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Elevating
the Level of Care in Suffolk
- Stony
Brook University Hospital (SBUH) is Suffolk County’s only tertiary
hospital and Level 1 Trauma Center, and is the only academic medical
center on Long Island. With 597 beds and more than 5,500 employees, it is
the largest hospital in Suffolk County. SBUH treats approximately 31,000
inpatients, provides care for more than 230,000 outpatient visits and performs
more than 20,000 surgical cases.
- SBUH
provides training programs for community hospitals in the region (e.g.,
Institute for Healthcare Improvement patient safety regional trainers, regional
disaster preparedness).
- SBUH
is the regional referral center for trauma, stroke and stroke
intervention, perinatal and neonatal intensive care, burns, pediatric and
maternal HIV/AIDS, sickle cell disease and comprehensive psychiatric emergency
services.
- SBUH
brings new advances to Suffolk, such as stroke clot removal from the
brain, robot-assisted surgical devices, advanced cardiac imaging, ventricular
assist devices for heart failure, MRSA vaccine (to prevent super bug
methicillin-resistant staphylococcus
aureus infections) and other groundbreaking clinical trials.
- SBUH
established and funds the First Responder Program in Eastern Long Island,
serving the areas of Riverhead and Mattituck in an effort to enhance
access to advanced life support.
The
Role of Academic Medical Centers
Many of SBUH’s patients
are transferred from other hospitals,
requiring the specialized physicians and advanced services only available at SBUH.
An important role of academic medical centers is to care for these very sick
patients. SBUH’s healthcare excellence has been recognized by numerous external
groups such as the Institute for Healthcare Improvement (IHI), Healthcare
Association of New York State (HANYS), University HealthSystem Consortium and the U.S. Department of
Health and Human Services.
Quality
Indicators and Initiatives
SBUH’s care and outcomes have been consistently improving because of a long-term commitment to team-based performance improvement involving patients, staff, physicians and allied health professions, extensively using technology to ensure effective care. - Survival rates for patients identified in the Emergency Department with severe sepsis infections have steadily improved by 51% from 2006 through the end of 2010. Stony Brook was recognized for these efforts in 2011 by the National Association of Public Hospitals (NAPH) with one of its national patient safety awards.
- Reduced the incidence of ventilator-associated pneumonia in all adult intensive care units (ICUs) with an 80% improvement from 2006 through most of 2011.
- Reduced hospital-wide central line-associated bloodstream infection (CLABSI) rates by 59% from 2008 to 2010. For these efforts, SBUH received an Outstanding Leadership Award in 2011 from the U.S. Department of Health and Human Services and the Critical Care Societies Collaborative.
- Improvements in neonatal nutrition and the use of checklists have led to improvements in neonate head circumference for very low birthweight infants as a result of >20% increase in protein intake by day four and improved time to achieve a daily intake of 100 kcal/kg. These efforts have resulted in consistent improvement in neonatal head circumference (a measure of brain development).
- The adoption of the Patient Safety Net, an online medical error and near-miss reporting system, resulting in a 400% increase in reported incidents (compared to paper reporting), allowing more complete capture of potentially hazardous situations. SBUH understands the importance of encouraging reporting of potentially risky situations to prevent future events.
- The adoption of “simulations” in several areas to prepare and prevent high-risk conditions have led to improvements in outcomes. For example, simulations and team training for code blue (cardiac arrest), for Code Noelle for maternal hemorrhage (SBUH developed the state-endorsed best practice) and the adoption of a uniform education, simulation and supervision program for certification for central-line insertion.
- Process changes have led to substantial decreases in hospital-acquired pressure ulcers.
- In the operating room (OR), workflow and process redesign relating to medication management and tissue specimen management with the adoption, in part, of medication and tissue "time-outs" have improved patient safety.
Preventing
Errors by Deploying Systematic Processes
- Designed
to reduce cardiac arrest “codes,” SBUH has put in place Rapid Response
Teams (RRT) to respond immediately, 24 hours a day, seven days a week, to
acute deterioration in patient status throughout the Hospital. These teams
can be activated by healthcare providers and/or patients and families. RRTs
have been successful.
- Designed
to reduce the number of Rapid Response calls, SBUH has put in place
proactive early warning systems, to rapidly catch potential patient deterioration,
called pediatric early warning scores (PEWS), medical early warning scores
(MEWS) and obstetric early warning scores (OB-EWS).
- Designed
to improve communication and speed recovery, all intensive care units have
adopted unit-specific daily goal sheets and initiated multidisciplinary
rounding.
- Tactical
initiatives to improve “nurse sensitive indicators” like prevention of hospital-acquired
pressure ulcers and urinary tract infections have been widely initiated.
- The
deployment of numerous IHI “bundles” or checklists, to ensure best
practice, and in areas like cardiology, we are approaching the 100%
compliant milestones.
- Widespread training related to Crew Resource
Management through the use of the federal Agency for Healthcare Research and
Quality’s program known as TeamSTEPPS, which promotes systematic, thorough
communication to alert caregivers about safety concerns by the use of
designated, escalating “code phrases” for levels of concern.
- The launch of Patient Safety First, a broad
institutional effort to enhance the safety culture within SBUH in a measurably
significant way that is felt and experienced by all who pass through the
Hospital doors. Patient Safety First has already led to marked improvements
within SBUH’s safety culture that reinforce and speak volumes about the
Hospital’s fierce commitment to patient safety.
- The rollout of the Cerner Electronic Health
Record, which incorporates multiple safeguards, reminders and alerts to
caregivers to ensure patient safety.
- SBUH
has had a focus on improving patient satisfaction, which has been
consistently rising as measured by Press Ganey Surveys. SBUH now ranks in
the 90th percentile on Long Island for overall inpatient satisfaction and
the highest in food services satisfaction.
- Consistent
with the road map laid out by the Institute of Medicine, we are integrating
Patient and Family Centered Care to improve safety, quality of care and
operational efficiency. The patient and family become equal and important
members of each healthcare team. SBUH has had a focus on involving
patients and families in the care delivery process, putting in place
numerous family advisory groups (pediatrics, cancer, heart, etc.).
Making
Connections with the Community
- Established
Quality Assessment Review Board (QARB) to help SBUH further improve clinical
process and outcomes. The members of QARB are a group of well-recognized New
York residents chaired by Mr. John Gallagher, former Suffolk County Police
Commissioner. Dr. Arthur Aufses, former Chair, Department of Surgery at
Mount Sinai Hospital, chairs the QARB’s Quality Subcommittee.
- Established
First Responder Program in the Riverhead/Mattituck area of Eastern Long
Island in an effort to reduce cardiac mortality.
- SBUH’s
Patient Transfer Center simplifies patient transfer via a single phone
call.
- As
part of its community service activities, SBUH provides educational and
health-related programs and events each year to the community.
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