Advocate Condell Sexual
Assault Development Plan
Jody Jesse RN
Director of ED
March 2010
Objectives
“Right Thing to Do”
Benefits
Compassionate care
Evidence properly collected
Photo documentation
Medical records/ organized process
Higher conviction rates
Place to call for questions
States attorney
Expert witness
Greater knowledge base/experience
MAGNET status
Good statistical data
Community Education
Collaborative effort for success
Partnership with Community
Improved documentation and evidence collection
Inspiration for the SANE Center
• Fort Wayne, Indiana
– Staffed by 4 full-time SANE nurses
– Staffed by 8 on-call SANE nurses
– All sexual assaults go to one place
Now have a 10,000 square foot facility
• Milwaukee, Wisconsin
-Have a full time staff and two SANE Centers for the
county
-All sexual assaults transported to the Centers.
Traditional Procedure
– Initial complaint made
to law enforcement,
DCFS, or patients
come into closest
hospital
– Law enforcement or
DCFS will send to the
closest hospital once
contacted
– Evidence collected in
emergency room by a
nurse and a physician
– Law enforcement
called to pick up
evidence
– Transport evidence to
crime lab
History of Lake County and SANE
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Lake County SART and SANE Task Force-2008
Illinois SANE Pilot Program late 1990’s
Lake County Sexual Assault Coordinating Council
Lake County Medical Sub Committee-10/09
Only SANE nurses in Lake County are at
Veteran’s hospital and Cancer Treatment Center
Need a Sexual Assault Treatment Center of
Excellence
Challenges to Traditional Procedure
• Busy ED and wait time.
• Loss of evidence and general frustration of victims they end up
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leaving.
ED patient flow and make it difficult for nurse to take this case.
(generally a 3-4 hr commitment due to chain of custody)
Views of certain staff makes a difference on how victim is treated.
Lack of training on forensic evidence collection. Sometimes may not
see many cases.
Difficult for law enforcement to ask questions of the nurse about the
case or documentation
No photos
Evidence not properly stored. Chain of custody problems
Many cases dropped by States Attorney related to poor
documentation and contamination of kits.
What is a SANE nurse?
• Sexual Assault Nurse Examiner-Adult/Adolescent SANE-A
• Sexual Assault Nurse Examiner-Pediatrics SANE-P
• RN who has completed a forensic SANE training program-40 hours
classroom plus clinical
• SANE-P RN with additional training in Pediatrics-24 hr classroom
plus clinical
• Conduct examinations using the sexual assault evidence collection
kits without the presence of a MD
• Final certification shows expertise
Condell Hospital SANE Center
Proposal
– Would cover suburban
Lake County. Similar to
Level 1 Trauma Center
– SANE Coordinator
– SANE RNs 24/7
– 1 to 1 RN patient care
– Compassionate care
– Private room-minimal wait
time
– Lake County Child
Advocacy Center wants a
partnership
– Proper Evidence collection
and documentation
– Specialized Equipment
• Colposcope/Digital
photography
– Reliable source to answer
questions
– Medical Records same day
– Medical Screens and
follow-up provided
– ED physicians support the
program for SANE
– Currently have 1 SANE
nurse in clinical
Current Volumes in Condell ED
In 2009 we had 54 Sexual Assault Cases
Projection 2010-54
Projection 2011- 120
Projection 2012- 200
Building Our SANE Center
Already have
• Private room
• Computer
• Printer/Copier/Fax
• Appropriate Patient Carts
• All Patient Supplies
Need
• Colposcope
• Photo printer and supplies
• $ for training hours for SANE
nurses
• $ Travel expenses for nurse
training
• Pediatric MD administrative
fees until We have a SANE-P
Nurse
Start Up Needs/Costs - 2010
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SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0
RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$
Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------$2,000
Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500
On-Call RN pay (3rd and 4th quarter 2010 --------------------------------------------------------$13,104
Overtime Pay (estimate) Time and ½ (3rd and 4th quarter 2010)------------------------------ $9,600
Will need a designated printer for pictures---------------------------------------------------------$ 600
**We do need is a Culposcope- However see next page for grant $-------
Colposcope Costs-Proposal
• Lake County Child Advocacy Center would like us to be designated
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site for Child Assaults-these are scheduled visits as children are late
reporters.
Approximately annual volume – 130 patients (estimate 2-3 wk)
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 administrative
costs (court time and prep)
I anticipate SANE P later this year in fall to be available in ED
At that time we could eliminate pay to MD’s
If we commit to being the site for these exams the Advocacy Center
has donor who will pay for our Culposcope (cost $30,000)
Start Up Needs/Costs - 2010
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SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0
RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$
Travel and Hotel for 2 SANE nurses- (June)--------------------------------------------------------$2,000
Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500
On-Call RN pay (3rd and 4th quarter 2010 --------------------------------------------------------$13,104
Overtime Pay (estimate) Time and ½ (3rd and 4th quarter 2010)------------------------------ $9,600
Will need a designated printer for pictures---------------------------------------------------------$ 600
**We do need is a Culposcope- However see next page for grant $-------
Medications- per pharmacy
"our cost"
Kaletra (Lopinavir/Ritonavir) 200 MG-50 MG dosed: 2 tabs po q12h
cost $5.63/pill (4pills/24hr/$22.52) ---------------------------------------3day supply $
Combivir (Lamivudine/Zidovudine) 150 MG-300 MG dosed: 1 tab po q12h
cost $13.30/pill (2pills/24hr/$26.60) -------------------------------------3day supply $
Both drugs 3 day supply "our costs" ------------------------------------------------ = $
Suggested Funding
• Philanthropy
• Associate Giving Campaign
• Donations from Community
• Fundraising and grants
SANE Coordinator Role
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Need a champion person to be responsible for the program.
Organize the program
Schedule training SANE applicants
Training new SANE
Policy and Procedure
Performance Improvement Activities
Networking in the Community and attending meetings.
Community education, law enforcement, EMS, schools, community
services requesting information.
Patient care.
Fundraising.
Keeping up with daily phone calls and appointments.
LIST GOES ON!!!!!!
Current Situation in ED/Next Steps
• Currently I have 1 SANE nurse in clinical and 6 nurses in ED willing to train
and take on call
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Get Administrative Approval to proceed
Get Nurses to training
Give commitment to Child Advocacy
Increase Volume
Increase Community Programs and Awareness
• Need a SANE Coordinator full time
2011 Condell SANE Center
Budget
• Hire a full-time SANE nurse ---------------------------------------------------------- $72,000
• Continue with our on-call SANE team 16 hr/day/24/7 weekend and holiday--$18,500
• Train 4 additional nurses---------------------------------------------------------------$5,120
• Travel and Hotel for 4 SANE nurses- --------------------------------------$4,000
Reimbursements• In working with Finance on this we have discovered some opportunities to improve
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our billing but it involves the whole revenue cycle process so more information to
come on this per Amanda.
Billing needs to be handled properly to get reimbursed properly for all those involved,
including ED, lab, pathologists, EMS…
Sexual Assault is billed through individual insurance plans and whatever remains can
be sent through the State for reimbursement with the exception of Medicaid
Medicaid reimbursement is $181- (approximately 1/3 of current cases)
No insurance is 100% billable to the State.
Voucher system is in place in ED already
Physician’s Support
• Infinity supports the SANE program
• Will need a SANE medical director
– Support program, case review, review
policy/procedures, professionalism
Administration’s Support
• Mary Hillard, Chief Nursing Officer
• Jody Jesse RN, MHA, ED Director
Positive for nurse recruitment
Community Benefit and Outreach
• Making a difference in our community
• Community education/awareness
Final Thought
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Process can work!
Teamwork and collaboration is key
More hospitals on board can form a network
Use Shannon Liew, Illinois SANE Coordinator
and South Suburban SANE Center to help if
needed. No sense in recreating the wheel.
Starting a SANE Center has lots of advantages
Important to advocate for best practice and best
standard of care for victims.
Thank You!