Resource Newsletter Archive
Rural hospitals and the COP — How One Hospital Stepped Up to the Challenge
In western Montana, 70 miles northwest of Missoula and 70 miles southwest of Kalispell lies the community of Plains, population 2,500.
There, serving as the sole acute care provider for the town and the other 7,500 citizens of Sanders County is Clark Fork Valley Hospital (CFVH). The one-story, gray wood-sided building has 16 acute care beds – four or five are occupied on an average day — and an attached 28-bed skilled nursing facility. The hospital operates four clinics and a Home Health Agency, and employs seven physicians, two physician assistants, and about 150 full-time-equivalent staff.
In each of the last two years, the Northwest Tissue Services (NTC) has been called for a tissue recovery at the hospital. While one donor per year may not sound impressive at first, the statistic takes on new meaning when viewed in historical context.
At one time, organ, eye and tissue recovery was a rare occurrence at rural medical facilities. That changed in August 1998 when the Health Care Financing Administration (HCFA) implemented its Conditions of Participation (COP) of Medicare for organ, eye and tissue procurement.
Since then, the Tissue Services and other regional donation agencies have worked with area hospitals to comply with the COP. When the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) adopted the regulation as a requirement for its accredited hospitals, rural facilities like CFVH in Plains embarked on a new and uncharted administrative journey. (Non-JCAHO accredited hospitals are audited by state agencies.)
Coping with the COP “When COP went into effect, it hit small hospitals pretty hard,” said Jan Hendrix, the Tissue Services's regional supervisor. “Rural hospitals had the challenge of complying with the new provisions, which include calling the Donor Referral Line upon each death and imminent death, having their staffs trained as designated requestors, and writing procedures. It can be overwhelming.”
As daunting as compliance was — and still is — CFVH and other rural hospitals have been up to the challenge. “They have shown that they can do it,” notes Hendrix. “It's been positive for the staff, community and families and they've joined together to prove that it's doable, that there are people who want to donate in rural areas.”
Hendrix started the process by talking with hospital staff, the coroner, funeral directors, police and clergy. At CFVH, Linda Sund was ready to get involved. “I have always found organ and tissue procurement interesting,” said the director of nursing services, who had attended workshops in Missoula. “ I had a goal in mind that we would be offering this locally,” she noted. “What a wonderful way to help a grieving family — to give a gift of life.”
More training followed: the hospital developed a chaplain program, and Hendrix took part in training staff members who would be obtaining consent of prospective donor families. In such a small community, the knowledge picked up in training by the local professionals soon made its way into the public awareness. By the time it became mandatory to offer the option of donation to families, not many were surprised by the question; often it was simply a reminder.
However, regardless of what they know about donation, people are vulnerable when it's time to make such a decision. “The important thing,” said Hendrix, “is that the family is approached at the right time and by a trained professional who is caring and sensitive to the family's situation and needs.”
Pulling together “You have to appreciate what it's like for us to go into a small town to recover tissue,” said Hendrix. “It's a time-consuming process because of the remoteness of the area.” Ironically, that geographic isolation also can be somewhat of a benefit, she adds, “because it becomes a community event – everyone pitches in to make it work.”
For instance, when NTC technicians fly in from Seattle for a recovery in Plains, that means the local police have to drive to the 3,000-foot-long Thompson Falls airfield to turn on the lights for the landing – usually in the fog that pervades the area. The fire department then transports the technicians and equipment to the hospital.
In the meantime, since there is no morgue at the hospital, a local funeral director has taken the donor to the funeral home's cooling facilities. The funeral home also affords the family some private time with the loved one. The director then makes the return drive to the hospital in time to meet the NTC technicians as they join the rest of the team: nursing staff, physicians, chaplain, police and fire department personnel.
“Everything was in sync and worked; it seemed to fall into place like were doing this everyday,” said Sund after the first recovery. “We had an excellent response from the procurement team...it was so wonderful to see how everyone pulled together.”
The Sanders County Ledger even published an article about the recovery. And the story raised a lot of questions – positive questions. Those who were familiar with the possibility of tissue recovery were surprised that it actually had taken place at CFVH and consequently, the news generated talk and interest. “Word of mouth was very positive,” said Sund.
Notes Hendrix: “Being part of a small town does make a difference; there really is that hometown hospitality you hear about, and people really do go out of their way to help you. The people of Plains have been very supportive…and very nice.”