Reducing ED Board Times and Improving Placement, Even During the Pandemic

The American College of Emergency Physicians (ACEP) in August last year identified boarding times for patients in hospital emergency departments as at an “all-time high.” This is for all patients waiting to be transferred to a different facility for needed treatment, whether a behavioral health facility or hospital providing a higher level of acute care.

ACEP identified two reasons for increasing boarding times: 1) hospital staffing shortages and 2) influx of seriously ill patients, with COVID-19 and with other emergent conditions, in part due to patients’ delaying necessary medical care during the pandemic.

For patients needing behavioral health treatment, even prior to the COVID-19 pandemic, the average wait time in an acute hospital ED conservatively was estimated at eight hours. Anecdotally, however, hospitals across the country often reported much longer wait times as clinically appropriate, available psychiatric beds were hard to identify, particularly for certain populations, such as children and adolescents, older patients, and those with co-occurring conditions.

Today, just five months after ACEP raised concerns about all-time high boarding times, the problem is yet more serious as the country is experiencing an even-higher number of COVID-19 cases, fueled by the Omicron variant, and even more acute staffing shortages.

For hospitals using XFERALL to automate and expedite acute medical and behavioral health patient transfers, the picture is not as bleak. In Texas alone, hospitals using XFERALL to transfer medical patients between August 2020 and July 2021 got a response from a receiving hospital to their transfer request in less than 1 minute, 18 seconds and secured acceptance for patient transfer in less than 20 minutes. Over the last two years, even during the pandemic, XFERALL’s partners reduced behavioral health patient transfer times by 86%.

XFERALL empowers health care systems and providers to quickly identify medical and behavioral hospitals with the capacity and capability to accept patients for transfer. The XFERALL technology automates the patient transfer process, creating less work for the health care provider and improving emergency department capacity by reducing transfer times. By automating the patient transfer process and increasing visibility into a wider network of potentially available beds, XFERALL eliminates the need for nurses and other clinicians to make labor-intensive phone calls and faxes to identify clinically appropriate care for patients needing transfer.

There is no easy fix to the nation’s health care staffing crisis, and the end to COVID-19 remains elusive. The good news is that hospitals nonetheless can reduce care delays and mitigate the consequences of the staffing shortage by implementing internal logistics and operations that accelerate the effective and efficient transition of patients to appropriate treatment. Improvement starts with questioning old habits of picking up the phone and faxing clinical information and being open to modernizing the patient transfer process. There’s never been a more urgent time to do so.

To learn more about the work with DC-area hospitals and behavioral health teams, contact Jennifer Witten, senior vice president, government affairs and policy, at Jennifer.Witten@xferall.com.

DCHA Announces 2022 Slate of Board of Director Officers

The District of Columbia Hospital Association (DCHA) at its December 15 Board of Directors Annual Meeting, voted to elect a new slate of Board officers for terms beginning in January 2022. DCHA is the unifying voice for hospitals and health systems in the District of Columbia and works to advance health policy to strengthen the District’s world-class health care system to ensure that it is equitable and accessible to all. The DCHA Board of Directors sets the strategic direction for the association. The 2022 Board Officers are:

Dr. Hasan Zia, Board Chair
President & Chief Operating Officer, Sibley Memorial Hospital

Anita Jenkins, Vice Chair
Chief Executive Officer, Howard University Hospital

Dr. Christopher King, Secretary
Associate Professor, Georgetown University Medical Center

Dania O’Connor, Treasurer
Chief Executive Officer, Psychiatric Institute of Washington

John Rockwood, Immediate Past Chair
President, MedStar National Rehabilitation Hospital & Senior Vice President, MedStar Health

Jacqueline D. Bowens, President & Chief Executive Officer
District of Columbia Hospital Association

In addition to the new Board of Directors, DCHA appointed one At-Large member and welcomed a new addition to the Board with the departure of James Linhares from BridgePoint Hospital Capitol Hill:

Kathy Hollinger, At-Large Board Member
President & Chief Executive Officer, Restaurant Association of Metropolitan Washington

Ryan Zumalt, Board Director Chief Executive Officer, BridgePoint Hospital Capitol Hill

“DCHA is privileged to have such an esteemed group of individuals serve the association, our hospitals and the residents of the District of Columbia,” said Jacqueline D. Bowens, President and CEO of DCHA.

 

 

Member Profile: Denise Boehm, RN

Meet Your ONE-DC President, Denise Boehm, RN

Ms. Denise Boehm was named Associate Director for Patient Care Services/Chief Nurse Executive in September 2017. She previously served as Associate Director for Patient Care Services/Nurse Executive at the Louis A. Johnson VA Healthcare System in Clarksburg, West Virginia. from 2012 to 2017. Prior to her roles in executive leadership, she served Veterans and staff at the VA Pittsburgh Healthcare System as a staff nurse, critical care nurse educator, nurse manager of the Emergency Department and associate chief nurse for Primary Care. Ms. Boehm is a native of Pittsburgh, Pennsylvania. She has served in various professional organizations to include: local chapters of the American Nurses Association and the American Association of Critical Care Nurses where she coordinated education and community support events. She earned a Bachelor of Science Degree in Nursing and a Master of Science Degree in Nursing Leadership and Education from Carlow University in Pittsburgh. She is certified by the American Nurses Credentialing Center as a Nurse Executive-Advanced. Ms. Boehm completed the Network Executive Healthcare Leadership Institute (NEHCLI) and the Nurse Executive Leadership Program at the Federal Executive Institute and is a coach for the Healthcare Leadership Development Program. Ms. Boehm has been an Adjunct Nursing Faculty member at Carlow University and Waynesburg University in Waynesburg, Pennsylvania.

ONE-DC: Who We Are

ONE DC is a non-profit organization consisting of nurse leaders and nurses aspiring to be leaders. This includes nurses from all settings and specialties, who hold positions as nurse executives, administrators, nurse managers, nurse educators, nursing quality managers, nursing staff leaders and researchers from across the District of Columbia. The organization addresses the nursing workforce, administration, education, evidence-based practice, research, health policy, and professional practice issues.

ONE DC Officers:

Laura Hendricks-Jackson – Interim President/Treasurer
CNO, Sibley Memorial Hospital

Hazel Darisse – Secretary
Assistant CNO, The George Washington University Hospital

DCHA’s 40th Anniversary Events Featuring Impressive Line-Up of Speakers

Washington, D.C. – The District of Columbia Hospital Association (DCHA) is celebrating its 40th Anniversary as the
unifying force advancing hospitals and health systems in the District of Columbia.

DCHA is hosting an educational symposium on Nov. 15, DISRUPTION! Relevance, Impact & The Road Ahead for Health Care at the Kaiser Permanente Center for Total Health, featuring keynoters, thought leaders and presenters conversing about disruption in the marketplace, consumerism, leveraging technology, pay for performance, workforce resiliency and other important topics impacting hospitals, health care providers and patients. The symposium will explore factors driving disruption, including the shift to alternative and less expensive health care provided in non-traditional settings, price transparency, skills transfer and technology-based care. The Symposium features keynoters:

Dr. John Whyte, MD, CMO, WebMD, who will address consumerism and the shift of power and control in health care delivery from physicians and hospitals to consumers. From an increasing sophistication when it comes to their own health, to their role in provider transparency, Dr. Whyte will discuss the powerful role of today’s consumers and how hospitals can better engage them to remain relevant and successful.

Dr. Farzaneh (Fazi) Sabi, Associate Medical Director, Kaiser Permanente Mid-Atlantic Medical Group, will focus on historical trends and changes in the hospital industry over the last few decades, and some of the advancements in the medical industry which are gearing towards less invasive approaches to care, faster recovery, and more care in the ambulatory setting. This will set the stage for a provocative discussion about what hospitals in the future will look like, and the role we will play in this transformation.

Zeke Emanuel, Health Care Futurist, is a nationally recognized health “change agent.” Dr. Emanuel is one of the leading practitioners shaping the future of health care. With extensive experience and engagement at the most senior levels of policy making, Zeke has been instrumental in shaping the way health care is delivered and financed in the U.S. Zeke is an engaging, incisive, forthright, and witty speaker on health care policy and the transformation of American medicine.

The Thought Leaders Panel will react and respond to the message delivered by the keynote speaker and discuss their perspectives on disruptive innovation; and the moderator will ask the panel thought-provoking questions about disruptive innovation, is the D.C. market ready and how to lead in a disruptive environment. Panelists include:

Elaine Batchlor, MD, MPH, is the CEO of Martin Luther King, Jr Community Hospital, which opened in 2015. Dr. Batchlor was the driving
force behind the effort to open the new, state-of-theart, community-oriented, safety-net hospital providing compassionate, quality care and improving the health of the South Los Angeles community. Dr. Batchlor received a Bachelor of Arts degree from Harvard University, a Master of Public Health degree from the University of California, Los Angeles, and a Doctorate in Medicine degree from Case Western
Reserve University.

J. Stephen Jones is President and CEO of Inova, the health care system that serves more than two million people annually in its five hospitals and multiple ambulatory programs. Dr. Jones previously served as President of Cleveland Clinic Regional Hospitals and Family Health Centers. He led 11 hospitals and more than 24 large ambulatory centers. He also served as Professor of Surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and held the Leonard Horvitz and Samuel Miller Distinguished Chair in Urologic Oncology. This endowed chair has now been renamed the J. Stephen Jones Distinguished Chair in Urology Research.
He earned a BS in Zoology at the J. William Fulbright College of Arts & Sciences at the University of Arkansas and his M.D. at UAMS.

Ken A. Samet is the President & CEO of MedStar Health, and is responsible for a $5.6 billion not-for-profit, health care delivery system. With more than 35 years of experience in health care administration, Samet provides strategic oversight and management for MedStar Health the largest health care provider in Maryland and the Washington, D.C., region, comprised of 10 hospitals, a comprehensive network of health related businesses that includes ambulatory, home health, a large multispecialty physician network, and several insurance products with more than 145,000 members. MedStar has large research and innovation platforms and one of the largest graduate medical education programs in the country. In addition, MedStar Health serves more than half-a-million patients and their families each year. Samet received his master’s degree in health services administration from the University of Michigan.

DCHA is also hosting a 40th Anniversary Celebration Gala on Nov. 16, 2018 at the Ronald Reagan Building in Washington, DC to honor and salute the health care community from 1978-2018. Complete details of both events at www.dcha.org/40years.

DCHA Gives 2019 Patient Safety & Quality Awards to Deserving Individuals and Teams

DISTRICT OF COLUMBIA HOSPITAL ASSOCIATION GIVES 2019 PATIENT SAFETY & QUALITY AWARDS

On June 6, the District of Columbia Hospital Association (DCHA), awarded its 2019 Patient Safety & Quality Awards recognizing five exceptional individuals and teams in the hospital community. Two individuals and three teams were recognized at DCHA’s Patient Safety and Quality Summit at the Marriott Marquis in D.C.

“We are so pleased to recognize and celebrate individuals and teams for working tirelessly every day on behalf of patients and families,” said DCHA President & CEO Jacqueline D. Bowens, “It’s through the hard work of hospital personnel that help us prepare for a better health care system and outcomes for the residents of D.C.”

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The 2019 Patient Safety & Quality Awards were given to:

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Dr. Khadijatou Njimoluh, Howard University Hospital, for her creation of multidisciplinary Power Rounds, a unique approach to discussing a patient’s plan of care and discharge. Dr. Njimoluh exhibited key communication components that directly promoted quality and safety for patients. Her creation of multidisciplinary Power Rounds, designed to discuss a patient’s plan of care and discharge, allowed for substantial information sharing which resulted in improved staff communication in line with Howard University Hospital’s Patient Safety goals. The Power Rounds, supported by physicians, nursing staff, social workers, rehabilitation and physical therapists, post-graduate residents and medical students, and of course, patients and family, markedly improved the quality of care during the patient’s stay because of a new way to approach care coordination and decision-making. Dr. Njimoluh accomplishments go beyond just clinical work. Her exceptional ability to communicate and connect to a broad audience is noted daily. She is enthusiastic, culturally sensitive and absorbs knowledge quickly. She possesses exceptional interpersonal skills, is a team player and has a cooperative spirit. Dr. Njimoluh adjusts well, welcomes critique and uses it to elevate her experience during her training. She will undoubtedly excel as she continues to grow in the field of medicine.

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Rachel Buckman, MedStar Washington Hospital Center, for her excellence in infection prevention and patient safety. In the three short years that Rachel Buckman has been with MedStar Washington Hospital Center, not only has she excelled in her initial role of infection prevention and reducing CLABSIs, she’s excelled in leading MedStar Washington Hospital Center’s patient safety program. Rachel has recruited and trained new patient safety coaches and introduced many program innovations. Rachel also leads the hospital’s peer review process, hand hygiene compliance program, quality improvement data initiatives, training, wellness and emergency preparedness.Rachel is a superb communicator, with excellent public speaking and writing skills. She often teaches groups and very ably shares the messages she must deliver, to clinical and non-clinical associates as well as to physicians. She is unafraid to speak up for safety and point out missed opportunities in a very professional and polite manner. Rachel is an extremely hard worker, never reluctant to take on new tasks. In fact, on more than one occasion when other associates have left the organization, she has immediately volunteered to assume some of their responsibilities. Her work product is always excellent, very carefully vetted before it’s presented. She is extremely well liked and universally noted to be a “star.”

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Clostridium Difficile Prevention Team, MedStar Washington Hospital Center, for their work to drastically lower C. Diff rates, a common hospital-inquired infection. The C. Diff Prevention Team is a multidisciplinary team approach consisting of a physician, nurse, infection preventionists and pharmacist. MedStar Washington Hospital Center’s onset C. Diff rate was persistently higher than goals set both by the Centers for Disease Control and MedStar Health. The work of the C. Diff team created to address the problem and the required process changes, were shared repeatedly with presentations at hospital leadership and staff meetings and on individual units. The team was very diligent about following the C. Diff testing guidelines that had been established. Members of the infection prevention team regularly contacted nurses to discuss C. Diff orders. Members of the executive team conducted “Triple C” rounds with C. Diff, CLABSI, and CAUTI prevention teams and spoke with associates and medical staff on the units about the program. The repeated communication, in various formats, engaged and educated staff, and ultimately inspired the necessary team work to drastically lower C. Diff rates which absolutely contributed to patient safety.

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Division of Nursing, MedStar Georgetown University Hospital, for outperforming the national teaching hospital average for injury falls, outpatient falls with injury, hospital acquired pressure ulcers, CLASBI and CAUTI, and prenatal care. The Division of Nursing at MedStar Georgetown has worked hard to have measurable impacts to patients, nursing and the community. For patients, MedStar’s overall patient experience scores outperformed the highest benchmark in the nurse patient relationship, education, efficiency, and pain management. For nurses, successes included providing an environment for autonomy in practice, excellence in nursing leadership, professional development opportunities and nurse-to-nurse interaction. The Division of Nursing’s focus on achievement creates a care environment that goes above and beyond to promote improvement, strengthen care and engage the stakeholders. The proof is in the data. MedStar Georgetown outperformed the national teaching hospital average for injury falls, outpatient falls with injury, hospital acquired pressure ulcers, CLASBI and CAUTI, and prenatal care.

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Reducing Vancomycin Use in the Neonatal Intensive Care Unit, Children’s National, for improving the quality of care by reducing vancomycin exposure. Benchmarking data on antibiotic use in 2016 and 2017 showed that vancomycin use in Children’s neonatal intensive care unit was more than three times that of the average level. Prompted by this data, Children’s assembled a multidisciplinary team to reduce vancomycin use by 50% in one year and to sustain for at least one year. The team developed and implemented interventions including clinical practice guidelines, educational initiatives, pharmacist-initiated prompts on rounds to de-escalate or discontinue vancomycin review from the antimicrobial stewardship team, and documentation of blood culture volumes. Within one year, their vancomycin days of therapy per 1,000 patient-days decreased by 60% and this decrease has been sustained for the past six months. The rate of vancomycin-associated acute kidney injury has similarly decreased by 50%. This project improved the quality of care provided at Children’s National by standardizing the approach to several infectious conditions in hospitalized neonates, by integrating pharmacists into antibiotic review, and by improving documentation of volume of blood culture samples. This project improved the safety of our patients by reducing unnecessary vancomycin exposure and by reducing vancomycin associated acute kidney injury.

 

Individual winners were presented with a $2,500 prize, and teams with a $5,000 prize thanks to support from Ascension. The award winners were chosen out of more than 25 nominees by a panel of independent judges from the health care industry.

Utilization Report-May 2019

Overview & Observations

In recent monthly summaries, we focused on the impact of the termination of Providence Hospital acute care services and decreased Emergency Department (ED) operations since December 2018. In addition to the previously noted shift in ED visits to other hospitals after the Providence closure, a general increase in ED visits per day was also noted across the majority of hospitals beginning in March 2019. These patterns are more pronounced when examining ED visits as a rate per day rather than by straight count per month. The table below summarizes the most recent 12 months of Emergency Department data with a color metric to highlight that the volume of daily admissions for most D.C. hospitals was highest in the spring months of 2019.

Download Report

April is National Donate Life Month

April is National Donate Life Month, a time to encourage people to register as organ, eye and tissue donors and to celebrate those that have saved lives through the gift of donation.

Across the U.S., there are more than 112,000 patients on the national transplant waiting list who need a kidney, heart, lungs, pancreas, liver, or intestine. Thousands more need tissues such as corneas to restore sight, skin to heal burns, heart valves to repair defects, bones to correct injuries and tendons/ligaments to restore movement.

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       Malkia White

Currently, there are more than 2,200 patients in the D.C. metropolitan area waiting for a lifesaving transplant. Patients like Malkia White who was diagnosed with kidney disease when she was a young girl. She successfully managed her disease most of her life, until a few years ago, when her kidney function went into rapid decline. Malkia, who is now on the waiting list for a new kidney, relies on dialysis treatment three nights a week to keep her alive.

Washington Regional Transplant Community (WRTC), the local non-profit organ procurement organization responsible for facilitating donation process, has a longstanding relationship with hospitals in D.C. Thanks to its hospital partners, WRTC recovered and allocated 485 lifesaving organs from 145 generous donors in 2019, saving the lives of 417 individuals. In addition, WRTC also recovered tissues from 462 benevolent donors, whose precious gifts could enhance the lives of nearly 35,000 people.

Be part of the miracle. During National Donate Life Month, give people like Malkia hope by registering to be an organ, eye and tissue donor at BeADonor.org.

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Thank You Health Care Workers & Frontline Responders

Every day, more than 30,000 dedicated health care professionals go to work in DC hospitals. Thank you to all the HEROES working to take care of us – no matter what!

© 2021. District of Columbia Hospital Association.