Clinically Screening Hospital Patients for Social Risk Factors Across Multiple Hospitals: Results and Implications for Intervention Development.

Background: Hospitals are increasingly screening patients for social risk factors to help improve patient and population health. Intelligence gained from such screening can be used to inform social need interventions, the development of hospital-community collaborations, and community investment decisions.

Objective: We evaluated the frequency of admitted patients' social risk factors and examined whether these factors differed between hospitals within a health system.

Predictors of Food Insecurity for Hospitals' Patients and Communities: Implications for Establishing Effective Population Health Initiatives.

As food insecurity interventions are incorporated into hospitals' population health initiatives, addressing the needs of hospitals' patients and communities through the same interventions may be ineffective if the groups vary and have different needs. This study examined whether food insecurity predictors were different in the general population compared to individuals with hospital discharges, and also whether food-insecure hospital patients differed from food-insecure community members. National data were extracted from the 2016 Medical Expenditures Panel Survey.

Journey to top performance: a multipronged quality improvement approach to reducing cardiac surgery mortality.

Background: In 2006, leadership at Long Island Jewish Medical Center (New Hyde Park, New York) noted significantly higher cardiac surgery mortality rates for isolated valve and valve/coronary artery bypass graft procedures compared to the New York State Department of Health's Cardiac Surgery Reporting System statewide average.

Methods: Long Island Jewish Medical Center, a 583-bed nonprofit, tertiary care teaching hospital, is one of the clinical and academic hubs of North Shore-LIJ Health System. Senior leadership launched an evaluation of the cardiac surgery program to determine why cardiac surgery mortality rates were higher than expected.

Not for industry only: medical students and office-based academic detailing the PIVOT (Pregnant women Influenza Vaccine Optimization Team) initiative.

Academic detailing is a method of educational outreach that utilizes individualized encounters with physicians to broach specific medical issues in an evidence-based and quality-driven manner. Medical students utilized the matter of influenza vaccination during pregnancy as a lens through which to explore the methods of academic detailing in a community setting. Structured and customized dialogues between North Shore-LIJ affiliated obstetricians and Hofstra North Shore-LIJ medical students were conducted regarding the disparity between the proportion of providers that recommend the vaccine and the percentage of pregnant women being vaccinated annually.

Medication reconciliation in continuum of care transitions: a moving target.

Objective: To study medication discrepancies in clinical transitions across a large health care system.

Design: Randomized chart review of electronic medical records and paper chart medication reconciliation lists across 3 transitions of care.

Settings And Participants: Subacute patient medication records were reviewed through 3 transition care points at a large health care system, including hospital admission to discharge (time I), hospital discharge to skilled nursing facility (SNF; time II) and SNF admission to discharge home or long term care (LTC; time III).

2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic.

Objective: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy.

Study Design: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug.

Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare.

Background: Hand hygiene is a key measure in preventing infections. We evaluated healthcare worker (HCW) hand hygiene with the use of remote video auditing with and without feedback.

Methods: The study was conducted in an 17-bed intensive care unit from June 2008 through June 2010.

Prevalence of dysglycemia among coronary artery bypass surgery patients with no previous diabetic history.

Background: Dysglycemia is a major risk factor for atherosclerosis. In many patient populations dysglycemia is under-diagnosed. Patients with severe coronary artery disease commonly have dysglycemia and there is growing evidence that dysglycemia, irrespective of underlying history of diabetes, is associated with adverse outcome in coronary artery bypass graft (CABG) surgery patients, including longer hospital stay, wound infections, and higher mortality.

Hand hygiene in long-term care facilities: a multicenter study of knowledge, attitudes, practices, and barriers.

An anonymous survey of 1143 employees in 17 nursing facilities assessed knowledge of, attitudes about, self-perceived compliance with, and barriers to implementing the 2002 Centers for Disease Control and Prevention hand hygiene guidelines. Overall, employees reported positive attitudes toward the guidelines but differed with regard to knowledge, compliance, and perceived barriers. These findings provide guidance for practice improvement programs in long-term care settings.

Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management.

Background: The pathogenesis of Chiari malformations is incompletely understood. We tested the hypothesis that different etiologies have different mechanisms of cerebellar tonsil herniation (CTH), as revealed by posterior cranial fossa (PCF) morphology.

Methods: In 741 patients with Chiari malformation type I (CM-I) and 11 patients with Chiari malformation type II (CM-II), the size of the occipital enchondrium and volume of the PCF (PCFV) were measured on reconstructed 2D-CT and MR images of the skull.

Laboratory surge response to pandemic (H1N1) 2009 outbreak, New York City metropolitan area, USA.

The North Shore-Long Island Jewish Health System Laboratories serve 15 hospitals and affiliated regional physician practices in the New York City metropolitan area, with virus testing performed at a central reference laboratory. The influenza A pandemic (H1N1) 2009 outbreak began in this area on April 24, 2009, and within weeks respiratory virus testing increased 7.5 times.

Diagnostic value of repeated enzyme immunoassays in Clostridium difficile infection.

Objectives: There has been a significant increase in the prevalence, severity, and mortality of Clostridium difficile infection (CDI), with an estimated three million new cases per year in the United States. Yet diagnosing CDI remains problematic. The most commonly used test is stool enzyme immunoassay (EIA) detecting toxin A and/or B, but there are no clear guidelines specifying the optimal number of tests to be ordered in the diagnostic workup, although multiple tests are frequently ordered.

Pressure ulcer PUSH score and traditional nursing assessment in nursing home residents: do they correlate?

Background: Over a decade ago, the National Pressure Ulcer Advisory Panel (NPUAP, 1997) recommended a new tool, the Pressure Ulcer Scale for Healing (PUSH) tool to document ulcers and monitor the healing process. Yet, traditional nursing observation remains standard practice in chronic care, thus prompting this correlational study between PUSH and traditional documentation of pressure ulcers.

Methods: Data were cross-tabulated through a retrospective chart review of all residents with stage II-IV decubiti at a 672-bed skilled nursing facility, between January 1, 2004, and December 31, 2006.

More quality bang for your healthcare buck.

The quality management department at North Shore-Long Island Jewish Health System has designed a collaborative process that improves patient safety, is accountable to the public, and increases efficiency on the basis of sound data management. By forging strategic alliances between the quality, finance, and materials support services departments at the health system level, a quality economic business model was developed that led to greater efficiencies in length-of-stay management, improved resource utilization in critical care, and standardization of skin care products and equipment. This article describes these quality initiatives.

Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care.

Study Objectives: To evaluate the impact of a multifactorial intervention to improve the quality, efficiency, and patient understanding of care for community-acquired pneumonia.

Design: Times series cohort study.

Setting: Four academic health centers in the New York City metropolitan area.

Hospitalized elders: changes in functional and mental status.

This article describes outcomes of a new model of care for hospitalized elders and their families. Patient functional and cognitive status on admission and discharge were evaluated for changes as a result of an educational program for preparing family-centered geriatric resource nurses. Patients in the intervention group (n = 173) demonstrated significant improvements in outcome measures (functional and cognitive status) from admission to discharge.

Reinforcing organizationwide pressure ulcer reduction on high-risk geriatric inpatient units.

Skin care and pressure ulcer prevention programs abound, although their content varies and their outcomes are often difficult to quantify. This article describes 2 complementary programs, their quality improvement processes, and a variety of ways of measuring their success. The first program was broad in scope, emphasizing system-wide changes in administration and coordination of resources, while the second focused on nursing education on high-risk units.

Expanding a performance improvement initiative in critical care from hospital to system.

Background: Concern about the expense and effects of intensive care prompted the development and implementation of a hospital-based performance improvement initiative in critical care at North Shore University Hospital, Manhasset, New York, a 730-bed acute care teaching hospital. THE HOSPITAL-BASED PERFORMANCE IMPROVEMENT INITIATIVE IN CRITICAL CARE: The initiative was intended to use a uniform set of measurements and guidelines to improve patient care and resource utilization in the intensive care units (ICUs), to establish and implement best practices (regarding admission and discharge criteria, nursing competency, unplanned extubations, and end-of-life care), and to improve performance in the other hospitals in the North Shore-Long Island Jewish Health System. In the medical ICU, the percentage of low-risk (low-acuity) patients was reduced from 42% to 22%.