A Regional Resource

Elevating the Level of Care in Suffolk

• Stony Brook University Medical Center is Suffolk County’s only tertiary hospital and Level 1 Trauma Center, and is the only academic medical center on Long Island. Certified for 540 beds, with more than 4,800 employees, it is the largest hospital in Suffolk County. SBUMC treats approximately 30,000 inpatients, more than 250,000 outpatients and is where more than 15,000 surgical cases are performed.

• SBUMC provides training programs for community hospitals in the region (e.g. Institute for HealthCare Improvement (IHI) patient safety regional trainers; regional disaster preparedness).

• SBUMC is the regional referral center for trauma, stroke and stroke intervention, perinatal and neonatal intensive care, burns, ALS, pediatric and maternal HIV/AIDS, pediatric and adult multiple sclerosis, and Comprehensive Psychiatric Emergency Services.

• SBUMC brings new advances to Suffolk, such as stroke clot removal from the brain, surgical robotic devices, MRSA vaccine (to prevent super bug methicillin resistant staphylococcus infections) and other groundbreaking clinical trials.

• SBUMC established and funds the First Responder Program in Eastern Long Island, serving the areas of Manorville/East Moriches and Riverhead/Mattituck in an effort to enhance access to advanced life support.

The Role of Academic Health Care Centers

Many of SBUMC’s patients are transferred after failing at another hospital, requiring the specialized physicians and advanced services only available at SBUMC. An important role of academic medical centers is to care for these very sick patients. SBUMC’s healthcare excellence has been recognized by numerous external groups such as the Institute for Healthcare Improvement (IHI), Healthcare Association of New York State, Consumer's Choice Award (National Research Corporation), University HealthSystem Consortium, and the U.S. Department of Health and Human Services.

Quality Indicators and Initiatives

SBUMC’s care and outcomes have been consistently improving because of a long-term commitment to team-based performance improvement involving patients, staff, physicians and allied health professions, extensively using technology to ensure effective care.

• Despite admission of the sickest patients, SBUMC has decreased hospital-wide mortality for five consecutive years with a decline of >25% since 2002 (approximately twice the decline in the national and University HealthSystem Consortium (UHC) averages). The rate of decline of mortality has been amongst the fastest in the nation, compared to academic health centers in the UHC, which recognized SBUMC for leadership in this effort.

• Reduced mortality of patients with severe sepsis admitted through the ED of 28% since 2006 (recognized by HANYS).
  
  
• Reduced the incidence of ventilator-associated pneumonia in the Medical ICU of 70% in 2007 vs. 2006.
  
  
• Reduced the incidence of retinopathy of prematurity (ROP) in the NICU. ROP is injury to a neonate’s retina which may result in permanent blindness; in three of the last five quarters there were none.

• Improvements in neonatal nutrition and the use of checklists have led to improvements in neonate head circumference for very low birth weight infants as a result of  >20% increase in protein intake by day four and improved time to achieve a daily intake of 100 kcal/kg. These efforts have resulted in consistent improvement in neonatal head circumference (a measure of brain development).

• The adoption of the Patient Safety Net, an online medical error and near miss reporting system, resulting in a 400% increase in reported incidents (compared to paper reporting) allowing more complete capture of potentially hazardous situations. SBUMC understands the importance of encouraging reporting of potentially risky situations to prevent future events.

• The adoption of “simulations” in several areas to prepare and prevent high risk conditions have led to improvements in outcomes. For example, simulations and team training for code blue (heart arrest), for Code Noelle for maternal hemorrhage (SBUMC developed the state-endorsed best practice) and the adoption of a uniform education, simulation and supervision program for certification for central line insertion. 

• Process changes have led to substantial decreases in hospital-acquired pressure ulcers.

• In the operating room (OR), work flow and process redesign relating to medication management and tissue specimen management with the adoption, in part, of medication and tissue "time-outs" have improved patient safety.

Preventing Errors by Deploying Systematic Processes

• Designed to reduce cardiac arrest “codes,” SBUMC has put in place Rapid Response Teams (RRT) to respond immediately, 24 hours a day, seven days a week, to acute deterioration in patient status throughout the Hospital. These teams can be activated by healthcare providers and/or patients and families. RRTs have been successful. The number of “cardiac arrest” codes per 1,000 discharges fell from an average of greater than 4.5 per month in the first four months of RRT operation to less than 3.5 per month in the corresponding period a year later – a greater than 20 per cent decline. This has also coincided with a significant decline in patient mortality. 

• Designed to reduce the number of Rapid Response calls, SBUMC has put in place proactive early warning systems, to rapidly catch potential patient deterioration, called pediatric early warning scores, medical early warning scores, and surgical early warning scores i.e. PEWS, MEWS and SEWS.

• Designed to improve communication and speed recovery, all intensive care units have adopted unit-specific daily goal sheets and initiated multidisciplinary rounding. 

• Tactical initiatives to improve "nurse sensitive indicators" like prevention of bed sores and urinary tract infections have been widely initiated.

• SBUMC has deployed numerous IHI “bundles” or checklists, to assure best practice, and in areas like cardiology, we are approaching the 100% compliant milestones. 

• SBUMC has had a focus on improving patient satisfaction, which has been consistently rising as measured by Press Ganey Surveys. SBUH now ranks in the 80th percentile on LI for overall inpatient satisfaction and the highest in food services satisfaction.

• Consistent with the road map laid out by the Institute of Medicine, we are moving toward Patient and Family Centered Care to improve safety, quality of care and operational efficiency. The patient and family become equal and important members of each health care team. SBUMC has had a focus on involving patients and families in the care delivery process, putting in place numerous family advisory groups (pediatrics, cancer, cardiology, etc.).

Making Connections with the Community

• Established Quality Assessment Review Board to help SBUMC further improve clinical process and outcomes. The members of QARB are a group of well-recognized NY citizens chaired by Mr. Matt Cody, a Port Jefferson resident.

• Established Stony Brook Patient Safety Council, a group of national and international quality experts to advise on strategies to improve care. 

• Established First Responder Program in Eastern Long Island (Manorville/East Moriches & Riverhead/Mattituck) in an effort to reduce cardiac mortality.

• Established Patient Transfer Center to speed and simplify patient transfer via a single phone call.

• As part of its community service activities, SBUMC provides nearly 1,000 educational and health-related programs and events each year to the community.