Westchester-Ellenville Hospital Inc

Programs: In-patient departments (med/surg and swing rehab) & ambulatory surgery (or): the hospital and our foundation continue to support our staff with tuition assistance and reimbursement for educational in-services. One of our full time nurses received assistance to pursue his bsn while another staff member who received assistance in 2016 completed his nursing degree at suny orange in may 2017, and has since joined our elite group of nurses. In addition, one of our emergency department patient care technicians received tuition assistance to complete her certified nurse assistant certification. (see continuation on schedule o)our swing rehabilitation unit is a multidisciplinary team made up of nursing, physical therapy, occupational therapy, speech language pathology, socialization activities and a registered dietitian. Maintaining a culture that prides on patient safety continues to be a paramount focus in our facility. Our safe patient handling committee continues strong and includes members of our nursing, rehab, radiology, quality and facilities staff with emphasis on maintaining safe transfer practices and proper use of transferring equipment. The committee held mandatory safe patient handling training in 2017. This training was required for all clinical nursing, pt, and radiology staff. The inpatient-nursing department continued to host and mentor registered nursing students from sullivan county community college and new visions students from local high schools. Ellenville regional hospital continues to hold high standards for our clinical staff: 100% of our in-patient registered nurses are certified in basic and advanced life support through the american heart association and are telemetry certified. As in previous years our nurse educator provided educational and informative in-services to ensure our clinical staff is knowledgeable on current trends and standards of care. Our nurses are now credentialed in the national institutes of health stroke scale (nihss) administration. Health care providers utilize this tool as well, objectively quantifying the impairment caused by a stroke. For our new hires, we provide a rigorous and robust orientation series. Annually, our nursing leadership joins forces with our nurse educator and director of pharmacy to put together multiple mandatory nurse education sessions. The swing bed unit continues to serve our inpatient sub-acute rehabilitation patients. The goal of this rehab model is to have patients return to home rather that transferring to long-term care facilities. The 2016 left ventricular assist device (lvad) program developed in collaboration with westchester medical center continues strong. In 2017 we had four patients in our swing unit.

emergency department:in 2017, innovation and collaboration were unquestionably the driving forces for our cohesive and accomplished team. The emergency department treated 12,994 patients. We continue to maintain high standards for our clinical staff with a clear focus on stellar performance, customer service and competency. We strive to deliver the highest quality care and believe this is necessary in order to achieve the best possible outcomes. Our dedicated ed team has executed consistently year after year, for about a decade, delivering unremarkable turnaround times of around 112 minutes. It is only fair to point out, once again, that this is far less than the national average of 4 hours and 7 minutes. (see continuation on schedule o)it is no secret that patient outcomes are positively impacted when evaluation and treatment are delivered promptly. Delivering quality emergency care in a rural setting can be a challenging task. Maintaining staff aptitude and competency is a high priority; therefore, 100% of our registered nurses are credentialed in basic, advanced adult and pediatric life support through the american heart association. They are also certified in telemetry by an american heart association accredited trainer. Many of our ed rns are also certified in trauma nursing and emergency pediatric care through the emergency nurses' association. In 2017, our model for full time lpns in the ed has added support to our night rns which yield higher staff and patient satisfaction. Our well-trained lpns manage medication administration, splinting, and clerical tasks, such as data gathering for pi and qa projects. 2017 was a year of great celebration as once again the ulster county emergency medical services committee recognized one of our full time rns as the emergency nurse of the year while one of our ed physician assistants was named emergency provider of the year. Overall 2017 was a year of outstanding collaboration. Our ed team engaged in three significant collaborative ventures. First, the max (medicaid accelerated exchange) series program. The success of our max (medicaid accelerated exchange) series program for the wmchealth pps dsrip and the continued partnership between erh (ellenville regional hospital) and the institute for family health that was initiated in 2016 continued to yield tremendous results in 2017. This groundbreaking, innovative and opportune venture contributed to measurable changes in prescribing patterns for opioids in the emergency department. It also allowed an opportunity to identify emergency department drivers of utilization such as addiction, psychological and socioeconomic issues. The erh max project has truly served as a model for other facilities to follow. It helped create institutional memory of high ed utilizers as high-risk, high-cost patients, facilitating follow up, and ultimately connecting patients to community services rather than just focusing in the traditional and ineffective "treat and release" mentality. On october 20, 2017, our chief operating officer and the ed manager had a chance to present the max project and its results in the iexcellus hospital quality alliance (hqa) meeting. Secondly, our emergency department (ed) joined forces with the american heart association (aha) in the mission life line initiative to improve care of patients with myocardial infarctions. As part of the initiative, we began data collection, participated in calls with emergency medical services (ems), first responder agencies and neighboring hospitals. The emphasis was on saving lives by streamlining and expediting care according to aha guidelines. Early identification of the patient experiencing an acute myocardial infarction (ami) was a key element. In order to achieve this goal, we adopted and implemented the aha rapid electrocardiogram criteria and educated our staff as to how to apply it. The second goal was timely transfers of patients to tertiary facilities (specifically to facilities designated as cardiac cauterization centers). To meet this objective, we began to utilize the signal 9 code for ground transfer or the interfacility - auto - launch alert for air transport when appropriate. In 2017 we transferred close to 5 % of our patients and over one third of these cases had some type of cardiovascular underlying component to it. It is evident that this collaborative effort touched a significant number of lives in our small community. In our third undertaking the emergency department team, led by our medical director, participated in the envision breakthrough series, this time joining forces with ema (emergency medical associates) and 20 other emergency departments teams from across the country. The focus of the series was to streamline ed throughput. The series consisted of three consecutive seminars (each a few months apart) with a format of lectures and action groups. Projects for improving workflows were developed and implemented. In the closing and final workshop, the erh team was asked to present the results of our project. Our data demonstrated that staff education and minor adjustments in triage management were effective measures in achieving our goal of improving door to ekg times.

radiology:in 2017, radiology made some major enhancements to existing technologies. We retired all of our outdated cr equipment and moved to a 100% digital imaging department. This ensures that we are utilizing the best technology and performing the highest quality imaging at the lowest possible dose. In 2017, we performed nearly 15,000 exams. We had outstanding gains in op ultrasound exams and continued the growth in ct contrast study volume. We made particular gains in cts for pulmonary emboli. (see continuation on schedule o)working with the radiologists, we have become comfortable with these complex exams and are routinely performing them with high quality results. We had some challenges with the mammography program in 2017. We had some difficulty meeting the standards of the acr and determined that we needed to revamp the program. We started by researching equipment and technology. We made the decision to go with a more expensive, but definitively superior product and purchased a hologic selenia dimension 3d mammography unit capable of performing 3d breast tomosynthesis and offering significant advantages in diagnosis. We also made a decision to perform the most comfortable exam possible and committed to offering every patient a padded mammogram that reduces pain and increases the quality of the exam. Our ultrasound and cardiology programs continue to progress. We are seeing significant gains in us numbers and most especially in outpatient procedures. We lost an ultrasound technologist who also performed echocardiography and were faced with some tough decisions. In the end, with much scrutiny, we decided to reduce some cost by eliminating on-call for ultrasound and hiring a specialized echo technologist. We are looking to push the cardiology program ahead, perform new and better exams and increase volume. By the end of 2017, we were seeing gains in volume, more rapid turnaround times and were looking into new technologies that we may be able to explore in 2018. We put in a great deal of work to streamline out "stroke protocol". Working with the er, we look to a goal of 45 minutes from arrival to report for all stroke related cts of the head without contrast. We are working with a number of resources to serve patients in our community who suffer stroke or stroke like symptoms.

the hospital also provides ambulatory surgery, lab services, iv therapy, physical therapy, cardiac rehab, and prescription drugs to our patients.