uality

2019 Clinical Excellence and Quality/Safety Report Northwell Health... We’ve reimagined what health care can be That’s why we’re more than just New York State’s largest health system. We’re a network of innovators raising the standard of care for all.

Northwell Health is New York State’s largest health care provider and private employer, with 23 hospitals, more than 700 outpatient facilities, more than 13,600 affiliated physicians and over 3,500 allied health professionals. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 68,000 employees – 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institute for Medical Research. We’re training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies.

For information on our more than 100 medical specialties, visit Northwell.edu. Unmistakable progress in quality, safety and access to care

Dear Friends, There are a number of remarkable trends leading the nation’s health care delivery system toward greater quality, safety, access and affordability. Among them are value-based payment systems, an increasing focus on population health and the need to target social determinants of health, to better understand the most pressing health care issues facing the communities we serve. We are ever-mindful of utilizing the tools of health care’s rapid technological expansion to increase patient and consumer engagement and provide individuals with immediate access to health care information. Programs such as OpenNotes, launched in our physician practices, provide consumers with direct access to their physician’s notes regarding medication and treatment instructions, promoting greater engagement and adherence to their plan of care. Michael J. Dowling Our Food as Health Program, in association with the US Department of Agriculture and Long Island Farms, is an example of our response to social determinants of health and how we are meeting the nutritional needs of our consumers. In addition to these developments, as a telehealth technology leader, Northwell Health remains at the forefront of virtual care innovation. For example, direct-to-consumer programs offer post- operative health care expertise to consumers at home. Our House Calls and eSNF (skilled nursing facility) programs use telehealth to remotely connect health care providers with patients who have serious or advanced illness, allowing patients to avoid an emergency department visit or re-hospitalization. Our 2019 Clinical Excellence and Quality/Safety Report highlights these and other innovative programs in our ongoing commitment to delivering the best possible care to the people and communities we serve.

Mark P. Jarrett, MD

Michael J. Dowling Mark P. Jarrett, MD President and CEO Senior Vice President, Chief Quality Officer and Associate Chief Medical Officer

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 3 2018 Highlights

Center for Emergency Medical Services (CEMS) Donald and Barbara Zucker School of Medicine at Each month, Northwell Health CEMS responds to over 7,000 Hofstra/Northwell requests from the New York City EMS system and transports over The Zucker School of Medicine celebrated its tenth anniversary in 4,500 patients to hospitals throughout the New York Metropolitan 2018. Eighty-six fourth-year students secured placements in many area. Northwell Health CEMS units are dispatched by the New York of the most sought-after residency programs in the country across City 911 emergency communications center for these requests. 15 different states and 22 specialty areas — including the school’s Center for Equity of Care first match to cardiovascular sugery and vascular surgery. Northwell Health continues to build the skill set of its workforce The Feinstein Institute for Medical Research in the areas of cultural sensitivity, health literacy and language (Feinstein Institute) access. Education is provided to all levels of staff including students at the Donald and Barbara Zucker School of Medicine at Hofstra/ The Feinstein Institute continues to be a leader in the field of Northwell and the Hofstra Northwell School of Graduate Nursing bioelectronic medicine research with national clinical trial sites and Physician Assistant Studies. for treating lupus, rheumatoid arthritis and paralysis. More than 4,000 researchers and staff study molecular medicine, genetics, Center for Learning and Innovation (CLI) oncology, brain research, mental health, autoimmune disease and Patient Safety Institute bioelectronic medicine. The Clinical Skills Center provides a unique opportunity to assess Health Solutions–Northwell Health Home both clinical and communication skills for all levels of staff through Designated by the NYS Department of Health, Northwell Health the use of standardized patients. Standardized patients provide operates one of 31 lead Health Homes responsible for providing detailed and realistic portrayals of patients, family members and vital care management services to high-risk Medicaid members staff in a learning environment. in Nassau, Suffolk and Queens. In collaboration with several Clinical Call Center community-based organizations, roughly 6,000 members received services in 2018. These services will be extended to residents of Staffed for 24/7 telephonic nursing support, the Clinical Call Staten Island in 2019. Center fielded nearly 25,000 patient/family inbound calls in 2018. Specialized nurse triage services were expanded to begin Hofstra Northwell School of Graduate Nursing and coverage for patients of Northwell Health Physician Partners Physician Assistant Studies medicine practices. Twenty-eight registered nurses completed their advanced practice Community Health studies at the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, becoming the school’s first graduating The Northwell Health Community Health program promotes class of nurse practitioners. The graduates, most of whom worked screening patients for social determinants of health, establishing full-time at Northwell Health hospitals while pursuing the three- a social vulnerability index, developing innovative solutions to the year, part-time program, earned Master of Science degrees with opioid crisis and using technology to improve health literacy. a specialty in either adult-gerontology, acute care nursing or Cohen Children’s Medical Center family nursing. The children’s hospital launched its Pediatric Kidney Transplant Human Trafficking Response Program Program and performed its first kidney transplant in Q4 2017. Since forming its Human Trafficking Response Program, Northwell There were seven transplants performed in 2018. Health has trained over 2,000 employees and intervened in numerous cases. The goal of the program is to train all employees in primary screening for human trafficking.

4 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report LabFly™ Perinatal Services Northwell Health released a beta version of its new LabFly™ With maternity programs at eleven hospitals, Northwell Health mobile app to employees, giving them the ability to schedule blood delivers approximately 40,000 babies annually, accounting draw services at home or work. Public launch of the mobile app is for 17 percent of all births in New York State and nearly planned for 2019. one percent in the nation. Military and Veterans Liaison Services SkyHealth Northwell Health hires hundreds of veterans a year, and over Designed specifically for helicopter EMS use, SkyHealth, an the past decade has also awarded more than $1.7 million to innovative joint venture between Northwell Health and Yale New employees who were mobilized and deployed overseas – funds Haven Health, has the latest technology and safety features. It that represent the difference between their military pay and the meets or exceeds all safety recommendations set forth by the regular salaries they would have earned at Northwell Health. In National Transportation Safety Board, ensuring that every flight recognition of its efforts, Northwell Health is ranked as the nation’s is a safe one. There were 476 transports completed by SkyHealth seventh top nonprofit employer by the veterans advocacy group in 2018. “Military Friendly.” Strategic Alliances Naloxone Saturation Campaign Northwell Health has alliances with CASA Columbia, Cold Spring Northwell Health’s Naloxone Saturation Campaign (NAL-SAT) Harbor Laboratory, Epworth HealthCare, Institute for Healthcare provides education on opioid overdose prevention, recognition, Improvement, Karolinska Institutet, One Brooklyn Health, Rothman response, and naloxone rescue to patients, families, and employees. Institute, University of Notre Dame and Western Connecticut As of 2018, fifteen clinical settings (five internal medicine practices Health Network. Affiliate hospitals include Boca Raton Regional and ten emergency departments) had an established NAL-SAT Hospital, Crouse Health, Maimonides Medical Center, Wyckoff program. Plans are to expand the program in 2019. Heights Medical Center and Nassau University Medical Center. Northeast Surgical Instruments Solutions Tele-intensive care unit (eICU) This joint venture between Northwell Health and the Steris The Northwell Health tele-intensive care unit (eICU) program Corporation provides comprehensive surgical instrument ranked in the top three for its low-risk hospital mortality ratio sterilization and loaned instrument management services to (actual/expected) in three of four quarters of 2018 compared to all Northwell Health hospitals and ambulatory centers. The facility Philips eICU programs in the country. processes upwards of 22 million surgical instruments annually and is the single largest facility of its kind in the world. Transplant Programs Northwell Health Physician Partners The adult heart transplant program at the Sandra Atlas Bass Heart Hospital at North Shore University Hospital received approval to Physician Partners continues to operationalize Open Notes, a open from the Organ Procurement and Transplantation Network national initiative that fosters patient engagement and adherence (OPTN) and performed its first transplant in Q1 2018. A total of to treatment by providing physician office notes directly to patients. 14 patients received heart transplants in 2018. The adult liver Approximately 50,000 portal notes are created every week. transplant program also received approval to open from the OPTN. Northwell Laboratories The first liver transplant is expected to be performed at North Shore University Hospital in Q2 2019. As part of the Clinical Laboratory of New York Alliance formed by Northwell Health and NYC Health + Hospitals, a new shared, VetConnectNYC centralized reference laboratory opened in 2018. The integrated Northwell Health is proud to lead the VetConnectNYC network, laboratory performs microbiology tests, including molecular the nation’s first community-based, coordinated network of public, diagnostics from hospitals, clinics and physician offices. private and nonprofit organizations working together to serve Palliative Care veterans and their families. As part of the AmericaServes initiative, VetConnectNYC is shaping the future as we define the new More than 500 advanced illness clinicians attended the Goals of standard by which our city views, treats, and serves our heroes. Care Conversation Education Program® (GoCCEP™) at the Center for Learning and Innovation. The program promotes realistic conversations through the use of standardized patient simulations, structured guidance and self-reflection.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 5 2019 Clinical Excellence and Quality/Safety Report

Table of Contents

2018 Highlights...... 4 Excellence ...... 7 Safety ...... 17 Reliable Care ...... 23 Teamwork ...... 29 Innovation...... 34 Awards and Recognition ...... 39

Northwell Health Karen Nelson Designed and produced by 2000 Marcus Avenue Deputy Chief Quality Officer Onward Publishing, Inc. New Hyde Park, NY 11042 464B Main Street (516) 321-6701 Lori Stier Port Jefferson, NY 11777 northwell.edu Assistant Vice President, (631) 757-8300 Clinical Excellence and onwardpublishing.com Quality/Safety

6 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Excellence

7 Measures of Distinction Antimicrobial stewardship

Senior leadership prioritized an organization-wide antimicrobial stewardship program in response to an increase in antimicrobial resistance that was detected in 2016. This increase coincided with the national trend reported by the Centers for Disease Control and Prevention (CDC). The program promotes the appropriate selection, dose, route and duration of antimicrobial therapy, as well as standardized processes, measures and education across the organization. The program decreases inappropriate antibiotic utilization, optimizes treatment and reduces the harmful effects of antimicrobial resistance, for example, Clostridium difficile infections and adverse drug events. The organization’s antibiotic reduction strategy aligns with the CDC’s campaign to prevent antimicrobial resistance and The Joint Commission (TJC) and Centers for Medicare & Medicaid Services (CMS) antimicrobial stewardship standards. As a result of this program antimicrobial days for five high-utilization antimicrobials have decreased, as shown.

Northwell Health was recognized for its antimicrobial stewardship program by the Healthcare Association of New York State (HANYS) with its 2018 Pinnacle Award for Quality and Patient Safety.

Northwell Health Antimicrobial utilization rate per 1,000 days present Five high-utilization antimicrobials* 2016–2018 240240

205205

170170 RATE PRESENT PER1,000 DAYS 135135

100100 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2016 2017 2018

* Includes Aztreonam, Levofloxin, Linezolid, Vancomycin & Zosyn Includes the following hospitals: Cohen Children’s Medical Center, Lenox Hill, Long Island Jewish (LIJ) Medical Center, LIJ Forest Hills, LIJ Valley Stream, North Shore University Hospital, Plainview, Southside, Syosset

Source: National Healthcare Safety Network (NHSN) Lower is better Data as of February 6, 2019

8 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Clostridium difficile

Clostridium difficile (C. diff), a bacterium that causes inflammation of the colon, is one of the fastest growing hospital-acquired infections affecting patients in acute and long-term care settings. It causes close to 500,000 illnesses and 15,000 deaths each year. Each Northwell Health site is focused on improving the prescribing of antibiotics to ensure the right antibiotic, for the right diagnosis, and the right route and duration. Specimens are sent to the laboratory when clinically indicated, and individuals are placed on precautions when infection is suspected and confirmed. Each site also developed a standardized communication plan that is used by the infection preventionists and environmental services team to ensure that patient rooms are properly cleaned daily and upon the transfer or discharge of a patient with C. diff. TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is used to encourage communication, as well as situational awareness related to handwashing, appropriate isolation and use of personal protective equipment. A C. diff toolkit, including all prevention strategies, patient and staff education, guidelines for environmental services and best practices from each site, is available to all staff on the health system’s intranet. Best practices are also disseminated at the medical director’s meetings and nurse executive council.

Northwell Health will implement PurpleSun, a new ultraviolet-light-based cleaning technology that disinfects surfaces in 90 seconds and also eliminates C. diff. It is currently being pilot tested in operating rooms at two hospitals.

Northwell Health Clostridium difficile-associated disease 2015 vs. 2018

1212 1010 37.6% Decrease 88 2015 VS. 2018

66 INDEX

44

22

00 2015 2016 2017 2018 N=715 N=695 N=556 N=500

Source: National Healthcare Safety Network (NHSN) Lower is better Data as of January 19, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 9 Adult cardiac surgery The Society of Thoracic Surgery (STS) provides the public with information about mortality and/or morbidity rates for certain cardiac procedures. These data help consumers make the most informed choices about their health care. The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care. Star ratings are derived by testing whether a participant’s score is significantly different from the overall STS national average in five cardiothoracic surgery programs. Three stars is the highest possible overall quality rating. STS Star ratings for Northwell Health hospitals are shown below.

The Sandra Atlas Bass Heart Hospital at North Shore University Hospital is one of only two cardiac programs in the US and Canada to receive three stars (highest quality rating) in all categories that were scored by the STS.

Northwell Health Adult Cardiac Surgery – Overall Star Ratings Society of Thoracic Surgeons Harvest Report – 3 2018

Isolated Isolated Isolated CABG + MV Coronary Artery Aortic Valve CABG + AVR Mitral Valve (MV) Replacement/ Bypass Graft (CABG) Replacement (AVR) Jul 2015 – Jun 2018 Replacement/ Repair Repair Jul 2017 – Jun 2018 Jul 2015 – Jun 2018 Jul 2015 – Jun 2018 Jul 2015 – Jun 2018

Sandra Atlas Bass Heart Hospital at North Shore University Hospital

Lenox Hill Hospital

Southside Hospital

Staten Island University Hospital * Not rated

7.25% of the 980 4.30% of the 980 4.73% of the 980 11.36% of the 980 7.45% of the 980 participants scored participants scored participants scored participants scored participants scored received 3 stars received 3 stars received 3 stars received 3 stars received 3 stars

*Not rated due to small number of cases. Did not meet minimum case requirement.

Source: Society of Thoracic Surgeons (STS) Adult Cardiac Surgery – most recent report 3 stars ( ) – Highest quality rating given Data as of October 2018

10 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Percutaneous coronary intervention Northwell Health continuously improves its performance by creating meaningful quality improvement programs and analyzing outcomes across the organization. In 2018, a total of 20,644 diagnostic cardiac catheterization procedures and 7,756 percutaneous coronary intervention (PCI) procedures were performed to diagnose and treat patients with simple and complex coronary artery disease. The Journal of the American College of Cardiology (JACC) Guidelines for Appropriate Use is the standard by which patients are selected for PCI. Five of the six participating Northwell Health hospitals ranked in the top decile for PCI in-hospital risk-adjusted mortality (all patients) compared to the most recent National Cardiovascular Data Registry (NCDR®), CathPCI Registry® Q2 Outcomes, as shown.

Long Island Jewish Medical Center had the best possible outcomes for four consecutive quarters with a zero percent mortality rate.

Northwell Health In-hospital risk-adjusted mortality (all patients) Percutaneous coronary intervention Q3 2017–Q2 2018

25% Percentile, 2.61% 50% Percentile, 2.01% 90% Percentile, 1.07%

3.03.0%

2.52.5%

2.02.0%

1.51.5% RATE

1.01.0%

0.50.5%

0.00% HUNTINGTON LENOX HILL LONG ISLAND SANDRA ATLAS SOUTHSIDE STATEN ISLAND JEWISH MEDICAL BASS HEART HOSPITAL UNIVERSITY CENTER HOSPITAL AT HOSPITAL NORTH SHORE UNIVERSITY HOSPITAL

Source: NCDR® CathPCI Registry® Lower is better Data as of November 18, 2018

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 11 Transcatheter Aortic Valve Replacement (TAVR) Transcatheter aortic valve replacement, or TAVR, has transformed the treatment of valvular heart disease, specifically in patients with symptomatic, severe aortic stenosis (AS). In contrast to traditional open heart surgery, aortic valve replacement can be performed through a catheter advanced from the patient’s femoral artery into the heart. Four Northwell Health hospitals (Lenox Hill, Sandra Atlas Bass Heart Hospital at North Shore University Hospital, Southside, and Staten Island University Hospital) performed almost 2,350 TAVR procedures collectively since the program’s inception. In 2018, these hospitals performed 563 TAVR procedures, making Northwell Health one of the highest- volume TAVR programs in the nation. Recent studies cite superior outcomes in the highest- volume TAVR centers.

In September 2018, Lenox Hill Hospital successfully performed a transcatheter mitral valve replacement (TMVR) procedure as part of a clinical trial to replace a leaky mitral valve without open heart surgery — the first such procedure in the Northeast.

Northwell Health 30-day mortality rates Transcatheter aortic valve replacement Northwell Health vs. Transcatheter Valve Therapy (TVT) Registry 2016–2018

TVT Registry benchmark: 3.10%

1010%

8%8

6%6

4%4

2%2

0%0 2016 2017 2018

Includes the following hospitals: Lenox Hill Hospital, Sandra Atlas Bass Heart Hospital at North Shore University Hospital and Southside Hospital (2016–2018). Staten Island University Hospital (2017–2018) as their TAVR program began in 2017.

Source: 2018 Transcatheter Valve Therapy (TVT) Registry — Most recent national report Lower is better Data as of February 2019

12 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Health Solutions Advanced illness management The Northwell Health advanced illness management program (House Calls) provides home-based primary care to homebound, frail, elderly individuals. House Calls utilizes a multidisciplinary care team to provide all aspects of primary care, from routine scheduled visits to urgent care. The team includes physicians, nurse practitioners, social workers, nurses and medical coordinators, all organized around the needs of patients and their families and caregivers. The program responds to patients’ needs around the clock and works closely with the Northwell Health Clinical Call Center, as well as its community paramedicine program. In 2018 the program provided care to 1,820 individuals. A multi-year partnership between House Calls and the West Health Institute is underway to develop strategies and resources to spread home-based primary care programs across the country to meet the current and future needs of the US population. Also in 2018, the House Calls program continued to show national leadership in the Centers for Medicare & Medicaid Services (CMS) Independence at Home demonstration project, a national investigation into the benefits of home-based medical care.

For the fourth consecutive year, Northwell Health exceeded quality standards in all six patient-important measures, and achieved a total cost savings to Medicare of more than $3.4 million.

Northwell Health Northwell Health House Calls Program House Calls Program CMS Independence at Home Demonstration Project CMS Independence at Home Demonstration Project Quality Measures 1, 2 and 4 Quality Measures 3, 5 and 6 Year 4 Year 4

CMS Quality Metric % to Meet or Exceed Quality Measure CMS Quality Northwell Health Northwell Health Year 4 Metric Ratio to Year 4 Quality Meet or Exceed Metric Ratio 100%100 Quality Measure 3: All-Cause Hospital Readmissions within ≤ 1 0.82 80%80 30 Days Quality Measure 5: Number of Hospital Admissions for ≤ 1 0.41 60%60 Ambulatory Care Sensitive Conditions 40%40 Quality Measure 6: Number of Emergency Department Visits ≤ 1 0.58 20%20 for Ambulatory Care Sensitive Conditions

0%0 Source: Independence at Home Reporting System Quality Measure 1: Quality Measure 2: Quality Measure 4: Follow-up Contacts Medication Annual ≤ 1 is better within 48 Hours of Reconciliation in Documentation of Data as of April 3, 2019 Hospital Admissions, the Home within Patient Preferences Hospital Discharges 48 Hours of and Emergency Hospital Discharges Department Visits and Emergency Department Visits

Source: Independence at Home Reporting System Higher is better Data as of April 3, 2019 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 13 30-Day Medicare readmission rate Northwell Health Solutions is reducing 30-day readmissions for qualifying Medicare patients by providing transitional care management services. These transitional services engage patients in the hospital and assist in their transition back into the community through follow-up phone calls and home visits. Throughout this process, Health Solutions collaborates with hospital sites on improving care coordination for post-discharge needs, and redesigning ED processes to better manage coordination with ED providers. Incremental improvements in the quality and satisfaction of care and a decrease in readmission rates across the organization have been realized.

Northwell Health 30-Day Medicare readmission rate 2016 – 2018

2020%

1818% 7. 1% Decrease 2016 vs. 2018 1616%

1414%

1212%

1010% 2016 2017 2018

Excludes Mather Hospital

Source: Northwell Health Solutions Accountable Care Analytics Lower is better Data as of March 21, 2019

In addition to transitional care management, patients are provided with the opportunity to enroll in Conversa, an automated texting platform that provides diagnosis specific conversations, as well as patient-focused education. This platform provides navigators with the ability to stay connected to their patients and to be alerted real-time to any concerning triggers.

14 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report CMS Comprehensive Care for Joint Replacement Model (CJR) Under the CMS Comprehensive Care for Joint Replacement (CJR) model, hospitals that perform total joint replacement surgery are responsible for both the cost and the overall quality of care delivered to Medicare patients for 90 days after their procedure. The CJR episode payment model started on April 1, 2016, at 12 Northwell Health hospitals. Northwell Health provides transitional care management services for all patients enrolled in the CJR program at hospitals and contracted partners. The clinical care navigation model includes patient engagement during the initial hospital stay and both telephonic and home visit follow-up for 90 days after discharge. Home visits and follow-up touchpoints are coordinated with Northwell Health At Home to ensure efficiency and maximization of services. All patient needs are provided for, including urgent changes in clinical condition. This extension of services into the community, combined with regular hospital engagement and care redesign, has led to incremental improvements in home discharge rates and 90-day readmission rates since the start of the CJR model.

Northwell Health Home discharge rate and 90-day readmission rate Comprehensive care for joint replacement (CJR) 2015 – October 2018

HOME DISCHARGE RATE 90-DAY READMISSION RATE

7070%

6060% Higher is better 5050%

4040% Lower is 3030% better 2020%

1010%

0%0 2015 2016 2017 2018 2015 2016 2017 2018 Jan-Oct Excludes Mather Hospital

Source: Northwell Health Solutions Accountable Care Analytics 2018 Home Discharge data shown for discharges through December 31, 2018 2018 90-Day Readmission Rates shown for discharges through October 31, 2018 Data as of March 28, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 15 Robotic surgery

Robot-assisted surgery is a minimally invasive alternative to traditional open procedures. Performed through tiny surgical incisions that allow for faster patient recovery with less pain, scarring, and blood loss and shorter hospital stays, robotic surgery can be used when traditional surgery is not an option. During robotic surgery, surgical technologies are integrated with a computer system to improve the surgeon’s vision, range of motion, dexterity and precision using flexible 3D cameras and precise instrumentation. Northwell Health surgeons utilize advanced robotics in breast, colorectal, general, gynecological, orthopedic, otolaryngology, thoracic and urological surgery.

Approximately one half of all robotic surgeries in the Northeast are done at Northwell Health hospitals.

Northwell Health is recognized as a Network of Excellence for Advanced Robotic Surgery by the Surgical Review Corporation.

C-SATS (Crowdsourced Assessment of Technical Skills), a performance management system, analyzes the technical skills of surgeons through video-recording and debriefs. Since inception, 2,000 cases were uploaded into the C-SATS performance management system. Education, research, training and continuing medical education (CME) opportunities are offered at the Northwell Health Center for Learning and Innovation (CLI) and Bioskills Education Center.

Northwell Health C-SATS (Crowd-Sourced Assessment of Technical Skills) Number of cases uploaded* 2016 – 2018

2,000 2,000 cases uploaded! 2,000 1,800 1,500 cases uploaded! 1,600 1,500 1,400 Thoracic Learning Event

1,200

1,0001,000 1,000 cases uploaded! 800 500 cases uploaded! 600 Robotic Program Commenced 500 400 Lap Pilot Commenced

200 Robotic Pilot Commenced

00 4/25/2016 7/18/2016 10/10/2016 1/2/2017 1/1/2018 3/26/2018 6/18/2018 9/10/2018 2016 2017 2018

* 180 participating surgeons

Source: C-SATS database Higher is better Data as of December 11, 2018

16 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Safety

17 Imaging service line Computerized tomography (CT) scans Computerized tomography (CT) scans of the abdomen and pelvis are commonly performed to investigate pain, stage cancer, or evaluate a patient after trauma. Many of these scans can be performed as a single-phase study, imaging the abdomen and pelvis one time. However, in a minority of cases, an accurate diagnosis requires a multiphase study which results in increased patient radiation. Radiologists from the imaging service line protocol each CT scan to ensure less radiation exposure and the best possible clinical care. An optimal protocol, based upon patient symptoms, laboratory results, age, and co-morbidities, balances the need for diagnostic accuracy against the need to reduce radiation exposure. In 2017, the imaging service line began to measure the percentage of multiphase CT scans of the abdomen and pelvis and found that 88.3 percent were performed with an optimal protocol. In response, radiologists, CT technologists, and referring clinicians were re-educated on the clinical information needed to determine whether a single or multiphase study should be performed. As a result the use of optimal protocols increased to 91.3 percent.

Northwell Health Computerized tomography (CT) scans of abdomen and pelvis using optimal protocols* 2018

2018 2017 baseline Stretch goal

100100%

9595%

9090% OPTIMAL PROTOCOL 8585%

8080% JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Excludes Mather, Phelps Memorial, Northern Westchester and Staten Island University hospitals due to diffferent reporting systems

Source: Siemens Syngo (Radiology Reporting System) Higher is better Data as of January 29, 2019

18 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Perinatal safety Obstetrics and Gynecology service line Weekly safety call Northwell Health Obstetrics and Gynecology inpatient programs provide antepartum, labor and delivery and postpartum care throughout the New York metro area. Although the size and scope of services vary based on birth hospital designation and volume, many of the challenges are similar. To enhance communication and learning across the service line, a weekly safety call was initiated in December 2018. This brief, 15-minute call provides an opportunity for maternity hospital leadership to share events of the previous week, discuss pending operational concerns, share “good catches” and identify performance improvement opportunities that can be resolved collaboratively in an efficient and timely manner. Examples of “good catches” include medication management, escalation, situational awareness and knowledge deficits.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 19 Pediatrics

Addressing the needs of children with neurobehavioral disorders with the BEE MINDFUL program Providing quality care to children with neurobehavioral disorders can be a challenge for providers. These patients have significant medical care needs and require specialized treatment to ensure the best outcomes. According to the literature, a traditional approach to health care often leads to negative experiences leading many families to avoid, or wait to seek further medical treatment.

BEE MINDFUL was extended throughout the Pediatric Service Line to ensure continuity of care for children with neurobehavioral disorders across the organization.

To address the unique needs of children Northwell Health with neurobehavioral disorders, Cohen Average length of stay for children with special needs Children’s Medical Center initiated the BEE Cohen Children’s Medical Center MINDFUL program to create a safe, patient- 2015 – 2018 centered care environment that alerts providers of the individual needs of each National Average LOS for all children 1 to 17 years old child. The multifaceted program includes an interactive educational module that provides 5 staff with a visual and auditory depiction of neurobehavioral disorders, as well as a pediatric neurobehavioral assessment 4 tool (PNAT) created by Cohen Children’s Medical Center. The PNAT assists staff with identifying a child’s unique needs to promote 3 safety, security and comfort. It determines potential triggers, such as bright lights, loud noises and sensory issues, as well as 2 NUMBER OF DAYS appropriate interventions such as noise- canceling headphones or weighted blankets. BEE MINDFUL program reports are included 1 on the hospital’s daily safety call heightening the awareness and sensitivity of staff to the 0 children’s special needs. 0 2015 2016 2017 2018 As a result of the program, length of stay N=424 N=450 N=687 N=652 (LOS) for children with neurobehavioral disorders decreased from 4.5 days at N = Number of patients baseline (2015) to 2.3 days (2018), lower Source: National Center for Health Statistics (2015) than the national average LOS for all children Lower is better ages 1–17. Data as of February 25, 2019

20 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Enhanced recovery after surgery

Northwell Health launched an organization-wide initiative to implement and standardize enhanced recovery after surgery (ERAS) guidelines to improve patient outcomes and expedite recovery after surgery. Early testing of ERAS interventions in the US, Europe and New Zealand showed improved pain control and decreased hospital length of stay. Preoperative optimization, anesthesia, deep vein thrombosis (DVT) prophylaxis, patient education, culture and resource variations and quality oversight are among the issues being addressed in implementing an ERAS program. ERAS offers evidence-based interventions from preadmission through post-discharge and is supported by several interconnected processes, including patient navigation, order sets, integrated data collection and outcome auditing.

In a pilot study of 532 colorectal surgery patients, more than 70 percent were discharged by day three. The 30-day, all-cause readmission rate for these patients was 7.0 percent, compared to 14.8 percent nationally.*

National Average LOS for all children 1 to 17 years old

*Source: Agency for Healthcare Research Quality [AHRQ] Statistical Brief # 154, April 2013

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 21 Patient safety culture surveys Hospital Survey Twenty Northwell Health hospitals participated in the 2018 Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture. Twelve dimensions of patient safety culture were assessed in the survey to identify strengths and opportunities for improvement, examine trends over time and raise awareness about patient safety. Northwell Health ranked at or above the national rate in nine of the 12 dimensions. Improvement was noted in 10 dimensions of patient safety compared to 2016 results. Medical Office Survey Northwell Health Physician Partners participated in the 2018 AHRQ Medical Office Survey on Patient Safety Culture and ranked at or above the national rate in 10 of the 10 dimensions that were surveyed, as shown.

Northwell Health 2018 Medical Office Survey on Patient Safety Culture Safety culture score (%) by dimension

Greater than or equal to the benchmark score

Medical Benchmark Dimension office score score

Patient tracking / follow-up 90% 86%

Teamwork 88% 86%

Organizational learning 82% 79%

Overall perceptions of patient safety and quality 81% 77%

Staff training 78% 73%

Communication about error 73% 72%

Office processes and standardization 72% 67%

Communication openness 70% 70%

Owner / managing partner / leadership 68% 66% support for patient safety

Work pressure and pace 50% 46%

Source: AHRQ Patient Safety Culture Surveys Higher is better Data as of January 31, 2019

22 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Reliable Care

23 Food As Health

The Food As Health (FAH) program is an evidence-based, integrated approach to reducing food insecurity in high-risk patients to improve health outcomes, decrease hospital readmissions and reduce avoidable ED visits. The program considers the social determinants of health that negatively impact food security, such as low income, rent burden and a low level of educational attainment. Through collaboration and partnerships with community-based organizations, FAH provides access to food, food vendors and internal stakeholders.

FAH was implemented at Long Island Jewish Valley Stream as a pilot project in 2018. Patients experiencing food insecurity are identified through the use of the evidence-based Children’s HealthWatchTM Hunger Vital Sign survey, which is the gold standard for assessing both children and adults.

FAH is aligned with the Institute for Healthcare Improvement (IHI) Quadruple Aim and the USDA Research, Education and Economics Action Plan for addressing hunger and food insecurity through three service options: –– A hospital-based food resource center, staffed by a registered dietician and supported by food vendors –– A mobile food pantry –– A program that provides medically tailored, home-delivered meals Each service provides emergency food supply, nutrition education, Supplemental Nutritional Assistance Program (SNAP) enrollment and social support through community resource navigation.

Launched in July 2018, during its first six months, FAH screened 678 patients, 189 of whom were positive for food insecurity. Of those, 54 received social work referrals, 50 attended the FAH Resource Center, 28 were discharged to a rehabilitation or skilled nursing facility, one was referred to the mobile food pantry and one was referred for home-delivered meals.

24 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Patient-centered medical home Medicine service line Forty-eight primary care practices in the medicine service line are currently recognized through the National Committee for Quality Assurance (NCQA) as patient-centered medical homes (PCMH). These practices elevate care by adopting team-based best-practice workflows, introducing new technologies at the point of care, improving communication and increasing available resources. Several new initiatives include: –– Quality dashboards that relay near real-time information regarding practice and provider quality scores, as well as information regarding patients with upcoming appointments that have preventive care needs. –– Transition of care management systems have been put in place to notify practices of patients who are seen for emergency care, or admitted to or discharged from a Northwell hospital or Northwell Health GoHealth Urgent Care Center. –– Annual wellness visits for patients over age 65 to create or update a personalized plan to prevent illness and promote wellness. –– Behavioral health integration with primary care to screen and refer patients for treatment as needed. As an example, the percentage of patients screened for clinical depression and provided with a follow-up plan at the Dolan Family Health Center is shown.

Northwell Health Screening for clinical depression & follow-up plan Dolan Family Health Center 2017 – 2018 2016 CMS benchmark 100100%

8080%

6060%

4040%

2020%

0%0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018

Source: Northwell Health Physician Partners Database, KQMI Vector of Measures Higher is better Data as of February 21, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 25 Physician Partners Screening to improve health Screening for hepatitis C and human immunodeficiency virus (HIV) provides the advantage of early treatment for these diseases. The Northwell Health Physician Partners quality team partnered with physicians in screening patients for hepatitis C infection and HIV by providing education, enhancing the electronic health record and developing a reporting tool. As a result, screening for these conditions has consistently increased from 2017 to 2018.

Northwell Health Hepatitis C screening Physician Partners 2017 – 2018

100%100

80%80

60%60

40%40 COMPLIANCE

20%20

0%0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018 Source: Northwell Health Physician Partners Database, KQMI Vector of Measures Higher is better Data as of March 27, 2019

Northwell Health Human Immunodeficiency Virus (HIV) screening Physician Partners 2017 – 2018

100100%

80%80

60%60

40%40 COMPLIANCE

20%20

0%0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018 Source: Northwell Health Physician Partners Database, KQMI Vector of Measures Higher is better Data as of March 27, 2019

26 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Northwell Health At Home Heart failure disease management program The heart failure disease management program improves quality of life for patients. It provides the highest quality of clinical care, educates health care professionals, provides continuity of care, empowers patients to self-manage their illness and decreases avoidable hospitalizations and emergent care visits. The program was developed utilizing clinical practice guidelines from the American Heart Association, the Heart Society of America and the New York Heart Association Functional Classification.

Northwell Health At Home readmission rates for heart failure patients were consistently lower than the Strategic Healthcare Programs (SHP) benchmarks in 2018 (National and New York State).

In December 2018, Northwell Health At Home earned The Joint Commission’s Gold Seal of Approval® for Heart Failure Certification. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care.

Northwell Health Heart failure 30-day rehospitalizations Northwell Health At Home 2018

Strategic Healthcare Programs (SHP), NY State SHP National

2525%

2020%

1515%

1010%

5%5

00 Q1 Q2 Q3 Q4

Source: Outcome and Assessment Information Set (OASIS) Lower is better Data as of April 5, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 27 Hospital-acquired conditions Northwell Health continues to decrease catheter-associated urinary tract infections, central line-associated blood stream infections and hospital-acquired pressure injuries. Results comparing 2015 vs. 2018 are shown.

24% decrease ICU and Non-ICU Catheter-associated urinary tract infections 66% 17% decrease decrease Hospital-acquired ICU and Non-ICU pressure injuries Central line-associated bloodstream infections

28 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Teamwork

29 Screening, Brief Intervention and Referral to Treatment A system-level approach to addressing substance use Northwell Health’s Screening, Brief Intervention and Referral to Treatment (SBIRT) program identifies and intervenes with patients who may be dealing with consequences due to their alcohol and/or drug use. Clinical team members utilize evidence-based screening questions to engage in conversations that help them understand a patient’s substance use status and begin a process of partnership and support. Through brief interventions (conversations similar to a motivational interview) the care team and patient explore avenues for change and, if needed, referral for further services.

Northwell Health Screening, Brief Intervention and Referral for Treatment (SBIRT) Referrals for treatment 2017–2018 500500

400400

300300

200NUMBER 200

100100

00 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018

Includes emergency departments in eight acute care hospitals, one children’s hospital and free- standing emergency department as well as in five physician practices

Source: Business Intelligence & Healthcare Analytics reports, SBIRT REDCap Database, and Mather Hospital Delivery System Reform Incentive Payment (DSRIP) reports Higher is better Data as of March 1, 2019

30 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Timely referrals for organ donation

In 2018, Northwell Health and LiveOnNY designed and executed strategies to improve the organ and tissue referral process. In collaboration with LiveOnNY, Northwell Health educated over 250 nurses from hospitals throughout the organization in all aspects of organ and tissue donation through the Donor Nurse Champion course. Nurses completing the course act as a clinical resource for their colleagues and LiveOnNY during the organ donation process and participate in outreach and events that promote organ donation at their sites. Their efforts are instrumental in improving outcomes for individuals waiting for an organ transplant throughout New York State and the country. The timeliness of organ donation referrals has increased due to the efforts of our clinical teams in collaboration with LiveOnNY staff.

There was a 30 percent increase in the number of organ donors and a 40 percent increase in the number of organs transplanted at Northwell Health hospitals, due in part to the increase in timely referrals (2017 vs. 2018).

Northwell Health Organ referral timely rate 2017 vs. 2018

LiveOnNY Benchmark = 95% 100100% 6.26% 9090% Increase 2017 vs. 2018 8080%

7070%

6060%

5050% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018

Source: LiveOnNY Database Higher is better Data as of January 26, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 31 Adult renal transplant

Kidney transplants are limited by a shortage of organ availability. Many patients wait 5–7 years for a donor. To manage the organ donor shortage, the North Shore University Hospital (NSUH) Renal Transplant program increased the number of kidney transplants performed using organs from donors with hepatitis C. With available treatments, 100 percent of the recipients are hepatitis-free and wait-time for transplant was greatly reduced. In 2018, almost half (49 percent) of organ recipients were successfully transplanted with kidneys from this new pool of organ donors.

Innovations by organ transplant program leadership led to successful use of hepatitis C-positive donors and the development of protocols for patient management. Only 10 academic medical centers in the United States perform the majority of these transplants.

The Scientific Registry of Transplant Recipients (SRTR) ranks 250 transplant programs across the country with a five-tier rating system based on risk-adjusted patient survival. In 2018, North Shore University Hospital achieved the highest tier, a level-five rating, leading the 20 adult kidney transplant hospitals in all of New York, New Jersey and Connecticut.

32 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Pediatric renal transplant

The Pediatric Renal Transplant and Living Donor program performed its first transplant in Q4 2017. Since that time, the program has successfully performed 15 pediatric transplants, making the program at Cohen Children’s Medical Center the 4th largest in New York State.

The one-year survival rate for pediatric transplant patients was 100 percent according to the 2019 Scientific Registry of Transplant Recipients.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 33 Innovation

34 Information Services Delivering Care in a Digital World dPx (digital Patient Experience) A new division of Northwell Health, dPx (digital Patient Experience) was launched in 2018 to reimagine how care is delivered to patients in a digital world. Leaders throughout the organization collaborated to shape this digital transformation. The dPx platform is a set of digital tools and features that patients can access with a single login through easy to use web and mobile applications. Initial features deployed in 2018 included: –– Launch of an online payment portal to simplify the overall financial experience and introduce alternative payment options. To date, over 150,000 transactions have been processed. –– Implementation of a digital forms feature that enables patients to complete any required forms electronically. Over 10,000 forms have been processed electronically so far.

Biometrics, specifically iris scanning and deep facial recognition, is used to expedite registration processes, improve patient identification/authentication and reduce duplicate medical records. The biometric technology was deployed to a dozen practices including pediatrics and over 15,000 patients have enrolled their biometrics to date.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 35 BioFire Improving time to effective therapy in bloodstream infections and sepsis Bloodstream infections and sepsis rank among the top causes of hospitalization and mortality in the United States. Time to effective therapy is a goal for optimizing treatment. Methods to improve early recognition and treatment are necessary to reduce mortality due to bacterial and fungal bloodstream infections. The blood culture identification (BCID) panel is a molecular-based test performed directly on a positive blood culture. It can detect up to 24 different bacterial and fungal pathogens and three antibiotic resistant genes. This can result in earlier escalation of therapy for uncommon or antibiotic-resistant organisms such as vancomycin resistant Enterococcus (VRE). In addition, the BCID panel permits earlier deescalation of antimicrobial therapy, for example, going from a broad-spectrum to narrower-spectrum antibiotics.

The blood culture identification (BCID) panel revolutionized laboratory workflow by reducing the time to organism identification. It is now a system standard. Since its implementation, the time to escalation for VRE decreased from 31 to 5 hours.

Northwell Health Time to appropriate antimicrobial therapy in patients with vancomycin resistant Enterococcus (VRE) bacteremia 2017 – 2018

3535

3030 2525 26 2020 Hour 15 (HOURS) MEDIAN 15 Decrease 1010

55

00 PRE-BCID: POST-BCID: Q1 & Q2 2017 Q1 & Q2 2018

Includes the following hospitals: Huntington, Lenox Hill, LIJ Forest Hills, LIJ Valley Stream, North Shore University Hospital, Plainview, Southside and Syosset hospitals Source: Northwell Health Labs Quality Assurance Database Lower is better Data as of February 26, 2019

36 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Pediatric behavioral health urgent care Addressing mental health access gaps for rapid evaluation and treatment One in five children experience a mental health issue in any given year, and suicide is now the second leading cause of death in youth age 10 to 24. However, timely access to child and adolescent mental health services is not consistently available, due to provider shortages and lack of affordable outpatient models. As a result, emergency department (ED) visits for behavioral health conditions have increased 44 percent across the country consistently for the last decade, leading to protracted patient stays that are associated with safety concerns, inefficient resource allocation and compromised overall care. To address this crisis, the Northwell Health Pediatric and Behavioral Health Service Lines partnered to establish Pediatric Behavioral Health Urgent Care at Cohen Children’s Medical Center. This unique program allows children and families confronting a psychiatric crisis to avoid already congested EDs by providing immediate access to mental health evaluation and treatment in an alternative setting. This model has helped decrease ED visits by 11 percent. Furthermore, through enhanced post-visit linkage to community providers, repeat visits decreased by nearly 60 percent as shown.

Since its inception in May 2017, the Behavioral Health Urgent Care at Cohen Children’s Medical Center has been utilized by 1,600 families. Ninety-eight percent of families agreed or strongly agreed that the visit met their child’s needs and 96 percent would recommend the service to others.

Northwell Health Repeat behavioral health emergency department visits within 7 days Cohen Children’s Medical Center Pediatric Behavioral Health Urgent Care 2017 – 2018

8%8 7%7 6%6 5%5 4%4 3%3 2%2 1%1 0%0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2017 2018

Source: Emergency Department – Behavioral Health Business Intelligence Report Lower is better Data as of February 21, 2019

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 37 Telehealth Direct-to-consumer telehealth initiative Direct-to-consumer telehealth technology allows health care professionals to deliver care to patients in a variety of settings by utilizing real-time audio and video virtual sessions. By partnering with telemedicine company American Well to develop a patient and provider-focused virtual platform, Northwell Health united its 23 hospitals and more than 700 outpatient practices under one telehealth infrastructure including physician offices, imaging centers, laboratories, same-day surgical centers, skilled nursing facilities, home care, emergency medical and air ambulance services.​ The Northwell Health Anticoagulation Clot Council is utilizing the platform for a pilot program that allows patients on Long Island to have real-time virtual visits with nurse practitioners at Staten Island University Hospital. The goal of the program is to increase the amount of patient time in therapeutic range (TTR), a clinical outcome associated with anticoagulant control, and improve patient satisfaction. Since the start of the pilot program in May 2018 there have been 85 virtual visits with a nurse practitioner.

Average time in therapeutic range (TTR) increased from 32 percent (pre-telehealth) to 73 percent (post telehealth) during the pilot program. Based on these successful results, program expansion is planned.

eSNF An innovative telemedicine program (eSNF) was launched at the Stern Family Center for Rehabilitation to provide real-time support to clinical staff at the bedside. Most skilled nursing facilities (SNFs) don’t have physicians on site around the clock, and in the past if a patient’s condition changed after hours, clinical staff relied on telephone consults, or patient transfer to an acute care facility for further assessment and treatment. Now, through eSNF, if an acute medical situation arises, staff at the bedside can consult with clinicians at the telehealth command center through the use of two-way cameras, monitors and computer programs that transmit information directly between the providers. Intensivists and/or critical care physicians and nurses at the command center have real- time access to the patient’s vital signs and cardiac rhythm, as well as his or her electronic health record, to assess, diagnose and minimize hospitalizations.

The Stern Family Center for Rehabilitation was the first skilled nursing facility (SNF) at Northwell Health to implement telehealth technology (eSNF). Forty patient readmissions were prevented during the initial pilot program. In September 2018, eSNF was extended to the Orzac Center for Rehabilitation.

38 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 2018 Quality awards and recognition

39 Northwell Health

–– American Hospital Association (AHA) Quest for Quality Prize. –– Center of Excellence, Endovascular and Vascular Center, Surgical Northwell Health is the first and only health system in the Review Corporation (SRC). country to receive this award for its commitment to improving –– CEO Cancer Gold Standard, CEO Roundtable on Cancer. access to care, value, partnerships, well-being, coordination and the health of the community. –– Diagnostic Center of Excellence, Imaging Services, American College of Radiology (ACR). –– Healthcare Association of New York State (HANYS) Pinnacle Award for Quality and Patient Safety. This award recognizes –– Leader in LGBTQ Healthcare Equality, Human Rights Campaign Northwell Health’s organization-wide approach to antimicrobial Foundation Healthcare Equality Index. stewardship and the results of the program. –– Minimally Invasive Gynecology Network of Excellence, SRC. –– One of the World’s Most Ethical Companies, Ethisphere Institute. –– Network of Excellence in Advanced Robotic Surgery, SRC. –– 100 Best Places to Work for Diversity. Northwell is the only –– Reaccreditation–Epilepsy Center, National Association of health care provider in New York State named as part of this Epilepsy Centers: ranking, Fortune. • Cohen Children’s Medical Center, Pediatric Epilepsy Center –– 150 Great Places to Work in Healthcare, Becker’s Hospital Review. • North Shore University Hospital, Comprehensive Epilepsy –– Top 12 Hospitals and Health Systems for Diversity, fifth place Center ranking, DiversityInc. • Lenox Hill Hospital, Comprehensive Epilepsy Center, Level 3 • Southside Hospital, Epilepsy Center, Level 3 –– Bariatric Surgery Center of Excellence, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program: –– Stars of Life, American Ambulance Association. • Huntington Hospital –– Verified Trauma Centers, American College of Surgeons (ACS): • Lenox Hill Hospital • Cohen Children’s Medical Center, Level 1–Pediatrics • Mather Hospital • North Shore University Hospital, Level 1–Adult • Northern Westchester Hospital • Staten Island University Hospital, Level 1–Adult and • North Shore University Hospital Level 2–Pediatrics • Peconic Bay Medical Center • Southside Hospital, Level 2–Adult • Syosset Hospital • Huntington Hospital, Level 3–Adult

40 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Glen Cove Hospital Glen Cove Hospital is a 247-bed community hospital that offers inpatient medical and surgical care, acute rehabilitation, critical care and a brain injury unit. –– Community Cancer Program, American College of Surgeons (ACoS), Commission on Cancer (CoC). –– Diagnostic Imaging Center of Excellence, Designated Lung Cancer Screening Center, ACR. –– Disease Specific Care Certification (DSC) for Advanced Inpatient Diabetes, The Joint Commission (TJC). –– National Hospital Organ Donation Campaign–Bronze Recognition, Health Resources and Services Administration (HRSA). –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, American Heart Association (AHA). –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

Huntington Hospital Huntington Hospital is a 408-bed community hospital that offers inpatient services, including medical and surgical, pediatrics, critical care, maternity, Level II perinatal, behavioral health, palliative and complementary medicine. –– Academic Center for Excellence for Minimally Invasive Surgery in Gynecologic Oncology and Gynecology, American Institute of Minimally Invasive Surgery (AIMIS). –– “Best Hospitals” regionally ranked #20 in NY, #16 in NY metro area; high performing in colon cancer surgery, gastroenterology & GI surgery, heart failure and hip replacement. U.S. News & World Report (2018–19). –– Comprehensive Community Cancer Program, ACoS, CoC. –– Center of Excellence in Robotic Surgery, SRC. –– Diagnostic Imaging Center of Excellence, Designated Lung Cancer Screening Center, ACR. –– DSC for Advanced Palliative Care, TJC. –– DSC for Joint Replacement–Hip and Knee, TJC. –– “HealthCare’s Most Wired” recognition, College of Healthcare Information Management Executives (CHIME). –– Magnet® Designation for Nursing Excellence, American Nurses Credentialing Center (ANCC). –– Minimally Invasive Gynecology Center of Excellence, SRC and American Association of Gynecologic Laparoscopists (AAGL). –– National Accreditation Program for Breast Centers, ACoS. –– National Hospital Organ Donation Campaign–Platinum Recognition, HRSA. –– Own the Bone – Star Performer, American Orthopedic Association. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 41 Lenox Hill Hospital Lenox Hill Hospital is a 652-bed, acute-care hospital located on Manhattan’s Upper East Side. Manhattan Eye, Ear and Throat Hospital is a division of Lenox Hill Hospital, providing ambulatory surgery and a variety of outpatient specialty services. Lenox Health Greenwich Village is a division of Lenox Hill Hospital which is comprised of a free-standing emergency center and medical complex. –– “Best Hospitals” regionally ranked #6 in NY, #8 in NY metro area; high performing in cancer, chronic obstructive pulmonary disease, gastroenterology & GI surgery, geriatrics, heart bypass surgery, heart failure, hip replacement, nephrology, neurology & neurosurgery and urology. U.S. News & World Report (2018–19). –– 100 Best Hospitals (National), Healthgrades. –– Cancer Registry Timeliness Award, NYSDOH. –– Diagnostic Imaging Center of Excellence, ACR. –– Distinguished Hospital Award for Clinical Excellence, Healthgrades. –– DSC for Advanced Palliative Care, TJC. –– DSC for Advanced Total Hip and Knee Replacement, TJC. –– “HealthCare’s Most Wired” recognition, CHIME. –– Mission: Lifeline Emergency Medical Services (EMS) Bronze Recognition– Receiving Plus Recognition Award, AHA. –– National Hospital Organ Donation Campaign–Silver Recognition, HRSA. –– Stroke Excellence Award, Healthgrades. –– Stroke Gold Plus Recognition, Get With The Guidelines—Stroke, AHA. –– Target: Stroke Honor Roll­–Elite Plus, Get With The Guidelines–Stroke, AHA.

Long Island Jewish Medical Center Long Island Jewish Hospital is a 583-bed tertiary care teaching hospital serving the greater metropolitan New York area. –– Academic Center for Excellence for Minimally Invasive Surgery in Gynecologic Oncology and Gynecology, AIMIS. –– Academic Comprehensive Cancer Program, ACoS, CoC. –– “Best Hospitals” regionally ranked #15 in NY, #13 NY metro area; high performing in chronic obstructive pulmonary disease, colon cancer surgery, heart failure, lung cancer surgery, nephrology and urology. U.S. News & World Report (2018–19). –– Center for Excellence for Transcarotid Arterial Revascularization (TCAR), Silk Road Medical. –– Center of Excellence in Robotic Surgery, SRC. –– Diagnostic Imaging Center of Excellence, Designated Lung Cancer Screening Center, ACR. –– DSC for Advanced Inpatient Diabetes, TJC. –– DSC for Advanced Palliative Care, TJC. –– DSC for Joint Replacement—Hip and Knee, TJC. –– “HealthCare’s Most Wired” recognition, CHIME. –– Magnet® Designation for Nursing Excellence, ANCC. –– Minimally Invasive Gynecology Center of Excellence, SRC, AAGL. –– National Accreditation Program for Breast Centers, ACS. –– National Hospital Organ Donation Campaign—Gold Recognition, HRSA. –– Nurses Improving Care for Healthsystem Elders (NICHE) designation, NICHE. –– Safe Sleep Project Quality Improvement Award, NYS Perinatal Quality Collaborative. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

42 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Long Island Jewish Forest Hills Long Island Jewish Forest Hills is a 312-bed hospital located in central Queens. –– Baby-Friendly USA, World Health Organization and United Nations Children’s Fund. –– Community Leader Award, Central Queens Y and Samuel Field Y. –– “HealthCare’s Most Wired” recognition, CHIME. –– Lung Cancer Screening Center of Excellence, ACR. –– Magnetic Resonance Imaging (MRI) Accreditation, ACR. –– Minimally Invasive Gynecology Center of Excellence, SRC, AAGL. –– National Hospital Organ Donation Campaign–Gold Recognition, HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

Long Island Jewish Valley Stream Long Island Jewish Valley Stream is a 284-bed hospital that focuses on patient-centered care and offers a comprehensive continuum of inpatient and outpatient services. Its full range of services includes orthopedics, medical and surgical care, wound care and ambulatory surgery. –– Beacon Award, Bronze (Critical Care), American Association of Critical Care Nurses (AACN). –– Diagnostic Imaging Center of Excellence, Designated Lung Cancer Screening Center, ACR. –– National Hospital Organ Donation Campaign–Silver Recognition, HRSA. –– Nurses Improving Care for Healthsystem Elders (NICHE) designation, NICHE. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 43 Mather Hospital Mather Hospital is an accredited 248-bed, non-profit community teaching hospital that has been providing a wide spectrum of high quality health care services to communities in the Town of Brookhaven and Suffolk County since 1929. –– Accredited Practice Transition Program, ANCC. –– Breast Imaging Center of Excellence, ACR. –– Center of Excellence in Robotic Surgery, SRC. –– Comprehensive Community Cancer Program, ACoS, CoC. –– Magnet® Designation for Nursing Excellence, ANCC. –– National Hospital Organ Donation Campaign–Bronze Recognition, HRSA. –– Patient Experience–4 Star, CMS. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

Northern Westchester Hospital Northern Westchester Hospital is a 189-bed acute care hospital that offers a wide range of medical-surgical, inpatient and outpatient services. Specialties include bariatric, gamma knife and robotic surgery, cancer treatment, pain management and palliative care. –– “Best Hospitals” regionally ranked #23 in NY, recognized in Hudson Valley, #20 in NY metro area; high performing in heart failure, hip replacement and knee replacement, U.S. News & World Report (2018–19). –– Breast Imaging Center of Excellence, Diagnostic Imaging Center of Excellence, ACR. –– Center of Excellence in Robotic Surgery, SRC. –– CEO Cancer Gold Standard, CEO Roundtable on Cancer. –– Certified Cardiac Rehabilitation Program, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). –– Comprehensive Community Cancer Program, ACoS, CoC. –– Distinction for Leadership and Innovation in Patient-Centered Care, the Planetree Organization. –– Magnet® Designation for Nursing Excellence, ANCC. –– National Accreditation Program for Breast Centers, ACoS. –– National Hospital Organ Donation Campaign–Platinum Recognition, HRSA. –– Robert A. Warriner III Center of Excellence Award for Wound Care and Hyperbaric Medicine Center, Healogics. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

44 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report North Shore University Hospital North Shore University Hospital is a 764-bed quaternary care teaching hospital that offers a comprehensive continuum of inpatient and outpatient services. –– Academic Center of Excellence for Minimally Invasive Surgery in Gynecologic Oncology and Gynecology, AIMIS. –– Academic Comprehensive Cancer Program, ACoS, CoC. –– Accredited Adult Stem Cell Program, Foundation for the Accreditation of Cellular Therapy (FACT). –– America’s 100 Best Hospitals Award, Healthgrades. –– America’s 100 Best Hospitals for Coronary Intervention and Gastrointestinal Care Award, Healthgrades. –– America’s 50 Best Hospitals for Cardiac Surgery Award, Healthgrades. –– Bariatric Surgery Excellence Award, Cardiac Care Excellence Award, Cranial Neurosurgery Excellence Award, Distinguished Hospital Award for Clinical Excellence, General Surgery Excellence Award and Stroke Care Excellence Award, Healthgrades. –– Beacon Award, Gold, Neonatal Intensive Care Unit (ICU), AACN. –– Beacon Award, Silver, Coronary Care Unit, Cardiothoracic ICU, Medical ICU, Neurosurgical ICU, AACN. –– “Best Hospitals” regionally ranked #9 in NY, #11 in NY metro area (includes Syosset Hospital); high performing in abdominal aortic aneurysm repair, aortic valve surgery, chronic obstructive pulmonary disease, colon cancer surgery, geriatrics, heart bypass surgery, heart failure, lung cancer surgery and neurology & neurosurgery, U.S. News & World Report (2018–19). –– Center of Excellence in Minimally Invasive Gynecology and Robotic Surgery, SRC. –– Consumer Choice Award. –– Diagnostic Imaging Center of Excellence, Designated Lung Cancer Screening Center, ACR. –– DSC for Advanced Comprehensive Stroke Center, Advanced Inpatient Diabetes, Advanced Palliative Care, Advanced Ventricular Assist Device, Joint Replacement– Hip and Knee and Spine Surgery, TJC. –– Endoscopy Unit Recognition, American Society for Gastrointestinal Endoscopy (ASGE). –– “HealthCare’s Most Wired” recognition, CHIME. –– Magnet® Designation for Nursing Excellence, ANCC. –– National Hospital Organ Donation Campaign–Platinum Recognition, HRSA. –– Patient Safety and Innovation Award, Medical Staff Society. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

Peconic Bay Medical Center Peconic Bay Medical Center is a 182-bed medical center that offers a wide range of health care services including advanced surgical care, comprehensive inpatient medical care, palliative care and an extensive range of outpatient services. –– Blue Distinction Center for Bariatric Surgery, Empire Blue Cross and Blue Shield. –– Diagnostic Imaging Center of Excellence, ACR. –– DSC for Advanced Palliative Care, TJC. –– DSC for Joint Replacement–Hip and Knee, TJC. –– National Hospital Organ Donation Campaign–Bronze Recognition, HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 45 Phelps Hospital Phelps Hospital is a 238-bed acute care community hospital, located in central Westchester County. Emergency, acute care inpatient services, as well as a host of outpatient services are provided. –– Accredited for Echocardiography, Intersocietal Accreditation Commission (IAC). –– Accredited for Sleep Medicine, American Academy of Sleep Medicine. –– Baby-Friendly, USA, World Health Organization and United Nations Children’s Fund. –– “Best Hospitals” high performing in hip replacement, U.S. News & World Report (2018–19). –– Breast Imaging Center of Excellence, Diagnostic Imaging Center of Excellence, ACR. –– Certified Cardiac Rehabilitation Program, AACVPR. –– Community Hospital Cancer Program–Accredited with Commendation, ACoS, CoC. –– Hyperbaric Center–Accredited with Distinction, Undersea and Hyperbaric Medical Society (UHMS). –– National Hospital Organ Donation Campaign–Platinum Recognition, HRSA. –– Nurses Improving Care for Healthsystem Elders designation, Exemplar Status (highest level), NICHE. –– Platinum Fit Friendly Award, AHA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

Plainview Hospital Plainview Hospital is a 204-bed teaching hospital serving Eastern Nassau County. –– Accredited for Echocardiography, IAC. –– Accredited for MRI, CT, and Ultrasound, ACR. –– “Best Hospitals” high performing in heart failure, U.S. News & World Report (2018–19). –– Designated Lung Cancer Screening Center, ACR. –– DSC for Advanced Inpatient Diabetes, TJC. –– “HealthCare’s Most Wired” recognition, CHIME. –– Hyperbaric Center–Accredited with Distinction, UHMS. –– Minimally Invasive Gynecology Center of Excellence, SRC, AAGL. –– National Hospital Organ Donation Campaign–Silver Recognition, HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite, Get With The Guidelines–Stroke, AHA.

46 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Southside Hospital Southside Hospital is a 320-bed tertiary hospital with the following inpatient services: medical surgical, intensive and cardiac care units, OB/GYN with a Level II perinatal service, orthopedics, pediatrics and medical rehabilitation. –– “Best Hospitals” high performing in hip replacement, U.S. News & World Report (2018–19). –– Breast Imaging Center of Excellence, Diagnostic Imaging Center of Excellence, ACR. –– Center of Excellence in Robotic Surgery, SRC. –– DSC for Joint Replacement–Hip and Knee, TJC. –– HealthCare’s Most Wired” recognition. CHIME. –– Minimally Invasive Gynecology Center of Excellence, SRC, AAGL. –– National Hospital Organ Donation Campaign–Gold Recognition, HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA. –– Top 50 Cardiovascular Hospitals, IBM Watson Health.

Steven and Alexandra Cohen Children’s Medical Center Steven and Alexandra Cohen Children’s Medical Center of New York is the largest provider of pediatric health care services in New York State, with 169 beds and covering a service area that includes 1.8 million children in Brooklyn, Queens, Nassau and Suffolk counties. –– “America’s Best Children’s Hospitals” nationally ranked Top 50 in eight pediatric specialties: diabetes & endocrinology, gastroenterology & gastrointestinal surgery, neonatology, nephrology, neurology & neurosurgery, orthopedics, pulmonology and urology, U.S. News & World Report (2018–19). –– Beacon Award for Excellence, Pediatric Intensive Care Unit, AACN. –– Gold Plus Center of Excellence for Extracorporeal Membrane Oxygenation (ECMO), Extracorporeal Life Support Organization. –– Magnet® Designation for Nursing Excellence, ANCC. –– National Hospital Organ Donation Campaign–Gold Recognition, HRSA. –– Resuscitation Award, Get with the Guidelines–Resuscitation, AHA.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 47 Staten Island University Hospital Staten Island University Hospital is a 714-bed tertiary teaching hospital that occupies two large campuses, plus a number of community-based health centers and labs. –– Academic Comprehensive Cancer Program–Gold Level Commendation, ACoS, CoC. –– “Best Hospitals” regionally ranked #26 in NY, #26 in NY metro area; high performing in chronic obstructive pulmonary disease, diabetes & endocrinology and heart failure, U.S. News and World Report (2018–19). –– Diagnostic Imaging Center of Excellence, ACR. –– “HealthCare’s Most Wired” recognition, CHIME. –– National Hospital Organ Donation Campaign–Platinum Recognition (North Site). Gold Recognition (South Site), HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

Syosset Hospital Syosset Hospital is a 103-bed community hospital operated by North Shore University Hospital with inpatient medical-surgical units and an intensive care unit. –– Accredited for Computerized Axial Tomography (CT) Ultrasound and Nuclear Medicine, ACR. –– Certification for Echocardiography, Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). –– Diagnostic Imaging Center of Excellence, ACR. –– DSC for Inpatient Diabetes, TJC. –– DSC for Joint Replacement–Total Hip and Knee, TJC. –– DSC for Spine Surgery, TJC. –– “HealthCare’s Most Wired” recognition, CHIME. –– Minimally Invasive Gynecology, AAGL. –– National Hospital Organ Donation Campaign–Bronze Recognition, HRSA. –– Stroke Gold Plus Recognition, Get With The Guidelines–Stroke, AHA. –– Target: Stroke Honor Roll–Elite Plus, Get With The Guidelines–Stroke, AHA.

Northwell Health At Home Northwell Health At Home served more than 42,000 patients and conducted over 592,000 home care visits in 2018. Specialty programs include behavioral health, diabetes, heart failure, palliative home care and telehealth. –– Community-Based Palliative Care Certification, Northwell Health At Home Advanced Illness Program, TJC. –– Heart Failure Certification (Long Island Jewish Home Care Agency), TJC. –– Heart Failure Certification (North Shore Home Care), TJC.

48 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report Northwell Health Physician Partners Northwell Health Physician Partners is one of the largest physician group practices in the country. –– Merit-based Incentive Payment System (MIPS)–achieved a score of 88.2 out of 100 for the ACO, CMS. –– Medicare Access and CHIP Reauthorization Act (MACRA)–achieved 39.9 out of 50 of available quality points in the first MACRA performance year, CMS. –– Patient Centered Medical Home (PCMH) recognition–61 primary care practices received this recognition, National Committee for Quality Assurance (NCQA).

The Zucker Hillside Hospital The Zucker Hillside Hospital is a 234-bed behavioral health facility known for its pioneering work in the diagnosis, treatment and research of mental illness. The hospital provides a comprehensive continuum of behavioral health services to all age groups. –– Nurses Improving Care for Healthsystem Elders designation, NICHE. –– Pioneer Award for Perinatal Psychiatry Services, Postpartum Resource Center of New York. –– Recovery After an Initial Schizophrenia Episode (RAISE), National Institute of Mental Health. –– Using Care Managers and Technology to Improve the Care of Patients with Schizophrenia — three-year grant, CMS.

South Oaks Hospital South Oaks Hospital is a 202-bed behavioral health facility dedicated to providing treatment and recovery from acute psychiatric illness and addiction. –– Gold Fit–Friendly Award, AHA.

Northwell Health | 2019 Clinical Excellence and Quality/Safety Report 49 Orzac Center for Rehabilitation The 120-bed Orzac Center for Rehabilitation specializes in short-term rehabilitation, skilled nursing and extended care services. –– “America’s Best Nursing Homes” five-star rated, U.S. News & World Report, (2018–2019). –– Five-star rated, CMS. –– Ranked in the 1st Quintile (Best) in NYS Nursing Home Quality Pool, NYSDOH.

Stern Family Center for Rehabilitation The 249-bed Stern Family Center for Rehabilitation specializes in short- term rehabilitation, skilled nursing and extended care services. –– “America’s Best Nursing Homes” five-star rated, U.S. News & World Report, (2018–2019). –– Five-star rated, CMS. –– Ranked in the 1st Quintile (Best) in NYS Nursing Home Quality Pool, NYSDOH. –– Top Performing Nursing Home (third consecutive year), NYSDOH.

50 Northwell Health | 2019 Clinical Excellence and Quality/Safety Report

Truly Compassionate

Truly Innovative

Truly Ambitious

Truly Together

Truly Ourselves

Northwell Health 2000 Marcus Avenue New Hyde Park, NY 11042 (516) 321-6701 northwell.edu