Hospitalist Quality Improvement & Safety Initiatives
Faculty in the Hospitalist Program, part of NYU Langone’s Division of General Internal Medicine and Clinical Innovation, continuously investigate ways to transform patient care with the goal of delivering high-quality, high-value, patient-centered healthcare.
Patient quality and safety improvement is paramount to our work. As clinicians, we continually strive to advance patient care through quality assurance projects and partnerships with NYU Langone’s Value-Based Medicine team. Below is a selection of successful quality improvement and safety initiative research projects with continuing excellence. Our investigators are also involved with clinical trials and several other research focus areas, including research related to the COVID-19 pandemic.
Hotspot Rounds to Identify Our Sickest Patients
As the severity of illness among hospitalized patients increases, quick recognition of a patient who might deteriorate can be difficult. To improve the identification of decompensating patients, the value-based medicine team at Tisch Hospital, led by Katherine Hochman, MD, and Kevin D. Hauck, MD, is collaborating with the Predictive Analytics Unit in the Department of Population Health, led by Yin Aphinyanaphongs MD, PhD, to deploy a deterioration prediction model.
This tool runs continuously and uses data in the electronic medical record (EMR) to identify key indicators of potential early decompensation. Patients are flagged as “hotspot” patients in the EMR and a systematic, clear plan to escalate care is initiated. Hotspot rounds have become a clinical and educational intervention that models interdisciplinary teamwork and ensures that our sickest patients are cared for well.
Standardized Hospitalist–Primary Care Provider Communication
Hospitalists Marwa M. Moussa, MD, and Carrie M. Mahowald, MD, designed and piloted a protocol to standardize communication between primary care providers and hospitalists at NYU Langone Hospital—Brooklyn with the goal of more effectively coordinating patient care.
As part of the protocol, hospitalists call primary care providers upon a patient’s hospital admission and follow up again when the patient is discharged. The standardized communication includes a narrative generated through our electronic medical record, ensuring effective continuity of care. This research is funded by NYU Langone’s Center for Healthcare Innovation and Delivery Science.
Care Transitions After Heart Failure
Hospitalist Himali M. Weerahandi, MD, MPH, is developing best practices for transitioning patients with heart failure from skilled nursing facilities to the home, an essential component of the healthcare continuum.
Dr. Weerahandi conducts translational research that targets systemic drivers of adverse health outcomes, such as hospital readmission and mortality, to improve healthcare quality. The goal of this research project, which is funded by an NIH K23 grant, is to analyze the transition-to-home process after hospitalization for heart failure and design effective systems-level, quality improvement interventions, including for patients who are identified as frail and cognitively impaired.
Delirium Prevention Intervention
Delirium, a common experience for people over 65, is one of the foremost geriatric emergencies and can lead to higher healthcare expenses, morbidity, and mortality. To address this problem, Nina Blachman, MD, a Merrin Master Clinician Fellow in the Division of Geriatric Medicine and Palliative Care, created and implemented an interdisciplinary delirium prevention program, called Empowering Elder Novel Interventions (ERNI), at NYU Langone’s Tisch Hospital and Kimmel Pavilion.
ERNI creates a partnership among geriatrics, psychiatry, nursing, and rehabilitation faculty and staff to proactively identify patients who are at high risk for delirium and trains volunteers to provide nonpharmacologic delirium prevention interventions.
Vascular Access Stewardship Program
Sparked by a patient safety intelligence report from house staff, leadership at NYU Langone Hospital—Brooklyn and Tisch Hospital analyzed use of peripherally inserted central catheter (PICC) lines. They determined that 1 in 12 patients on the internal medicine service received a PICC. In addition, 13.4 percent of patients who received a PICC died within 3 months of placement.
To respond to these discoveries, Frank M. Volpicelli, MD, Charles M. Okamura, MD, Katherine Hochman, MD, and Nicole M. Adler, MD, initiated the Vascular Access Stewardship (VAS) program for the medicine service at both hospitals. Physicians, house staff, nurse practitioners, and physician assistants received education on the safest access for each patient. Success of the VAS initiative was demonstrated by a significant decrease in the number of PICCs placed and on the number of days that patients spent with a PICC. The number of midlines placed (a safer alternative) increased dramatically. The rate of central line–associated bloodstream infections also decreased by more than half. In addition to enhancing patient safety, this project is cost-effective, since midlines do not require a chest x-ray to confirm placement. The VAS project is an effective and highly reproducible strategy that enhances patient safety and reduces costs.