Nursing Risk Assessment

Client
New York-Presbyterian Hospital
Faculty
John Donnellan
Team
Jill Burton, Kerri Donohoe, Jodi Elkins, Kathleen Schwarz

A leader in medical education, research, and patient-centered care, New York Presbyterian Hospital (NYP) consists of six core campus sites plus several regional affiliated hospitals. Recently, NYP and five select regional hospitals agreed to change their legal status to “active parent affiliates.” With this change, NYP has greater responsibility for, and control over, the management of the regional hospital and the quality of nursing care provided. NYP engaged a Capstone team to conduct a risk assessment of each regional hospital’s processes for creating, reviewing, and implementing nursing policies and procedures. The team interviewed each regional hospital’s Chief Nursing Officer and Nursing Management team and surveyed clinical nursing staff using an electronic survey. After reviewing each regional hospital’s table of organization and policies, the team created a risk assessment grid. The team produced a final report which included examples of best practices for policy creation and review, and explored areas for integration between the core campuses and the regional hospitals.

Reducing Length of Stay on General Medicine Units

Client
New York-Presbyterian Hospital
Faculty
John Donnellan
Team
Jennifer Carew, Sarah Flood, Alicia Glavin, Alexandra Grainger, Jodi Kneisel

The effective management of Length of Stay (LOS), or the duration of a single episode of hospitalization, is critical to ensuring positive patient outcomes as well as managing hospital resources effectively. In order to reduce LOS, it is imperative to understand the root causes of increased LOS. NewYork-Presbyterian/Weill Cornell Medical Center, a leading medical center in New York City, engaged a Capstone team to examine delays and develop action plans to reduce and/or eliminate delays to decrease LOS. Focusing on inpatient medical units, the team surveyed members of the interdisciplinary teams, collected data during observation of interdisciplinary rounds, and conducted focus groups. From this research, the team identified common communication and process barriers to an effective and timely patient discharge. In addition, the Capstone team performed a comprehensive literature review to identify best practices for LOS reduction. The team analyzed staff perceptions of barriers to timely discharges and recommended strategies for improving communication between all stakeholders to reduce delays related to the discharge process.

Integrating Social Determinants in a 30-Day Congestive Heart Failure Readmission Assessment Tool

Client
New York-Presbyterian Hospital
Faculty
John Donnellan
Team
Virginia Bjornton, Billy Faller, Lucia Hu, David Suarez

Affiliated with two Ivy League medical schools, New York-Presbyterian Hospital (NYP) is one of the largest hospitals in New York City. Of NYP’s 44,764 patients discharged from January – May 2015, 3,509 (7.8%) were readmitted within 30 days. Among the 1,024 Congestive Heart Failure (CHF) patients, however, 161 (15.7%) were readmitted within 30 days. Many CHF readmissions can be prevented through improved follow-up care and collaboration among healthcare providers. A strong indicator of whether NYP is doing its best to manage high-risk patients and improve transitional care is the correlation between preventable 30-day readmissions, follow-up care, and collaboration. Social determinants of health play a crucial role in hospital readmissions. Current stratification tools, utilized to assess the level of risk for readmission, do not integrate these social determinants. The Capstone team designed a CHF Readmission Risk Assessment Tool for NYP with an emphasis on social determinants.

Medication Dispensing System

Client
New York-Presbyterian Hospital
Faculty
John Donnellan
Team
Regina Mansfield, Yana Schramer, Jo Ellen Stache, Kayann Stephens

New York-Presbyterian (NYP) Hospital is a university hospital in New York City. NYP’s nursing leadership and key stakeholders recognize the importance of providing efficient, safe, and cost effective methods of delivering medications from the point of pharmacy dispensing to the point of administering them to patients at their bedside. Desiring further improvements in its medication dispensing process, NYP sought to identify best practices and models that could facilitate improvement. NYP engaged a Capstone team to determine best practices of medication dispensing. The team described the necessary steps of a medication dispensing system that can assist in delivering medication at bedside, and defined measurement processes to evaluate the impact of these recommended improvement strategies. The team examined the strengths and weaknesses of the current system, defined potential improvements that could be implemented to justify moving forward with the current system, and assessed the cost/benefit of full replacement of the existing medication distribution system.

Evaluating and Improving Interdisciplinary Practice

Client
Hospital for Special Surgery
Faculty
John Donnellan
Team
Amy Beer, Mariel Carney, Stephanie Chu, Courtney Elms, Lisa Schmutter

The Institute of Medicine (IOM), a division of the National Academies of Sciences, Engineering, and Medicine that aims to help the government and private sector make informed health decisions, recommends interdisciplinary redesign and integrated infrastructures to support collaborative practice. Additionally, the IOM suggests evidence-based processes supported by clinical information systems to improve outcomes. Although the best methods for implementing interdisciplinary practice (IP) are unclear, leaders at the Hospital for Special Surgery (HSS), the oldest orthopedic hospital in the United States, recognized that it is essential for providing excellent care. HSS sought to evaluate the extent to which current organizational structures are effective in operationalizing IP and how these structures can be improved. HSS engaged a Capstone team to analyze the current state of its IP, assess the functionality of current organizational structures, identify strategies for the operationalization of IP, and suggest an action plan to advance IP at HSS. 

Business Model for Sustainable Growth

Client
Urban Zen Foundation
Faculty
Sarah Gurwitz
Team
Rafael Ayoub, Amit Loungani, Timothy Marsigliano, Jennifer Nahass, Sidharth Sehrawat

The Urban Zen Integrative Therapy (UZIT) program is part of the Urban Zen Foundation, which was established by Donna Karan to raise awareness and inspire change in the areas of well-being. UZIT trains doctors, nurses, and allied healthcare professionals in an integrative approach to symptoms management through yoga therapy, essential oil therapy, Reiki, nutrition, and contemplative care. UZIT is exploring new settings for the provision of its services, such as skilled nursing facilities, corporate wellness programs, and home care. The organization engaged a Capstone team to refine its business strategy and plans for sustainable growth. The team conducted a market assessment, interviews, and industry research to determine the core areas of focus necessary to make the UZIT business model sustainable: online education, credentialing and certification, support resources, and data structures. The team’s final report outlined recommendations on prioritization of these focus areas and action items to move forward with each one.

Community Model for Improving Child Wellness on Staten Island

Client
Staten Island Partnership for Community Wellness
Faculty
John Donnellan
Team
Anna Mae Green, Erica Green, Breanna Ostrander, Vikashini Savadamuthu, Sarah Schuyler

Staten Island Partnership for Community Wellness (SIPCW) works to identify and address emerging health needs on Staten Island. Through partnerships with the Office of the Borough President and myriad community organizations, SIPCW seeks to mobilize an aligned collaborative response to address the borough’s most urgent public health needs. Childhood obesity rates on Staten Island’s north shore are close to 40%, with even higher prevalence among minority children. As obese children are at risk for developing long-term chronic diseases, including diabetes, heart disease, and cancer, SIPCW has been tasked with mitigating this growing trend. SIPCW requested a Capstone team to assess key drivers of childhood obesity on Staten Island and research evidence-based models. Through metadata, key informant interviews, and focus groups, the team analyzed key Staten Island child health indicators, resources, norms, and barriers. The team also conducted research on effective community-based models and interventions in comparable communities that may be later tailored to Staten Island’s unique demography, culture, and resources. The team recommended a community-based strategy to improve childhood wellness on Staten Island.

Mapping the Pediatric Patient Experience

Client
NYU Langone Medical Center
Faculty
Sarah Gurwitz
Team
Alexandra Berdebes, Steven Bondi, Zeeshan Haque, Tatiana Hryhorowych, Julie Kim

NYU Langone is an academic medical center located in New York City, and the Patient Experience department is dedicated to improving patient satisfaction, identifying unmet needs and values of patients and visitors, and identifying system issues that impact care and quality. Working throughout the entirety of the Medical Center, the Patient Experience department strives to improve performance related to these areas. Based on results of a 2014 survey, the Patient Experience department determined that the pediatric unit was an area that the Capstone team could analyze, map, and improve. With this department as a focus, the Capstone team analyzed previous survey data; interviewed staff, patients, and family members; performed site observations; and created a patient map that identifies stress points in the current state. The final deliverables included a comprehensive high-level map of the patient experience, as well as a final report outlining the project, the current state, and policies for improvement.

Hematology Oncology Palliative Care Delivery Models

Client
NYU Langone Medical Center
Faculty
Susan Abramowitz
Team
Bhakti Kanade, Stephanie Ma, Sharon Ramot, Stephanie Stadig, Harrison Wolnick

NYU Langone Medical Center (NYULMC) is a top-tier academic medical center located in New York City, and the hospital has been a member of the U.S. News and World Report hospital honor roll since 2012. NYU Langone Cancer Center is looking to improve its continuum of care between inpatient and outpatient cancer treatment. NYULMC engaged a Capstone team to design and determine the viability of a palliative care model for the Cancer Center that will reduce end-of-life spending, while simultaneously maintaining or improving the quality of care for hematology patients. The team investigated current industry trends surrounding cancer care through a literature review, analyzed internal and external industry data, and conducted interviews with administrative and clinical staff. Recommendations of various care models were presented to the client, including a gap and financial analysis to investigate the financial feasibility of implementation in the clinical setting.

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