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

Health Quest reduces sepsis mortality

Sepsis is a serious threat to patient safety and public health. It has been found in more than one-third of patients whose hospitalization culminated in death, and inpatient care for sepsis is a crucial and substantial cost driver for hospitals. In 2017, Health Quest implemented steps to reduce sepsis mortality.

Multidisciplinary sepsis committees were created at each hospital with representation from inter-departmental staff. Committees reviewed common areas of weakness in the sepsis protocol, including timely nursing assessment, early identification of barriers, caregiver education, electronic medical record challenges and alarm fatigue. Using committee recommendations, annual sepsis education modules were established, a rapid response code was instituted and education on early sepsis recognition was provided to care partners. Committees then focused on identifying the most at-risk patients based on extensive data review and customized the existing sepsis protocol to address opportunities they found. The protocol is continually reviewed and revised as needed.

The sepsis mortality rate decreased from 20.7% in 2013 to 7.8% in 2017. The sepsis mortality ratio decreased 54% from 2013 to 2017. Health Quest outperformed the New York State average by 25% for three-hour sepsis bundle adherence and outperformed the state average by 70% for composite sepsis bundle adherence.

For more information, contact Diane C. Kantaros, MD, Associate Vice President, Clinical Quality, at (845) 475-9734 or at dkantaros@health-quest.org.

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Northwell Health provides behavioral health treatment to students

Studies show psychological distress in students is tied to lower academic success. Additionally, college is an especially vulnerable time for individuals’ mental health, with students often at greater risk of depression, anxiety and substance abuse. Northwell Health launched the Behavioral Health College Partnership at Zucker Hillside Hospital in 2009 to provide rapid, comprehensive mental health treatment to area college students.

At the point of crisis, students are met with a college public safety officer and paramedic trained to deal with psychiatric crises and taken to Long Island Jewish Medical Center's ED for assessment. This avoids a 911 call, which can be embarrassing for students and can inhibit their attempts to seek care. If inpatient care is needed the program has a special unit (located at Zucker Hillside), a welcoming, dorm-like environment catered to young people that allows for a sense of normalcy as students stabilize. Moreover, the program works with college counselors and administration throughout the treatment process to ensure successful transfer of the patients back into the school environment.

More than 3,200 students have been admitted to the Partnership since it began. Seventy-seven colleges in the New York metropolitan area currently participate in the program. In 2017, the Partnership was launched at Northern Westchester Hospital to serve local colleges.

For more information, contact Laura Braider, PhD, Director, Behavioral Health College Partnership, Zucker Hillside Hospital, Northwell Health, at (516) 410-5903 or at lbraider@northwell.edu.

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NewYork-Presbyterian supports overdose survivors through the Relay Program

According to CDC, unintentional drug overdoses killed more than 70,000 Americans in 2017, a 10% increase over 2016. Every six hours a person dies from an overdose in New York City and more than 80% of those deaths involve opioids. In 2017, hoping to reduce opioid-use mortalities, NewYork-Presbyterian began offering the Relay program.

When a patient experiences an opioid overdose, NYP notifies Relay and a “wellness advocate” with personal substance abuse experience arrives within an hour to offer patients naloxone kits, refer them to medication-assisted treatments and assist in obtaining needed social services such as housing or health insurance. Patients can work with the wellness advocate for up to 90 days. NYP also educated staff on treating addiction patients, focusing on non-opiate pain relief options and collaborating with community-based organizations to get treatment. Additionally, NYP has been providing free kits and conducting public training sessions on how to administer naloxone.

Since Relay’s launch, 157 overdose survivors from NYP have chosen to participate in the 24/7 program and more than 900 naloxone kits have been distributed through Relay, with 60% of recipients saying it was their first time receiving a kit.

For more information, contact Lauren Browdy, Media Associate, Communications, NewYork-Presbyterian, at (646) 951-2898 or at lab9125@nyp.org.

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Crouse Health Halts Preterm Labor and Birth

Babies born before 37 weeks are at risk for increased short- and long-term health problems and potential mortality—and U.S. preterm birth rates are on the rise. The reason for preterm labor and birth is not entirely known but can be managed using evidence-based practices. In 2018, Crouse Health initiated a collaborative program called H.A.L.T.T.: Hold All Labor ‘Til Term to streamline these practices.

H.A.L.T.T. team members designed a preterm labor management algorithm that breaks down specific pathways based on assessment findings and the patient’s gestational age. Nurses, midwives and providers were educated on the algorithm to promote understanding, consistency and adherence. The program works to clarify and expedite confirmation of preterm labor and initiate vital interventions to improve outcomes. It also works to aid in ruling out preterm labor; this allows hospital staff to reassure patients and avoid administering unnecessary treatment, hospital admissions and long triage times.

Data collected during the year revealed increases in the use of diagnosis and risk assessment tools and timely interventions. Triage time decreased by 48% (2.8 fewer hours) and progesterone delivery increased by 59.1% at obstetrical offices. The preterm birth rate has decreased by 3.2% and further reduction is expected as the program continues.

For more information, contact Amanda Martin, RNC, BSN, Project Coordinator, Crouse Health, at (315) 470-7429 or at amandamartin@crouse.org.

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Jamaica Hospital Medical Center Lowers Emergency Department Overutilization

Systematic overutilization of hospital services is not only a drain on provider and patient finances and a misappropriation of resources, it can also lead to poorer health outcomes. In an effort to reduce overutilization, Jamaica Hospital Medical Center (JHMC) used the New York State Department of Health Medicaid Accelerated eXchange (MAX) program to develop a strategic plan.

Once high utilizers are identified, senior clinical leadership and post-discharge staff connect patients with community-based care and support. JHMC created visible, real-time alerts in the electronic medical record and senior clinical leaders perform aggressive case review. When a patient comes to the emergency department for a potential fourth admission within a 12-month period, a best practice advisory occurs for all care providers, prompting the attending physician to consult with the inpatient service attending physician before admitting the patient. Dedicated patient care facilitators enforce and ensure continuation and adherence to the individualized care plan designed by the medical team.

From these efforts, JHMC reduced 90-day pre/post hospital utilization by 72 percent. A root cause analysis conference is now conducted within one business day of a patient’s admission, allowing the hospital to be “self-critical” on behalf of the patient.

For more information, contact Angelo Canedo, PhD, Vice President, Jamaica Hospital Medical Center at (718) 206-6595 or at acanedo@jhmc.org.

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