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

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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Catholic Health Services of Long Island Improves Care Access for Behavioral Health Patients

Studies show that prompt psychiatric consultation during hospitalization is associated with reduced length of stay, use of hospital resources and burden on family and caregivers. However, due to the severe psychiatrist shortage, these services are a challenge to provide in a timely fashion. Catholic Health Services of Long Island addressed this challenge using telepsychiatry.

The health network first earned approval from the Office of Mental Health to implement a telepsychiatry pilot program. The pilot program began with three of the system’s six hospitals during peak weekend times: 6 p.m. to 7 a.m. Robust process improvement techniques were applied to implement the program. The creative use of technology connects the remote psychiatrist to behavioral health patients, providing a quicker response and access to this specialized care regardless of shift or location, with coverage spanning two counties.

The average turnaround time to complete a psychiatric consult for 341 emergency department patients was reduced by ten hours, from 12 hours to one hour and 55 minutes. A patient survey demonstrated a 97% satisfaction rate with the program (29% response rate).

For more information, contact Ronald Brenner, MD, Medical Chief, Behavioral Health Service Line, Catholic Health Services of Long Island, at (516) 695-7615 or at ronald.brenner@chsli.org.

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Thompson Health Decreases Opiate Use with Innovative Surgical Technology

Patients who undergo surgical procedures typically experience acute post-operative pain and require a regimen for pain management. Commonly, opiates are prescribed as the main component of a pain management regimen but the increasingly severe opioid crisis has compelled surgeons to investigate other avenues of pain management. At Thompson Health, four general surgeons have committed to significantly limiting the number of patients prescribed opioids for post-operative pain control.

The doctors employed a unique surgical approach for one of their most common surgeries, hernia repair. Instead of open surgery, they perform less invasive, robotic-assisted hernia repair, and developed a novel pre- and post-operative non-opiate based pain control regimen. In addition, they found prescribing post-operative opiates to be administratively burdensome. Instead they prescribed an alternative pain control regimen of over-the-counter acetaminophen and ibuprofen.

As a result of this novel surgical process, 95 percent of these patients are not receiving opioids. There have been no complaints from patients about this alternative treatment and patients return to work faster and experience fewer complications.

For more information, contact Joseph A. Talarico, MD, FACS, General Surgeon and Director, SRC Center of Excellence in Hernia, Thompson Health at (585) 398-8363, or at Joseph.Talarico@ThompsonHealth.org.

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