North Shore-LIJ House Calls, an advanced illness management program, provides care to homebound elderly patients with multiple chronic illnesses and functional impairments. The homebound elderly typically have reduced access to essential health care services, leading to a high number of emergency department visits and elevated hospital admission rates.
Inpatient mortality among these homebound seniors is also high. The homebound elderly require intense interdisciplinary and coordinated medical care, much of which is unreimbursed.
Two interdisciplinary North Shore-LIJ teams comprised of physicians, nurse practitioners, social workers and care coordinators, in addition to administrative personnel care for approximately 800 homebound patients through this program.
As part of its disaster preparedness planning for any emergency, North Shore- LIJ hospitals, long-term care facilities, and ambulatory services activated their emergency operations centers three days in advance of Superstorm Sandy’s arrival. They remained staffed around the clock throughout the week of the storm, enabling the leadership of the health system and its facilities to maintain ongoing communications and arrange for and allocate resources and supplies as necessary. Providing for the medical needs of homebound patients was extremely important in order to prevent an influx of patients in our emergency departments.
In 2010, in an effort to reduce cardiac surgery readmissions, leadership of the North Shore-LIJ cardiothoracic team introduced an innovative program known as Follow Your Heart. After discharge, the program provides follow-up care to patients at home by nurse practitioners and physician assistants who cared for the patient in the hospital. An added feature of the program is ongoing collaboration with the North Shore-LIJ Home Care Network. Together these programs are working to help patients manage their medications at home and improve communication between acute and post-acute care settings.
North Shore-LIJ has adopted numerous measures to contain, minimize and eliminate the spread of infection. Our goal is zero. Our current priorities are improving hand hygiene compliance, reducing clostridium-difficile (C-difficile) infections, catheter associated urinary infections and resistant organisms, and eliminating surgical site infections, central line associated bacteremias and ventilator associated pneumonias in both intensive care units (ICUs) and non-ICUs.
North Shore-LIJ is in the process of testing the use of the Modified Early Warning Score (MEWS). MEWS is a well-established scoring methodology that utilizes vital signs and other clinical data to help identify patients who require closer monitoring, or more aggressive interventions. The score is meant to prompt action such as escalation, rapid response team activation, or triage to a higher level of care. In 2012, after a number of pilot tests were conducted, all North Shore-LIJ hospitals began implementation of MEWS on their medical-surgical units.
The hallmark of the Patient Safety Institute (PSI), one of the largest simulation centers in the country, is inter-professional education and teamwork. Through extensive inter-professional team training using cutting-edge simulation and an array of patient simulators, PSI fosters unique, collaborative learning opportunities that ultimately improve quality and patient safety. In 2012 alone, over 9,000 clinical staff participated in medical simulation programs.
Cohen Children’s Medical Center has adopted daily safety briefs to increase patient safety and reduce the risk of harm to patients, families and staff at all levels of the organization. A daily safety brief is a detailed report of actual and potential safety risks, or events involving patient harm. Problem solving occurs during and after the call, and resources to resolve any issues are immediately deployed.
North Shore-LIJ continues to prioritize perinatal safety among its eight hospitals offering maternity services, including two regional perinatal centers and two newly opened Katz Women’s Hospitals. As part of the commitment to standardizing processes and reducing adverse maternal-fetal outcomes, North Shore-LIJ is participating in two important initiatives, the Centers for Medicare and Medicaid Services (CMS) Partnership for Patients and the New York State Initiative to Stop Non-Medically Necessary Elective Deliveries of Babies. These partnerships will provide North Shore-LIJ with access to a wide variety of educational programs, in addition to opportunities to benchmark performance with other organizations.
To advance patient safety and reduce patient exposure to radiation, North Shore- LIJ purchased 15 low-dose computed tomography (CT) scanners that have been installed throughout the New York area. The new scanners deliver lower levels of radiation while also providing high-quality diagnostic images. In addition to the new hardware, North Shore-LIJ is installing first-of-its kind monitoring software to track how much radiation is emitted by each CT scanner, monitor the levels of emission and enable radiologists to adjust their practices based on the latest clinical evidence.
North Shore-LIJ has launched a major system-wide initiative aimed at reducing sepsis mortality, a leading cause of death worldwide. Our initial efforts focused on improving care processes and patient outcomes in each of our Emergency Departments (EDs). As a result of our focus on sepsis, an ED specific sepsis treatment algorithm was developed and is followed whenever a patient with suspected sepsis arrives in the ED. Currently our focus is expanding to early recognition and treatment of sepsis on the inpatient medical-surgical units.