February Message from Steven L. Strongwater MD, CEO

February 2010

It has now been nearly three weeks since a devastating earthquake hit Haiti. Many of us are still riveted by the news being broadcast from that impoverished island nation, including rescues of survivors that seem nothing short of miraculous—a testament to the strength of the human spirit both of the survivors and their rescuers. Our thoughts and condolences go out to the people of Haiti and those here who have lost loved ones or whose loved ones have been injured or displaced by this disaster. One such person is Dr. Winfred S. Tovar of Stony Brook’s Maternal Fetal Medicine Division. Dr. Tovar went to Haiti to deal with his own family losses, including attending the funerals of his aunt and cousin. He also participated with Doctors Without Borders in the relief effort. We look forward to hearing about his experience and learning from him about how to help the people of Haiti. Dr. Tovar is one of many faculty, staff, and students helping Haiti.

What we do know is that help is pouring into Port-au-Prince, albeit more slowly than any of us would wish. Much more is needed. Even those of us living here, more than fifteen hundred miles away, can impact recovery efforts and the rebuilding of Haiti in a number of ways. So far, our immediate response has been mostly on a personal basis, with donations made to organizations engaged in recovery and rebuilding efforts such as the American Red Cross, Doctors Without Borders, Oxfam, UNICEF, and other relief organizations. Dr. John Shanley is organizing a plan to help Haiti over the long term, while Dr. Paul Lombardo is working on ways to help immediately. For a listing of some of the organizations involved in the Haitian earthquake relief effort, visit www.stonybrook.edu/sb/haiti. As in the past, when disaster strikes, our Stony Brook family is motivated by a desire and commitment to help those in need. As a healthcare organization, the Stony Brook University Medical Center (SBUMC) family has responded in the following ways:

• Donation collection containers are available in the cafeteria, the Gift Shop, Starbucks and at the Hospital Information Desk. Containers will also be available at our outpatient facilities. Your spare change can change the lives of those affected by this disaster. No contribution is too small.
• We are reaching out to the Haitian community in Suffolk County through the Haitian Americans United for Change Organization.
• Some 30 members of the SBUMC family from the Hospital, the School of Medicine, Nursing, Physician Assistants, Nurse Practitioners, and Social Work, met to plan a series of near-term fundraising initiatives within the Medical Center and elsewhere, to determine where the donated money would help the most among the large numbers of worthy charities. We will keep you apprised of their efforts.

In addition, President Stanley has informed us that the University has been in communication with the United Way and American Red Cross organizations and has learned that Stony Brook University faculty, staff, and FSA members can send financial contributions to be directed to Haitian relief efforts through donations to the SEFA-affiliated organizations listed below:

• United Way of Long Island (SEFA agency code 65-00318, please write “Haitian Relief Fund” after the code). Donations will be forwarded to the United Way Worldwide Disaster Fund.
• American Red Cross of Nassau County (SEFA agency code 65-00023, please write “Haiti Red Cross” after the code). Donations will be forwarded to the Haiti Relief Fund.
• American Red Cross of Suffolk County (SEFA agency code 65-00022, please write “Haiti Red Cross” after the code). Donations will be forwarded to the Haiti Relief Fund.

To download a pledge form, please visit our Stony Brook Cares Web site at www.stonybrook.edu/sb/stonybrookcares/how.shtml. For questions or assistance, contact Darschay Harris at darschay.harris@stonybrook.edu or (631) 632-4360. Donations will be accepted until Friday, February 12, 2010.

A memorial is being held at the Student Activities Center on Tuesday, February 2, from 8:00 pm to 10:00 pm. All are invited to join together with members of the campus community to honor and remember the victims of the earthquake in Haiti. For questions, contact Rabbi Joseph Topek at 632-6565.

In addition, students from the Student National Medical Association in conjunction with Stony Brook University Medical Center and the Health Sciences Center have organized a Memorial Vigil for Haiti to be held on Wednesday, February 10, at the HSC Galleria, 11:45 am to 1:00 pm.

Whatever you choose to do, the contribution you make will be more than repaid in gratitude from the people of Haiti, a nation that in its 200+ years of existence has suffered far more and far more often than any of us could expect to endure.

Anything, everything, will be appreciated.

Visit www.StonyBrookMedicalCenter.org and click on “Stony Brook’s Response, Haiti Relief Efforts” for updates and links.

New technology offers advanced patient care at SBUMC’s Radiation Oncology. RapidArc™ is a radiotherapy technology that improves dose conformity while significantly shortening treatment times for patients being treated for cancer. RapidArc delivers treatments two to eight times faster than our fastest treatments today and increases precision using IGRT (image-guided radiation therapy).

SBUH receives three patient safety awards. SBUH’s efforts to standardize the central line insertion credentialing process, “Moving Beyond the Central Line Bundle,” was recognized by the Nassau-Suffolk Hospital Council, Inc. as an honorable mention award winner of its 2009 Excellence in Patient Safety. As a result of the standardization process, our Pediatric Intensive Care Unit experienced a 41 percent reduction in central line infections; our Surgery Intensive Care Unit experienced a 66 percent reduction; and the Medical Intensive Care Unit experienced a 61 percent reduction in infections in 2008, as compared to rates reported in 2007. Another submission “First Do No Harm,” was also recognized as an honorable mention for the same award for SBUH’s focus on reducing mortality rates and striving for high reliability performance. Finally, the Healthcare Association of New York State (HANYS) Pinnacle Award-winning application, “High Reliability Organization,” was also recognized with an honorable mention. Consequently, SBUH took three places out of ten honorable mention slots for all of Long Island. Congratulations to the teams working on these efforts!

General Medicine goes live with ambulatory electronic record—STARS (Stony Brook Totally Automated Record System, Cerner Powerchart). As part of a tremendous patient safety advance, the STARS implementation team, Cerner, and the doctors and staff in the General Medicine office on Belle Mead Road completed their two full weeks using STARS for outpatient documentation, ordering, and billing. Highlights include doctors using Dragon Speak to dictate notes directly; use of ePrescribing of non-narcotic orders; printing of prescriptions; electronic documentation of allergies, home medications, and diagnosis or problems directly into the note, which for inpatients should be viewable in the system; and phone messages taken at the front desk routed to the inbox pool for the residents/doctors to address. Everyone is working together toward the goal of total electronic documentation. Over the next 18 months all additional outpatient practice sites will be fully live with the EMR. 

First patient is enrolled in prestigious study for treatment of heart attack. The Division of Cardiology has enrolled its first patient in the OSIRIS 403 Study, which is investigating the use of mesenchymal stem cells to treat individuals who have had a first heart attack, or myocardial infarction. The study is part of a multinational clinical trial involving 40 sites in the United States and Canada. The SBUMC arm of the study is the only one on Long Island and one of two in New York State. Principal Investigator, Dr. Luis Gruberg, notes that this is a highly demanding study requiring careful collaboration among all branches of Cardiology and other SBUMC departments and he extends special thanks to Diane Marrone, Dan Roberts, and Jude Webber from Nursing; Dr. Nabil Hagag and Marie LeBlanc from Bone and Marrow Stem Cell Transplantation; Dr. Michael Poon, Cardiovascular Medicine; the entire Echocardiography team; Lynda Enden, RN, and Jackie Skarre, RN, Research Coordinators, and Jeanne Kidd, Regulatory Coordinator. For more information, call (631) 444-7238.

Stony Brook researcher is awarded grant. The National Foundation for Eye Research has chosen Thomas White, PhD, as the recipient of the Cataract Research Award for 2010. The award consists of a plaque and $2,500 honorarium. Dr. White is an Associate Professor with Stony Brook University’s Department of Physiology and Biophysics.

Madagascar fossil exhibit becomes a permanent attraction at SBUMC. Thanks to the generous support of the SBUMC Development Council, a fossil exhibit featuring highly significant finds made in Madagascar by Dr. David Krause and his team of researchers will take up permanent residence in the SBUMC lobby. The unveiling of dinosaur fossils and the mammoth frog dubbed Beelzebufo is planned for Tuesday, February 9, at noon, and all are welcome to attend this exciting event. To learn about the ongoing efforts in Madagascar by Dr. Krause and his team, and Stony Brook students and healthcare professionals, visit www.ankizy.org.

Stony Brook’s Physician Assistant (PA) Student Society’s Longitudinal Health Literacy Project receives three grants. The American Academy of Physician Assistants (AAPA) has awarded a total of three grants to the PA Health Literacy Project, a community service project, where PA students read and educate children from ages 4 to 15 on age-appropriate health topics. The funds were awarded in recognition of the success of the program and will support efforts to foster health literacy among children and young adults. Sessions are provided in local communities where English is both a first and a second language.

Stony Brook University Hospital (SBUH) CEO, Dr. Steven Strongwater, is recognized for achievement and innovation. A recipient of the David Award, Dr. Strongwater was among eight Long Island men honored by Networking® magazine. The award represents the ideal Renaissance man and acknowledges professional achievement, giving, and service to the Long Island community. Dr. Strongwater was recognized for his role and commitment to expanding services, improving patient safety and care, and incorporating the latest medical innovations and additional expertise to SBUMC. Networking specifically cited his work to improve patient safety over his 25-year career, which helped SBUMC to receive the Healthcare Association of New York State (HANYS) Pinnacle Award for Quality and Patient Safety and the Nassau-Suffolk Hospital Council’s inaugural Excellence in Patient Safety Award.

PATIENT SAFETY
“Patient Safety Fridays” is coming to SBUH. To better integrate safety and quality with operations, senior leadership at SBUH has committed to join in a strategy that has successfully changed culture at New York Presbyterian (NYP) Hospital. SBUH’s leadership team, which includes the level of manager on up, will join together to look at safety and regulatory issues aimed at making improvements. The team will engage in a united effort devoted to education, observation, staff, patient feedback, and rapid issue resolution. Beginning March 12, and coinciding with National Patient Safety Week, every Friday the team will devote mornings to education and tracer activity. Issues will be brought back to a leadership meeting for resolution. Afternoons will be devoted to unit- and service-based safety and quality activities. This focused effort will serve to enhance SBUH’s culture of safety.

Patient Safety Committee is soliciting employee feedback. Employee Patient Safety Breakfasts are being held monthly to invite feedback from staff members who have interacted with the Hospital’s inpatient healthcare system. Employees who have been inpatients or have been companions to family members who were inpatients are being invited to attend and share their insights into the care delivered. Representatives from the Patient Safety staff, Patient and Family Centered Care, and Hospital leadership, including Dr. Strongwater, will attend. If you qualify and would like to participate, please call 444-1956.

Measures are initiated aimed at improving the chart review process. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator Review Process FMEA Team has initiated measures to help improve the chart review process, which focus on key patient safety indicators. This effort will help compile and trend indicator results in an attempt to reduce coding, documentation, and clinical opportunities through communication with the responsible services. In alignment with organizational performance improvement priorities, the ultimate goal is to help services improve quarterly relative performance ratings and achieve a five-star Quality and Accountability Rating.

Efforts to decrease hospital-acquired infections continue. Efforts in the intensive care units (ICUs) to decrease hospital-acquired infections have been successful. With respect to ventilator-associated pneumonia (VAP), the Pediatric ICU had zero VAPs in December 2009, the unit’s seventh consecutive month without an infection, more than 230 consecutive infection-free days. The Surgical ICU was also VAP-free in December 2009, and is working to hold the gain. The Neonatal ICU returned to its goal in November 2009 with zero VAP infections. The unit has had only one infection in the past 17 months. Concerning central line infections, the most recent data shows zero infections for the Surgical ICU in November 2009. The Pediatric ICU achieved the ninth consecutive month without a central line infection, which is nearly 300 consecutive days of being central line infection free. While Neonatal ICU is working hard to decrease all of its central line infections, it has been free from umbilical line infection since October 2008—more than 460 days without an infection related to an umbilical line.  

Venous symposium is planned for March 27. Stony Brook University’s Office of Continuing Medical Education and School of Medicine is sponsoring a Venous Symposium: Prevention and Treatment of Venous Thromboembolism on Saturday, March 27. Visit www.venous-symposium.com or call 444-2094 for further details and registration.

The Department of Vascular Surgery successfully employs Crew Resource Management techniques. With consistent use of the surgical safety checklist, the Vascular Surgery Department achieved 100 percent compliance for the second quarter of 2009, meeting its Surgical Care Improvement Project objectives. Congratulations to all!

PATIENT SATISFACTION   
SBUMC is working to enhance its patient-centered care. Staff members are participating in the IHI (Institute for Healthcare Improvement) Expedition: Improving Your HCAHPS Scores Through Patient-Centered Care, a webinar designed for organizations seeking to make their care more patient centered and improve their HCAHPS results. Several sessions have been conducted with the following successful strategies presented: AIDET, Hourly Nurse Rounding, and Nurse Shift Report at Bedside.

• AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You) is a simple acronym to help staff working with patients gain trust and communicate effectively with people who are nervous, anxious, and feeling vulnerable. AIDET is a way to consistently demonstrate courtesy, respect, and professionalism when working with patients and their families.
• Hourly Nurse Rounding is a protocol to keep patients informed and address clinical and comfort needs. Hourly, nurses making rounds complete scheduled tasks such as changing a dressing or giving medications, and checks the three P’s, potty, position, and pain, the most frequent reasons patients use call lights. The effect is reduced use of call lights and higher patient satisfaction.
• Nurse Shift Report at Bedside is a way to exchange information with oncoming staff that improves patient satisfaction and patient safety. The strategy incorporates a standardized report structure and allows for oncoming staff to be introduced to patients and for patients to ask questions and comment. In addition to improving satisfaction and safety, the process also reduces the interval between when nurses come on shift and when they first see their patients.

Units 15N and 15S are incorporating all of these strategies to improve satisfaction. Unit staff members are being reacquainted with AIDET, hourly rounding is underway, and nurse shift report at bedside began in January.

Emergency Department decreases wait time. As a result of the Emergency Department’s efforts to decrease patient wait time and overall turnaround time, the incidence of people seeking care and leaving before receiving care or leaving against medical advice is at an all-time low of 1.4 percent.

Urgent Matters ED Patient Flow Collaborative Leadership plans site visit. A national team will visit SBUH Wednesday, February 3. The Urgent Matters Emergency Department (ED) Patient Flow Team has worked diligently to decrease ED turnaround time by concentrating on the consult process, which is now an electronic process in Cerner. Our surgery, orthopedic, and neurology services are collaborating with ED leadership to decrease time to initiation of consult and time to consult completion. Stony Brook team leaders were asked to share experiences in improving the consult process on a conference call sponsored by Urgent Matters Learning Network with the other five participating hospitals in February.

Healthcare Teleservices undergoes an upgrade. The HealthConnect® call center recently upgraded to a web-based software application, Echo Access. This application provides enhanced functionality for the call staff and eliminates workstation installs resulting in reduced need for IT support. The members of the Project Team who made this upgrade possible are Richard Piazza, Lead Programmer Analyst; Brian Ennis, Application Engineer; Jason Spatz, Database Administrator; and Harbinder Singh, Systems Administrator.

COMMUNITY CONNECTIONS
Attend an open forum with SUNY officials on Thursday, February 4. Chancellor Nancy L. Zimpher and approximately 200 SUNY delegates will visit Stony Brook University as part of the Chancellor’s strategic planning efforts. The keynote speaker will be Dr. Steven E. Koonin, Under Secretary for Science in the U.S. Department of Energy. The program, open to all University faculty, staff, students, and the greater community, will include a conversation on the topic of energy and sustainability, and an open forum inviting comment on SUNY’s Strategic Plan 2010. The program will begin at 8:30 am in the Student Activities Center, followed immediately by the keynote address at 10:00 am. Visit www.stonybrook.edu/pres for more information.

SBUMC Development Council celebrates a successful start. Two years ago, six civic-minded community members formed the SBUMC Development Council with a mission to further the Medical Center’s vision of becoming a world-class organization through philanthropy and community support. Today, the Council has grown to 14 members, it has hosted nine cultivation events to generate support within the community, and its activities are already having an impact on the Hospital. As part of the Major Modernization Project, the Council made it possible for a selection of paintings by local artists to grace the new lobby. Most recently, it funded the purchase of a piano for the lobby, supported enhancements for the chapel, and will unveil its newest venture on February 9—the creation of a permanent exhibit in the Hospital lobby featuring fossil discoveries from Stony Brook University’s Distinguished Service Professor David Krause and his team of researchers.  

SBUH Auxiliary donates $100,000 for the purchase of pediatric testing equipment. The Auxiliary has approved the purchase of pediatric pulmonary function testing equipment. This gift was decided based upon recognition of the important work being done in the cystic fibrosis (CF) program, and the unique nature of the program (Stony Brook has the only CF program on Long Island). The Auxiliary’s gift also recognizes the excellence of the SBUH pediatrics program and is an expression of the Auxiliary’s support of the Stony Brook Long Island Children’s Hospital initiative.

Custodial Services takes next step in recycling efforts. Last June, a recycling program for cans, bottles, newspapers, magazines, corrugation, and paper was instituted and has been met with support and success. Efforts are now underway to recycle paper in some non-clinical service areas, with a focus on improving current procedures and reducing the quantity of “clean paper” currently placed into HIPAA containers. The Patient Protected Health Information criteria states: “Any form of media that contains any of the following identifiers is considered protected health information: patient names, social security numbers, telephone numbers, medical record numbers, etc.” Any paper that falls outside of these criteria is acceptable as non-sensitive documentation and may be recycled internally. For additional information or questions, call HIPAA Privacy Office, Stephanie Musso, at 444-5796. To initiate recycling in your location, please e-mail or call Moira Rouggly (444-2232) in the Department of Custodial Service.

Stony Brook medical students partner with the Ward Melville Heritage Organization (WMHO). Stony Brook University medical students are participating in a program developed by the SBUMC and the Ward Melville Heritage Organization (WMHO) called “Medicine: Past, Present, and Future,” designed to spark elementary-aged students’ interest in the fields of science, research, and medicine. Begun in January, the program melds the historical expertise of the WMHO staff and knowledge of 21st century medicine and research via Stony Brook University medical students. The medical students are teaching through the lens of the life of Dr. Samuel Thompson, a self-educated 18th century physician, at his home, the Ward Melville Heritage Organization’s (WMHO) 300-year-old Thompson House.

SBUMC’s healthcare professional provides nutrition outreach. Suzette Smookler, MS, RD, will be moderating a discussion of the film “Food Inc.” at the Emma Clark Library in Setauket on Saturday, February 20. The film raises issues about the food industry.   

SBUMC celebrates American Heart Month. This month, in support of the American Heart Association and its national campaign, “Go Red for Women,” SBUMC will host free lectures and cholesterol screenings to bring attention to the importance of heart health. Look for flyers and posters announcing the events, and visit the Medical Center Web site. Hospital staff members are invited to show their support for raising awareness about women’s heart disease by wearing red on Friday, February 5, National Wear Red Day, and joining in a group photo at noon the HSC Galleria, Level 3. SBUH will be providing free blood pressure screenings to the community at the Riverhead and Central Islip Courts at rotating days during the month.

Mind/Brain Lecture Series hosts “Waking from the Dark.” The talk, by Dr. Nicholas Schiff, Director of Laboratory of Cognitive Neuromodulation at Weill Cornell Medical College, will focus on understanding the recovery of consciousness after brain injury. The free presentation takes place on Monday, March 15, at 4:30 pm at the Staller Center for the Arts and is intended for a general audience. The Mind/Brain Lecture Series is sponsored by the Swartz Foundation in cooperation with the Department of Neurobiology and Behavior and Stony Brook University.

Second Annual Multiple Sclerosis (MS) Awareness Day is scheduled for March 10. The event, open to all, will take place in the SBUMC lobby from 7:00 am to 7:00 pm and is presented by the Department of Neurology, the MS Comprehensive Care Center, and the National Pediatric MS Center. Come learn about the progress being made in MS research. Posters, exhibits, and education materials will be on display and visitors will have the opportunity to speak with Stony Brook’s team of MS experts. 

Support the Stony Brook Cares (SEFA/United Way) Campaign. During these difficult financial times, it is imperative that we support the reputable organizations that help our neighbors on campus, in our community, across the nation, and around the world. Consider making a charitable donation through the Stony Brook Cares (SEFA/United Way) Campaign. Annually, 90 percent of contributions go directly to the agency/agencies of the donor’s choice. Visit our Stony Brook Cares Web site at www.stonybrook.edu/sb/stonybrookcares/index.shtml to download a pledge form, for information on how to give, and for the SEFA list of charities. Contact Darschay Harris at darschay.harris@stonybrook.edu or 632-4360 if you have any questions. Donations will be accepted through February 12.

My Last Touch
Do you know what umami is? It is a great sounding word. It rolls off your tongue and almost sounds as if it is not a real word at all. But it is real enough. When we consider our sense of taste, for most of us four traditional sensations come to mind: sweet, sour, salty, and bitter. But, were you from the Eastern hemisphere, there would be at least two additional tastes: piquance (the spicy sensation provided by, among other things, chili peppers) and umami (also known as savoriness).

Umami is not an English word, which may be why it sounds unfamiliar. We borrowed it from the Japanese language and it means brothy, meaty, or savory. It is the flavor common to savory foods like meat, cheese, and mushrooms. It is what I think of as the “substance” of really hearty food. It is my contention that the difference between food in gourmet restaurants and home-cooked food is largely due to the umami. That said, I cannot ever recall a conversation about umami, even after a really spectacular meal. And yet, most of us know a great meal when we have one. Is it possible to experience something really wonderful and not quite understand what made it so?

Taste and food frequently serve as metaphors (please excuse the pun). Have you heard the expression the “sweet spot”? In many circumstances the sweet spot means you have gotten it perfectly right: in baseball, it means hitting the ball with the meaty part of the bat leading to a powerful and clean hit; for music lovers it refers to the perfect place within a room to listen to music (e.g., the optimal point between two speakers where you hear the stereo the way it was intended); in math it may be the perfect solution to a really complicated problem.

Is there umami in healthcare? More than in recent memory, healthcare has dominated the news. Discussion and debate have focused on many controversial issues—disparities in care, hospital readmission rates, high rates of uninsured, the escalating cost of care, oversight boards, different rules in different states, favoritism, political deal making, and more. The President has gone on national television seeking reforms. The question we now face is whether we will remember umami—the meaty, satisfying part of healthcare that we all need and crave.

Our role at SBUMC has to be on the sweet spot. The right balance. Fundamentally, whatever happens at the national level will not change patient needs. People will still get sick. Nurses and doctors will be at the bedside. Emergencies will still occur. As a profession, we know there are better ways to prevent illness and catch conditions before they become catastrophic, and thereby avoid unnecessary morbidity. The national debate has raised many important issues we can begin to address right now, like improving the health of large groups of patients (population-based medicine) while still caring attentively for individual patients.

As with new medical discoveries, widespread use of new models of care will take time to design and develop, including better prevention and active patient engagement with appropriate incentives for better lifestyles. That we understand there is a problem motivates solutions. SBUMC is working on solutions now. We are fortunate to be able to collaborate with the Stony Brook University Schools of Medicine, Dental Medicine, Health Technology and Management, Nursing, and Social Welfare, as we are all under one entity. There is no doubt that academic medical centers will help shape the platforms for care in the future. With the right focus and a concerted effort, we will be talking about the umami and the sweet spot in healthcare very soon.

We are fortunate to have such creative faculty and staff to help on this journey. 

Neither the life of an individual nor the history of a society can be understood without understanding both.
—C. Wright Mills

All life is an experiment. The more experiments you make the better.
—Ralph Waldo Emerson

I think I’ve discovered the secret of life—you just hang around until you get used to it.
 —Charles Schulz

Enjoy the journey.

Steven L. Strongwater, MD
Chief Executive Officer
Stony Brook University Hospital 

Patients First—World-Class Processes—Teamwork—Growth—Use Resources Wisely