Members of the community can feel confident turning to a trauma program that offers swift Emergency Department admission, access to expert treatments for STEMI and stroke, and medical care enriched by a collaboration with Stony Brook Medicine.
James A. Vosswinkel, MD, FACS, board-certified surgical critical care physician and new Trauma Medical Director at Brookhaven Memorial Hospital welcomes one of the many visiting ambulances, with more than 70,000 visits a year coming through the Emergency Department.
When patients come to the hospital via ambulance or the Emergency Department, they need fast service. They also want to feel cared for and reassured that they are receiving the advanced medical treatments they need. Physicians at Brookhaven Memorial Hospital are turning to data-driven processes to make sure that is exactly what happens.
“We have systemized our whole process to increase efficiency,” says Badri P. Nath, MD, MBA, general surgeon, past president of the Suffolk County Medical Society and past president of the medical staff at Brookhaven Memorial Hospital Medical Center. “We are working to offer a high-quality experience to each and every patient.”
New York State has shifted how it administers emergency and trauma medicine, according to James A. Vosswinkel, MD, FACS, board-certified surgical critical care physician and Trauma Medical Director at Brookhaven Memorial Hospital, and those changes are reflected in the care offered at Brookhaven Memorial Hospital.
“Most states run their own trauma systems, which are proven by the National Highway Traffic Safety Association to decrease trauma fatalities by 30 percent and to improve cost savings and increase productive years of life,” he says. “New York State originally developed its own trauma system, but, about three years ago, our Department of Health decided to transition from a state-verified system to the so-called ‘gold standard’ of trauma verification, which is the American College of Surgeons [ACS] Committee on Trauma [COT] verification system.”
This change established a new series of requirements that hospitals must meet to achieve or maintain their trauma designation, Dr. Vosswinkel continues. Brookhaven Memorial Hospital has welcomed these changes, adopting stringent criteria to help ensure patients receive optimal care.
“This is the process Brookhaven Memorial Hospital is going through now,” Dr. Vosswinkel says. “The ultimate aim is for every patient to receive optimal care, according to the high standards set by the ACS.”
Through the Door
The first change patients and families will notice when they visit the Emergency Department at Brookhaven Memorial Hospital is that they see a physician promptly, even before the intake process is complete.
“We’re focused on individual providers and their engagement with patients,” says Brian Lee, MD, Assistant Medical Director at Brookhaven Memorial Hospital. “In trauma care, that means patients receive screening and treatment as soon as possible. We have a physician in triage who is going to meet the patient first thing — in fact, the patient will see the emergency room physician before the admitting clerk. This physician assists the patient and makes an initial assessment.”
Brian Lee, MD, Assistant Medical Director at Brookhaven Memorial Hospital and Wehbeh A. Wehbeh, MD, Chief Quality Medical Officer, review the latest quality indicators, showing continual improvement.
After that, depending on the severity of the patient’s complaint, other mechanisms to expedite care come into play. Among these mechanisms is the early ordering of tests and scans, based on the intake physician’s initial assessment. While the patient will still see an Emergency Department physician for a full examination, the physician’s colleague in the admitting area will likely have a good idea of which tests will be required and can start the process.
For example, the intake physician may believe the patient will need a CT scan. However, CT scans must wait until some bloodwork can be done. The intake physician can order the bloodwork so when his or her Emergency Department colleague orders the CT scan, it can be performed more promptly. The positioning of a physician early in the process, along with the ability of colleagues to anticipate one another’s judgement, makes patient care more timely and less fragmented.
As a result, patients report higher satisfaction rates, and the “door to doc” times needed for ACS accreditation are also shortened. “These little steps help create better patient outcomes and greater satisfaction,” Dr. Nath says.
A Pledge to EMS Volunteers
Emergency medical service providers take point during any trauma case initiated through a 911 call. On call around the clock, these busy providers bring 2.4 patients every hour to Brookhaven Memorial Hospital.
Brookhaven Memorial is committed to offering high-quality service to the community volunteers who serve as first responders, emergency medical technicians and paramedics. The hospital’s EMS pledge details exactly what these community providers can expect for their patients.
Staff members treat EMS providers respectfully and accept care for patients immediately upon arrival. EMS members need not wait or turn down other calls; prompt handoffs are routine. Fresh, healthy food awaits EMS providers in their waiting area, while equipment left behind is cleaned and returned to the proper jurisdiction. Most important, Brookhaven Memorial Hospital realizes that EMS providers have a choice where they will transport patients, and pledges that patients taken to Brookhaven Memorial will receive high-quality care, immediately upon arrival and for the duration of their stay.
Care for Stroke and STEMI
Once patients are triaged — and more rapidly if they come via EMS transport — they can find high-quality, lifesaving care at Brookhaven Memorial Hospital, including stroke and heart attack treatments. For achieving American Heart Association/American Stroke Association performance criteria and quality measures, the Stroke Center was recently awarded the Get With The Guidelines Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll. Meanwhile, Brookhaven Memorial Hospital’s Knapp Cardiac Care Center features a state-of-the-art cardiac catheterization lab, and boasts low “door to balloon” times.
“We have a very robust team of nurses, nurse practitioners, neurologists and emergency physicians who oversee stroke care,” says Dr. Lee, who is himself board-certified in emergency medicine. “Each and every triage nurse is trained in stroke recognition and educated in the importance of timely care. We can swiftly identify possible stroke patients, order a CT scan and administer tissue plasminogen activator to those who need it. Our relationship with Stony Brook Medicine means we can smoothly transition those stroke patients who will need interventional procedures.”
“Brookhaven Memorial Hospital physicians provide their community with enhanced care, not just in trauma but in every field of medicine. We are trying to position ourselves to give the best quality and delivery of care we can to that community of patients who use Brookhaven Memorial as their primary hospital. We are not the Brookhaven Memorial Hospital of the past; we are the Brookhaven Memorial Hospital of the future. Under the guidance of our CEO, Richard T. Margulis, we are aiming to ensure we compete with quality.”
— Badri P. Nath, MD, MBA, general surgeon, past president of the Suffolk County Medical Society and past president of the medical staff at Brookhaven Memorial Hospital Medical Center
For patients experiencing an ST-elevation myocardial infarction, Brookhaven Memorial Hospital staff can administer treatments such as percutaneous coronary intervention. EMS providers are able to make quick decisions, knowing Brookhaven Memorial Hospital can receive both stroke and heart attack patients, Dr. Lee says.
A Partnership for Patient Care
An arrangement with Stony Brook Medicine benefits providers and patients alike.
“We’re collaborating specifically with their department of surgery and their subdivision of trauma,” Dr. Lee explains. “Their tertiary center can provide seamless care to patients with conditions more complex than we can handle in-house at Brookhaven.”
Dr. Vosswinkel with members of the OR team who take care of our trauma patients
Dr. Vosswinkel, as well as serving as Brookhaven Memorial Hospital’s Trauma Medical Director, represents Stony Brook Medicine, where he is a member of the faculty as well as Chief of Trauma, Emergency Surgery and Surgical Critical Care.
“My goal is to help Brookhaven Memorial Hospital advance care,” he says. “With Brookhaven and Stony Brook physicians working together, we augment the existing system.”
If patients do need to be transferred to a higher level of care, they can be swiftly moved to a Stony Brook facility. The Stony Brook physicians at Brookhaven Memorial Hospital need only contact their colleagues at Stony Brook Medicine to initiate the transfer, and imaging is sent electronically. However, the agreement also helps many patients receive treatment in place without leaving the community. Board-certified Stony Brook trauma providers housed at Brookhaven Memorial Hospital provide care alongside Brookhaven Memorial’s physicians, sharing knowledge and experience with them.
“They are on the ground floor next to us, taking trauma call and seeing patients in our Emergency Department, to the benefit of the community,” Dr. Lee says. “We aim to expand the services available to patients closer to home, and provide a higher level of care within a framework that ensures continuity.”
The collaboration with Stony Brook also contributes to Brookhaven Memorial Hospital’s quality improvement program, Dr. Nath says. A comprehensive Performance Improvement and Patient Safety (PIPS) program has been instituted, covering everything from a patient’s first pre-hospital contact, such as a 911 call, to discharge and rehabilitation. Dr. Vosswinkel brought a database manager and a trauma registrar devoted to quality improvement with him from Stony Brook Medicine. Careful record-keeping is necessary for a number of purposes: to achieve ACS trauma center verification, to measure performance against local and national benchmarks, and to examine individual incidents in order to discern where performance could have been improved.
Badri P. Nath, MD, MBA, general surgeon, past president of the Suffolk County Medical Society and past president of the medical staff at Brookhaven Memorial Hospital Medical Center, and Dr. Lee discuss the newly implemented trauma processes.
Dr. Nath, who has a background in quality assurance, takes a keen interest in performance data of all kinds.
“We use quality metrics and performance improvement processes so we can identify gaps, perform loop closures and improve our performance,” he says. “We are drawing on the expertise of Stony Brook’s trauma staff to help us in that regard.”
As part of the performance improvement process, Dr. Nath says, Brookhaven Memorial Hospital is incorporating Stony Brook’s data analysis techniques.
“For example, if a patient comes to the hospital and his or her outcome, according to national standards, should be discharge in three days and complete return to an active lifestyle in 20 days, but that patient is discharged in five days or can only resume full activities after 30 days, we know we want to do better,” Dr. Nath illustrates. “We look at the process our patient went through. For example, if a physical therapist initially saw the patient on day two versus day one of his or her stay, that can make a significant difference in the patient’s outcome. Early ambulation in the morning on the first day significantly impacts length of stay.”
“We evaluate everything and put action plans in place to address any issues that arise,” Dr. Vosswinkel adds. “We can isolate whether an error was due to a practitioner or a system flaw. We then resolve the issue to provide optimal care for the patient. The crux of the process is the PIPS program that is independent, yet integrated with the hospital. It allows us to put everything we do under a microscope and ensure we are giving the right quality care.”
“Brookhaven Memorial Hospital is here to stay as a trauma center. From our physicians on the ground to our administration, we are 100 percent committed to executing the best possible care for our community.”
— Brian Lee, MD, Assistant Medical Director at Brookhaven Memorial Hospital
Benchmarking is only part of this puzzle, Dr. Nath continues. Communication between departments is also key. In the above example, staff from the emergency physicians to the physical therapy team must share data and be on the same page regarding standards and outcomes. Additionally, integration among departments helps ensure patients receive uniform care.
“Previously, we were in silos,” Dr. Nath says. “Now, we are in one big circle of coordinated care. We are creating an integrated approach internally; externally, we are comparing ourselves to regional, state and national benchmarks. We have set defined protocols in each department so no one falls through the cracks. Patients are all treated the same way, so we can replicate processes and, if they fail, identify those points of failure to target for improvement.”
“The beauty of this process is we can scrutinize which specific criteria are met as patients progress through the whole system,” Dr. Vosswinkel says. “There are specifications for the operating room, the blood bank, radiology, rehabilitation — it’s a very complex, comprehensive system.”
All care of patients admitted to the Emergency Department, from first 911 call to discharge and rehab, falls under the purview of the trauma medical staff, Dr. Nath explains.
Cynthia Linder, Assistant Vice President of Nursing with Dr. Nath and two of the specialty trained emergency department nurses, an important part of the coordinated team.
“In the past, care was divided into different silos in the hospital,” he says. “Now, we are bringing providers together through an integrated approach. If a patient is admitted for cardiac issues, for example, a cardiologist will see him or her, but we as trauma surgeons are championing the process, taking the lead role to achieve better outcomes.”
This is in accordance with the ACS’s Resources for the Optimal Care of the Injured Patient, which charges trauma medical directors with overseeing the care trauma patients receive from first point of contact through rehabilitation.
As Chair of the Regional Trauma Advisory Committee for Suffolk County, Dr. Vosswinkel says he has an obligation to promote the best trauma care for every patient. Part of that mission is strengthening the community hospitals that provide that care.
“My colleagues [from Stony Brook Medicine] and I are excited to be at Brookhaven Memorial Hospital. We are entering an excellent institution and we are here to help them advance. We are excited to be part of the Brookhaven family, to interact with them and to share in the care of their patients.”
— James A. Vosswinkel, MD, FACS, Trauma Medical Director at Brookhaven Memorial Hospital
Dr. Vosswinkel, Chief of Trauma, Emergency Surgery and Surgical Critical Care at Stony Brook Medicine has taken on a new role, Trauma Medical Director at Brookhaven Memorial Hospital Medical Center to continue to improve and expand the trauma services available for the community.
“I believe Brookhaven Memorial Hospital is an essential part of our existing trauma system and has served in this role well over the years,” he says. “We are here to help them continue to grow, take excellent care of patients and to advance in step with the rest of the trauma system.
“Brookhaven Memorial Hospital is meeting and potentially exceeding national standards. When they come to our hospital, injured patients can rest assured they will receive top-notch care.”
To learn more, visit brookhavenhospital.org.