North Shore-LIJ continues to improve care and enhance clinical outcomes by engaging patients and their families in discussions about options for advanced care and treatment that are consistent with the patient’s values, beliefs and needs. As pioneer sponsors of the Conversation Project, a public engagement campaign with a goal of making sure that every person’s wishes for end-of-life care are expressed and respected, the health system is testing and spreading new and innovative ways to encourage conversations among patients, families and healthcare providers.
A new Community Paramedicine Program (CPP) offers an on-call system, twenty-four hours a day, seven days a week to patients who are living at home with advanced illness. The goal of this innovative partnership between the North Shore-LIJ Advanced Illness Program (House Calls) and the Center for Emergency Medical Services is to ensure that frail, home bound patients with advanced illness have immediate access to care at any time of day or night to avoid unnecessary emergency department visits and hospitalizations.
Through community outreach, the diabetes screening program provides resources and support to individuals who are at high risk for diabetes. The mission of this program is to provide resources and support for the prevention and treatment of diabetes in our local communities. Goals are to increase access to care, offer diabetes screening and community-based diabetes education, and refer individuals to diabetes prevention programs and/or treatment in order to reduce the impact of diabetes as a public health concern.
North Shore-LIJ was designated as one of the original 35 Ebola Virus Disease (EVD) treatment centers in the nation by the US Centers for Disease Control and Prevention (CDC). The health system was also designated as a regional resource for responding to EVD by New York State. In order to support the delivery of care to patients who present with EVD, or any other serious contagious disease, a Specialized Treatment Center was constructed at Glen Cove Hospital. The center is the first unit of its kind designed not only to care for adults with EVD, but also pediatric and obstetric patients with the disease.
In 2014, North Shore-LIJ launched a new patient portal/personal health record, called “Follow My Health.”Clinical information from a physician’s office and/or hospital electronic health record (EHR) is sent to the portal allowing patients to electronically access clinical information, such as medication lists, laboratory test results and discharge instructions from any computer, smartphone or tablet, twenty-four hours a day, seven days a week. The portal provides patients with educational materials and tools to facilitate communication with physicians and their staff about appointments and medication refills, among other things. The goal of “Follow My Health” is to engage patients in managing their care.
Healthcare-associated infections, such as catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSI), clostridium difficile associated disease (CDAD), carbapenem-resistant enterobacteriaceae (CRE), methicillin resistant staphylococcus aureus (MRSA) and surgical site infections (SSIs) may cause patient harm, increase morbidity and mortality, and prolong length of stay. In keeping with the national agenda to reduce healthcare-acquired conditions, North Shore-LIJ has adopted evidence-based clinical practices including daily surveillance and real-time feedback to staff to reduce the incidence of healthcare-associated infections.
Health information technology (HIT) has been shown to improve patient safety however as with any innovation or process automation it can introduce new areas of risk if it is not designed to support safe workflow, information transfer and effective communication between clinicians. A priority for the health system therefore, is to safeguard against the “unintended consequences” of HIT and ensure the safety of electronic health records.
The North Shore-LIJ Patient Identification initiative promotes awareness, education and implementation of best practices related to patient identification. There are currently 23 sites/service lines that are actively working on one or more high-risk patient identification initiatives. One example is correct patient identification during radiological testing and services. For its achievements in promoting patient safety through patient identification, North Shore-LIJ was the recipient of the 2015 John Q. Sherman Award for Excellence in Patient Engagement and the 2015 National Patient Safety Foundation (NPSF) Stand Up for Patient Safety Management Award.
The North Shore-LIJ Patient Safety Institute (PSI), one of the largest simulation centers in the country, promotes interprofessional education, teamwork and a culture of safety across the entire organization. Through extensive interprofessional team training using cutting edge simulation and an array of patient simulators, PSI fosters unique, collaborative learning opportunities that ultimately enhance quality and patient safety.
Daily safety briefs have been implemented across all levels of the organization to increase patient safety and reduce the risk of harm to patients, families and staff. The purpose of the patient safety brief is to identify, predict and mitigate potential safety risks, or events involving patient harm. Participation in the daily call includes department leaders and representatives. Problem solving occurs during or after the call, and resources to resolve any issues are immediately deployed.
Perinatal Safety continues to be a top priority for the health system. Our aim is to continue to enhance the quality of obstetrical and perinatal care by adopting best practices, reducing variation in care and improving communication among all providers. The American Congress of Obstetricians and Gynecologists (ACOG) District II Safe Motherhood Initiative (SMI) is being implemented to standardize care for patients at risk for obstetric emergencies. Efforts to enhance perinatal safety include team training for all perinatal service providers using TeamSTEPPS,® (Team Strategies and Tools to Enhance Performance and Patient Safety), standardized electronic fetal monitoring with documentation of competency and simulation training geared toward emergent, high-risk scenarios. Strategies to eliminate non-medically indicated deliveries at less than 39 weeks have been implemented to reduce elective preterm deliveries. The Center for Learning and Innovation/Patient Safety Institute promotes a culture of patient safety through the use of life-like simulation scenarios that promote teamwork and inter-professional communication.
A number of quality priorities have been identified by the perioperative services leadership that include expansion of video-assisted technology to monitor compliance with surgical time-out procedures and implementing a Surgical Information System (Electronic Health Record) in the operating room (ORs) over the next two years. Onsite hospital instrument reprocessing will transition to an off-site reprocessing model with a goal of 100% of central sterile staff becoming certified in central sterile, decontamination and sterilization. A fellowship program to educate new nurses in the OR and post anesthesia care unit (PACU) is being launched.
The North Shore-LIJ Pressure Ulcer Task Force, chaired by a Certified Wound Specialist Physician and a Wound Ostomy Continence Nurse has established a uniform standard of care for pressure ulcer prevention and treatment across the continuum. As a result of its achievements, North Shore-LIJ was the recipient of the 2014 Hospital Association of New York State (HANYS) Pinnacle Award for Quality and Patient Safety for its system-wide approach to reducing healthcare-acquired pressure ulcers.
North Shore-LIJ completed its planned upgrade of computerized tomography (CT) technology, which included the purchase of 15 new scanners that offer low-dose technology. Part of this initiative, which targeted CT for a number of dose reduction initiatives, involved the installation of comprehensive CT dose monitoring software that aggregates data about radiation exposure in real time. These data are monitored continuously and trends are reviewed by the Imaging Service Line’s Radiation Safety Team, a group composed of radiologists, imaging technologists and medical physicists. By looking for patterns of radiation exposure, the Radiation Safety Team can recommend changes to imaging protocols that are more radiation efficient and safer for patients.
By launching a system-wide initiative to reduce sepsis mortality, North Shore-LIJ has developed reliable processes, reduced variation in practice and implemented evidence-based best practices and protocols across 11 acute-care hospitals in all ED, inpatient and pediatric settings. These achievements propelled North Shore-LIJ into a leadership position, earning the health system the 2014 John M. Eisenberg Patient Safety and Quality Award.
In collaboration with the Rory Staunton Foundation, North Shore-LIJ is mobilizing a national movement to improve the early diagnosis and prevention of sepsis. New York is the first state in the nation to mandate a series of protocols to diagnose and treat sepsis before it becomes fatal. The protocols which relied heavily on our health system’s best practices were named Rory’s Regulations for a 12-year-old boy, Rory Staunton, who died in a New York City hospital from an undiagnosed case of sepsis.
North Shore-LIJ launched the New York area’s first hospital-based Helicopter Emergency Medical Service in 2014.The program, called SkyHealth, is a partnership with Yale-New Haven Health in Connecticut. Patients of both health systems experiencing life-threatening illnesses, or trauma receive emergency medical care by helicopter and are quickly flown to the most appropriate hospital. North Shore University Hospital, the home of SkyHealth’s new helipad, is verified as a Level I Trauma Center by the American College of Surgeons (ACS) and is the first hospital in the downstate region to receive this designation. Southside Hospital is verified as a Level II Trauma Center by ACS.