CEO Update August 2007

The information below is an employee update of activities at Stony Brook University Medical Center prepared by Stony Brook University Hospital CEO, Steven L. Strongwater, M.D.  Dr. Strongwater distributes a monthly update which is sent to all hospital faculty and staff to communicate initiatives and activities undertaken at the Medical Center to reach goals in the areas of patient satisfaction, patient safety and community connections.

August 1, 2007 

This is a special time at Stony Brook University Medical Center. We are in the midst of great change and reshaping our future. It is exciting. This month we have a great deal to celebrate, from the arrival of many new faculty, to the development of new programs, to the naming of Urology to the Top 50 in US News and World Report.

As part of this renewal, you may recall that we are reevaluating SBUMC's mission and vision. For those who have already participated in this dialog, thank you. In case you missed the opportunity to comment, please review the proposed mission and vision statements and share your comments and reactions at UH_CEO@stonybrook.edu

Proposed Mission Statement

Stony Brook University Medical Center improves the lives of our patients, families, and communities, educates skilled healthcare professionals and conducts research that expands clinical knowledge.

Proposed Vision Statement

Stony Brook University Medical Center will be:

•  A world-class healthcare institution, recognized for excellence in patient care, research, and healthcare education
•  The first choice of patients for their care and the care of their families
•  An academic medical center that attracts educators and students with the desire and ability to provide and receive the highest quality, innovative education
•  One of the top federally funded institutions for scientific research and training

Stony Brook Pride

SBUMC's Urology Department Named to US News and World Report Top 50!

US News & World Report ranked SBUMC's Urology Department to the top 50 in the nation. Urology was one of only four in NY State and the only LI hospital so ranked. All US hospitals were eligible and more than 1300 were reviewed for at least one of the services ranked. Some of the survey methodology is based on the annual AHA hospital services questionnaire from 2005. Congratulations to Dr. Waltzer, Chair. Congratulations also to all the faculty and staff in Urology. This is a team effort. It is wonderful to receive this kind of external recognition. It is my hope this is the first of many awards as we work toward becoming "world class."

Health and Human Services Medal of Honor Awarded to SBUMC. The New York Organ Donor Network informed SBUMC on June 25^th that we were awarded the Health and Human Services Department's Organ Donation Medal of Honor this year. This award is given to only 11 hospitals in the region that have more than a 75% consent rate for organ donation within the past 12 months. There is an award ceremony scheduled in October in Nashville, Tennessee. Congratulations to the organ donor team.

SBUMC First in Suffolk to Treat Chronic Sinusitis with Balloon Sinuplasty. Ghassan J. Samara, M.D., assistant professor of surgery, has begun performing balloon sinuplasty to relieve chronic sinusitis. Dr. Samara is the first physician in Suffolk County to perform this minimally invasive procedure which holds promise to avoid more extensive and invasive surgery.  

Stony Brook Heart Center Receives Trifecta in Accreditation in Echocardiography.

Under the leadership of Smadar Kort, M.D., Director of Cardiovascular Imaging, and Director of the Echocardiography Laboratory, SBUMC received accreditation in adult transthoracic, adult transesophageal and adult stress testing of cardiac patients from the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Accreditation status signifies the Heart Center has been reviewed by an independent agency, which recognizes Stony Brook's commitment to quality testing for the diagnosis of heart disease. It is effective through March 2010.

Eric Rashba, M.D., Performs First Ablation Procedures for Atrial Fibrillation in Suffolk. Eric Rashba, M.D., Director of Electrophysiology in the Heart Center at Stony Brook University Medical Center recently performed the first atrial fibrillation (AF) ablation procedures in Suffolk County. AF is the most common cardiac arrhythmia and one that is increasing in prevalence as the population ages. Radiofrequency ablation is a non-surgical procedure often used to treat rapid, uncoordinated heartbeats. During the procedure, a physician guides a catheter with an electrode at its tip to the area of heart muscle where there is an accessory (extra) pathway. Then, a painless radiofrequency energy (similar to microwave heat) is transmitted to the pathway. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch). That stops the area from conducting the extra impulses that caused the rapid heartbeats. With a success rate of over 90 percent and a low risk of complications, ablation therapy is the preferred treatment for many types of rapid heartbeats. The use of ablation therapy is increasing in the management of AF patient population, and SBUMC is in the process of establishing a Destination Center for the management of AF.

New Faculty. We are excited about the many new faculty joining SBUMC and the skills they bring to Suffolk County. Of special note, joining the staff at SBUMC are Dr. Rahudlev (aka Raul) Bhalla, a urologist and expert in advanced robotic surgery and Dr. Henry Woo, a dually trained neurosurgeon and interventional radiologist, who will be developing an interventional stroke program. The surgical robot will also be used by other services over time including cardiothoracic surgery, gynecology and perhaps others. The robot will be a key tool used to train the next generation of surgeons.

So many of our current faculty deserves recognition for introducing innovations to care. For instance, the Cardiovascular Surgery Program under the direction of Todd Rosengart, M.D., has introduced a left ventricular assist device (LVAD) to help people whose hearts cannot keep up leading to congestive heart failure.

So please join us in warmly welcoming new faculty members who have signed on dating back to January 2007. We are pleased they have chosen to become a part of the SBUMC team.

New Faculty Arrivals Since January in the School of Medicine

Patient Satisfaction

New highs achieved in 4 of 6 Press Ganey Patient Satisfaction Scores: Inpatient, ED, Ambulatory Surgery and Outpatient Oncology.  SBUMC now ranks above the 50th percentile in the PG database and has moved to the 75^th percentile for University Health System Consortium database. Patient satisfaction in the ED improved again for the forth consecutive quarter, the highest rating ever achieved by the ED. The Ambulatory Surgery Center had the highest score ever achieved by the Center with many items receiving ratings well above the 90th percentile in all peer groups.

Thank you for your teamwork.  Thank you also for continuing to use the phrase, "I have time; is there anything else." You are making a difference. Your patients notice it. 

Distinguished Dining Continues to Receive National Recognition. One year after the program was introduced, with 17 different menus, a professional call center staffed with room service operators to take patient orders, and room service "ambassadors" clad in a black vest, trousers and white shirt, who explain menus and deliver food promptly, SBUMC is setting the standard for hospitals on Long Island. Press Ganey patient satisfaction scores now rank the Hospital's Distinguished Dining food service in the 99^th percentile among Long Island hospitals and University HealthSystem Consortium (UHC) Hospitals, a benchmark comparator group among academic medical centers. It has improved to the 90th percentile when compared to hospitals in Press Ganey national database. Congratulations to Diane Carillo, Suzette Smookler and her team!

Patient Safety

Survival Rates at SBUMC Improve for 17^th Straight Quarter - Mortality Lowest in Hospital History. For the past 17 quarters, SBUMC mortality rates have steadily declined to what is now the lowest overall mortality rate in Hospital history - 1.61% after the first quarter of 2007. (Mortality rate is calculated using the number of inpatient deaths per year divided by the number of patients discharged from the hospital during that year - or whatever time interval is in question.) Here's a snapshot of the decline in raw hospital-wide mortality at SBUH over the past four years (note, during this same time period, the case mix index, a measure of patient severity has increased, suggesting that sicker patients are surviving longer at SBUH):

2003 - 2.01%              2006 - 1.68%

2004 - 1.94%              2007 - 1.61% (Q1)

2005 - 1.81%

As I have previously shared, SBUMC was recognized by University Health System Consortium (UHC) as having the most improvement in the nation amongst UHC members in reducing mortality from 2003 to 2006. This is due to a number of programs and systems put in place at SBUMC including IHI 100,000 Lives Saved and 5 Million Lives Unharmed, Rapid Response Teams, the acute MI team, the Congestive Heart Failure service, the institution-wide initiative in early recognition and management of severe sepsis (with an associated 25% decline in severe sepsis mortality), the IHI teams in the ICUs, communications programs, documentation programs and others. Our most recent initiatives with enormous potential are Pediatric Early Warning Scores (PEWS), now up and running on 11 North, and the soon to be trialed Modified Early Warning Scores (MEWS) in adults. My congratulations to the many teams of staff and faculty working together to achieve these results.

Rapid Response Team (RRT) Helps Reduction in Code Blue Calls - An Update. RRT is called when a member of the patient care team, whether a nurse, a physician or a non-clinical hospital employee, or even a family member, notices a change in a patient's condition that causes great concern. RRT is comprised of clinicians who bring critical care expertise to the bedside or wherever needed. The team is unique in that four permanent, full time critical care-trained nurse practitioners are at the core of the team weekdays; on weekends and evenings it is staffed by senior medical house staff (physicians). Respiratory therapists always accompany the NP or physician. We have observed a correlation - as the number of RRT calls increase, the number of cardiac arrest codes decrease. Specifically, the number of RRT calls increased from four (4) in December 2005 (our first month) to 43 in April 2007 (our peak month) to 29 in June 2007. The number of codes (cardiac arrests) per 1,000 discharges fell from an average of greater than 4.5 per month in the first four months of RRT operation to less than 3.5 per month in the corresponding period a year later (Dec 2006 to March 2007), a greater than 20% decline. More importantly, this has also coincided with a significant decline in patient deaths, which is a continuation of a trend observed at Stony Brook over the past five years. This resulted in the highest survival rates in the first quarter of 2007 in the history of the Hospital.

Neonatal Benchmarking Process. The NICU IHI team and Quality Management are joining the Vermont Oxford Network to obtain benchmarks for its dashboard metrics and to learn best practices from other neonatal intensive care units caring for babies less than 1500 grams.

PEWS Update (Pediatric Early Warning Scores). 11 North is in the process of modifying the PEWS assessment tested in July to include parameters for hypotension and hypertension.  Once the scoring system is modified, tested, team members will request score postings to be incorporated into Cerner.

Modified Early Warning Scores (MEWS) to be Piloted on 13 North mid August. These scores are recorded at least every 8 hours with measures of behavioral, cardiovascular and respiratory conditions. A score is calculated and depending upon the result, a color coded magnet is placed on a white board by the nursing station (green, yellow, orange or red). Orange or red requires action (contact by a house officer or an attending). A modified early warning scoring system (MEWS) is being developed now for adults that will be piloted on 13 North beginning August 15, 2007. We have learned how helpful the white board displays are; just by looking at the board, you can tell how "sick" the unit is.  

Pneumonia Care Improves. According to UHC report our data reveals the  median time to antibiotics was 61 minutes for the first quarter of 2007, while other hospitals reporting to UHC (in aggregate) have a median time of 204 minutes.  Our mean for antibiotic timing is at 117 minutes while other hospitals reporting to UHC (in aggregate) have a mean time of 162 minutes. 

Care for Acute Myocardial Infarction (AMI) Improves. According to the UHC report for Quarter 1 2007, median time to Primary PCI is 71.0 minutes, while other hospitals reporting to UHC (in aggregate) have a median time of 92 minutes.  Our mean for Time to PCI is 80 minutes while other hospitals reporting to UHC (in aggregate) have a mean time of 116 minutes.  This improvement denotes significance at the .01 level. 

Failure Modes and Effects Analysis (FMEA). Two new Failure Mode and Effect Analysis Teams will be formed in August to improve processes involving communication of critical values after hours and to address opportunities relating to central line insertion and other procedural causes of iatrogenic pneumothorax. In an ongoing effort to proactively enhance patient safety, team progress will be shared at the Patient Safety Committee meeting.

Patient Deaths. An "Expiration Packet," which provides a step-by-step guide for physicians and nurses to follow when a patient expires, is now available for all inpatient units.  The packets can be ordered by calling Laboratory Administration at 4-2319

Community Connections

SBUMC Unveils New Web Site. Stony Brook University Medical Center recently unveiled a new web site design, complete with new graphics and links to resources to useful and important programs and services offered at the Medical Center. StonyBrookMedicalCenter.org provides insider access links to the School of Medicine, Schools of the Health Sciences and University Physicians at Stony Brook. The site also offers easy reference for physician referral, links to Centers and Institutes, a gateway to the Health Sciences Library, access to recent Medical Center Newsletters and much more. To log on, go to www.StonyBrookMedicalCenter.org. Your comments and suggestions for material are welcome: UH_CEO@stonybrook.edu

SBUMC Launches First Responder Program in Riverhead. SBUMC launched a first responder program in collaboration with Peconic Bay Medical Center to improve response time to life saving advanced cardiac life support. One vehicle will be stationed in Aquebogue and the other in Manorville. Our thanks to Eric Niegelberg, Dr. Victor Tarsia (EMS Medical Director) and Dr. Mark Henry for their leadership in developing this program which we anticipate will save lives.

Howard Adler, M.D., Receives Citation on Behalf of SBUMC Prostate Care Program.  In a special tribute to the Prostate Care Program at Stony Brook University Hospital, NYS Assemblyman Robert K. Sweeney presented Dr. Howard Adler, program medical director, with a citation of recognition on July 24 during one of three annual screening events at North Lindenhurst Fire Department (NLFD). Originally conceived by Dr. Maurice Gonder, the first Chairman of the Department of Urology, the program is now in its 12^th year of partnership with Assemblyman Sweeney and the NLFD. 300 men are screened at the Fire House each year. During his tenure as program director of the mobile screening program, Dr. Adler has provided free screenings for more than 11,000 men from Manhattan to Montauk. He and his team have offered screenings at police stations, fire stations, churches, community centers, schools, medical clinics and corporate offices. Approximately 15 per cent of those screened are recommended for a follow up for abnormalities with PSA testing, prostate evaluation, or both. Congratulations and thank you.

SBUMC Holds Successful Kids Fair on July 11, 2007.  On July 11, the SBUMC sponsored its second annual Kids Health & Safety Expo, held at Flowerfield in St. James. About 800 community members attended the Expo, which is coordinated by the hospital's Department of Community Relations.  Over 50 exhibitors participated including 36 hospital and university departments as well as outside community groups including the Suffolk County Police Department, the Sheriff's Department, and the Department of Probation. Parents and children learned about topics ranging from the benefits of proper nutrition and a good night's rest to the damage that can be done through body piercing, smoking and overexposure to the sun. My thanks Yvonne Spreckels and to everyone who organized and participated in this important event.

New Garden for Cardiac Thoracic Intensive Care Unit. With the support of Laurie Rafkin and Dr. Todd Rosengart, the Cardiac Thoracic Intensive Care Unit now has a garden for patients and their families to enjoy. Our patients and their families are enthusiastic to see the greenery out of their windows and experience a positive environment.

Community Faculty Town Hall Meeting Planned for September 11, 2007 at the Watermill in Smithtown from 6 to 8 PM.  In an effort to reinforce our commitment to engage the community, a Town Hall meeting has been scheduled for September 11, 2007. We will discuss a variety of topics including our new Patient Transfer Center; new services and innovative techniques such as LVAD (left ventricular assist device); same-day faxing of discharge notes; and free valet parking for community physicians. We will give updates on the Major Modernization Project, the Berger Commission, and HealthConnect®.

New Breast Pumping Room. We are pleased to announce that we have identified and designated space for a Breast Pumping Room for women who are lactating. The room will be available in mid August. Further details about accessing the room will be forthcoming from Ronni Schultz.

Last Touch

An e mail I received....

"I just came from the emergency room.  My daughter-in-law took my grandson to be seen for a bite.  It turned out to be classic tick bite, bullseye rash and all.  My daughter is a nurse and has worked here and at St. Catherine's. Her pediatrician always tells her to go to another local hospital where we have waited for hours (even though it did not appear to be very busy).  Since my other daughter-in-law raves about Stony Brook, she took it upon herself to come to SBUMC.  She told the doctor it was the best emergency room experience she ever had. 

My daughters-in-law are good moms and very demanding about the treatment of their children.  They are not easy to please.  Coming from a family where athletic males are in abundance, emergency room visits become an all too common experience.  While I don't look forward to being back anytime soon, if it happens I know we will be getting quality care.

Something is changing at Stony Brook and for the good!"

I have struggled to find ways to consistently bring compassion back to healthcare. Doesn't this sound odd? After all this is a health care institution. But can an impersonal institution be compassionate? The answer has to be yes. The question is how.

There is little doubt that the hectic demands of your daily activities can be distracting from compassionate care. It happens to us all, honestly. We are all human. But knowing what is important and doing something to make a difference is what distinguishes you and in turn SBUMC. Although this is "work", pride in what you do and recognition for it is special. Indeed, the highest form of praise is recognition of your actions by your patients, their family or your peers. In the words of George Elliot, "You are judged by your deeds."  Bring passion and compassion to SBUMC. Pride will follow.

On the journey to world class......

Steven L. Strongwater, M.D.

CEO

SBUMC