Citation: Lambert, D., & Gale, J.A. (2012). Integrating care in rural areas. In Smalley, K.B., Warren, J.C., & Rainer, J.P. (Eds.), Rural Mental Health. (pp. 131-148). New York, NY: Springer Publishing Co.
The traditional, film-based radiology system presents serious limitations for patient care. These include forcing clinicians to make decisions based on information that is often less than optimal and making transfers of films and prior studies to other facilities more complicated than they need to be. Picture Archiving and Communication Systems (PACS) address these issues by allowing for acquisition, storage, display, and communication (e.g., transportation) of images in a digital format. Although PACS has been shown to improve patient care, many rural health care organizations have found obtaining these systems cost-prohibitive. The Consolidating Imaging Initiative (CI-PACS) in Maine provides an alternative way to offer this technology to rural hospitals. Through CI-PACS, a tertiary care hospital and its health care system have implemented a shared, standards-based, interoperable PACS in two rural hospitals (one belonging to the larger health system and one not). In this article, we discuss how the regional system works, and how it will be sustained. We also highlight the unique challenges associated with implementing a regional system.
The Tennessee Rural Hospital Patient Safety Demonstration Project sought to improve patient safety in small rural facilities by strengthening their capacity to implement priority patient safety interventions. The project focused on interventions relevant to the core services and capacities of rural hospitals and was sensitive to their structure and processes. A process for assessing the status of hospital patient safety programs and providing technical assistance tools, and resources was developed. Organizational and clinical changes designed to prevent errors and improve safety were initiated. Eight participating hospitals completed a self-assessment tool to identify and prioritize rural hospital patient safety interventions. These hospitals implemented three interventions: assessment of patient safety culture and implementation of a safety culture plan, development and implementation of emergency department protocols, and use of personal digital assistant devices (PDAs) by clinicians at the point of care to decrease medication errors.