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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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slide1

North Shore University Hospital The Joint Commission

Advanced Certification for Palliative Care

January 31, 2012

slide2

Mission & Vision

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

slide3

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
slide4

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
slide5

Key Initiatives

  • Patient Experience
  • Collaborative Care Councils
  • Team Stepps
  • Patient Safety Rounds
  • Administrative Rounds
  • Employee Wellness
slide6

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
slide7
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

slide8
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
slide9
Consultation team

ACGME accredited Hospice and Palliative Medicine Fellowship

Flagship program providing mentorship to 15 NSLIJHS hospitals

Palliative Care Unit

The Palliative Care Program

slide10
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

palliative care consultation volume 2005 2011
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

timeliness of palliative care consult
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.

slide13
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

slide14
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

slide15
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

slide16

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
slide18
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

slide20
Terminal Tissue Injuries

Skin changes near death

Unlike traditional pressure ulcers

Research: Terminal Tissue Injuries

slide21
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

slide24
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

slide25
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