1. Advocate Condell Sexual Assault Development Plan Jody Jesse RN Director of ED March 2010

2. 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 Collaborative effort for success Partnership with Community Partnership with Community Improved documentation and evidence collection Improved documentation and evidence collection

3. Inspiration for the SANE Center Fort Wayne, Indiana 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 Milwaukee, Wisconsin -Have a full time staff and two SANE Centers for the county -Have a full time staff and two SANE Centers for the county -All sexual assaults transported to the Centers. -All sexual assaults transported to the Centers.

4. 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

5. History of Lake County and SANE Lake County SART and SANE Task Force-2008 Lake County SART and SANE Task Force-2008 Illinois SANE Pilot Program late 1990’s Illinois SANE Pilot Program late 1990’s Lake County Sexual Assault Coordinating Council Lake County Sexual Assault Coordinating Council Lake County Medical Sub Committee-10/09 Lake County Medical Sub Committee-10/09 Only SANE nurses in Lake County are at Veteran’s hospital and Cancer Treatment Center Only SANE nurses in Lake County are at Veteran’s hospital and Cancer Treatment Center Need a Sexual Assault Treatment Center of Excellence Need a Sexual Assault Treatment Center of Excellence

6. Challenges to Traditional Procedure Busy ED and wait time. Busy ED and wait time. Loss of evidence and general frustration of victims they end up leaving. Loss of evidence and general frustration of victims they end up 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) 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. 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. 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 Difficult for law enforcement to ask questions of the nurse about the case or documentation No photos No photos Evidence not properly stored. Chain of custody problems Evidence not properly stored. Chain of custody problems Many cases dropped by States Attorney related to poor documentation and contamination of kits. Many cases dropped by States Attorney related to poor documentation and contamination of kits.

7. What is a SANE nurse? Sexual Assault Nurse Examiner-Adult/Adolescent SANE-A Sexual Assault Nurse Examiner-Adult/Adolescent SANE-A Sexual Assault Nurse Examiner-Pediatrics SANE-P Sexual Assault Nurse Examiner-Pediatrics SANE-P RN who has completed a forensic SANE training program-40 hours classroom plus clinical 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 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 Conduct examinations using the sexual assault evidence collection kits without the presence of a MD Final certification shows expertise Final certification shows expertise

8. 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

9. Current Volumes in Condell ED In 2009 we had 54 Sexual Assault Cases Projection 2010-54 Projection 2011- 120 Projection 2012- 200

10. Building Our SANE Center Already have Private room Private room Computer Computer Printer/Copier/Fax Printer/Copier/Fax Appropriate Patient Carts Appropriate Patient Carts All Patient Supplies All Patient SuppliesNeed Colposcope Colposcope Photo printer and supplies Photo printer and supplies $ for training hours for SANE nurses $ for training hours for SANE nurses $ Travel expenses for nurse training $ Travel expenses for nurse training Pediatric MD administrative fees until We have a SANE-P Nurse Pediatric MD administrative fees until We have a SANE-P Nurse

11. Start Up Needs/Costs - 2010 SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0 SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0 RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$ 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 2 SANE nurses- (June)--------------------------------------------------------$2,000 Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500 Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500 On-Call RN pay (3 rd and 4 th quarter 2010 --------------------------------------------------------$13,104 On-Call RN pay (3 rd and 4 th quarter 2010 --------------------------------------------------------$13,104 Overtime Pay (estimate) Time and ½ (3 rd and 4 th quarter 2010)------------------------------ $9,600 Overtime Pay (estimate) Time and ½ (3 rd and 4 th quarter 2010)------------------------------ $9,600 Will need a designated printer for pictures---------------------------------------------------------$ 600 Will need a designated printer for pictures---------------------------------------------------------$ 600 **We do need is a Culposcope- However see next page for grant $------- **We do need is a Culposcope- However see next page for grant $-------

12. Colposcope Costs-Proposal Lake County Child Advocacy Center would like us to be designated site for Child Assaults-these are scheduled visits as children are late reporters. Lake County Child Advocacy Center would like us to be designated site for Child Assaults-these are scheduled visits as children are late reporters. Approximately annual volume – 130 patients (estimate 2-3 wk) 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) 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 I anticipate SANE P later this year in fall to be available in ED At that time we could eliminate pay to MD’s 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) If we commit to being the site for these exams the Advocacy Center has donor who will pay for our Culposcope (cost $30,000)

13. Start Up Needs/Costs - 2010 SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0 SANE Nurse Training and SANE-P –Free ---------------------------------------------------------------$0 RN Training/Education time – total RN hrs- 104 hrs (2 RN 40 hrs each plus 1 RN 24)-----$ 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 2 SANE nurses- (June)--------------------------------------------------------$2,000 Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500 Travel and Hotel for 1 SANE-P nurses- April--------------------------------------------------------$ 500 On-Call RN pay (3 rd and 4 th quarter 2010 --------------------------------------------------------$13,104 On-Call RN pay (3 rd and 4 th quarter 2010 --------------------------------------------------------$13,104 Overtime Pay (estimate) Time and ½ (3 rd and 4 th quarter 2010)------------------------------ $9,600 Overtime Pay (estimate) Time and ½ (3 rd and 4 th quarter 2010)------------------------------ $9,600 Will need a designated printer for pictures---------------------------------------------------------$ 600 Will need a designated printer for pictures---------------------------------------------------------$ 600 **We do need is a Culposcope- However see next page for grant $------- **We do need is a Culposcope- However see next page for grant $-------

14. 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" ------------------------------------------------ = $

15. Suggested Funding Philanthropy Philanthropy Associate Giving Campaign Associate Giving Campaign Donations from Community Donations from Community Fundraising and grants Fundraising and grants

16. SANE Coordinator Role Need a champion person to be responsible for the program. Need a champion person to be responsible for the program. Organize the program Organize the program Schedule training SANE applicants Schedule training SANE applicants Training new SANE Training new SANE Policy and Procedure Policy and Procedure Performance Improvement Activities Performance Improvement Activities Networking in the Community and attending meetings. Networking in the Community and attending meetings. Community education, law enforcement, EMS, schools, community services requesting information. Community education, law enforcement, EMS, schools, 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!!!!!!

17. 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 Currently I have 1 SANE nurse in clinical and 6 nurses in ED willing to train and take on call Get Administrative Approval to proceed Get Administrative Approval to proceed Get Nurses to training Get Nurses to training Give commitment to Child Advocacy Give commitment to Child Advocacy Increase Volume Increase Volume Increase Community Programs and Awareness Increase Community Programs and Awareness Need a SANE Coordinator full time Need a SANE Coordinator full time

18. 2011 Condell SANE Center Budget Hire a full-time SANE nurse ---------------------------------------------------------- $72,000 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 Continue with our on-call SANE team 16 hr/day/24/7 weekend and holiday--$18,500 Train 4 additional nurses---------------------------------------------------------------$5,120 Train 4 additional nurses---------------------------------------------------------------$5,120 Travel and Hotel for 4 SANE nurses- --------------------------------------$4,000 Travel and Hotel for 4 SANE nurses- --------------------------------------$4,000

19. Reimbursements- 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 information to come on this per Amanda. 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 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… 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 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) 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 already Voucher system is in place in ED already

20. Physician’s Support Infinity supports the SANE program Infinity supports the SANE program Will need a SANE medical director Will need a SANE medical director –Support program, case review, review policy/procedures, professionalism

21. Administration’s Support Mary Hillard, Chief Nursing Officer Mary Hillard, Chief Nursing Officer Jody Jesse RN, MHA, ED Director Positive for nurse recruitment Jody Jesse RN, MHA, ED Director Positive for nurse recruitment

22. Community Benefit and Outreach Making a difference in our community Making a difference in our community Community education/awareness Community education/awareness

23. Final Thought Process can work! Process can work! Teamwork and collaboration is key Teamwork and collaboration is key More hospitals on board can form a network 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. 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 Starting a SANE Center has lots of advantages Important to advocate for best practice and best standard of care for victims. Important to advocate for best practice and best standard of care for victims.

24. Thank You!