Quality and Safety

Joint Commission Visits Stony Brook for Triennial Survey

From June 1 to 5, Joint Commission surveyors evaluated Stony Brook University Hospital's compliance with Joint Commission accreditation standards, elements of performance and National Patient Safety Goals. Tracers were conducted on inpatient units, outpatient ambulatory care areas, ambulatory surgery care, the Operating Room and laboratories. Surveyors also reviewed the hospital's environment of care, life safety processes and emergency management practices.

The surveyors commented frequently on the best practices they found throughout the organization, practices which they intend to carry with them to other hospitals they survey. They encouraged the staff to share these same best practices with each other internally.

"Our team members rose to the occasion during The Joint Commission visit. The best practices the surveyors sited are a testament to many of the good things happening here and the outstanding, committed efforts of our team," said L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital.

The surveyors also uncovered a number of opportunities for improvement. Work is already under way to address the issues they have identified. Surveyors are expected to return to ensure compliance in key areas of concern.

"While we are focusing on the issues identified by the surveyors, there is no doubt that the survey uncovered many areas of excellence," said Dr. Pasternak. "We were reminded that we are on a journey to becoming a high reliability organization, a journey which will continue. Thank you to everyone who helped prepare for our Joint Commission survey, and who is helping us move forward on our journey to excellence."

SB Safe Now Online

Employees have a new system to report patient safety events: SB Safe. Replacing Patient Safety Net (PSN), SB Safe is a user-friendly system available on the hospital intranet. Employees can quickly select events from the icon wall page and enter information, including adverse events, near misses and safety concerns, using convenient drop-down menus.

Enhanced reporting features include event submission, report creation and real-time acknowledgment and feedback to users.

For those not yet trained on the system, visit the Learning Management System (LMS) on the hospital intranet to view the training modules. Nurse managers and staff from Quality Management and Risk Management are also available on the units to answer questions.

Ensuring Safe and Timely Administration of IV tPA Earns Stroke Program May iCare Award

Stony Brook Medicine's Stroke Program, which has already been recognized for its measures to improve quality of patient care and outcomes by both The Joint Commission (Advanced Stroke Certification) and American Heart Association/American Stroke Association (Gold Plus Stroke Program for five consecutive years, as well as the Target Stroke Award the past two years), recently earned the May iCare Award for excellence in patient safety. The award recognizes the improvements made by the Stroke Program Team to enhance the safe and timely administration of IV tPA.

IV tPA (also referred to as a clot buster) is a weight-based medication. It is administered to patients with symptoms of a stroke upon their arrival to the Emergency Department (ED) after a CT scan has confirmed that there is no bleeding on the brain. Because "time is brain" and every second counts, the estimated weight of a patient had been an accepted method of calculating the correct dose. It was also thought that taking time to weigh a patient would increase door-to-needle time. However, estimating weight can result in overdosing and underdosing.

To help eliminate the chance of error in administering IV tPA, the Stroke Program Team at Stony Brook Medicine recently implemented a new quality improvement process. Measured weights are now entered on all stroke Code BAT (brain attack) patients prior to ordering and administering IV tPA. New stretchers with integrated scales were purchased and placed outside of the ED CT Scan Room so that after completion of the CT scan, the patient is moved to a stretcher for measured weight before being transported back to the ED. When IV tPA is ordered, if a measured weight is not in the electronic medical record, the physician is required to provide a rationale. Additionally, a "time out" is conducted at the patient's bedside by the ordering physician and nurse administering the medication, which verifies the patient's identity, weight and correct IV tPA dose.

This process initiated by the Stroke Program Team did not negatively impact door-to-needle times. In fact, the average door-to-needle time for IV tPA continues to decrease, and the average is 58 minutes for patients who are admitted to the ED. One patient even received IV tPA within 24 minutes. To put this in perspective, an improvement of just 3.7 minutes represents more than 7 million neurons saved.

Effecting such change requires the collaborative efforts and dedication of many -- the Stoke Program Team, colleagues across many different departments within Stony Brook Medicine and at local EMS agencies.

Members of the Stroke Program Team: from left, Alison Rowe, RN; Andrea Kabacinski, RN; Eileen Dowdy, RN; Jennifer Rosales; Louis Calderon, RN; Julie Mount, RN; Donna Taylor, RN; Scott Weingart, MD; Joanna Foley, RN; Eileen Conlon, RN; Denise Heeren, RN; Michael Guido, MD; Ann Arneaud St. John, RN; Christine Hofbauer, RN; Juan Serna, RN; Roxana Ossenfort, RN; Jennifer Lipari, RN; and Elyse Velardi

Service

Hospital Auxiliary Donates Funds for New Ambulance

Funds raised by the Stony Brook University Hospital Auxiliary were used to purchase a new state-of-the-art ambulance for the Department of Emergency Medicine.

The ambulance is the fourth one the Auxiliary has been able to secure for the hospital. "It is wonderful to be able to give something so valuable to the hospital," said Karen Villanueva-Walsh, President, Stony Brook University Hospital Auxiliary. "We're proud to be able to use funds to purchase critical equipment that will make a difference on the front line of patient care and benefit the entire community."

The new ambulance, valued at $159,000, is stocked with a full complement of critical care equipment and medications, including ventilators, pacemaker, monitor/defibrillator, portable IV pumps and dopplers that qualify it for transporting the most critically ill patients. The vehicle can transport up to two infants in separate critical care transport isolettes, a single adult or pediatric patient who require critical care treatment, as well as critical cardiac patients requiring intra-aortic balloon pump treatment.

The ambulance is also equipped with a GPS system that relays to the hospital's Transfer Center the exact location of the vehicle every 30 seconds. Enhanced safety features for the clinical transport staff include three seating locations with five-point harness restraints and a second computerized control panel to use the built-in oxygen and HVAC system, allowing staff to remain seated with seat belts fastened while providing care.

"On behalf of the staff and patients of Stony Brook Medicine, I would like to thank the Hospital Auxiliary for all they do," said L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital. "They are extremely responsive to our needs and year after year support us by agreeing to fund much-needed equipment."

Since its formation in 1981, the Auxiliary has raised close to $7 million, which has successfully funded numerous projects, including surgical intensive care sonograms, mammographic ultrasound equipment and automated external defibrillators. These funds have been raised through special events, the Auxiliary Gift Shop, vendor sales, membership dues and donations from grateful patients.

From left, Stony Brook University Hospital Auxiliary members Linda Shamash and Barbara Delfyett; Carol Gomes, Chief Operating Officer, Stony Brook University Hospital; Auxiliary members Elena Middleton, Janice Rohlf, Caroline Gassner Levine, Patricia Macarchuk, Janet Hovnanian and Uta Dee; L. Reuven Pasternak, MD, CEO, Stony Brook University Hospital; Karen Villanueva-Walsh, President, Hospital Auxiliary; and Gloria Snyder, Auxiliary member

Stony Brook Rocks at Battle of the Bands Fundraiser to Support  

Cancer Center

Acoustic Downtime

Stony Brook Medicine's first Battle of the Bands was held on June 7 at the Brickhouse Brewery in Patchogue. The bands performing at the event featured musicians who are Stony Brook staff members, physicians and students. Proceeds from the event benefitted Stony Brook University Cancer Center's Stem Cell and Bone Marrow Transplantation Program.

The Honey Badgers

Acoustic Downtime, featuring Ed Mocko from Information Technology and Thomas Wilson, MD, Department of Pediatrics, was awarded the Judges' Choice Trophy. The Honey Badgers received the People's Choice Trophy with Stony Brook staff Frank Albergo, RPh, Pharmacy; Chris Conard and Carter O'Brien, Operating Room; and Michael Lydic, MD, Department of Obstetrics, Gynecology and Reproductive Medicine.

Music Therapy

Also performing was the band Music Therapy, made up of all Stony Brook Medicine staff: John M. Hutter, Department of Surgery; Ramin Parsey, MD, PhD, Chair, Department of Psychiatry; Jamie Romeiser, MPH, Departments of Surgery and Anesthesiology; Mark Talamini, MD, Chair, Department of Surgery; and Nehal Vadhan, PhD, Department of Psychiatry.

Visit Flickr to view additional photos from the event. 

People

Stony Brook Physicians Named to  

New York Magazine's Best Doctors' List

Eighteen Stony Brook Medicine physicians have been named to the list of Best Doctors for 2015, published in the June 8-14, 2015, issue of New York Magazine.

Thomas V. Bilfinger, MD, Thoracic and Cardiac Surgery

Alexander B. Dagum, MD, Plastic Surgery

Raphael P. Davis, MD, Neurological Surgery

Roger Fan, MD, Cardiac Electrophysiology

Suzanne D. Fields, MD, Geriatric Medicine

Todd R. Griffin, MD, Obstetrics and Gynecology

Lynn E. Hallarman, MD, Hospice and Palliative Medicine

Catherine E. Kier, MD, Pediatric Pulmonology

Leonard Kristal, MD, Dermatology

William E. Lawson, MD, Interventional Cardiology

Lloyd Lense, MD, Cardiovascular Disease

Robert I. Parker, MD, Pediatric Hematology/Oncology

Michael Poon, MD, Cardiovascular Disease

Michael W. Schuster, MD, Hematology

Apostolos K. Tassiopoulos, MD, Vascular Surgery

James R. Taylor Jr., MD, Thoracic and Cardiac Surgery

Carmen Tornos, MD, Pathology

Henry H. Woo, MD, Neurological Surgery

The doctors are selected by Castle Connolly Medical Ltd. each year through a peer-review survey. Licensed physicians vote online for doctors they view as exceptional. Participating physicians are asked to nominate those doctors who, in their judgment, are the best in their field and related fields, taking into account not only professional qualifications and reputation, but also skills in dealing with patients. Doctors cannot nominate themselves, and all nominations are confidential.

The 1,282 New York Magazine honorees are a smaller subset of the annual Castle Connolly list from its guidebook Top Doctors: New York Metro Area, which lists those whom Castle Connolly considers among the top 10 percent of the region's physicians, numbering 6,497 in all this year.

Stony Brook Nurses Recognized for Excellence

Adriann Combs, RN, BSN, and Kathleen M. Gambino, EdD, RN -- who both serve as an inspiration to the nursing profession -- were among the 25 nominees recognized at the Nassau-Suffolk Hospital Council Nurse of Excellence Award Ceremony.

From left, Valerie Terzano RN, member of the Nassau-Suffolk Hospital Council (NSHC) Nurse of Excellence Subcommittee; Margaret Duffy, Associate Director of Nursing, Stony Brook University Hospital; Adriann Combs, RN, BSN; and Gara Edelstein RN, Chairperson, NSHC Nurse Executive Committee

Combs, who demonstrates excellence in nursing practice, quality, research and community service, is the Regional Perinatal Center Coordinator/Magnet Program Director. In her career, Combs has helped to establish many evidence-based best practices. For example, she participated in a March of Dimes-sponsored study that reduced early-term deliveries by 75 percent. She serves as the co-chair of Stony Brook's Nursing Research Committee and has participated in a range of multidisciplinary and multi-site research projects. Combs serves on a number of professional committees, gives public lectures, speaks at national conferences and academic settings, and has written many articles in professional publications.

From left, Valerie Terzano RN, member of the Nassau-Suffolk Hospital Council (NSHC) Nurse of Excellence Subcommittee; Kathleen Gambino, EdD, RN; Lee Anne Xippolitos, PhD, RN, Dean, Stony Brook University School of Nursing; Marie Marino, EdD, RN, Associate Dean, Academic Affairs, School of Nursing; and Gara Edelstein RN, Chairperson, NSHC Nurse Executive Committee

Gambino, Clinical Associate Professor/Program Director of the RN Baccalaureate and Baccalaureate to Masters Program for the School of Nursing, has a passion for nursing education. She is fully dedicated to a state-of-the-art curriculum and the provision of clinical opportunities aimed at meeting the needs of the associate-to-bachelor's students. Gambino has developed unique clinical experiences for students that were previously unavailable to them; these include rotations in local hospitals in areas such as the operating room, telemetry, emergency department and intensive care units. Her goal is to ensure that new RNs have refined clinical skills, making them more marketable, and better serving the community. Gambino also has worked to develop a distance learning education experience that meets the challenges of adult learners in the associate-to-bachelor's program.

Growth

Team of Cancer Researchers Uncover Role of Mutant p53

Ute Moll, MD, in front, with postdoctoral fellows Evguenia Alexandrova, PhD (left), and Alisha Yallowitz, PhD

Removing accumulated mutant p53 protein from a cancer model showed that tumors regress significantly and survival increases. This finding, by an international team of cancer researchers led by Ute Moll, MD, Professor of Pathology at Stony Brook University School of Medicine, is reported in a paper published in Nature.

For two decades cancer researchers have looked unsuccessfully for ways to develop compounds to restore the function of mutant p53 proteins. This team of researchers discovered that eliminating the abnormally stabilized mutant p53 protein in cancer in vivo has positive therapeutic effects.

p53 is the most important tumor suppressor protein that protects cells from becoming cancerous. However, mutations in p53 that insert incorrect amino acids can generate aberrant proteins with not only abrogated tumor suppressor function but newly gained oncogenic function (GOF) that promote malignant progression, invasion, metastasis and chemoresistance.

"Our study clearly shows that mutant p53 overexpressing tumors are dependent on continuous overexpression for survival and maintenance," said Dr. Moll. "This model has direct relevance for similar cancers in humans with the same mutation. Our work may have important clinical implications and be a foundation for a new way to treat mutant p53-related cancers."

Sustainability

Financial Results Report

Through April 2015, discharges at Stony Brook University Hospital were 31,091, which was 731 discharges above budget. Average length of stay was .06 of a day higher than the prior year at 5.46 days.

Case mix index was 5.6 percent higher than the prior year at 1.81. Significant increases in case mix index occurred in the surgical DRGs for tracheostomies and transplants, cardiology and infectious diseases, and the medical DRGs for neonates and infectious diseases.

Total Emergency Department visits increased by 5,826 from the prior year to 85,487 year to date. Inpatient surgeries increased by 469 to 7,742, and outpatient surgeries decreased by 226 to 11,254. Endoscopy volume was 1,019 above plan at 11,942.

P/L (profit/loss) was $8.9 million versus budget of $4 million. Revenue was $47 million above plan due to the recognition of $6.5 million of DSRIP (Delivery System Reform Incentive Payment) program revenue as well as disproportionate share hospital (DSH) revenue of $28 million, and inpatient and outpatient volume being above plan.