Quality & Safety

Aldo Peixoto, MD, Vice Chair, Quality & Safety

The Department of Internal Medicine is committed to providing high-quality care by improving safety measures for patients, faculty, and staff.

Continued Improvement

Over one year, YNHH achieved its stretch goal for congestive heart failure (CHF) 30-day readmissions, with a rate of 19% from October 2022 to September 2023. The department’s physicians included Jared Moreines, MD, PhD; Adam Ackerman, MD; Samuel Hahn, MD; and Tariq Ahmad, MD, MPH.

YNHH demonstrates continued improvement in inpatient mortality by identifying patients transitioning from receiving comfort measures to hospice care. L. Scott Sussman, MD, and Jensa Morris, MD, are leaders in comprehensive end-of-life care.

New Initiatives and Pathways

A new initiative has been established following the success of YNHH’s Propel project, which aims to discharge patients by 11 a.m. The initiative is called the Right Patient, Right Service, Right Time, Right Bed; its goal is to reduce the time it takes for admitted patients to be assigned to and placed in rooms by 20% by March 2024. The Department of Internal Medicine is proud of its work in creating and disseminating care signature pathways to advance the quality of care in hospital and ambulatory care sites. The top pathways used during this period that directly involved department faculty in their development were COVID-19, C. difficile/diarrhea, alcohol withdrawal, chest pain, opioid use disorder, chronic obstructive pulmonary disease, cellulitis, diabetes, pneumonia, and pulmonary embolism.

An Adult Inpatient Hypertension Care Signature Pathway was developed and launched in July 2023 to treat acute hypertension in hospitalized patients. The pathway addresses the overuse of intravenous medications and the attendant risks of stroke and acute kidney injury. Overtreatment of inpatients with hypertension is a common problem nationwide, and the department is leading this important quality improvement initiative. Department leaders in the work included Antonio Giaimo, MD, and Janjenali Villaflor, MD. Many other pathways have been developed this past year with input from department faculty. Faculty, trainees, and staff members are encouraged to use these pathways consistently in patients’ daily care.

The TALK IT OUT Campaign, which allows trainees to discuss or report concerns and incidents to leadership, also encourages a safe environment. The campaign was spearheaded by Lloyd Friedman, MD; Rebecca Slotkin, MD; and Andrea Asnes, MD, MSW, to give trainees additional resources to address a situation appropriately. Individuals may use the GME confidential phone line or bring concerns directly to program directors or attendings.

A verbal abuse section was added to the Care Signature Pathway developed by Daniel Heacock, PA-C, to address verbal issues that might arise in the workplace. The principles noted in the TALK IT OUT campaign were used with advice from YNHH’s Workplace Violence Committee. The Workplace Verbal Aggression/Abuse and Violence: Adult Ambulatory/ED/Inpatient Pathway provides a roadmap for individuals who find themselves in an uncomfortable situation that includes inappropriate remarks or behaviors from colleagues, patients, and/or families.

The Partners in Care Program was launched in January 2021 to improve collaboration between nurses, physicians, and staff members. The program is under continued development to encourage positive interactions, employee recognition, and camaraderie in each hospital unit’s safe and friendly environment. First established by Lloyd Friedman, MD, and Debora Lindewall-Matto on 5-5, the project was subsequently overseen by Jessica DeMaio and now Laurie Devin. It is implemented on a trial basis from 9-7 and will soon be extended to the medicine floors.

Morbidity and Mortality Conferences

The Quality and Safety team set up a framework and deployed morbidity and mortality conferences across the department’s 11 sections. The conferences are considered open forums to discuss issues, errors, and adverse events to learn safely while improving the care provided by the department.

The housestaff morbidity and mortality conference was optimized over the last year. VA Chief Resident in Quality and Patient Safety (CRQS) Samantha Magier, MD, MEng, obtained survey data and modified the conference format to continue offering residents anonymity in discussing such issues openly.