimack, NH 890Parkland Medical Center Community Rockingham, NH 83Elliot Hospital Community Hillsborough, NH 547Catholic Med Ctr Ed Community Hillsborough, NH 258Southern Nh Reg Medical Ctr Community Hillsborough, NH 266Saint Joseph Hospital Community Hillsborough, NH 61

HospitalsHospitals-- NH, VTNH, VT

Phases of Outreach grant expansionPhases of Outreach grant expansion

CREST Network pilot membersCREST Network pilot members

►►New London HospitalNew London Hospital►►Weeks HospitalWeeks Hospital►►Upper Connecticut ValleyUpper Connecticut Valley

DartmouthDartmouth-- Hitchcock Medical Hitchcock Medical CenterCenter

New London HospitalNew London Hospital Upper Connecticut Upper Connecticut Valley HospitalValley Hospital

Weeks Medical Weeks Medical CenterCenter

County popCounty pop 85,336 85,336 (1,750 square miles)(1,750 square miles)

148,085 148,085 (956 square miles)(956 square miles)

33,019 33,019 (1831 square miles)(1831 square miles)

33,019 33,019 (1831 square miles)(1831 square miles)

Town and populationTown and population Lebanon, NHLebanon, NH12,606 pop12,606 pop

New London, NHNew London, NH4,455 pop4,455 pop

Colebrook, NHColebrook, NH2,395 pop2,395 pop

Lancaster, NHLancaster, NH3358 pop3358 pop

Distance to DHMCDistance to DHMC 26 miles26 miles 122 miles122 miles 88 miles88 miles

ER (visits/year)ER (visits/year) 30,000 30,000 8500 8500 50005000 65006500

Admits (patients/year)Admits (patients/year) 23,00023,000 950950 600600 850850

Admits in transfer from Admits in transfer from acute care hospitals acute care hospitals (patients/year)(patients/year)

~6000~6000

Transfers to DHMC over 5 Transfers to DHMC over 5 yearsyears

604604 399399 548548

Pertinent ServicesPertinent Services 24/7 E.R. coverage in24/7 E.R. coverage in--house house (non(non--boarded)boarded)24/7 General Surgery24/7 General SurgeryOrthopaedicsOrthopaedicsFixed CFixed C--TTMobile MRIMobile MRINo OB (Delivery Service)No OB (Delivery Service)Weekday HospitalistWeekday Hospitalist

24/7 E.R. coverage in24/7 E.R. coverage in--house (nonhouse (non-- boarded, often nonboarded, often non--MD)MD)Limited General SurgeryLimited General SurgeryOrthopaedicsOrthopaedics LimitedLimitedFixed CFixed C--TTMobile MRIMobile MRINo OBNo OBWeekday HospitalistWeekday Hospitalist

24/7 E.R. coverage in24/7 E.R. coverage in--house (nonhouse (non-- boarded, often nonboarded, often non--MD)MD)General SurgeryGeneral SurgeryOrthopaedicsOrthopaedics (not 24/7)(not 24/7)Mobile MRIMobile MRIFixed CFixed C--TTNo OBNo OBWeekday HospitalistWeekday Hospitalist

New London HospitalNew London Hospital New London, NHNew London, NH

►►Pop 4,455Pop 4,455

Upper Connecticut Valley Upper Connecticut Valley Colebrook, NHColebrook, NH

►►Pop 2,395Pop 2,395

Weeks Medical CenterWeeks Medical Center Lancaster, NHLancaster, NH

►►Pop 3,358Pop 3,358