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Improving Care for Athletes: Lessons from The Glasgow 2014 Commonwealth Games. Liz Mendl John Maclean

Improving Care for Athletes: Lessons from The Glasgow 2014 Commonwealth Games Liz Mendl John Maclean 2 4,500 Athletes, 17 Sports, ~ 250 Golden Moments Aquatics * Athletics * Badminton * Boxing * Cycling
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Improving Care for Athletes: Lessons from The Glasgow 2014 Commonwealth Games Liz Mendl John Maclean 2 4,500 Athletes, 17 Sports, ~ 250 Golden Moments Aquatics * Athletics * Badminton * Boxing * Cycling Gymnastics Hockey * Judo Lawn Bowls * Netball * Rugby Sevens * Shooting Squash * Table Tennis Triathlon Weightlifting * Wrestling 3 Integrated Para-Sports: 20 medal events in 5 sports Aquatics Athletics Cycling Lawn Bowls Weightlifting 4 40 venues, 3 clusters, 1 perfect stage 3 new landmark competition venues 25 existing competition venues 15 non-competition venues 3 compact Glasgow city clusters 5 Task & Scope: Planning and delivery for the provision of all medical services Athletes and support staff = 6,500 Commonwealth Games Family Media Workforce Spectators Setting up a Polyclinic (Games Hospital) at the Commonwealth Games Village Providing medical services at: Competition venues Training venues 6 Demographics for Glasgow 2014 Total Encounters 10,559 Athlete Encounters 69% Polyclinic Encounters 65% Demographics for Glasgow 2014 Medical Services An Overview Deliver services to every client group accredited and ticketed 11 core staff 31 additional games time staff 1400 skilled volunteers +30 roles 6000 pieces of equipment +200 drugs on the Games Formulary 84 Medical Services Facilities 1 Polyclinic 2 Satellite Polyclinics 35 Athlete Medical Rooms 46 First Aid Rooms Stakeholder Engagement Scottish Government NHS Health Boards Public Health Scottish Ambulance NHS 24 Volunteers Stakeholders & Governance Medical Advisory Group Composition Chair: Sir Harry Burns Glasgow 2014 Chief Medical Officer Glasgow 2014 Medical Services / Sport Representative from: Commonwealth Games Scotland National Health Service (Glasgow) Scottish Ambulance Service Royal College of Physicians/Surgeons London 2012 (IOC Medical) Terms of reference Key medical stakeholder involvement Objective to advise/support: Implementation of Medical Strategy Operational plans, policies and delivery Compliance with CGF requirements Alignment with stakeholder operations Workforce planning and operations Review risks and issues Meet minimum bi-annual Clinical Experts Clinical Expert Groups Polyclinic Physiotherapy Sports Massage Recovery Imagery Podiatry Primary Care Nursing Emergency Response Dentistry Optometry Pharmacy First Aid Field of Play Lessons from 2012 experience Core essentials Leadership new roles Integrated health care team with Scottish ambulance Quality assurance positions Improvement programme during games time from Olympics to Paralympics Volunteer training Strategy & Planning Commonwealth Games Federation framework & input from CMO Dr Jega Opportunity to develop & implement strategy Plans in place to inform staff & volunteers Staff recruited to ensure experienced delivery at Games Time Strong framework supported by Policies & Procedures to underpin delivery Volunteer Training Integrated interactive forum Clinical experts working together Scenarios from previous Games CPD opportunity Learning from experts Opportunity for single discipline discussion New Models of Healthcare Field Of Play working with SAS Control Drugs within Ambulance only Minimised medicine list Venues Medical Room managed by physiotherapist Polyclinic Recovery Centre available Public Health & Infectious Disease Management: Pre-Games planning Early engagement with Health Protection Scotland, NHS GG&C and Glasgow City Council Environmental Health planning groups with Glasgow 2014 CMO attending Public Health Consultant seconded as part of core Medical Services team Back up advice & clinical support from NHS GG&C Infectious Disease Consultants Early engagement with team doctors (1/3 rd of competing teams) Public Health & Infectious Disease Management: Daily reporting Robust electronic Medical Encounter system ensured all illness and injury consultations were recorded in real time Continuous data analysis which allowed for immediate pattern identification from all venues/locations with formal report at 2300 and 0700 Responsibility & cooperation between team doctors and Glasgow 2014 Medical Services Remainder of athlete medical care provided by Glasgow 2014 in Polyclinic or at competition/training venues Importance of athlete education especially on infectious disease Symptomatic athletes seen in accommodation as house call Data available for: CGF Medical Commission 0800 meeting Public Health teleconference 1000 Health Protection Scotland epidemiological data GG&C Health Board surveillance data Glasgow 2014 Medical Encounters data - Allowed for coordinated action plan - All groups media and communications involved Scottish Government Norovirus: practical issues Common everyday problem in healthcare with a well recognised clinical and Public Health management plan Glasgow 2014 issues Protection of athletes and support staff External workforce affected with issues re staff payment Media Management Multiple agencies involved Press statements agreed Glasgow 2014 GM & CMO role Major issue was getting other parties to understand importance of usual outbreak management tried and tested response. Norovirus: Adaptive measures & Polyclinic changes Based on expert advice Super-cleaning/hygiene measures in Village inc accommodation/dining/ communal areas Education of Village residents not to come to Polyclinic if symptomatic Increased Polyclinic staff vigilance esp reception staff House calls for symptomatic athletes Importance of liaison with Team medical staff esp re isolation in accommodation and issue of athletes competing Are they well enough Risk to other athletes Glasgow 2014: Norovirus strikes 48 people at Games Athletes' Village as outbreak spreads Glasgow 2014 bosses identify source of suspected norovirus bug at Athletes Village Ebola Major concern due to number of athletes from affected countries Pre-games advice from Infectious Disease consultant Excellent daily communication to Team Medical and Medical Services staff High level of clinical suspicion in febrile patient from affected country Immediate isolation advice to stay in accommodation Immediate hospital transfer 2 Sierra Leone cyclists admitted both negative Process worked really well A petrified athlete told of his horror at being quarantined and tested by doctors dressed in special suits who feared he had Ebola. Endurance cyclist Moses Sesay, from Sierra Leone, was placed in isolation for four days after it was thought he may have brought the deadly virus into Britain from his homeland. The 32 year old was admitted to Glasgow hospital after falling ill last Thursday, a day after the Opening Ceremony. Sesay said: I was sick. I felt tired and listless. All the doctors were in special suits to treat me they dressed like I had Ebola. I was very scared. Athlete Tested For Ebola At Commonwealth Games A Sierra Leone cyclist who was put in isolation in Glasgow for four days is given the all-clear. Polyclinic 24 hour Emergency Medicine & Primary Care Physiotherapy Sports & Exercise Medicine Sports Massage Therapy Pharmacy Optometry Podiatry Emergency Dental Care Imaging Wheelchair & Prosthetic repairs & service Polyclinic Unique model of healthcare? Unique environment - short-lived operational life - therefore achievable One integrated cohesive experienced team with a named person in charge but a collective responsibility rather than individual ownership to make it work No competition for resources = no division in care Different type of pressure for most volunteers but ultimately it was just different and it was fun. Polyclinic - Communication Command & Control Polyclinic Management FACC Daily briefings Daily review of improvements made to systems Newsletter Radios Telephone system Mobiles Polyclinic Case Study Male Badminton player Falkland Islands Normally employed as a fulltime fireman 10 days before arrival at CGV had fallen awkwardly and twisted right knee Treated with ice, rest and rehab prior to arrival in Glasgow Seen in the polyclinic on 20 th July Examination R knee - significant effusion and difficult to examine, AP glide increased, tender over posterior horn of the lateral meniscus. Referred for immediate MRI MRI report - Evidence of recent pivot-shift injury with : Complete rupture of the ACL, Peripheral red-zone tear of medial meniscus; Posterior root tear of the lateral meniscus; Subchondral impaction fracture of the lateral femoral condyle at the sulcus terminalis and characteristic bone-bruise pattern; Grade 2 MCL and LCL injury and loose body seen posterior to the PCL tibial attachment Patient counselled and withdrawn from competition 2 day later, taken by SEM doctor to see Orthopaedic Surgeon Advice given regarding immediate rehab and long term strategy Patient returned home to his native country and returned 6 months later for surgery in Edinburgh Now 4 month post-op and progressing well. Back at work but unable to compete at Island Games (Jersey) this year Polyclinic Adaptive measures and changes Process adapted over first couple of days at the soft opening Used previous experience of staff to refined process of patient flow and booking process Dynamic assessment of process and refinement where required or when the situation changed i.e. loss of MRI Communication absolutely key Polyclinic management team hands-on and effective managers. Polyclinic Challenges Human v Environmental Factors Human Leadership Expectations Volunteers v Contractors Athletes v Team Officials v Games Family v Staff Rostering (First Aid) Processes Constant dynamic reassessment of process Daily briefing and integration of services to work i.e. SAS Environmental Polyclinic as a temporary building Completion of surrounding surfaces of the Polyclinic so late on Computer system and IT integration for imaging Paper records Breakdown of MRI and dental chair 33 Hospital referrals Well planned and agreed procedure with dedicated Glasgow 2014 and GG&C single point of contact ensured efficient and confidential transfer of patient (admission and discharge) and medical information Priority not appropriate and all assessed on clinical need but taking into account athlete s need to compete Glasgow 2014 CMC available for input as required Admissions?Ebola x2/other Infectious Disease admissions General medical/surgical No orthopaedic admissions (Spinal unit x1) Laboratory Services Excellent twice daily collection for analysis in GG&C laboratory with secure electronic same-day reporting Glasgow 2014 Clinical manager responsible for all results management inc athlete follow-up Quality Indicators for Success Shared goals & finite timescale Strong stakeholders engagement & strategy Clear communication of expectations along with Policies & Procedures underpinning delivery Empowerment of experienced staff & volunteers with full clinical autonomy
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