DCHA Abstract Competition Open

Submit Your Abstracts by July 8, 2024

The purpose of the Abstract Competition, as part of the 2024 Health Care & Innovation Summit (formerly known as the Patient Safety & Quality Summit) on October 30, is to stimulate systematic investigation by health care professionals, provide a venue to share innovative and effective programs, showcase unique projects, and encourage networking among peers with similar interests. The theme of this year’s Summit is Transforming Health Care: Lead. Collaborate. Improve.

1 Gold – $2,500
1 Silver – $1,500
1 Bronze – $1,000

December 2023 Utilization Report


Most utilization metrics saw a decrease from November to December with the exception of emergency department visits and psychiatric admissions. While ED visits present their highest volume in the past 15 months, ambulatory surgeries on the other hand saw their biggest decrease in volumes this month going from -4% below the pre-COVID baseline in November to -14% in December. Newborn admission saw a decrease in volumes this month and are now below the median and civil commitment admissions on the other hand remain above the median of 198 after the the dip in September 2023.


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Minority-Owned Business Enterprises: Transforming Health Care And Advancing Health Equity

Equity is defined as the absence of systemic disparities between groups with different levels of underlying social advantage/disadvantage—wealth, power or prestige. From voter suppression to housing discrimination, racial differences in health outcomes can be explained by centuries of policies and practices that have intentionally excluded nonwhite groups from access to opportunity. Moreover, inequitable practices baked into the “institutions” that shape society sustain seemingly intractable disparities in health.

The institutions of medicine and health care are no exceptions. But as discussed below, many minority-owned business enterprises (MBEs) are challenging the status quo in health and health care, advancing health equity in transformative ways, and bridging the gap between health care and the many social factors that occur outside of care settings but have a huge impact on health.

Authors: Dr. Christopher King, Dean of School of Health, Georgetown University Medical Center and Deliya Banda Wesley, Senior Director of Health Equity, Mathematica

The Cost of the Status Quo: The Consequences of Prolonged Emergency Department Boarding

Op-ed written by Shana Palmieri, LCSW, Chief Clinical Officer and Cofounder, XFERALL


The Washington Post recently published the article ‘An autistic teen needed mental health help. He spent weeks in an ER instead.’ It is beyond distressing to hear repeated stories about the suffering of patients and families like Zach’s, spending days and in this case months in the emergency department waiting for a transition to behavioral health treatment.

As health care providers and administrators, you have likely faced the challenge to ensure timely access to behavioral health services for patients like Zach experiencing a crisis. The health care team working around the clock to facilitate better referrals and placement for clinically appropriate care to meet their needs. Often this is met with challenges, outdated processes and limited options to which this article provides an insight to.  These stressful situations impact everyone involved, the patient, the family, caregivers, and the entire care team.

Speaking from my own experience, many of us have walked into our emergency departments with patients lined up on stretchers needing behavioral health crisis services waiting for hours and days for placement. The challenge is nationwide, with patients languishing in the emergency department causing a myriad of operational and quality of care challenges. Meanwhile the  consequences of emergency department boarding of psychiatric patients present increased risk often leading to negative outcomes that are distressing, traumatic, or potentially life-threatening. The consequences of maintaining the status quo without a systemic intervention to drive improvements spreads across multiples domains.

Quality Patient Care, Safety & Risk Management 

Psychiatric patients boarding in the emergency department increases risk events for the patient themselves, health care professionals and other patients presenting to the emergency department for acute medical conditions. As emergency departments reach their capacity limits, staff are stretched thin sometimes resulting in increased risk events. Quality of care is impacted for all patients because of obstacles to efficient throughput. The entire health care system can become bottlenecked, patient care suffers and at times safety is compromised.

Workforce Inefficiencies and Shortages

The health care industry is amid a critical health care workforce shortage. According to the 2022 NSI National Healthcare Retention & RN Staffing Report, the average hospital turnover rate is now 25.9% – an increase of 6.5%.

During this challenging workforce shortage, highly trained healthcare professionals have to follow manual processes to coordinate care by making repeated phone calls and faxing to find an available behavioral health placement, while delays and patient care is waiting. Hours and hours of precious staff time is wasted on an inefficient process when the opportunity to use resources to automate and improve productivity drastically reducing emergency boarding times is available.

Lost Opportunity and Cost 

The cost of psychiatric emergency department boarding to health system’s is significant. Delayed care leads to poor outcomes and emotional stress felt by staff and patients. Additionally there are financial implications when these scenarios become the norm. Health systems may have to limit their ability to treat and admit higher acuity medical patients. This right sizing for facilities is critical to ensure all services can continue to be provided for communities.

Extended behavioral health boarding costs occur when clinicians are searching for bed placement, for example a mid-sized acute-care hospital were transferring on average 90 behavioral health patients a month. This process took on average over 8 hours per patient to find an appropriate transfer for a bed placement That equated to over 720 hours per month just in staff time to find placement. At the estimated cost of $250 an hour to board a behavioral health patient in the emergency department (includes cost of care and opportunity lost) those 720 hours is equal to a loss of $180,000 per month or $2,160,000 per year. This hospital automated the bed placement process and today their average time to find a bed is under 55 minutes. With these changes the same 90 patients now cost the system only $22,500 per month or $270,000 per year.  That is a cost savings of $1,890,000 annually.

Changing the Status Quo 

The cost of maintaining the status quo is significant. Change is hard. We consistently ask our patients to make significant, difficult, life transforming changes to improve their health, improve their mental health symptoms and eliminate their addictions. Healthcare systems, clinicians and administrators also must engage in this type of proactive change to reap the positive benefits in the years to come.  The cost is too high to keep things the way they are for patients, for families, for health care providers and for the health care system.

A Behavioral Health Automated Transfer Network is available in the District of Columbia and surrounding states.  The automated network offered through XFERALL, a web-based platform with companion mobile application, is available to healthcare systems, first responders, mobile crisis teams and local crisis providers. Working together, standing up an  network, expediting transfers, and using real-time data to drive continuous quality improvement will lead us one day at a time away from the challenges, excess cost, and negative patient and healthcare provider experience and into a future that drives consistent improvements in quality patient care, decreases risk events, improves safety, provides transparent data to enhance regional capacity, addresses staff safety, and improves access to care that ensure patients and families similar to Zach’s have immediate access to quality care.

La plateforme de transfert réduit les temps d'attente et augmente la connectivité au sein de la santé comportementale


Approche collaborative XFERALL en santé comportementale et crise du 988

Depuis des décennies, il est communément admis que les personnes confrontées à une urgence médicale ne doivent pas attendre un traitement. Les directives de traitement pour les personnes victimes de crises cardiaques, d'accidents vasculaires cérébraux et de blessures traumatiques privilégient une réponse rapide. La communauté médicale se réfère à «l'heure dorée» - les 60 minutes pendant lesquelles une personne blessée ou malade devrait recevoir un traitement définitif à partir du moment de la blessure ou de l'apparition des symptômes. Si les soins sont retardés au-delà de cette heure, le risque de complications graves à long terme ou de décès augmente considérablement. De nouveaux systèmes de soins, souvent régionalisés, ont émergé pour s'assurer qu'aucun temps précieux n'est perdu dans le transport, la stabilisation, le traitement et le transfert des patients.

Pourtant, pour les personnes vivant une urgence psychiatrique ou liée à la toxicomanie, une urgence similaire associée à un changement de système n'a pas prévalu. Même en 2022, trop d'hôpitaux, d'équipes de crise, de premiers intervenants et d'autres personnes ayant besoin d'amener rapidement les gens à suivre un traitement de santé comportementale doivent s'appuyer sur des processus manuels obsolètes pour localiser les soins cliniquement appropriés, ce qui entraîne des retards critiques dans les soins. Dans leur recherche de placement, les cliniciens appellent les établissements et les programmes de santé comportementale un par un, laissant des messages, faxant des documents et attendant que les appels soient renvoyés. L'acte apparemment simple de transférer un patient vers des soins de santé comportementale oblige les cliniciens à passer d'innombrables heures sur des tâches administratives répétitives qui les éloignent des soins directs aux patients.

Le résultat est que, bien trop souvent, les enfants, les adolescents et les adultes en crise de santé comportementale attendent des heures, voire des jours, pour être placés dans un traitement thérapeutique cliniquement approprié. Une étude documente une durée moyenne de séjour aux urgences hospitalières pour les admissions psychiatriques de 18 heures, contre 5 heures pour les admissions non psychiatriques1. D'autres ont estimé les durées moyennes d'embarquement entre 6,8 heures et 34 heures pour les patients nécessitant un traitement psychiatrique. 2,3

Aujourd'hui, ces temps d'attente sont probablement encore plus longs, car la pandémie a aggravé la crise de l'embarquement aux urgences de deux manières. Premièrement, les hôpitaux sont à pleine capacité ou au-delà de leur capacité avec des patients atteints de COVID-19 et d'autres conditions physiques graves associées à des pénuries de personnel toujours croissantes. Deuxièmement, la pandémie et l'anxiété, le stress et l'isolement qui y sont associés ont contribué à un besoin accru de soins de santé comportementale, en particulier chez les enfants et les adolescents. Les hôpitaux pour enfants auraient enregistré une augmentation de 45 % des cas d'automutilation et de suicide pédiatriques entre janvier et juillet 2021.4 En 2020, les visites aux urgences des hôpitaux pédiatriques liés à la santé mentale ont augmenté de 24 % pour les enfants âgés de 5 à 11 ans et de 31 % pour les enfants plus âgés et les adolescents. .5

La mission de XFERALL est de faire gagner considérablement du temps au personnel clinique et de réduire le temps que les patients passent aux urgences en attendant un transfert vers le centre de soins le plus approprié en appliquant des solutions technologiques innovantes. La plate-forme permet une communication en temps réel afin que les cliniciens qui doivent placer un patient puissent demander un placement dans aussi peu ou autant d'établissements qu'ils le souhaitent ; recevoir des réponses d'établissements ou de programmes qui peuvent accepter et traiter le patient ; et partager des informations cliniques, le tout en quelques minutes et au sein d'une source unique. Cette approche coordonnée permet aux soignants et aux patients de participer également au processus décisionnel.

La District of Columbia Hospital Association et XFERALL, la principale plate-forme mobile de transfert de patients du pays, ont conclu un partenariat qui offre aux hôpitaux du DC un nouveau processus de transfert des patients en santé aiguë et comportementale vers des établissements de soins de santé cliniquement appropriés. Pour en savoir plus, rejoignez-nous le 10 mai pour un webinaire gratuit, Technologie de transfert et de placement des patients en santé comportementale, et découvrez ce programme et comment il peut contribuer à améliorer l'accès pour les patients en crise.

XFERRAL Webinar Graphic

1 Nicks BA, Manthey DM. L'impact de l'embarquement des patients psychiatriques dans les services d'urgence. Emerg Med Int 2012 ; 2012 : 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Déterminants liés au patient et à la pratique de la durée du séjour aux urgences pour les patients atteints de maladie psychiatrique. Ann Urgence Méd. 2012;60(2):162–71.

3 Tuttle AG. Accès aux lits psychiatriques et impact sur la médecine d'urgence. Chicago, Illinois : Conseil des services médicaux, Association médicale américaine ; 2008.

4 Pédiatres, psychiatres pour enfants et adolescents et hôpitaux pour enfants déclarent une urgence nationale en santé mentale pour enfants, 19 octobre 2021.

aacap.org/aacap/zLatest_News/Pediatricians_CAPs_Childrens_Hospitals_Declare_National_Emergency_Childrens_ Mental_Health

5 Idem

ONE-DC : Qui sommes-nous ?

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 – Secrétaire
Assistant CNO, The George Washington University Hospital

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.


       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.


© 2024. District of Columbia Hospital Association.