Improving Care for Athletes:

Lessons from The Glasgow 2014

Commonwealth Games

Liz Mendl

John Maclean

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4,500 Athletes, 17 Sports,

~ 250 Golden Moments

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Aquatics * Athletics * Badminton * Boxing * Cycling Gymnastics

Hockey * Judo Lawn Bowls * Netball * Rugby Sevens * Shooting

Squash * Table Tennis Triathlon Weightlifting * Wrestling

Integrated Para-Sports:

20 medal events in 5 sports

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Aquatics Athletics

Lawn Bowls

Weightlifting

Cycling

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

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Task & Scope:

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• 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

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

• 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)

Stakeholders & Governance

Composition

Medical Advisory Group

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 (1/3rd of competing teams)

• 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”

Public Health & Infectious Disease Management:

Daily reporting

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

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.

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.

Polyclinic

24 hour Emergency Medicine & Primary

Care

0700-2300 0800-2200

Physiotherapy Optometry

Sports & Exercise

Medicine Podiatry

Sports Massage

Therapy

Emergency Dental

Care

Pharmacy 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 20th 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

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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

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

Quality Indicators for Success