Innovation Spotlight: New York Hospitals Are Improving Health, Enhancing Quality, and Reducing Costs.

Adirondack Health empowers patients and their families

Having patients, their families and caregivers central in planning the course of treatment improves health outcomes, quality of care received and cost of care. In 2018, Adirondack Health created its Patient and Family Advisory Council to empower patients and families to take a more active role in improving the patient experience.

First, Adirondack developed the PFAC infrastructure, including job descriptions, ground rules, evaluations and more. Next, they recruited and interviewed potential advisors, asking department directors, social workers and case management staff to identify patients they thought would be interested in volunteering to serve on the council. Having a cross representation of volunteers from the primary service areas, service lines and age demographics was key to success. The team plans to start staggering meetings to include evening times to be more inclusive to a variety of schedules. Hospital staff are encouraged to consult the PFAC for patient input when they are tackling new initiatives or revisiting older procedures.

As a result of its PFAC, Adirondack Health enhanced its website with more color and graphics, improved promotion of quality ratings, expanded physician information (i.e., which insurance they accept, personal philosophy on healthcare, etc.) and streamlined its Patient and Family Guide.

For more information, contact Terry Lewis, patient advocate and PFAC facilitator, at (518) 897-2721 or tlewis@adirondackhealth.org.

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NYC Health + Hospitals/Bellevue advances quality care for trauma patients

Ventilator-associated pneumonia is the second most common nosocomial infection affecting critically ill patients. Incidence of VAP and related complications extend patients’ duration of mechanical ventilation and increase intensive care, hospital length of stay, costs and mortality risk. An increase in antibiotic use is also commonly associated with VAP. In 2017, NYC Health + Hospitals/Bellevue began its Ventilator-Associated Pneumonia in Adult Trauma Patients initiative to

reduce the rate of VAP in adult trauma patients by achieving a culture change through multidisciplinary effort and empowerment.

Interventions implemented through the initiative included execution of a ventilator bundle, creation of an oral care tracking system, adoption of an analgesia/sedation guideline and the use of a tracking tool to monitor compliance and enable real-time feedback. This project followed the Six Sigma methodology by using the DMAIC (define, measure, analyze, improve, control) steps. Making the program a success required efforts by all staff, including the trauma program, intensive care unit physicians, ICU nursing, infection control and respiratory therapy.

As a result of this initiative, compliance with the ventilator “bundle” of care protocols increased from 93% to 100%. All ICUs in the hospital now use a standard ventilator bundle on all mechanically-ventilated patients.

NYC Health + Hospitals/Bellevue was recognized with HANYS’ 2019 Pinnacle Award for Quality and Patient Safety for this successful program. Watch our video for an in-depth look at this initiative and its results.

For more information, contact Margaret Ewen, MS, PA-C, trauma performance improvement coordinator, at (212) 562-8313 or margaret.ewen@nychhc.org.

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Stony Brook University Hospital enhances diabetes care

Studies indicate diabetic patients are three times more likely to be hospitalized than non-diabetic individuals. Hyperglycemia in patients — with or without prior diagnosis of diabetes — is connected with increased risk of complications and mortality. In 2015, Stony Brook University Hospital saw an opportunity to improve the care and outcomes of its diabetic patients and began the Quality Diabetes Care: Creating a Culture of Excellence Through Innovation initiative.

The hospital formed a multidisciplinary diabetes advisory committee with a workgroup focused on the development and implementation of “glucometric” defined dashboard monitors for patients with diabetes and associated risk indicators, standardized insulin order entry and system-wide education. The development of an innovative tracking monitor gleaned from the electronic medical record provided immediate identification of the patient population while guiding interventions for endocrine consultations, insulin pump care or proper dietary and education referrals.

An institutional culture of excellence and awareness was established regarding the care of patients with diabetes through standardized insulin order entry and administration. Stony Brook achieved significant improvements in system-wide diabetes outcomes, including a reduced length of stay, decreased readmission rates and increased hbA1c monitoring.

Stony Brook University Hospital was recognized with HANYS’ 2019 Pinnacle Award for Quality and Patient Safety for this successful program. Watch our video for an in-depth look at Stony Brook University Hospital’s initiative and its results.

For more information, contact Paul F. Murphy, BS, CSSBB, quality management practitioner, at (631) 444-4536 or paul.f.murphy@stonybrookmedicine.edu.

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Faxton St. Luke’s Healthcare fights C. difficile infection

Clostridium difficile is a leading cause of healthcare-associated infections, often resulting in significant morbidity and mortality. Despite medical advances, C. diff has grown in prevalence and is becoming increasingly resistant to standard treatments. In 2018, Faxton St. Luke’s of the Mohawk Valley Health System implemented CDIFFerently: A Bundled Approach to Sustained C. diff Infection Prevention, an initiative aimed at lowering their rates of hospital onset C. diff infection.

In 2017, Faxton St. Luke’s introduced new cleaning products, enhanced education and promoted antibiotic stewardship in inpatient and outpatient settings. These strategies were then combined with the CDIFFerently program. Multiple disciplines collaborated to track and trend processes to improve accountability, which significantly reduced C. diff infections. Staff used a define-measure-analyze-improve-control process improvement model to better understand the reasons for the high infection rates and develop a comprehensive reduction plan. The strategy focused on diagnostic stewardship, environmental contamination, transmission prevention and education. The individual CDIFFerently elements were augmented by a marketing campaign to pique interest and sustain engagement.

Outcomes of the program included a 48% reduction in the rate of hospital-onset C. diff infection, greater than 80% compliance with the testing algorithm and use of an ultraviolet light disinfection system was expanded to include 98% of C. diff discharge rooms and 13% of total discharge rooms.

Faxton St. Luke’s Healthcare was recognized with HANYS’ 2019 Pinnacle Award for Quality and Patient Safety for this successful program. Watch our video for an in-depth look at the Faxton St. Luke’s initiative and its results.

For more information, contact Sarah M. Deming, RN, BSN, CIC, infection preventionist, at (315) 801-4250 or sdeming@mvhealthsystem.org.

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Saratoga Hospital fights sepsis mortality

Early signs of sepsis are difficult to identify and usually begin in patients before arriving at the hospital. This is especially problematic as early detection and aggressive treatment are essential to fighting sepsis mortality. To combat sepsis, Saratoga Hospital began an internal awareness campaign that has matured into a comprehensive, collaborative and structured program.

The initiative focuses on saving lives, improving the health and experience of patients and the community, along with meeting and exceeding regulatory requirements. To accomplish this, Saratoga Hospital developed innovative technologies to improve timeliness of recognition and treatment, expanded community outreach and engagement. Using a team-based, structured approach while leveraging the organizational culture, leadership support and technology, Saratoga Hospital achieved improvement in key outcome metrics. This organization-wide effort encompassed all professions, staff, units, departments and leaders. The program has expanded to include the post-acute ambulatory setting, community nursing homes, patients and families.

In New York state and nationwide, Saratoga Hospital achieved performance in the top 10% on compliance with the Centers for Medicare and Medicaid Services’ sepsis care recommendations. Its 30-day readmissions for severe sepsis improved 60% and 30-day mortality for severe sepsis improved 43%.

Saratoga Hospital was recognized with HANYS’ 2019 Pinnacle Award for Quality and Patient Safety for this successful program. Watch our video for a more in-depth look at Saratoga Hospital’s initiative and its results.

For more information, contact Anna Gaeta, RN, BSN, MS, CPHQ, CPPS, associate vice president, quality, at (518) 580-2665 or agaeta@saratogahospital.org.

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