Q&A: White Plains Hospital exec on streamlining an emergency department | Crain's New York Business

2022-07-29 09:41:21 By : Mr. yan qian

White Plains Hospital, which is a member of Montefiore Health System and the tertiary care hub in the Hudson Valley, recently completed a full emergency department renovation designed to increase efficiency and streamline care. The hospital is home to the busiest emergency department in the county, having launched a 250,000-square-foot ambulatory center last year, seeing just shy of 65,000 visits in 2021 and expecting almost 70,000 visits this year. Dr. Dean J. Straff, who was appointed director of emergency medicine in 2021, provided insight into why White Plains decided to revamp its emergency room, the success it has experienced so far, and how other hospitals can adopt similar models of care.

Why did you decide to streamline the emergency department?

Our emergency department is the busiest emergency department in Westchester. Many high volume emergency departments often struggle with patient flow and efficiency issues, which can lead to an increased overall length-of-stay capacity challenges and lower patient satisfaction. A few years back as we continued to get busier—partially due to our success—there were these new challenges. In order to do this successfully we wanted to flip the department upside down and do a complete redesign package to improve overall patient care and provide a better experience.

Can you give a timeline of the renovation?

Back in March of 2018, we realized we needed to do something different. When emergency departments eclipse that 60,000 [patient] volume mark, you have to start thinking differently. This was a multipronged approach that took a number of months to roll out. Initially the leadership team hypothesized how we could change things and got input from the front-line staff and brought in more and more people to get their input and feedback until we rolled it out to the whole department. We have a quarterly interdisciplinary meeting [with physicians, nurses, care management, security and the like] and we used that platform to get everybody on board.

What do you think were the most important changes?

At the top [was] redefining what we think of triage traditionally and utilizing that “quick look” team upfront. Upon the patient’s arrival, a quick look team would do this brief assessment and enter information into a software program that uses predictive analytics in combination with some very complex rules to figure out where the patient goes first. That process takes one to two minutes to be complete, then the patient is assigned to the appropriate team and care path. That quick look team decides how sick they are and where they need to go, and then there’s the streaming-of-care model. You have to put patients into evaluation tracks, and each track might have a defined role and dedicated process for those patients. We’re going to treat a patient with an ankle sprain very differently than someone who presents with symptoms of a stroke. Not all patients need to be horizontal, some can be horizontal-sitting and actively waiting to get the care they need. The other biggest piece of this was developing a team-based care model to improve overall communication. In a traditional sense you go to triage, we’ll put you back in the waiting room, and then when we’re ready, we’ll bring you to the back. And then a nurse comes, and then a provider, and each time you’re answering questions you’re answering slightly different and maybe that critical piece of information that will crack the case might not have gotten to the right person. [Our teams] are a physician or an advanced care provider, two to three nurses and a nurse tech working in a geographic zone. So you have 11 or 12 care spaces and you as a team are assigned those patients. You walk in there and collaborate and when they tell that story you’re all hearing it, and everyone knows what’s needed next. The theory was that by increasing collaboration among the caregivers, it would increase efficiency, decrease potential medical errors, improve patient experience and increase employee satisfaction. We realized the idea of having a no-wait emergency department—the sooner the patient can be seen by the provider, we can figure out what’s going on and what needs to be done.

Do you have specific data in terms of how wait time has decreased?

Before our implementation of this, we geographically designed the whole department as well. We renumbered, lifted computers and moved them around, lifted glass … localizing teams together also. Before our redesign, our door-to-provider time was about 22 minutes. We are down to 10 minutes.

Do you have information on the financials of the project, either how much it costs or how much it’s projected to save?

I don’t have that, but I think you can look at … I want to be able to get to patients. We want to make sure our number of [patients who leave without being evaluated] remains as low as possible. That means we’re able to take care of them. Nationally it’s about 3%. There are secondary financials, but that’s not why we do this. We don’t do any of this from a financial perspective—it’s done always from a patient-centered approach. When we did this, we did it from a patient-centered perspective, not being afraid to do something different and think outside of the box.

A research consortium led by Weill Cornell Medicine has been awarded a five-year, $14.7 million federal grant to study technologies that can support older adults with cognitive impairments and help promote well-being as adults age, the institution announced Thursday.

Researchers will use the funding to launch three multiple-site projects that will examine how technology can be used to help older adults stay engaged and manage certain tasks.

One study will assess virtual reality technology for use in fostering cognitive and social engagement among aging adults. The second, a collaboration with the IBM Watson Research Center, will develop speech analysis software to engage older adults in storytelling and use that to detect cognitive decline. The third project will focus on digital tools that older adults with cognitive impairments can use to perform health care-related tasks, such as enrolling in Medicare or Medicaid.

“We really think that technology, if it’s well-designed and it’s implemented correctly, really can do a lot in terms of providing support for aging adults both with and without impairment,” said Dr. Sara Czaja, professor of gerontology in medicine at Weill Cornell Medicine.

The consortium, known as the Center for Research and Education on Aging and Technology Enhancement, includes Florida State University, the University of Miami and the University of Illinois at Urbana-Champaign.

Researchers from Weill Cornell Medicine’s division of geriatrics and palliative medicine and the departments of neurology, population health sciences and information technology and services will also collaborate with colleagues at the Cornell Tech and Cornell Ithaca campuses.

This will be the fifth iteration of the Center for Research and Education on Aging and Technology Enhancement, which first received funding in 1999 to ensure that older adults could use technology for daily living.

Czaja said she hoped the projects’ findings would inform how tech developers design their tools.

“We really want our findings to influence the design of future and current technology systems so they can be used and are useful to aging adult populations,” she said. —Maya Kaufman

New York Attorney General Letitia James sued CVS on Thursday, alleging it violated antitrust laws and forced some safety-net hospitals to use a CVS-owned third-party administrator for 340B drug programs and incur millions of dollars in additional costs while it left other hospitals to miss out on critical federal funds.

The federal 340B program allows hospitals to stretch their funding by getting discounts on eligible drugs they prescribe to patients and use the savings on patient care. Most safety-net providers such as hospitals use third-party administrators to administer their 340B programs, and the hospitals must keep records of the revenue they collect on prescriptions, including drugs to treat HIV/AIDS and hepatitis C. Third-partner administrators are responsible for confirming that each drug transaction is eligible for the program.

The lawsuit alleges that since 2017, CVS acquired a third-party administrator, Wellpartner, and forced the hospitals it contracted with to use the program for patients using CVS—and that CVS did not contract with hospitals that didn’t want to use Wellpartner.

Many hospitals objected, James’ office said, because they were already using other third parties. Other hospitals, upon contracting with CVS, had to use Wellpartner exclusively because they couldn’t afford to pay two third-party administrators.

The hospitals that chose not to use Wellpartner were not eligible to collect 340B payments from patients using CVS pharmacies, losing money that could’ve been reinvested in care, the lawsuit alleges. Meanwhile, hospitals that did use Wellpartner incurred millions of dollars in additional costs by hiring and training staff to understand that system.

James is seeking prohibitive action through the lawsuit, her office said, and monetary relief for the hospitals involved. In addition, James wants CVS to be required to tell safety-net hospitals and providers that they are not obligated to use Wellpartner in order to contract with CVS, her office said.

More than 4,440 safety-net providers, including Federally Qualified Health Centers, hospitals, rural referral centers, family planning clinics and the like, were enrolled in 340B programs in the state in 2021. —J.N.

NYC Health + Hospitals/Metropolitan will make a $4.9 million investment in upgraded CT scans and ultrasound machines, thanks to a capital award from City Council.

The funding was awarded by City Council member Diana Ayala and City Council Speaker Adrienne Adams for fiscal 2023. It will allow the East Harlem hospital to replace its 10-year-old CT scanning machine.

Dr. Hassan Matari, chief of radiology services at the hospital, described the upgrade as a “quantum leap.” In addition to faster scans, the new machine will give technicians far more information about the health of patients’ hearts, and it is even used to diagnose heart disease, he explained.

“This scanner achieves whole imaging of the heart within a short time using low-dose radiation, providing more visible details about the heart function and structures,” he said. Matari added the new machine would require patients to spend less time in the scanner.

CT scans usually take a series of 64 X-ray images, or slices, to form a three-dimensional image of a particular body part. The new machine will take 256 slices instead, forming a more accurate picture and diagnosis.

The facility’s eight-year-old ultrasound machines will also be upgraded. The hospital will use the funds to purchase a new C-arm machine, which is a flexible and portable imaging device that can be used to take X-rays in hard-to-reach places with minimal movement of the patient.

The funding builds on the $1.9 million provided by Ayala in last year’s budget.

NYC Health + Hospitals/Metropolitan on East 97th Street is one of 11 hospitals in the city’s public health care network. It has 338 beds. —James O’Donnell

MONKEYPOX DEMOGRAPHICS: The state department of health released demographics of people with confirmed or probable monkeypox cases for the week through July 27, excluding NYC residents, on Thursday. According to the data, most patients with cases are between 30-34 (23%), 25-29 (21%) and 35-39 years old (20%). Nearly all patients (98%) identified as male, 74% of patients with cases identified as lesbian or gay and 15% identified as bisexual. About a third of patients (35%) identified as Hispanic or Latino, 31% identified as white and 16% as Black. 40% of patients with cases were in Westchester and 21% were in Suffolk County. The health department issued a warning Thursday that monkeypox is an “imminent threat to public health” for all New Yorkers. Learn more about monkeypox in NYC here.

PHARMA EARNINGS: Merck announced $14.6 billion in sales for the second quarter of the year on Thursday, up 28% from this quarter of 2021, led by the cancer drug Keytruda. Its selling-and-administrative expenses grew by 10%, while research-and-development expenses dropped by nearly 35%. Merck is headquartered in Kenilworth, NJ. Meanwhile, Pfizer’s revenue grew 47% to $27.7 billion, it reported Thursday, a record for the company. Its Covid vaccine brought in $8.8 billion and antiviral Paxlovid brought in $8.1 billion. It projects Covid products will bring in $50 billion this year.

PAYMENT BOOST: The Centers for Medicare and Medicaid Services will be boosting payments for inpatient rehabilitation facilities, inpatient psychiatric facilities and hospice providers, Modern Healthcare reported Thursday. Hospices will receive 3.8% more, inpatient rehabilitation providers 3.2% and inpatient psychiatric provides a 2.5% hike. According to provider groups, however, these hikes aren’t enough to cover rising costs of operating facilities.

WHO'S NEWS: The "Who's News" portion of "At a Glance" is available online at this link and in the Health Pulse newsletter. "Who's News" is a daily update of career transitions in the local health care industry. For more information on submitting a listing, reach out to Debora Stein: [email protected] .

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