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Lifelines is Stony Brook Medicine's employee newsletter. Content is organized based on the Hospital's strategic priorities, known as the five pillars: quality and safety, service, people, growth and sustainability.

Stony Brook's Trauma Center Sets the Standard for Trauma Care

Every second counts, especially when sustaining a serious injury, and where you seek treatment really matters.

Going to the highest level Trauma Center possible can make a significant difference. As Suffolk County's only Regional (Level 1, the highest state-designated level) Trauma Center, Stony Brook is at the ready 24/7 with experienced trauma surgeons and specialists, such as orthopedic surgery, neurosurgery and plastic surgery, and the full range of equipment needed to care for trauma patients.

"Regional Trauma Centers bring better outcomes, save more lives and are rooted in the idea that injury should be treated as a disease that can be managed to reduce severity," said Mark Henry, MD, Chair, Department of Emergency Medicine. "We've been doing just that at Stony Brook for more than 20 years."

According to two consecutive New York State Trauma System reports, Stony Brook is one of two trauma centers in New York State with inpatient survival rates for seriously injured patients that are significantly above the statewide average.

"While no one likes to think about being injured, the entire Stony Brook trauma team is focused on working together to save lives and set the standard for trauma care," said James Vosswinkel, MD, Chief, Division of Trauma, Emergency Surgery and Surgical Critical Care. "And, as an academic medical center, Stony Brook leads the way in advanced trauma training, performance improvement and injury prevention."

Quality and Safety

Refocusing Quality Efforts with The Big Q

As part of Stony Brook's ongoing commitment to ensuring high-quality and safe care for its patients, the Hospital is refocusing its efforts dedicated to quality in a new initiative called "The Big Q."

The Big Q is a multidisciplinary quality improvement program that crosses all facets of the organization. It is patient- and family-oriented by design.

Five functional workgroups (analytics, processes, practice, people and safety) have been created. Overseeing them is a Strategic Advisory Group, with representation from each workgroup. The Advisory Group will recommend strategic quality goals to the senior leadership of the Hospital. Once the goals are approved, the functional workgroups will focus on implementation.

The Big Q will initially concentrate on quality improvements related to acute myocardial infarction, the Surgical Care Improvement Project (SCIP), venous thrombolytic embolism, immunizations and readmissions. The goal of the program is to reach the Top 10 for quality and accountability in the University HealthSystem Consortium (UHC) within five years.

Preparations for Joint Commission Survey Are Underway

Stony Brook's last Joint Commission accreditation survey took place in June 2012, which means that it is just about time for another survey visit. The Joint Commission survey is unannounced and can take place any time within 18 months of the accreditation end date, which is June 8, 2015. Surveyors are expected to arrive at any time starting in December of this year through the spring of 2015.

Readiness efforts to meet and exceed Joint Commission standards are ongoing throughout the Hospital. To further help employees prepare, a mock survey with consultants from Joint Commission Resources is planned for September. The survey will help assess the Hospital's state of readiness, and identify strengths, as well as areas for improvement.

"Regardless of when The Joint Commission survey occurs, we should always be in a state of readiness to ensure that our patients receive high-quality and safe care," said Carolyn Santora, MS, RN NEA-BC, CSHA, CPHQ, Regulatory Affairs. "All staff should be aware of the areas of improvement that were identified in our last survey, and make sure those issues have been addressed."

Joint Commission Survey Readiness Tip: What's the most effective way to prevent the spread of infection? Wash your hands. Recent Patient Safety First surveys indicated a hand washing compliance rate of only 73 percent, and for the year through June, the average rate is only 84 percent. Protect your patients and yourself -- washing hands saves lives.

17 North Receives Inaugural iCare Award

17 North staff at the Department Head meeting. From left: Joan Gordon-Biggs, CNA; Lesley Pronesti, RN; April O'Connor, RN; Stacey Kitterle, RN, Clinician; Joyce von Knoblauch, MSN, RN, Nurse Manager; Mary Ann Donohue, PhD, RN, Chief, Patient Care Services; and L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital, and Vice President for Health Systems, Stony Brook Medicine.

To recognize teams for their extraordinary work in the realm of quality, safety and the patient experience, Stony Brook Medicine has launched the iCare Award. iCare stands for Stony Brook's values of integrity, compassion, accountability, respect and excellence. This monthly award honors those teams that exemplify Stony Brook's value of excellence -- setting the highest standards for safety, clinical outcomes and service.

The first iCare Award was presented to 17 North at the July 10 Department Head meeting by L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital, and Vice President for Health Systems, Stony Brook Medicine.

17 North, home to Surgical Oncology, earned this award for improving the patient experience through teamwork. This was evidenced by a score of 94.4 on a 100-point scale for the Press Ganey question "staff worked together to care for you," combined with a score of 92.8 on patients' "overall rating of care."

Members of the day and night staff of 17 North, front row from left: Debbie Coleman, RN, Clinician; Arlene Haller, CNA; Laura Ficarelle, RN; Cheryl Koller, RN; Margaret Kroll, RN; and Megan Matera RN. Back row from left: Christian Routh, RN; Christina Treacy, RN; Karen Kranz, RN, Clinician; Julie Pidgeon, RN; Amy Strauss, RN; April O'Connor, RN; Catherine Castro, RN; Noopa Kurian, RN; and Alicja Kusnierz, CNA.

"Staff worked together to care for you" is the Press Ganey question that's most highly correlated with patients' overall satisfaction and it is a Top Ten priority for patient satisfaction at Stony Brook.

So that others can learn from 17 North's best practices, an iCare award scrapbook has been created to showcase team photos, quotes and stories about the iCare winning unit's accomplishments. Each month, the scrapbook will be passed along to the next iCare winner to share their accomplishments and commitment to exceptional patient care.

Service

From left, Maggie Knight, RN, 19 South; Matt Anderson, former Right Wing, New Jersey Devils; Mike Fariello's children Patrick and Abby; patient Mike Fariello; Matt Gilroy, Defenseman, Florida Panthers; and Patrick Dineen, medical school student and Dr. Patrick J. Dineen Memorial Foundation founder

Surprise Visit by NHL Players Lifts Patient's Spirits

Hockey fan Mike Fariello, a patient on 19 South, received the surprise of a lifetime when National Hockey League players Matt Anderson and Matt Gilroy stopped by for a visit made possible by Patrick Dineen and the Dr. Patrick J. Dineen Memorial Foundation. Dineen has been partnering with Stony Brook University Cancer Center for the past six months and called on his friends Anderson, former Right Wing with the New Jersey Devils, now playing professional hockey in the Russian League, and Gilroy, former Defenseman with the New York Rangers, currently playing with the Florida Panthers, to see Fariello. The foundation honors the memory of his father Dr. Patrick J. Dineen, and its mission is to help ease the time during treatment for patients and their families.

One of Fariello's nurses, Maggie Knight, RN, initiated the request for the visit, and secretly planned with his wife, and the unit's Nurse Manager, Patricia Doty, to have his family present. The hockey players spent time with Fariello and his family, and presented him with hockey-themed gifts.

Join the Best Office Party of the Summer

Grab your sneakers and get ready for an evening of fun in support of Stony Brook Children's Hospital at the Corporate FunRun on Thursday, Aug. 7, 6:30 pm, at Bethpage Ballpark, home of the Long Island Ducks.

Known as the "Best Office Party of the Summer," the evening begins with a 5K run/walk through local streets and ends inside Bethpage Ballpark for a celebration that includes music, food and fun. Registration is $40 per person, with 10 percent of that benefiting Stony Brook Children's.

Additional online fundraising by teams or individuals will further support Stony Brook Children's. Solicit pledges from co-workers, family members and friends, or make your own donation. All monies raised at the run/walk for Stony Brook Children's will be matched dollar for dollar by an anonymous donor to support the hospital's new state-of-the-art building.

For more information and register, visit the Corporate FunRun website.

Learn to Save Lives and Help Set a Record for Stony Brook

It's a fact: CPR performed by family and friends can increase survival from sudden cardiac arrest by three-fold.

Learn this important lifesaving skill in just 30 minutes at Stony Brook's free Hands-Only CPR Event on Sunday, Sept. 7, at LaValle Stadium, Stony Brook University. In addition to helping make Suffolk County safer, participants can also help Stony Brook Medicine set a record for the largest CPR training event in the U.S.

Hands-only CPR (without mouth-to-mouth breaths) uses the hands to push hard and fast in a rhythmic motion in the center of the victim's chest. Training is necessary to ensure proper technique and learn about other steps that should be taken at the same time.

Stony Brook's goal is to train as many community members as possible in this vital technique to make Suffolk County safer, so invite family members, friends, co-workers and neighbors to participate as well. Register online as an individual or with a team and choose a 30-minute training period. Sessions will take place every half hour between 10 am and 4 pm.

The five largest teams will win automated external defibrillators; the next five largest will win CPR equipment.

People

New School of Health Technology and Management Program Focuses on Healthcare Quality and Patient Safety

Stony Brook University School of Health Technology and Management has created a new master's degree program in healthcare quality and patient safety. The program is specifically designed for clinical and non-clinical health professionals who wish to develop the knowledge, skills and competencies required to pursue careers or enhance career mobility in the following areas: healthcare quality, healthcare risk management, healthcare patient safety and related fields. This degree requires a completion of 36 credits.

The School is also offering a new 18-credit advanced graduate certificate program in patient safety. This professional development program is intended for healthcare professionals or non-clinical professionals in healthcare-related industries. It is designed for those who seek greater in-depth knowledge about, and professional advancement in, the healthcare specialties of healthcare quality, healthcare risk management and healthcare patient safety. This program has rolling admissions.

For more information and to apply, visit the School's website.

New Associate DIO and Executive Director of GME Named

Catherine Eckart, MBA

Catherine (Carrie) Eckart, MBA, has joined Stony Brook as the new Associate Designated Institutional Official (DIO) and Executive Director of Graduate Medical Education (GME). Eckart will partner with Frederick Schiavone, MD, Vice Dean for GME/DIO, in providing increased oversight of Stony Brook's residency and fellowship programs in the context of the Accreditation Council for Graduate Medical Education's new accreditation system, Clinical Learning Environment Review (CLER). This will include a focus on training related to the six CLER priorities: patient safety, quality improvement (including healthcare disparities), transitions in care, resident supervision, duty hours oversight/fatigue management and mitigation, and professionalism.

Eckart has worked in the field of graduate medical education for more than 25 years and is known nationally as a featured GME speaker. In May 2014, she completed her term as President of the Association for Hospital Medical Education (AHME) and continues to serve as a consultant to the ACGME's Professional Development and Education Workgroup for Advancing Training in the Clinical Learning Environment. Prior to joining Stony Brook Medicine, Eckart served as the Assistant Vice President of GME at UPMC, Pittsburgh, where she was responsible for the training of more than 1,700 residents and fellows in 200 specialties and subspecialties in a system of over 20 hospitals.

Growth

A New Home for Preoperative Services

As a result of increased surgical volume, Stony Brook's Preoperative Services has moved from the Ambulatory Surgical Center to a spacious location at 1320 Stony Brook Road (the corner of Stony Brook Road and Route 347/Nesconset Highway) in the Coventry Commons Shopping Center. The new area allows for Preoperative Services to expand from six exam rooms to 18.

Preoperative Services helps prepare patients for a successful and safe hospital experience. The team works with patients to identify and modify risk factors to help ensure the best possible outcome, and to prevent last-minute delays and cancellation of surgery.

Led by Deborah Richman, MD, the team is made up of anesthesiologists, nurse practitioners, physician assistants, registered nurses and clinical assistants.

For more information or to schedule an appointment for a patient, call Preoperative Services at (631) 444-9404.

Employee Parking Lot Opens

Staff members (including residents) hired since April 2013 now have access to the newly opened employee parking lot near the power plant. The parking lot was designed to provide additional space for employees, and generate extra capacity within the hospital parking garage for patients and visitors. The project included road widening along Pellegrino Road, and the addition of new pedestrian walkways, landscaping and site lighting. Signal modification improvements were made at the intersection of Pellegrino Road and Health Sciences Drive, and a new right turn acceleration lane and left turn lane extension on Health Sciences Drive were added.

Future phases of the project include improvements such as the completion of the Hospital loop road (connecting Hospital Drive to Pellegrino Road), the addition of a roundabout (traffic circle), relocation of hospital garage entrance and gates, overhead digital signage and self-pay kiosks.

Sustainability

What is case mix index and how does it impact care?

The Hospital has made significant improvements in its case mix index or CMI, which is a comparison of each hospital's average patient acuity or severity of case to the statewide average. "At Stony Brook, we want the case mix index to be high," said L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital. "A higher case mix index means that we are caring for the sickest patients -- patients that as an academic medical center and the region's only tertiary care center, we are best equipped to handle."

A higher CMI also equates to higher reimbursement levels. "Higher reimbursement levels helps ensure that we have the resources to care for those challenging cases," explained Gary Bie, Chief Financial Officer. "Proper clinical documentation of a patient's level of complexity is essential to having those needed resources."

The hospital's Clinical Documentation Improvement Program (CDIP) was significantly enhanced in 2012. Led by Karen Chase, RN, the CDIP team works with physicians to improve the accuracy of documentation so that such things as comorbidities are all noted in the patient's record, creating an accurate picture of the patient's severity of illness. Coders then report what the physician documents in the patient's record.

"Since the program began, our case mix index for patients with Medicare has improved from 1.7 to our current index of 1.8," said Bie. "Each .1 increase of CMI is significant, and helps keep us financially viable and enables us to continue to provide quality care."

Labor and Delivery Recognized by UHC for Reducing Expenses

Many think that a reduction in expenses leads to a decline in quality. Stony Brook's Labor and Delivery Unit has proven that theory wrong. The unit was recognized by the University HealthSystem Consortium (UHC) as the most improved Labor and Delivery unit and invited to present a webinar on its success in reducing total expenses by 3.9 percent per newborn delivery during Fiscal Year 2013.

Following a collaborative review with the departments of Nursing and Finance, the unit established budgets, determined thresholds for new and replacement hires and set productivity targets.

"We focused on the skill mix of the employees to make some needed changes," said Susan Little, MS, RN, NP, Nurse Manager. "We increased the amount of clinical and clerical support staff and added three hospital attendant positions to allow nurses to remain at the patient's bedside. The staff schedule was revised to align with expected fluctuations in patient volume, and the on-call schedule was expanded during peak volume hours."

Little noted that the unit also reduced its medical supply expenses slightly per newborn delivery. This was accomplished through the creation of par levels for supplies and a staff education campaign to encourage staff to be more mindful when using supplies.

As a result of these efforts, the unit achieved a 13 percent reduction in staff average hourly rate, a five percent reduction in labor expense per newborn delivery and a three percent reduction in overtime -- all while maintaining or improving the unit's patient satisfaction and quality scores.

The unit's overall patient satisfaction score on the Press Ganey survey increased from 88 percent to 92 percent. Patient satisfaction with amount of time to bond with baby increased from 89.2 percent to 96.5 percent. Patients' ratings on the amount of support from labor and delivery nurses during labor increased from 89 percent to 97 percent.

Improved quality measures for the unit included an increase in the rate of exclusively breastfeeding from 34 percent to 50 percent. The rate of non-separation of mother and baby also increased from below 10 percent to 80 percent, and is currently greater than 93 percent. Another important quality measure, providing mother and baby skin-to-skin contact directly after birth, increased from 53 percent to greater than 90 percent after vaginal delivery, and from 25 percent to 90 percent following cesarean section.