Advocate Condell Sexual Advocate Condell Sexual Assault Development PlanAssault Development Plan

Jody Jesse RNJody Jesse RN

Director of EDDirector of ED

March 2010March 2010

ObjectivesObjectives“Right Thing to Do”“Right Thing to Do”

BenefitsBenefitsCompassionate careCompassionate careEvidence properly collectedEvidence properly collectedPhoto documentationPhoto documentationMedical records/ organized processMedical records/ organized processHigher conviction ratesHigher conviction ratesPlace to call for questionsPlace to call for questionsStates attorneyStates attorneyExpert witnessExpert witnessGreater knowledge base/experienceGreater knowledge base/experienceMAGNET statusMAGNET statusGood statistical dataGood statistical dataCommunity EducationCommunity Education

Collaborative effort for successCollaborative effort for success Partnership with CommunityPartnership with Community Improved documentation and evidence collectionImproved documentation and evidence collection

Inspiration for the SANE Inspiration for the SANE CenterCenter

• Fort Wayne, IndianaFort Wayne, Indiana– Staffed by 4 full-time SANE nursesStaffed by 4 full-time SANE nurses– Staffed by 8 on-call SANE nursesStaffed by 8 on-call SANE nurses– All sexual assaults go to one placeAll sexual assaults go to one placeNow have a 10,000 square foot facilityNow have a 10,000 square foot facility

• Milwaukee, WisconsinMilwaukee, Wisconsin -Have a full time staff and two SANE Centers for -Have a full time staff and two SANE Centers for

the countythe county -All sexual assaults transported to the Centers.-All sexual assaults transported to the Centers.

Traditional ProcedureTraditional Procedure

– Initial complaint Initial complaint made to law made to law enforcement, DCFS, enforcement, DCFS, or patients come or patients come into closest hospitalinto closest hospital

– Law enforcement or Law enforcement or DCFS will send to DCFS will send to the closest hospital the closest hospital once contactedonce contacted

– Evidence collected Evidence collected in emergency room in emergency room by a nurse and a by a nurse and a physicianphysician

– Law enforcement Law enforcement called to pick up called to pick up evidence evidence

– Transport evidence Transport evidence to crime labto crime lab

History of Lake County and History of Lake County and SANESANE

• Lake County SART and SANE Task Force-2008Lake County SART and SANE Task Force-2008

• Illinois SANE Pilot Program late 1990’sIllinois SANE Pilot Program late 1990’s

• Lake County Sexual Assault Coordinating CouncilLake County Sexual Assault Coordinating Council

• Lake County Medical Sub Committee-10/09Lake County Medical Sub Committee-10/09

• Only SANE nurses in Lake County are at Veteran’s Only SANE nurses in Lake County are at Veteran’s hospital and Cancer Treatment Centerhospital and Cancer Treatment Center

• Need a Sexual Assault Treatment Center of Need a Sexual Assault Treatment Center of ExcellenceExcellence

Challenges to Traditional Challenges to Traditional ProcedureProcedure• Busy ED and wait time. Busy ED and wait time. • Loss of evidence and general frustration of victims they end up Loss of evidence and general frustration of victims they end up

leaving.leaving.• ED patient flow and make it difficult for nurse to take this case. ED patient flow and make it difficult for nurse to take this case.

(generally a 3-4 hr commitment due to chain of custody) (generally a 3-4 hr commitment due to chain of custody)• Views of certain staff makes a difference on how victim is Views of certain staff makes a difference on how victim is

treated.treated.• Lack of training on forensic evidence collection. Sometimes Lack of training on forensic evidence collection. Sometimes

may not see many cases.may not see many cases.• Difficult for law enforcement to ask questions of the nurse Difficult for law enforcement to ask questions of the nurse

about the case or documentationabout the case or documentation• No photosNo photos• Evidence not properly stored. Chain of custody problemsEvidence not properly stored. Chain of custody problems• Many cases dropped by States Attorney related to poor Many cases dropped by States Attorney related to poor

documentation and contamination of kits. documentation and contamination of kits.

What is a SANE nurse?What is a SANE nurse?

• Sexual Assault Nurse Examiner-Adult/Adolescent SANE-ASexual Assault Nurse Examiner-Adult/Adolescent SANE-A• Sexual Assault Nurse Examiner-Pediatrics SANE-PSexual Assault Nurse Examiner-Pediatrics SANE-P

• RN who has completed a forensic SANE training program-40 RN who has completed a forensic SANE training program-40 hours classroom plus clinicalhours classroom plus clinical

• SANE-P RN with additional training in Pediatrics-24 hr SANE-P RN with additional training in Pediatrics-24 hr classroom plus clinicalclassroom plus clinical

• Conduct examinations using the sexual assault evidence Conduct examinations using the sexual assault evidence collection kits without the presence of a MDcollection kits without the presence of a MD

• Final certification shows expertiseFinal certification shows expertise

Condell Hospital SANE CenterCondell Hospital SANE CenterProposalProposal

– Would cover suburban Would cover suburban Lake County. Similar to Lake County. Similar to Level 1 Trauma CenterLevel 1 Trauma Center

– SANE CoordinatorSANE Coordinator– SANE RNs 24/7SANE RNs 24/7– 1 to 1 RN patient care1 to 1 RN patient care– Compassionate careCompassionate care– Private room-minimal Private room-minimal

wait timewait time– Lake County Child Lake County Child

Advocacy Center wants Advocacy Center wants a partnershipa partnership

– Proper Evidence Proper Evidence collection and collection and documentationdocumentation

– Specialized EquipmentSpecialized Equipment• Colposcope/Digital Colposcope/Digital

photographyphotography– Reliable source to answer Reliable source to answer

questionsquestions– Medical Records same Medical Records same

dayday– Medical Screens and Medical Screens and

follow-up providedfollow-up provided– ED physicians support ED physicians support

the program for SANEthe program for SANE– Currently have 1 SANE Currently have 1 SANE

nurse in clinical nurse in clinical

Current Volumes in Condell Current Volumes in Condell EDED

In 2009 we had 54 Sexual Assault In 2009 we had 54 Sexual Assault Cases Cases

Projection 2010-54Projection 2010-54

Projection 2011- 120Projection 2011- 120

Projection 2012- 200 Projection 2012- 200

Building Our SANE CenterBuilding Our SANE Center

Already haveAlready have• Private roomPrivate room• ComputerComputer• Printer/Copier/FaxPrinter/Copier/Fax• Appropriate Patient Appropriate Patient

CartsCarts• All Patient SuppliesAll Patient Supplies

Need Need • ColposcopeColposcope• Photo printer and suppliesPhoto printer and supplies• $ for training hours for $ for training hours for

SANE nursesSANE nurses• $ Travel expenses for $ Travel expenses for

nurse trainingnurse training• Pediatric MD Pediatric MD

administrative fees until administrative fees until We have a SANE-P Nurse We have a SANE-P Nurse

Start Up Needs/Costs - 2010Start Up Needs/Costs - 2010

• SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0$0

• RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$24)-----$

• Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------$2,000$2,000

• Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500500

• On-Call RN pay (3On-Call RN pay (3rdrd and 4 and 4thth quarter 2010 -------------------------------------------------------- quarter 2010 --------------------------------------------------------$13,104$13,104

• Overtime Pay (estimate) Time and ½ (3Overtime Pay (estimate) Time and ½ (3rdrd and 4 and 4thth quarter 2010)------------------------------ quarter 2010)------------------------------ $9,600$9,600

• Will need a designated printer for pictures---------------------------------------------------------$ Will need a designated printer for pictures---------------------------------------------------------$ 600600

• **We do need is a Culposcope- However see next page for grant $-------**We do need is a Culposcope- However see next page for grant $-------

Colposcope Costs-ProposalColposcope Costs-Proposal

• Lake County Child Advocacy Center would like us to be Lake County Child Advocacy Center would like us to be designated site for Child Assaults-these are scheduled visits designated site for Child Assaults-these are scheduled visits as children are late reporters.as children are late reporters.

• Approximately annual volume – 130 patients (estimate 2-3 Approximately annual volume – 130 patients (estimate 2-3 wk)wk)

• Currently we would need to use Peds ED MD’s for this (until Currently we would need to use Peds ED MD’s for this (until we have SANE P) and the MD’s are asking for $/hour for we have SANE P) and the MD’s are asking for $/hour for administrative costs (court time and prep)administrative costs (court time and prep)

• I anticipate SANE P later this year in fall to be available in EDI anticipate SANE P later this year in fall to be available in ED

• At that time we could eliminate pay to MD’sAt that time we could eliminate pay to MD’s

• If we commit to being the site for these exams the Advocacy If we commit to being the site for these exams the Advocacy Center has donor who will pay for our Culposcope (cost Center has donor who will pay for our Culposcope (cost $30,000)$30,000)

Start Up Needs/Costs - 2010Start Up Needs/Costs - 2010

• SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0$0

• RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$24)-----$

• Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------$2,000$2,000

• Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500500

• On-Call RN pay (3On-Call RN pay (3rdrd and 4 and 4thth quarter 2010 -------------------------------------------------------- quarter 2010 --------------------------------------------------------$13,104$13,104

• Overtime Pay (estimate) Time and ½ (3Overtime Pay (estimate) Time and ½ (3rdrd and 4 and 4thth quarter 2010)------------------------------ quarter 2010)------------------------------ $9,600$9,600

• Will need a designated printer for pictures---------------------------------------------------------$ Will need a designated printer for pictures---------------------------------------------------------$ 600600

• **We do need is a Culposcope- However see next page for grant $-------**We do need is a Culposcope- However see next page for grant $-------

Medications- per pharmacyMedications- per pharmacy

"our cost"

Kaletra (Lopinavir/Ritonavir) 200 MG-50 MG dosed: 2 tabs po q12hcost $5.63/pill (4pills/24hr/$22.52) ---------------------------------------3day supply $Combivir (Lamivudine/Zidovudine) 150 MG-300 MG dosed: 1 tab po q12hcost $13.30/pill (2pills/24hr/$26.60) -------------------------------------3day supply $

Both drugs 3 day supply "our costs" ------------------------------------------------ = $

Suggested FundingSuggested Funding

• PhilanthropyPhilanthropy

• Associate Giving CampaignAssociate Giving Campaign

• Donations from CommunityDonations from Community

• Fundraising and grantsFundraising and grants

SANE Coordinator RoleSANE Coordinator Role

• Need a champion person to be responsible for the program.Need a champion person to be responsible for the program.• Organize the programOrganize the program• Schedule training SANE applicantsSchedule training SANE applicants• Training new SANETraining new SANE• Policy and ProcedurePolicy and Procedure• Performance Improvement ActivitiesPerformance Improvement Activities• Networking in the Community and attending meetings.Networking in the Community and attending meetings.• Community education, law enforcement, EMS, schools, Community education, law enforcement, EMS, schools,

community services requesting information.community services requesting information.• Patient care.Patient care.• Fundraising. Fundraising. • Keeping up with daily phone calls and appointments.Keeping up with daily phone calls and appointments.• LIST GOES ON!!!!!!LIST GOES ON!!!!!!

Current Situation in ED/Next Current Situation in ED/Next StepsSteps• Currently I have 1 SANE nurse in clinical and 6 nurses in ED willing Currently I have 1 SANE nurse in clinical and 6 nurses in ED willing

to train and take on callto train and take on call • Get Administrative Approval to proceedGet Administrative Approval to proceed

• Get Nurses to trainingGet Nurses to training

• Give commitment to Child AdvocacyGive commitment to Child Advocacy

• Increase VolumeIncrease Volume

• Increase Community Programs and AwarenessIncrease Community Programs and Awareness

• Need a SANE Coordinator full timeNeed a SANE Coordinator full time

2011 Condell SANE Center2011 Condell SANE Center Budget Budget • Hire a full-time SANE nurse ---------------------------------------------------------- Hire a full-time SANE nurse ----------------------------------------------------------

$72,000$72,000

• Continue with our on-call SANE team 16 hr/day/24/7 weekend and holiday--Continue with our on-call SANE team 16 hr/day/24/7 weekend and holiday--$18,500$18,500

• Train 4 additional nurses---------------------------------------------------------------Train 4 additional nurses---------------------------------------------------------------$5,120$5,120

• Travel and Hotel for 4 SANE nurses- --------------------------------------Travel and Hotel for 4 SANE nurses- --------------------------------------$4,000$4,000

Reimbursements-Reimbursements-

• In working with Finance on this we have discovered some opportunities to In working with Finance on this we have discovered some opportunities to improve our billing but it involves the whole revenue cycle process so more improve our billing but it involves the whole revenue cycle process so more information to come on this per Amanda.information to come on this per Amanda.

• Billing needs to be handled properly to get reimbursed properly for all Billing needs to be handled properly to get reimbursed properly for all those involved, including ED, lab, pathologists, EMS…those involved, including ED, lab, pathologists, EMS…

• Sexual Assault is billed through individual insurance plans and whatever Sexual Assault is billed through individual insurance plans and whatever remains can be sent through the State for reimbursement with the remains can be sent through the State for reimbursement with the exception of Medicaidexception of Medicaid

• Medicaid reimbursement is $181- (approximately 1/3 of current cases)Medicaid reimbursement is $181- (approximately 1/3 of current cases)• No insurance is 100% billable to the State.No insurance is 100% billable to the State.• Voucher system is in place in ED alreadyVoucher system is in place in ED already

Physician’s SupportPhysician’s Support

• Infinity supports the SANE program Infinity supports the SANE program

• Will need a SANE medical directorWill need a SANE medical director– Support program, case review, review Support program, case review, review

policy/procedures, professionalismpolicy/procedures, professionalism

Administration’s Support Administration’s Support

•Mary Hillard, Chief Nursing Mary Hillard, Chief Nursing OfficerOfficer

• Jody Jesse RN, MHA, ED Director Jody Jesse RN, MHA, ED Director Positive for nurse recruitmentPositive for nurse recruitment

Community Benefit and Community Benefit and OutreachOutreach

• Making a difference in our Making a difference in our communitycommunity

• Community education/awarenessCommunity education/awareness

Final ThoughtFinal Thought

• Process can work!Process can work!• Teamwork and collaboration is keyTeamwork and collaboration is key• More hospitals on board can form a networkMore hospitals on board can form a network• Use Shannon Liew, Illinois SANE Coordinator Use Shannon Liew, Illinois SANE Coordinator

and South Suburban SANE Center to help if and South Suburban SANE Center to help if needed. No sense in recreating the wheel. needed. No sense in recreating the wheel.

• Starting a SANE Center has lots of Starting a SANE Center has lots of advantages advantages

• Important to advocate for best practice and Important to advocate for best practice and best standard of care for victims. best standard of care for victims.

Thank You!Thank You!