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North Shore University Hospital The Joint Commission Advanced Certification for Palliative Care

North Shore University Hospital The Joint Commission Advanced Certification for Palliative Care. January 31, 2012. Mission & Vision. To be a national health care leader, committed to excellence, compassion and improving the health of the community. North Shore University Hospital - Profile.

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North Shore University Hospital The Joint Commission Advanced Certification for Palliative Care

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  1. North Shore University Hospital The Joint Commission Advanced Certification for Palliative Care January 31, 2012

  2. Mission & Vision To be a national health care leader, committed to excellence, compassion and improving the health of the community.

  3. North Shore University Hospital - Profile NSUH is an 812-bed quaternary teaching hospital. The campus is home to the Katz Women’s Hospital, Feinstein Institute for Medical Research, Stern Family Center for Extended Care and Rehabilitation and the Schwartz Ambulatory Surgery Center. NSUH also operates the 103 bed Syosset Hospital. 2010 Hospital Discharges • 6,645 employees • 3,240 physicians • 1,558 nurses • 600 allied health • 55,124 discharges/year • 5.3 day mean LOS • 4.25 % operating margin • 80,000 annual ED visits

  4. Hospital Recognition • Designated Renal Transplant Center • Bariatric Surgery Centers of Excellence • Stroke Center • Foundation for the Accreditation of Cellular Therapy (FACT) Accreditation – Adult Bone Marrow • HealthGrades Awards 2012: Awards in 14 specialties • One of the Top 50 Hospitals in the Country - AARP • Thomson Reuters Top 100 Hospitals® for Cardiovascular Care • Consumer’s Choice Award for last 10 years as most preferred hospital on quality and image • CMS award for participation in Health Quality Incentive Demonstration Project (HQID) – 2010 • International study site for excellence of treatment for chest pain in the Emergency Department (Early Heart Attack Care) • Ranked #1 for Emergency Angioplasty by the State Department of Health report • US News & World Report 2012 Best-In Geriatrics and Gastroenterology • 2010 “Top Performers on Key Quality Measures” • New York State Hospital Report Card 2011, one of “America’s Safest Hospital” • Nassau and Suffolk Counties, Honorable Mention

  5. Key Initiatives • Patient Experience • Collaborative Care Councils • Team Stepps • Patient Safety Rounds • Administrative Rounds • Employee Wellness

  6. Starting Out Creating an Infrastructure Established Program • ACGME accreditation for HPM Fellowship • Inpatient hospice capacity • HANYS Recognition • NSLIJHS “President’s Teamwork Award” • Palliative Care Information Act • Growth of HPM Fellowship • Philanthropy • Palliative Care Unit Opens • HPM Fellowship to 2003 to 2005 2006 2007 2008 to 2010 2011 to 2012 • Create Palliative Care Institute • Conference with national leaders • CAPC Leadership Center • Clinical service begins • Harvard Faculty Development Grant • NSLIJ Health System Senior • Leadership Retreat on Palliative Care

  7. Dana Lustbader MD, Section Head Michael Frankenthaler MD Sindee Weiss MD Kathy Trombley RN, Nurse Manager Elizabeth Gorowski NP Adriana Calosso NP Trish Klare LCSW Lynda Cooper LCSW, Administrator Rev. Jon Overvold MDiv.,BCC, Chaplain The Palliative Care Team

  8. Pastoral Care Spiritual support Interfaith memorial service Community clergy relationship Child Life Prepare children for death of loved one Center for Hope - bereavement Hand prints, bedside grief Nutrition Accommodate dietary requests during end of life Mini bar – scotch, beer Nutritional strategies for patients with terminal disease Other Team Members • Pharmacy • Policy development: ketamine, subcut infusions • Antibiotic stewardship • Respiratory Therapy • Weaning protocols • Non invasive ventilation • Volunteers • Quilt to cover gurney to morgue for dignity • Junior volunteer fundraising • Holiday food • Pet therapy – dogs • High school work study

  9. Consultation team ACGME accredited Hospice and Palliative Medicine Fellowship Flagship program providing mentorship to 15 NSLIJHS hospitals Palliative Care Unit The Palliative Care Program

  10. 1,700 new consults per year 6,000 visits per year Average daily census = 30 pts Reduced hospital LOS for MICU patients that die (Lustbader et al. Pal Supp Care 2011) Diagnosis Cancer 40%; Non cancer 60% 30% consults from ICUs DNR at death = 96% Consults ordered by anyone Palliative Medicine Consultation Service Discharge Disposition

  11. Palliative Care Consultation Volume (2005-2011) Consultation growth of 300% over seven years Increased penetration into ICUs and Oncology Growth sustained with administrative support and backing by senior leadership

  12. Timeliness of Palliative Care Consult More timely palliative care referral Anyone can order palliative care consult Mean days from admission to consultation reduced by 46% from 2006 to 2011 from 13 days to 7 days.

  13. ACGME accredited HPM Fellowship - 4 per year Fellows are part of pediatric palliative care team at Cohen Children’s Hospital and NICU Provide palliative care education to trainees The family meeting room Located outside ICU Training with actors Palliative Medicine Fellowship and Education

  14. Provide mentorship to System hospitals Site visits Shared resources Standardized orders and policies Brochures (What is Palliative Care, What is a Trach?) IHI Palliative Care Strategic Partnership Palliative care integration with home care and hospice through Advanced Illness Coordinating Committee (AICC) Palliative Care Team and The NSLIJ Health System

  15. Local Complex Care Rounds - LOS > 45 days Palliative Care Grand Rounds Regional Harvard Faculty Development Grant Empire Clinical Research Investigation Program GNYHA - Palliative Care Leadership Network National CAPC - The IPAL-ICU Project ABIM – Palliative Care Test Writing Committee AAHPM Local, Regional and National Involvement

  16. Palliative Care Unit • Align treatments with patient preferences • Terminally ill ICU patients requiring mechanical ventilation moved to more appropriate site for care • Weaning protocols • DNR not required • Inpatient hospice care

  17. Palliative Care Unit

  18. Patient centered care Sleeper sofas Open visiting Family rounds Family pets Follow up telephone call Bereavement resources RN death pronouncement NP death certification Palliative Care Unit

  19. Donna’s Story

  20. Terminal Tissue Injuries Skin changes near death Unlike traditional pressure ulcers Research: Terminal Tissue Injuries

  21. Palliative Care RN Certification Halo effect in normalizing palliative care for other NSUH nurses Family centered care Child Life Special events Anatomic Gift Program Palliative Care Nursing

  22. Palliative Care Education, Research and Grants

  23. Max’s Story

  24. Sam was a 39 year old man with metastatic pancreatic cancer receiving chemotherapy He was followed by his oncologist and home health care program. Outpatient palliative care for pain management Max

  25. Progressive debility Inpatient hospice in PCU for paracentesis for massive ascites, pain and treatment of DVT Klezmer band in PCU Sam died with wife and children at bedside after making memorial handprints with his daughter Max

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