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Innovations in Clinical Care
The Innovations in Clinical Care award is presented to the physician, nurse and/or team who demonstrates a visionary approach to problem solving and performance improvement.
Howard County General Hospital: Neesha Patel, M.D., respiratory therapist
In response to a need to identify difficult airways (native and surgical), respiratory therapist Neesha Patel and her team developed a system that classifies airways as stable, difficult or to be managed only by doctors. This ensures that anyone assessing these airways will know what needs to be done and by whom, and when to ask for help. The team categorizes airway types and color codes them using physical tags attached to the patient’s airway and corresponding signage in the room. For example, pink indicates a new tracheostomy that is to be manipulated only by physicians. This system has identified patients with problematic airways and prevented harm. As the signage and tags are evident to everyone on the care team — including family — the system facilitates communication about the patient’s care.
Johns Hopkins All Children’s Hospital: David Kays, M.D., pediatric surgeon
Under the care of David Kays and the congenital diaphragmatic hernia (CDH) team, overall survival of patients with CDH is higher than 95%, compared with 50%–75% at other centers. Dr. Kays not only successfully moved a diaphragmatic hernia program to Johns Hopkins All Children’s Hospital, but also leads a new team and unit, which opened in October 2018. This team combined best practices from several units to create an intensive care unit dedicated to comprehensive care of newborns and pediatric patients who have CDH or need extracorporeal membrane oxygenation for respiratory illness. The outcomes of these patients have been the best in the world, and the patients are discharged breathing on their own and eating, with lower morbidity and decreased length of stay compared with national averages.
Raena Hariharan, M.D., Heather Agee, M.D., Hannah Fetting, C.R.N.P., and the Multidisciplinary Empowerment for Sustainable Health (MESH) Program
The MESH team created and implemented an innovative complex care model to improve the health of Medicare patients within their practice who are the highest users of care. This multidisciplinary, interprofessional approach disrupts the traditional primary care model to reduce utilization and improve health. In doing so, the team focuses on the patient’s goals of care and reduces barriers to care. There is proactive outreach and better coordination with specialists and inpatient health care teams. The MESH team has created this new model and successfully enrolled more than 100 patients in the program to date. Their early evaluation indicates a reduction in emergency department visits and total charges, while increasing total primary care visits with the MESH team.
Direct Primary Care is fundamentally changing the delivery of primary care. This new practice is part of a series of innovative primary care models in the JHCP platform. Led by Norman Dy and Carolyn Le, the practice continuously achieves the highest patient experience scores among all primary care practices nationally. Furthermore, Direct Primary Care aims to decrease unnecessary urgent care, emergency care and specialty visits through strong, personal relationships, a health care team approach and robust 24/7 telemedicine. The practice has made significant strides in the first 10 months since its launch, and JHCP is hopeful for further achievements in excellence in the months to come.
In an effort to reduce readmissions and utilization costs, the Heart Failure Bridge Clinic team works collaboratively with patients and their primary providers to ensure optimal care. The clinic completes over 2,000 visits per year and played an integral role in reducing 30-day readmissions for heart failure patients who follow up in the clinic following an acute stay. The team works hard to coordinate care for a very complex population and is dedicated to ensuring each patient’s care is tailored to their exact needs.
The interventional radiology (IR) team at Sibley Memorial Hospital includes four interventional radiologists, a nurse practitioner, radiology nurses, interventional radiology technologists, schedulers and administrative assistants. Because their patient population is located throughout all areas of the hospital, the team interacts with every other service and collaborates with them for the best patient outcomes. Over the past two years, they have added a provider phone line that is carried by a nurse practitioner or physician during daytime hours for more direct access. IR team members have also expanded their presence on hospitalwide committees and serve on many multidisciplinary teams in order to be more available to the hospital community, update policies and improve the patient experience.
Suburban Hospital: Nicholas Peters, Pharm.D., and Courtney Morgan, Pharm.D.
Courtney Morgan and Nick Peters tenaciously pursue perfection for the patients of Suburban Hospital. By morning rounds, they will have reviewed endless labs and medications to make recommendations for adjustments and changes. They go above and beyond to help correct the medication reconciliations, often for patients who have come from a nursing home with no less than 20 medications. They make recommendations on how to update Epic and improve workflow and have helped revise a number of outdated order sets and policies.