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A big public service project by a small hospital lab.

A big public service project by a small hospital lab

Troubled by low patient census and test volume this rural hospital launched an areawide coronary risk screening program that paid big dividends.

Several years ago, our community voted to build a 24-bed, full-service hospital, but now only a small number of the 1,500 townspeople were using it.

To find out why census was declining, I polled about 50 people on my walks downtown. I also spoke to patients in the emergency room, as well as hospital visitors. Most automatically headed for the big city of Spokane, 40 miles away, because they thought sophisticated medical care was not available locally. They were particularly confused about the laboratory, assuming that we merely drew the blood and sent it out to be tested.

It was clear that we had to inform the public about our facility and what it offered. Sponsoring low-cost coronary risk profiles consisting of total cholesterol, lipoprotein, and triglyceride testing-seemed an ideal way to spread the word and provide a valuable community service.

Planning began in December 1986. One of the staff physicians agreed to act as the medical sponsor. He would order the tests and sign the laboratory slips; in addition, he volunteered to speak at a follow-up seminar. I also asked the director of nurses to speak on the role of proper nutrition in preventing coronary heart disease.

I contacted the hospital's business office to determine the best way to handle billing. We decided the time and expense of ledger posting and insurance paperwork could be eliminated by having participants pay the $5 fee for the coronary risk profile prior to the blood draw. Participants could submit the receipt to their insurance carriers at a later date.

Hospital administration agreed to sponsor the project along with the local doctors' clinic and the American Heart Association. As an added public service, we planned to hand out occult blood test kits supplied by the American Cancer Society. The laboratory staff-two full-time medical technologists, including the author, and one part-time technologistworked out scheduling to handle all the extra blood drawing and test volume.

After two months of planning, we announced the program. Articles in the town's weekly newspaper on Jan. 29 and Feb. 5, 1987, told the community that blood specimens for coronary risk profiles would be collected Feb. 9-13 at the hospital laboratory. A coupon accompanying one of the articles doubled as a requisition form (Figure 1). It gave the hours for the blood drawing (9 a.m. to 4 p.m.) and also included fasting instructions.

I contacted local businesses, and they agreed to display our posters. I also distributed handbills containing another coupon. The hours for blood drawing shown in this coupon (8 a.m. to 3 p.m.) differed from the hours in the newspaper. We hoped the staggered periods would help even the flow of participants.

Townspeople and area residents responded immediately. We accommodated callers who asked to be drawn even before the project began. Others wanted to come early in the morning before they went to work-the idea of fasting through lunch was not popular.

In all, 263 people from 17 towns were drawn. Some traveled as much as 85 miles. The youngest was 12; the oldest, 85.

The drawing station was located outside the door to the laboratory, so all participants could see our up-to-date facilities. When time permitted, we explained how the random access analyzer worked, and they could watch it process their specimens.

Tours of the hospital were available, and visitors saw that we had a fully equipped surgical suite capable of handling far more than tonsillectomies. They stopped at the ultrasound, radiology, and mammography areas, and learned about the hospital's breast cancer screening program. We could tell that they were pleasantly surprised to find such a modern medical facility right in their midst.

The next week, 300 individuals attended the follow-up evening seminar at the high school auditorium. Participants received test results (Figure 11) as they arrived, and had a chance to have their blood pressure checked. The seminar opened with a brief explanation of the results. Since the data were easy to interpret, most in the audience assessed their own coronary risk status. Those at risk were advised to consult a physician. Unclaimed test reports were mailed to the patients.

Dr. Dan L. Husky of the hospital medical staff spoke about aneriosclerosis, coronary heart disease, and related topics. Judy VanPevenage, director of nurses, outlined diets that could help lower cholesterol and triglyceride concentrations. They answered questions from the audience for at least an hour. The local pharmacist fielded questions about overthe-counter diet products. After the seminar, I placed a personal ad in the local paper to thank the community for its support.

Many people told us they were sorry they missed the screening. Because of this interest, we scheduled a second round of profiles for June; this time, 167 turned out. A third screening in February 1988 attracted 321.

Among those tested in all three screening programs, there was a high proportion of individuals at risk of heart disease. Seventy-two per cent exceeded the recommended limits, based on the current guidelines of 200 mg/dl of cholesterol. Different normal values for cholesterol were originally applied in the first two screenings, and 33 per cent of those tested were at risk (see Figure II) . If the 200 mg/dl value had been used in 1987, 68 per cent of the participants would have had abnormal cholesterol values.

A grand total of 75 1 people have been tested. We discovered that 44 per cent of the screening participants had abnormal HDLs; 41 per cent, abnormal LDLs; and 24 per cent, abnormal triglycerides.

Of the 450 occult blood test kits distributed, 184 were returned. We found four positives; the American Cancer Society notified these patients.

This year we expanded our coronary risk profile to include diabetic risk by adding a glucose test, and the total fee rose from $5 to $8.50. Sixteen per cent of 321 persons tested in February had abnormal glucose values.

A neighboring rural hospital has successfully duplicated our program. Laboratory colleagues at larger hospitals have expressed surprise at how well the screenings worked.

We in the laboratory feel good about ourselves for contributing to the health of the community in which we live. Hospital administration is pleased because inpatient census is climbing and so is test volume. The clinic (operated by the town's three doctors) is seeing more patients, and we have gained some of the work.

The hospital has started a rehabilitation program for patients recovering from heart attacks or heart surgery, or other cardiac problems. The program addresses diet, exercise, and physiological and psychological changes in such patients. The goal is to teach them to live as normally as possible within the confines of their condition. A separate program of seminars and menu instruction, conducted by a dietitian, helps those who have not yet developed heart problems.

By helping our townspeople, we have helped ourselves. The public has a new awareness of the community's sophisticated medical facility. Everyone also has a better appreciation of what two full-time technologists and one part-time technologist can accomplish in rural hospital!
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Title Annotation:areawide coronary risk screening program
Author:Schmidt, Shirley A.
Publication:Medical Laboratory Observer
Date:Jul 1, 1988
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