Quality Showcase Publication: Best Practices from DC Hospitals

DC Hospitals are Leaders in Creating Quality Systems of Care
As the District of Columbia Hospital Association (DCHA) celebrates the milestone of 45 years acting as a unifying force advancing hospitals and health systems in the District, we are proud to share examples of our hospitals’ commitment to patient safety that drives positive outcomes. In collaboration with members and the community, we seek to promote policies and initiatives that strengthen our system of care, preserve access, eliminate disparities, and promote better health. We are proud to highlight the work of our hospital members to improve patient safety and quality in a time of competing priorities. The initiatives presented in this publication emphasize quality improvement methodology and highlight the innovative and effective projects taking place within District hospitals. These initiatives represent the dedication of our health leaders in the District to provide quality and equitable care for the communities we serve.

 

Sibley Memorial Hospital Addresses Equity, Diversity and Inclusion with its Ward Infinity Program

 

Ward Infinity is designed to partner with change agents to magnify and accelerate their capacity to radically improve underinvested communities’ health and well-being by reducing health disparities and building health equity through community-driven solutions. We partner with founders in Washington, D.C. that have an impact and show a commitment to creating wealth and solving for social determinants of health that significantly impact Wards 7 & 8. The goals of the program are to eliminate disparities, increase inclusion, build trust and ensure viability. The program also addresses food, relationships, environment, health technology and health care systems.

July 2023 Utilization Report

There was a slight increase in the percentage of psychiatric admissions compared to the January 2020 pre-COVID baseline from -23% in June to -22% in July. Also, of note regarding psychiatric admissions: The impact of St. Elizabeths Hospital reopening beds closed during COVID can be seen in tables 6 and 7 of the report where the percent change from the prior year ranges from 44.4% – 87.5%. All other utilization metrics highlighted in Fig. 1 below decreased from June to July a compared to the January 2020 baseline month. Although ambulatory surgery and observation volumes are among those that declined from June to July, information available in the report indicates that both have increased overall when comparing the most recent 12 months to the prior 12 month period by 3.25% (Table 16) and 6.48% (Table 17) respectively.

 

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

Chairman Vincent C. Gray and Dr. Kurt Newman to Receive Awards

Hospital and Health Care Advocates to Receive Awards at

DCHA’s 45th Anniversary Gala, November 16

 

Chairman Vincent C. Gray to Receive Health Equity Award

The DCHA Board of Directors has selected Chairman Vincent C. Gray (Ward 7 Councilmember and Chair, Committee on Hospital & Health Equity) as the first honoree to receive DCHA’s Health Equity Award. This much deserved recognition is in honor of Chairman Gray’s decades of service to the District of Columbia and his perseverance in ensuring that all residents have access to quality health care. Chairman Gray’s steadfast and unwavering commitment to creating a system of health care that ensures access that should not be limited based on zip code will soon be a reality with the opening of the Cedar Hill Regional Medical Center, slated to open the Fall of 2024. This is just one example of his legacy of commitment and dedication to eradicating health disparities.

Dr. Kurt Newman to Receive Robert L. Sloan Leadership Award 

The DCHA Board of Directors has selected Dr. Kurt Newman, former President & CEO of Children’s National Hospital, to receive the Robert L. Sloan Leadership Award for his years of service and demonstrated leadership qualities. Dr. Newman’s commitment to fostering successful relationships and partnering with the DC health care community, along with his high personal integrity and professional excellence, has made a positive impact on the residents of DC and beyond. The Robert L. Sloan Leadership Award is presented to a senior level individual from a DCHA member hospital for having demonstrated the qualities of leadership inspired by Mr. Sloan. Named in honor of the former President & CEO of Sibley Memorial Hospital from 1985 until 2012, he also served two terms as Chairman of the DCHA Board of Directors.

MedStar Washington Hospital Center Named Socially and Racially Responsible Hospital

MedStar Washington Hospital Center is the most socially responsible hospital in Washington, D.C. and is tops in the nation, according to the Lown Institute, a nonpartisan health care think tank.

The 2023-24 Lown Institute Hospitals Index evaluated more than 3,600 hospitals nationwide, and MedStar Washington Hospital Center ranked #1 in D.C. and is one of only 54 U.S. hospitals to earn Honor Roll status with “A” grades in all top categories: Social Responsibility, Health Equity, Value of Care, and Patient Outcomes — key performance metrics that contribute to the overall rating. It also named MedStar Washington the most racially inclusive hospital in the District.

In 2022, MedStar Washington Hospital Center earned the designation of “LGBTQ+ Healthcare Equality Leader” in the Human Rights Campaign Foundation’s Healthcare Equality Index (HEI), with the top score of 100. This designation recognizes the hospital’s continued commitment to an equitable, inclusive environment for both patients, visitors, and staff.

To compile its rankings, the Lown Institute used publicly available data from Medicare fee-for-service and Medicare Advantage claims, Centers for Medicare and Medicaid Services safety data and hospital cost reports, Internal Revenue Service 990 forms, and other sources. Learn more at LownHospitalsIndex.org.

Behavioral Health Emergency Room Dilemma: Children Waiting in Crisis

Logo of XFERRAL

While emergency department (ED) visits for other medical causes that affect children declined in the early stages of the pandemic, the number of children’s mental health-related ED visits rose 24% among 5- to 11-year-olds. It also surged 31% among 12- to 17-year-olds in April 2020 through October, compared to that period in 2019, according to a November Centers for Disease Control and Prevention report. During the pandemic we also saw a rise in ED visits for suspected suicide attempts among young people. Among teen girls, such visits were up 51% from February to March earlier this year compared to 2019, according to a June CDC report. These are staggering experiences facing youth and children today. Complicating these situations even more is the difficult experience of accessing care when crisis care is needed.

Most children and adolescents experiencing a behavioral health crisis wait hours or even days for placement in clinically appropriate therapeutic treatment. One study documents an average length of stay in the hospital emergency department for psychiatric admissions of 18 hours, compared to 5 hours for non-psychiatric admissions.1 Others have estimated average boarding times of between 6.8 hours and 34 hours for patients needing psychiatric treatment.2,3  Children’s hospitals reportedly saw a 45 percent increase in pediatric self-injury and suicide cases between January and July 2021. In 2020, pediatric mental health-related hospital emergency department visits increased 24% for children ages 5-11 and 31% for older children and adolescents.

“Extended ED boarding is detrimental for children and adolescents with behavioral health issues,” said Jennifer Wolff, PhD, an associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, a staff psychologist at Rhode Island Hospital and Bradley hospitals, and the director of the Adolescent Mental Health Collaborative at Brown.

Dr. Wolff and her colleagues found a threefold increase in the number of pediatric patients who boarded in their children’s hospital ED over the past three years and a 60% increase in the average time spent boarding in the ED. (Adm Policy Ment Health. 2023 Jan;1; https://bit.ly/3KaUqJ0.)

Dr. Wolff said care delayed further can also exacerbate existing problems. “For some of these kids who have really chronic psychopathology and are going to need long-term care, we run the risk of them having a negative experience that is so detrimental that it is a deterrent to them seeking care later on,” she said. “People are becoming aware that the system is broken and that we need to do more to serve these kids, but I wish there was more help coming faster.”

In August of 2023, American Academy of Pediatrics published a The Management of Children and Youth with Pediatric Mental and Behavioral Health Emergencies with Recommendations for Optimizing and Improving Care of Pediatric Patients with Mental Health Emergencies which included referral networks and the use of technologies to improve care coordination which is where XFERALL helps.

XFERALL’s mission is to drastically save time for clinical staff and reduce the amount of time patients spend in EDs waiting for a transfer to the most appropriate care center by applying innovative technology solutions. XFERALL enables real-time communication so that clinicians needing to place a patient can request placement at as few or as many facilities as they choose; receive responses from facilities or programs that can accept and treat the patient; and share clinical information — all within minutes from a single source.

This coordinated approach allows caregivers and patients to be engaged in the decision-making process. In states that have adopted XFERALL, finding placement for youth and children went from multiple hours or days to sixty minutes or less on average.  In just a matter of minutes, providers can coordinate and provide options for families seeking care for their child.

XFERALL partners with health systems, mental health crisis teams and healthcare providers across the nation to expedite access to care for children and adolescents experiencing a mental health crisis. In July of 2023, the median time to secure placement on the XFERALL network was 36 minutes.  XFERALL is available nationwide and continues to expand with the mission of driving quality improvement through expediting access to care. To learn more about this program and how it can support improving access for youth in crisis visit us aqui.

Sources:

1 Nicks BA, Manthey DM. The impact of psychiatric patient boarding in emergency departments. Emerg Med Int 2012; 2012: 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Patient and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Ann Emerg Med. 2012;60(2):162–71.

3 Tuttle GA. Access to psychiatric beds and impact on emergency medicine. Chicago, IL: Council on Medical Service, American Medical Association; 2008.

4 Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health, October 19, 2021.

June 2023 Utilization Report

Highlights: There was a decrease in volumes across all five summary utilization metrics from May to June 2023. Observation admissions show the steepest decline going from 34% over pre-COVID baseline in May to -2% below baseline in June 2023, followed by ambulatory surgery with a change from 6% above baseline in May to -1% below baseline in June. There was a slight decrease in acute care admissions from -13% below baseline in May to -14% in June, while emergency department visits decreased from -18% to -20%. Please note that civil commitment admissions for FD-12 hospitals were added to the report and are depicted in Table 5 and Chart 3 of the report. Civil commitment admissions were above the 15-month median (April 2022 – June 2023) for the most recently reported four months ending in June 2023.

Children’s National Hospital Diversity, Equity and Inclusion Report

Children’s National Hospital is committed to a foundation of transparency, accountability and commitment to build a culture of diversity, equity and inclusion. By using data to inform their DEI work, helps improve the accuracy of race and ethnicity data to better engage both the patient and provider communities to investigate and address any identified inequities in care.

The integration of data-driven approaches allows Children’s National to base their work on the collection and analysis of evidence, use it to identify root causes for any inequities and develop interventions based on the data. It also helps to measure and track progress over  time. Children’s National strives to support their diverse employees, patients and families and foster, nurture and sustain a culture in equitable and inclusive ways.

Social Determinants of Health Z Code Webinar

Recently, The Joint Commission and The Centers for Medicare and Medicaid Services released regulatory measures for hospitals to address social needs. This overlaps with DC Department of Health Care Finance/CRISP SDOH Initiative which aims to prioritize the collection, exchange, and use of social needs.

Join DCHA, in collaboration with the Haugen Education Group, for a live webinar to learn more about social determinants of health (SDOH) Z codes. Learn how to collect, document, use, report, map SDOH data codes, and how to increase use of SDOH Z codes to support your hospital in meeting these new initiatives. This activity qualifies for 1 AHIMA/AAPC CEU.

© 2024. District of Columbia Hospital Association.