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 piattaforma di trasferimento riduce i tempi di attesa e aumenta la connettività all'interno della salute comportamentale


Approccio collaborativo per la salute comportamentale di XFERALL e crisi 988

Per decenni, è stato comunemente inteso che le persone che si trovano in un'emergenza medica non dovrebbero aspettare il trattamento. Le linee guida terapeutiche per le persone che subiscono attacchi di cuore, ictus e lesioni traumatiche danno la priorità alla risposta rapida. La comunità medica si riferisce all'"ora d'oro" - i 60 minuti entro i quali una persona ferita o malata dovrebbe ricevere un trattamento definitivo dal momento della lesione o dall'insorgenza dei sintomi. Se l'assistenza viene ritardata oltre questa ora, il rischio di complicazioni gravi a lungo termine o di morte aumenta significativamente. Nuovi sistemi di assistenza, spesso regionalizzati, sono emersi per garantire che non si perda tempo prezioso nel trasporto, stabilizzazione, trattamento e trasferimento dei pazienti.

Tuttavia, per le persone che vivono un'emergenza psichiatrica o da uso di sostanze, un'urgenza simile unita al cambiamento del sistema non ha prevalso. Anche nel 2022, troppi ospedali, squadre di emergenza, soccorritori e altri che hanno bisogno di portare rapidamente le persone a un trattamento sanitario comportamentale devono fare affidamento su processi manuali obsoleti per individuare cure clinicamente appropriate, che causano ritardi critici nelle cure. Nella loro ricerca di un posto, i medici chiamano uno per uno le strutture e i programmi di salute comportamentale, lasciando messaggi, inviando documenti via fax e aspettando che le chiamate vengano restituite. L'atto apparentemente semplice di trasferire un paziente all'assistenza sanitaria comportamentale richiede ai medici di dedicare innumerevoli ore a compiti amministrativi ripetitivi che li sottraggono alla cura diretta del paziente.

Il risultato è che, troppo spesso, bambini, adolescenti e adulti che vivono una crisi di salute comportamentale aspettano ore o addirittura giorni per essere inseriti in un trattamento terapeutico clinicamente appropriato. Uno studio documenta una durata media della degenza nel pronto soccorso dell'ospedale per ricoveri psichiatrici di 18 ore, rispetto alle 5 ore per ricoveri non psichiatrici.1 Altri hanno stimato tempi medi di imbarco compresi tra 6,8 ore e 34 ore per i pazienti che necessitano di cure psichiatriche. 2,3

Oggi, questi tempi di attesa sono probabilmente ancora più lunghi poiché la pandemia ha peggiorato la crisi dell'imbarco in DE in due modi. Uno, gli ospedali sono al di sopra o al di là della capacità con pazienti con COVID-19 e altre gravi condizioni fisiche associate a una carenza di personale sempre crescente. In secondo luogo, la pandemia e l'ansia, lo stress e l'isolamento associati hanno contribuito a un maggiore bisogno di assistenza sanitaria comportamentale, in particolare tra bambini e adolescenti. Secondo quanto riferito, gli ospedali pediatrici hanno visto un aumento del 45% dei casi di autolesionismo e suicidio pediatrici tra gennaio e luglio 2021.4 Nel 2020, le visite al pronto soccorso ospedaliero pediatriche relative alla salute mentale sono aumentate del 24% per i bambini di età compresa tra 5 e 11 anni e del 31% per i bambini più grandi e gli adolescenti .5

La missione di XFERALL è di risparmiare drasticamente tempo per il personale clinico e ridurre la quantità di tempo che i pazienti trascorrono in PS in attesa di essere trasferiti al centro di cura più appropriato applicando soluzioni tecnologiche innovative. La piattaforma consente la comunicazione in tempo reale in modo che i medici che necessitano di posizionare un paziente possano richiedere il posizionamento in tutte le strutture che desiderano; ricevere risposte da strutture o programmi in grado di accogliere e curare il paziente; e condividi le informazioni cliniche, il tutto in pochi minuti e all'interno di un'unica fonte. Questo approccio coordinato consente anche agli operatori sanitari e ai pazienti di essere coinvolti nel processo decisionale.

La District of Columbia Hospital Association e XFERALL, la principale piattaforma mobile per il trasferimento dei pazienti della nazione, hanno stretto una partnership che offre agli ospedali DC un nuovo processo per il trasferimento di pazienti affetti da patologie acute e comportamentali a strutture sanitarie clinicamente appropriate. Per saperne di più, unisciti a noi il 10 maggio per un webinar gratuito, Tecnologia di trasferimento e posizionamento dei pazienti per la salute comportamentale, e conoscere questo programma e come può supportare il miglioramento dell'accesso per i pazienti in crisi.

XFERRAL Webinar Graphic

1 Nicks BA, Manthey DM. L'impatto dell'imbarco dei pazienti psichiatrici nei reparti di emergenza. Emerg Med Int 2012; 2012: 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Determinanti relativi al paziente e alla pratica della durata della degenza in pronto soccorso per i pazienti con malattie psichiatriche. Ann Emerg Med. 2012;60(2):162–71.

3 Tuttle GA. Accesso ai letti psichiatrici e impatto sulla medicina d'urgenza. Chicago, IL: Council on Medical Service, American Medical Association; 2008.

4 Pediatri, psichiatri infantili e adolescenziali e ospedali pediatrici dichiarano l'emergenza nazionale nella salute mentale dei bambini, 19 ottobre 2021.

aacap.org/aacap/zLatest_News/Pediatricians_CAPs_Childrens_Hospitals_Declare_National_Emergency_Childrens_ Mental_Health

5 Ibid

ONE-DC: chi siamo

ONE DC è un'organizzazione senza scopo di lucro composta da leader infermieristici e infermieri che aspirano a diventare leader. Ciò include infermieri di tutti i contesti e specialità, che ricoprono incarichi come dirigenti infermieristici, amministratori, dirigenti infermieri, educatori infermieri, responsabili della qualità infermieristica, leader del personale infermieristico e ricercatori di tutto il Distretto di Columbia. L'organizzazione affronta la forza lavoro infermieristica, l'amministrazione, l'istruzione, la pratica basata sull'evidenza, la ricerca, la politica sanitaria e le questioni della pratica professionale.

Ufficiali ONE DC:

Laura Hendricks-Jackson - Presidente/Tesoriere ad interim
CNO, Sibley Memorial Hospital

Hazel Darisse – Segretario
Assistente 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.