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

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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River Hospital Combats Post-Traumatic Stress Disorder

While Post-Traumatic Stress Disorder (PTSD) is a common affliction military personnel face, they often experience hurdles and limited resources finding treatment. In 2013, River Hospital created the River Community Wellness Program (RCWP) to help treat PTSD for local soldiers at Fort Drum.

RCWP offers combat- and non-combat-related trauma care. Treatment is offered five days a week, five hours per day, for eight weeks and includes therapies such as cognitive processing, group and individual, peer-to-peer support, creative arts and imaginal. Typically, treatment is conducted in a group setting, ranging from six to ten soldiers. Soldiers are provided individual sessions a few times a week as well as a weekly medication management meeting. The combat-related trauma group offers rolling admission, allowing a soldier to join at any time. The non-combat-related trauma group starts once the program has received eight to ten referrals so the group can start and end the program together. In 2016, RCWP expanded to include veterans and created outpatient services.

River Hospital is the only civilian hospital nationally offering this level of mental health treatment to active duty soldiers. To date, more than 500 soldiers have graduated from RCWP.

Read the Watertown Daily Times article for more on this innovative program.

For more information, contact Brad Frey, PA-C, MPAS, Senior Director, Operations and Director, River Community Wellness Program, at (315) 482-1203 or at bfrey@riverhospital.org, or Amanda Fisher, Program Manager, at (315) 482-1225 or at afisher@riverhospital.org.

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A.O. Fox Hospital Diminishes Operating Room Infection

Surgical site infections (SSIs) cause significant burden and cost for patients and hospitals. SSIs are the second most common healthcare-associated infection and lead to higher rates of patient morbidity and mortality and prolonged hospital stays. In 2015, A.O. Fox Hospital created a surgical services environment bundle to reduce operating room (OR) infection.

An audit tool was created to measure bundle compliance. Hospital staff then implemented process changes and initiatives based on the findings, including:

  • hygiene education;
  • UV light to systematically disinfect ORs;
  • updated attire policy to meet Association of Peri-Operative Registered Nurses guidelines;
  • new mattresses for the stretchers;
  • disposable linens in ORs;
  • assignment of dedicated environmental services staff to ORs;
  • regular infection control rounds;
  • updated heating, ventilation and air conditioning system to monitor temperature and humidity for each OR;
  • new surgical hand scrub and revision of scrub procedure; and
  • use of peri-operative 2 percent chlorhexidine gluconate for pre-operative cleansing.

After implementation, overall SSI rates decreased from 0.87% (16 cases) in 2015 to 0.21% (one case) in 2016; and a predicted rate in 2017 of 0% (zero cases). An internal study proved a 14% reduction in bioburden when the UV light is used for disinfecting.

For more information, contact Russ Grant, Infection Control Coordinator, A.O. Fox Hospital, at (607) 431-5962 or at russell.grant@aofmh.org.

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