The New Standard

In-house 3D design and printing, page 5 Bystanders become lifesavers, page 23 Winners and inventors, page 49 Spotlight on organ and tissue transplants, pages 35 to 44

The employee publication of Northwell Health Volume 2, 2018 Issue highlights The New Standard Volume 2, 2018

Northwell Health Cancer Institute’s Editor in Chief new leader Terry Lynam

Richard Barakat, MD, is implementing growth strategies that Director of Editorial Services served him well at Memorial Sloan Kettering Cancer Center. 4 Maria Conforti Contributors Special section: Aiming for the stars Lisa Davis Northwell’s working to lift CMS scores with quality, Chris Gasiewski safety and patient experience initiatives. Brian Lima, MD Heather Ball Mayer 6 Andrea Mineo Jason Molinet Identifying and addressing Brian Mulligan Diane O’Donnell HIV hot spots Margarita Oksenkrug Michelle Pipia-Stiles Clinicians, researchers and community leaders are Christian Preston collaborating to increase access to care and prevention of HIV. 18 Adrienne Stoller Stu Vincent Walking the talk Allie Zendrian A pediatric bone marrow transplant nurse recently donated Graphic Design her own bone marrow to save an anonymous patient. Gina Reduzzi/Reduzzi Design

Production and Editorial Support 24 Onward Publishing, Inc.

Smart home Comments/Suggestions? Contact: Chris Levi recently moved into a donated home that’s Public Relations Department customized to accommodate the injuries he sustained in 2000 Marcus Avenue Operation Iraqi Freedom. Lake Success, NY 11042 29 [email protected] Advance-practice nursing grads The inaugural graduating class of NPs from the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies recently celebrated their achievement. 51 On the cover Farnita Cobb helps friends and neighbors make health connections as part of our For the Community, By the Community Program. 16

2 2018, Volume 2 | The New Standard A message from the president and CEO

Serving our communities, measuring success

In a vast health system like ours, we pride ourselves on maintaining a focus on all of the issues impacting the communities we serve and our ability to measure our success. One example is our stepped-up efforts to address the health disparities throughout Michael Dowling Northwell Health’s service area, where a difference of a few miles makes a significant difference in life expectancy.

Northwell’s Office of Community Health Investment, our care-management entity, Health Solutions, and others across the organization are working to identify the social determinants of health that adversely affect our neighbors. We’re also collaborating with many community-based organizations to develop solutions that will help improve Expanding access access to care, fill service gaps and target resources to reduce the incidence of chronic disease, including HIV. In-depth coverage of our community health investment to life-saving care is strategies appears on pages 14 to 19. obviously at the core Expanding access to life-saving care is obviously at the core of our mission, so we are developing transplant programs to benefit patients suffering from heart, liver of our mission. and kidney failure, as well as those who need bone marrow, stem cell and corneal transplants. Find a comprehensive look at our progress in the “Spotlight on Organ and Tissue Transplantation” section on pages 35 to 44.

Measuring the success of the medical care has been a major focus of government regulators. A decade ago, the US Centers for Medicare and Medicaid Services (CMS) instituted its Five-Star Quality Rating System to help consumers compare hospitals based on their quality of performance. See how Northwell is reducing hospital readmissions, lowering hospital-acquired infections and improving patient satisfaction Visit in the “Aiming for the Stars” section (pages 6 to 13).

Colleagues who reach for the stars day-to-day deserve our recognition. See the 2018 Innovation Challenge winners on page 49, and visit northwell.edu/PresidentsAwards for a web exclusive on this year’s President’s Awards.

This issue of The New Standard also highlights work underway to reduce overreliance on medications (page 20), the success of targeted safety initiatives (pages 22 and 23), the dedication of staff members returning from military deployment (pages 26 to 28) and recent news about Magnet designations achieved by North Shore University and Mather hospitals (page 33). You’ll also find the latest about the first graduating class of our advanced-practice nursing school (page 51) and Cohen Children’s Medical Center’s exceptional rankings in US News & World Report’s “Best Children’s Hospitals” issue (page 58).

There are numerous other engaging stories that I know you will enjoy. As always, I appreciate your interest.

2018, Volume 2 | The New Standard 3 Cancer Institute leader to expand, integrate care Richard Barakat, MD, comes to Northwell from Memorial Sloan-Kettering.

Consolidation, partnerships and competition are common in –– Promote research Building up the Cancer Institute’s clinical health care, so expanding and enhancing cancer services is a trials program is another prime directive because research top Northwell Health priority. That’s why the health system is critical to a world-class cancer center, said Dr. Barakat. has recruited Richard Barakat, MD, as physician-in-chief and Northwell Health is home to the Feinstein Institute for Medical director of the Northwell Health Cancer Institute and senior vice Research, where scientists are investigating next-generation president of the health system’s cancer services. cancer treatments. Just as promising is the health system’s relationship with Cold Spring Harbor Laboratory. Dr. Barakat comes to the health system after 29 years at Memorial Sloan-Kettering Cancer Center (MSK), where he was Northwell Health has “an unbelievable opportunity to create the director and vice chair of the organization’s regional care something that isn’t here now,” said Dr. Barakat. “It will be a lot network and the Ronald O. Perelman Chair in Gynecologic of work, but with the talent and the potential that’s here, we can Surgery. His clinical experience and MBA from Columbia Business build something great.” School were instrumental in increasing MSK’s presence across metro New York. Dr. Barakat’s growth strategies grew MSK from one Manhattan site into a network throughout Westchester, Long Island, New Jersey and Connecticut.

His key goals for the Northwell Cancer Institute are:

–– Build prominence Dr. Barakat’s first priority is to enhance Northwell’s visibility as a premier provider of cancer services. “Right now, this is a virtual Cancer Institute,” he said. “We need an identity. When patients pull up to one of our facilities, they should see who we are.”

–– Develop new programs New services will put the Northwell Cancer Institute on the map. We have to play to our strengths. Northwell has a tremendous opportunity to build programs for patients who have a hard time finding care elsewhere,” said Dr. Barakat. He added that the Cancer Institute can differentiate itself by providing care for challenging cases that require coordination with other subspecialties. For example, pregnant women who receive a cancer diagnosis cannot be treated at a cancer center that doesn’t offer obstetrics and gynecology. “Obstetrics is a strength here,” he said. “If you’re pregnant and have cancer, many cancer centers can’t treat you. But you could come to Northwell.”

–– Emphasize a continuum of care Dr. Barakat also envisions a diagnosis-through-survivorship cancer program. “Our patients have to know that no matter what happens to them, we are here for them,” he said. “You have to chaperone people through. They’re scared and they want to know we will handle Richard Barakat, MD anything that comes along. And we can do that at Northwell.”

4 2018, Volume 2 | The New Standard Dr. Goldstein working on a new prosthetic in the 3D Printing Lab. Gaining a new medical dimension 3D Design and Printing Department launches.

Northwell Health physicians’ access to The 3D Design and Printing Department surgeons, cardiologists, dentists and custom-printed models, prosthetics, centers on Form Cell, a fully automatic 3D otolaryngologists. An online ordering implants, training tools and cutting printer from the Massachusetts-based system will open to the entire Northwell guides just picked up speed and shed manufacturer Formlabs. The device Health community this summer. considerable dollars. comprises six 3D printers and a robotic arm. “We want the whole health system to The health system recently established “We have the very first of these to come know we’re here and ready to help,” said Dr. a 3D Design and Printing Department at off the assembly line,” said Dr. Goldstein, Goldstein. “We can work hand-in-hand with 600 Community Drive in Manhasset. director of 3D printing and innovation. our physicians to develop what they want “It’s perfect for what we need.” for patient care, research and education.” The 3D lab lets any health system physician place and receive an order Dr. Goldstein sets up multiple projects “much more quickly” than using an in a queue and Form Cell goes to work. external 3D-printing company, according “I can leave 30 Form Cell projects to be Open for to Matthew Keller, senior project manager done over the weekend, and the machine at Northwell Ventures. completes them,” he said. Average business turnaround time is 24 to 72 hours, The health system’s 2016 Innovation depending on the size of the project — Northwell’s 3D medical printing Challenge spawned the 3D lab. Bioengineer a significant gain in productivity. is limited only by your needs and Todd Goldstein, PhD, and his team won creativity. Inquire about items such as: the challenge with a 3D bio-printing Form Cell can create things such as dental –– Anatomical models project. Northwell doctors heard about implants within hours for same-day –– Surgical guides for open and the work and began to request customized surgery. Larger items — for example, a minimally invasive surgery medical items for their practices. Some full-sized teaching model of a human –– Cutting guides were new users and others had been using pelvis — can take upwards of 24 hours. –– Training models for specific commercial 3D printing labs, which are Regardless of the output, Northwell’s pathologies expensive and time-consuming. production times are faster than –– Prosthetics commercial 3D printers. Furthermore, –– Custom orthopedic braces “There was definitely an unmet clinical enterprise 3D printing services simplify –– Patient-specific implants need,” said Mr. Keller. “And since it’s patient privacy issues because all records now economically and technologically remain within the health system. –– Dental implants feasible to provide this service on-site, Learn more by emailing it’s a natural fit for Northwell to open a The 3D lab is beta-testing with a [email protected]. centralized 3D printing lab.” handful of orthopedists, plastic 2018, Volume 2 | The New Standard 5 Aiming for the stars

Northwell Health has launched a system-wide initiative to improve its scores in the Center for Medicare and Medicaid’s (CMS) Hospital Star Ratings Program. CMS ratings help consumers compare hospitals based on their performance. Almost 60 quality measures help determine whether a hospital gets a five- star rating or something lower. Four measures carry particular weight — mortality, patient experience, safety and hospital readmissions — each accounting for 22 percent of the score. Aiming for the stars shows how Northwell facilities are addressing those categories, and the changes that are making a difference. Sending patients home— and keeping them there By Lisa Davis

Sure, Northwell Health hospitals we lose in Medicare readmission penalties programs swing into action for patients provide top-flight care in contemporary every year,” Dr. Smith said. undergoing hip or knee replacement, heart accommodations. But being readmitted is surgery or who are admitted for heart no one’s idea of a good time. A hospital loses even more money when failure, heart attack, stroke or chronic there’s a readmission for a procedure obstructive pulmonary disease (COPD). A quick return to the hospital is more included in Medicare’s Bundled than merely irritating or inconvenient. Payments Program, such as a hip or knee “We’re seeing really powerful outcomes,” Health care quality experts know that a replacement. There’s an expected cost said Zenobia Brown, MD, Health Solution’s high readmission rate suggests a failure for a patient’s hospital and post-hospital medical director for transitional care. “For of the system. The causes may include care, and if a readmission boosts the cost joint surgery and heart surgery, we had unclear instructions as patients head out above that target, the hospital could owe a 25 percent decrease in readmissions in the door, or inadequate follow-up care Medicare money. just one year.” once they’re back home. Moving the needle A simple concept is at the heart The US Center for Medicare and Medicaid of Northwell’s transitional care Services (CMS) penalizes hospitals that Relatively high readmissions rates are management: Build a relationship with have too many patient U-turns. Its Hospital also a big reason why none of Northwell’s the patient and check in often in order Readmissions Reduction Program cuts hospitals received more than three to avoid or fix potential problems before reimbursement payments as much as three stars out of five in the 2017 CMS overall they get out of control. So before a percent for poorly performing facilities. hospital quality ratings. News media and planned hospitalization (or during an consumers give the Hospital Star Ratings unplanned one), a care manager meets Unfortunately, Northwell Health has Program a lot of attention. with the patient. They review what to had above-average readmission rates for expect and discuss issues that might years, according to Kristofer Smith, MD, “Our performance has been poor and make recovery difficult. There are more senior vice president of population health the numbers are a wake-up call. But the meetings and more conversations during management. Dr. Smith is working with good news is that we’re committed to the discharge planning process. Chief Medical Officer David Battinelli, MD, improving,” Dr. Smith said. “And once to lead the health system’s readmissions Northwell decides to do something, we Once the patient is home, the care reductions efforts through Northwell tend to be able to move the needle.” manager calls within 24 hours to make Health Solutions, the enterprise’s care sure that everything is going smoothly. management organization. In fact, an increased focus on care For instance, has a home care agency management during the transition from made contact? Are all the medications “The amount varies, but $12 million to $15 hospital to home is already producing good the doctor prescribed on-hand? Is there million is a reasonable estimate of what results. Transitional care management pain, fever or swelling? If the patient is at

6 2018, Volume 2 | The New Standard Aiming for the stars

high risk of returning to the hospital, the and put other interventions in place. Now, The benefits will be measured in dollars care manager will make a home visit to for the first time in a year, the patient is and cents, ratings and grateful comments check vitals and trouble-shoot. The care taking his medications regularly.” from patients and their families, said manager will stay in close touch for 30 to Joseph Lamantia, executive director of 90 days, depending on the reason for the Northwell first began transitional care Health Solutions and vice president of hospital stay. management four years ago. It covered population health. CMS ratings are based about 300 patients as part of Medicare’s on a three-year, rolling average of hospital Trust is key to making the process work, original bundled payment program. Now, metrics, so it will take a few cycles for Dr. Brown said. more than 15,000 Northwell patients improvements to register, but the health annually benefit from transitional care. system is in it for the long haul. “We had one patient who had returned home but hadn’t filled any of his A key element in cutting readmissions is “Readmission rates will be a major focus prescriptions,” Dr. Brown said. “English to make sure patients get linked back in for Northwell until we get it where it was his second language and he had an with their ambulatory care providers. So needs to be. It’s ultimately a quality- intense distrust of the medical system, ultimately, the health system’s readmission of-care issue and a patient-experience but he finally agreed to let a care manager reduction work has to extend beyond the issue,” Mr. Lamantia said. “We do a come to his home. It turned out he hospitals, Dr. Smith said. “Readmissions great job of caring for our patients in couldn’t afford his medications. are not a Health Solutions problem, not a the hospital. Now we’re applying that hospital problem and not an ambulatory same mindset to what happens when our “Once we knew that, we were able to network problem,” Dr. Smith said. “They’re patients leave.” get him on Medicaid. We got his meds in everyone’s problem, because everyone blister packs, which are easier to deal with, owns a piece of it.” 2018, Volume 2 | The New Standard 7 Continuing progress against infections Significant reductions come from upending some standard operating procedures. By Lisa Davis

Hospitals can be risky places for sick a catheter placed to drain urine from the people — because they’re full of sick bladder, said Donna Armellino, RN, DNP, the people. It can be tough to prevent germs health system’s vice president for infection from hopping from one patient to another prevention. That changed when health by airborne transmission, unwashed care professionals realized that a catheter hands or a contaminated device or bedrail. can function as a highway for a microbe to That’s why about three percent of those enter a new and welcoming neighborhood. who enter a hospital in the US develop an infection while they’re there, and why “At one point, in many departments, if nearly 100,000 succumb to a hospital- you didn’t have an IV and a Foley catheter, acquired infection annually. the feeling was you didn’t get the right care,” said Dr. Armellino. “Now, the health off a downward spiral for a fragile patient It’s also why Northwell Health has a care team is only going to give a patient a and CLABSIs have a high mortality rate,” massive program to prevent and control catheter if it’s truly needed, and will ask Dr. Armellino said. “So we know the steps hospital-acquired infection. The US Center every day whether it can come out.” we’ve taken have saved lives.” for Medicare and Medicaid Services (CMS) tracks rates of certain infections. Surgical site infections are also a big focus. In its five-star quality rating system, CMS New protections The infection team bundles a number of bases a hospital’s score on infection rates There’s been a similar change in standard changes together because many elements and other measures, such as the rate of operating procedure when it comes to before, during and after an operation can pressure ulcers. patients getting a central line — an IV help microbes gain a foothold. that traditionally is placed into one of the “Northwell has made tremendous body’s large veins, like the jugular vein in The infection-control team worked with progress in the past four or five years the neck or chest area or the femoral vein colorectal surgeon Anthony Antonacci, in bringing down some of the most in the groin. A central line delivers medicine MD, the health system’s vice president problematic infections,” said Mark Jarrett, quickly, but it can also ferry dangerous for surgical quality, to introduce the MD, the health system’s chief quality germs into the bloodstream. So medical bundled procedures for colon surgery. officer and associate chief medical officer. teams now avoid placing a central line Every patient now gets oral antibiotics “We’ve raised awareness dramatically and when they can. If you need a central line, before an operation, followed by another put effective programs in place. But we they give preference to placement in the dose at the time of incision. Throughout can’t stand still because the right number neck or chest instead of the germ-friendly surgery, the anesthesiologist monitors for hospital-acquired infections is zero.” groin, and remove it as soon as possible. temperature and blood sugar because immune cells become less active when It’s a daunting challenge, because there Upending old routines has made a big body temperature drops or blood sugar are so many kinds of pathogens and so difference. The health system decreased rises. When it’s time to close up, the many ways they can attack the body. So the rate of catheter-associated urinary surgeon uses a fresh pair of sterile gloves Northwell’s infection prevention team is tract infections (CAUTI) by nearly 70 and a new, sterile instrument tray. constantly devising new strategies. One of percent from 2012 to 2017. In roughly the the most effective has been a rethinking of same period, Northwell reduced central “All the instruments you’ve been using routine practices. For instance, it used to line-associated bloodstream infections are already contaminated from inside the be almost automatic for patients to have (CLABSI) by 40 percent. “A CAUTI can set body, so now you’re going to use them to 8 2018, Volume 2 | The New Standard Aiming for the stars

A Northwell OR initiative has decreased surgical site infections by 30-plus percent for certain procedures. close the wound?” said Dr. Armellino. “It MD, chief of infectious disease at North which is expected to hit the market early makes more sense to finish with freshly Shore University Hospital. A few years next year. (See page 13 for more about sterile gloved hands and unused sterile ago, he and his team struggled to save PurpleSun.) instruments.” a man who was admitted with the infection. The 50-year-old had been More infection control strategies are Infections started dropping as soon as generally healthy, but developed C. diff under development. One of Dr. Armellino’s the bundle was in place, she said. In just after his physician gave him antibiotics priorities is a set of care bundles that one year, surgical site infections after for an upper respiratory infection. target the rate of bloodstream infection colon procedures dropped by more than with methicillin-resistant Staphylococcus 25 percent. A similar approach is already “I’ll never forget it,” Dr. Farber said. “He aureus (MRSA), another nasty microbe being implemented for abdominal had to have his colon removed to save his that can grow quickly and become life- hysterectomy. life. He survived, but at what a price.” threatening. One measure will provide a daily antiseptic bath to anyone who has a Dr. Farber has been part of the push central line, in case skin is colonized with Rigorous, ongoing work to bring down hospital-acquired MRSA. Patients at higher risk, like those Northwell has also slashed infection C. diff infection through moves such who are receiving hemodialysis through a rates with Clostridium difficile (C. diff), as putting more emphasis on isolating central line, may get the daily bath plus an bacteria that’s on the rise across the infected patients, and by cleaning rooms antibiotic nasal ointment, because many country, partly because of overuse of approach to rooms even more rigorously people carry MRSA in their nose. antibiotics. The Healthcare Association before a new patient is brought in. of New York State recently recognized Infection rates are moving in the right Northwell’s campaign for appropriate The efforts paid off. Northwell has cut the direction, said Dr. Armellino, but the fight antibiotic use with its 2018 Pinnacle C. diff infection rate by 56 percent since won’t be over any time soon. Organisms Award for Quality and Patient Safety. 2011. Plans are also underway to roll out are constantly evolving, with some PurpleSun, the new ultraviolet light-based becoming more virulent or resistant to A C. diff infection causes diarrhea cleaning technology that kills C. diff and antibiotics. “We have to be on our toes and colon inflammation and can be fully disinfects surfaces in 90 seconds. and we have to be creative,” she said. “It’s shockingly aggressive, said Bruce Farber, Northwell has invested in PurpleSun, tough to get to zero, but that’s our aim.” 2018, Volume 2 | The New Standard 9 Aiming for the stars

Lead with empathy Revamp the patient experience and clinician connections.

It’s a common experience: You anxiously skills and reshapes how physicians talk said Agnes Barden, vice president of sit on an exam room table, legs dangling, and listen to their patients. patient and customer experience. wearing a backless gown. You have concerns and questions — a lot of questions. “It’s been transformative for me, and Besides ongoing courses, sustainment I hear the same thing over and over forums called “Communities of Learning There’s a knock at the door and you hear, from other doctors who have taken the and Practice” have begun at select sites. “May I come in?” You take a deep breath course,” said Dr. Kalman. She credited RCC graduates come back periodically to and tug one last time at your gown as RCC with making physician-patient discuss the course and share how they your doctor enters. interactions “much more vulnerable, have put the skills into practice. much more human.” Health care is dynamic and complex. The Office of Patient and Customer People have plenty of outlets to find RCC faculty includes 23 Northwell physician Experience is leading a study into the medical information. Yet studies indicate and patient experience leaders. All have impact of RCC on physician burnout, that patients often feel that their needs completed a comprehensive eight-day patient-centeredness and engagement. for explanation and compassion go training certification program run by Future goals include offering the course unmet with physicians. ACH. Through small-group role play and to residents, NPs and PAs. This will add to real-time coaching, participants focus on RCC’s depth and breadth and establish a Fortunately, educating medical nonverbal cues, empathy-building skills, common language and communication professionals about communication establishing rapport, eliciting all concerns approach within Northwell. and providing structured ways to and fueling connections. build empathy boosts patient-clinician Your doctor enters the exam room and takes interaction, and even reconnects What else? a seat next to you. You’re shocked and think, physicians to the work, said Jill Kalman, “It must be worse than I thought.” But no. MD, executive director at Lenox Hill Physicians learn to focus not solely on the You see a genuine smile and open up about Hospital and Northwell Health’s medical patient’s first complaint, but also to ask, the whole you — your life, family, job and director of patient experience. “What else is on your mind?” “What is concerns. You are not interrupted; in fact, most concerning to you?” These questions you are prompted to go on. Patient experience accounts for 22 unlock meaningful dialogue and help to percent of the overall score in the reveal the patient’s real concerns. “What else?” your doctor asks, and Medicare Hospital Star Ratings Program. you continue until all of your concerns Of 11 Northwell hospitals to receive a Launched in June 2017, RCC gives and questions are fully answered. You 2017 patient-experience ranking, seven physicians dedicated time to learn, are relieved. You feel safe, heard and scored below the national average. practice and hone communication skills comfortable. During the exam, as the in a supportive environment. About 500 stethoscope is placed on your chest, a In June 2016, Northwell’s Office of Patient have already participated. gentle hand on your shoulder reminds you and Customer Experience developed the are not alone. Empathy is powerful and Relationship-Centered Communication RCC reinvigorates physicians’ passion hard to define. But in that room, for those (RCC) course in collaboration with the and joy for medicine. It reconnects them sacred moments, you feel it. And you go Donald and Barbara Zucker School of to purpose and why they entered their home with ultimate trust and confidence. Medicine at Hofstra/Northwell, the field. “The program has been well- Center for Learning and Innovation received because it fosters a culture of and the Academy on Communication connectedness, awareness, respect and in Healthcare (ACH). This full-day class empathy by equipping physicians with focuses on enhancing communication evidence-based communication tools,”

10 2018, Volume 2 | The New Standard Health care IT boosts patient outcomes and satisfaction Northwell achieves measurable results with a suite of tools.

Northwell has improved emergency department (ED) patient Northwell’s results with the tools include: satisfaction, increased access to life-saving stroke care and –– up to 20 percent reduced mortality in eICU-connected units; reduced intensive care unit (ICU) mortality, through virtual –– doubled the number of ED patients assessed and prescribed for hospital services powered by Philips technology. the clot-busting drug, tPA; and –– doubled health system-wide organ-donation referrals aided by Begun five years ago, the Northwell/Philips initiative has integrated analytics and clinical decision support tools. achieved impressive clinical results and is expanding into new care areas and disease-specific treatments. “Our ultimate goal is to move from reactive to proactive care,” said Purna Prasad, MD, the health system’s vice president and The eICU program supports bedside care for critically ill people chief technology officer. “It’s difficult to be proactive when by remotely connecting with clinicians in a centralized telehealth the full patient view isn’t easily accessible. By partnering with center. Northwell gets a comprehensive view of ICUs via the Philips, we’ve implemented technology to build on the resources Philips IntelliSpace eCareManager, which aggregates data and we already have, like our top-notch staff, and become more integrates electronic health records (EHRs) information. efficient.” Ultimately, he added, that allows Northwell to serve patients better and deliver better care.

Patient satisfaction goes up with biosensor

About the size of a bandage, a Philips biosensor measures several Following the success of the eICU program, Northwell has health indicators and alerts a clinician if conditions deteriorate. recently extended its collaboration with Philips into other hospital areas. Its most recent work with the health technology company has launched an ED pilot program that uses Philips General Care Solution with the IntelliVue Guardian and wearable biosensor. The device monitors heart and respiratory rates and posture, and detects falls. The biosensor transmits the data for analysis and notifies a clinician if there are signs of patient deterioration. Patient satisfaction data from the study shows the positive impact wearable technology: –– 95 percent rate the biosensor as comfortable on their chest; –– 73 percent feel better cared for when wearing it; and –– 80 percent consider the biosensor to be “innovative care”

“Continual monitoring is critical to caregivers so they can detect early deterioration,” said Carla Kriwet, CEO, of Philips connected care and health informatics. “Northwell shows how innovative solutions enable hospitals to deliver better clinical outcomes and lower costs with improved patient and caregiver satisfaction.”

Visit bit.ly/nh-tech-care for a dialog between Dr. Prasad and Ms. Kriwet. Courtesy of Philips

2018, Volume 2 | The New Standard 11 Employee medical plan changes

The Northwell Health Value and Buy-Up employee medical plan designs have changed as of July 1, 2018. The deductible will increase for using out-of-system services and providers for orthopedic and cardiac care.

General rules for out-of-network orthopedic care –– Advanced heart failure can be treated at Long Island Jewish Medical Center, Lenox Hill and Manhasset hospitals by cardiac The new, higher deductible does not apply to care for a non- specialists. Staten Island University Hospital and Southside Northwell/out-of-system orthopedic provider in one or more of Hospital will soon follow. Cardiac specialists will be available the following scenarios: in Westchester as of July 2019. For now, Northwell employees who reside in eastern Long Island and Westchester will not –– Completed procedures with complications: Patients can keep pay the new deductible only if they need the services of the existing non-Northwell provider until December 31, 2018. For advanced heart clinician. nonsuperficial infections, until June 30, 2019. –– Regular cardiologist visits: Those in treatment or in a process of –– Joint reconstructions: Patients can keep existing non- being evaluated will be charged the new higher deductible if Northwell provider for post-op until June 30, 2019. they do not change to Northwell in-system provider –– Shoulder reconstruction: Patients can keep existing non- –– Dual transplants: These patients can keep existing physicians, Northwell provider until June 30, 2019. with no time limit. –– Elective orthopedics: Patients can keep existing non-Northwell –– Patients who have had an AFib ablation can continue with their provider until June 30, 2019. non-Northwell provider until June 30, 2019. Repeat ablations, –– Tumor orthopedics: Patients who had a tumor as a teenager when necessary, are covered without an increased deductible may keep existing non-Northwell provider, with re-evaluation until June 30, 2019. after 12 months. Patients diagnosed with a tumor as adults –– Patients with complex arrhythmia can continue to see their may keep existing non-Northwell provider until June 30, 2019. non-Northwell provider for until December 31, 2018. –– Trauma: Children can keep existing non-Northwell provider until –– For device implants such as a pacemaker or defibrillator to June 30, 2019. prior to July 1, 2018, patients can keep their existing non- –– Adults can keep existing non-Northwell provider for accidents, Northwell provider through October 31, 2018. falls and fractures until June 30, 2019. –– Other orthopedic surgeries: Patients can keep existing non- Northwell provider for 12 months (until June 30, 2019. More info and resources

–– Surgeries scheduled prior to July 1, 2018: Patients can keep –– Northwell Health Value and Buy-Up employee medical existing non-Northwell provider until June 30, 2019. plans’ $40 office-visit copay remains the same for in- system orthopedic and cardiac services and providers. General rules for out-of-network orthopedic Services are covered at 100 percent. and cardiac care –– If you fall under rules identified above and have any questions, please call the Human Resources Service Center –– There is no time limit for patients who have had a heart at (516) 734-7000. transplant or a heart pump (LVAD) surgery from a non- –– Visit Northwell.edu/insystem to confirm whether your Northwell provider. provider is in-system. –– The higher deductible applies to patients who have had –– Visit bit.ly/plan-details to see deductible details for out-of- evaluations for heart transplant or a heart pump surgery from system orthopedic and cardiac services and providers. a non-Northwell provider who do not change to a Northwell physician. The plan covers transportation for surgeries and –– Call the Clinical Coordination Center at 1 (855) 372-2237 follow-up appointments. for help with making an appointment with an in-system cardiologist or orthopedist.

12 2018, Volume 2 | The New Standard Above: PurpleSun glows as its ultraviolet light goes to work. Inset: Mr. Romo with Donna Armellino, RN, DNP, Northwell’s vice president for infection prevention. Invisible light kills unseen foes Crews disinfect ORs quickly and thoroughly with new tech.

Disinfecting hospitals and other medical also have small items with many nooks “Not only is the system fast, but it facilities has become faster and more and crannies. Proper manual disinfection largely eliminates any chance of human effective with a device that uses takes a lot of time, and there are a lot of variability or error in the disinfection ultraviolet (UV) rays to sterilize medical places where it can fail.” process,” said Luis Romo, president and equipment, operating rooms (ORs) and founder of PurpleSun. other patient care areas. The product Efficacy testing in Long Island Jewish comes from Northwell Ventures’ recent Medical Center ORs demonstrated Northwell Health plans to market the $3 million investment in PurpleSun, the impressive results. portable, modular PurpleSun unit to company that developed the modular other hospitals and expand use in its smart device. Team members sampled OR pathogen own facilities. By offering the technology levels before and after manual cleaning, through monthly subscriptions to other Hospital-acquired infections have long a process that can takes 30 minutes or providers, Northwell could earn back its challenged quality of care, resulting in longer. Colony counts were higher after investment and a good deal more — in poor industry report cards, extended manual cleaning than before. This was not addition to eliminating surgical site and patient stays and reduced reimbursement the result of human error, Mr. Feinstein other infections for itself and others. from health insurance companies. said. The environmental service staff followed protocols closely. PurpleSun and Northwell are also “There’s real incentive to attack this working to acquire more funding to build problem at the provider level,” said “They did everything right. This speaks to out a suite of products. “We are building Eric Feinstein, investment director at the limits of manual cleaning,” he said. a sister product that’s designed more for Northwell Ventures. “In a hospital, you smaller areas,” said Mr. Romo. “That will deal with large pieces of equipment that In comparison, PurpleSun wiped out 95 provide a set of products to attack all are difficult to disinfect, like beds. But you percent of OR pathogens in 90 seconds. areas of the hospital.”

2018, Volume 2 | The New Standard 13 Moving health care out of the doctor’s office Personal well-being often depends on surroundings and situations — the social determinants of health. By Lisa Davis

Ram Raju, MD, senior vice president and community health These are just two examples of what public health experts call investment officer at Northwell Health, still remembers two social determinants of health — life conditions that can help patients the finest clinical care couldn’t help. people stay healthy or make health all but impossible. Studies show that factors like housing and reliable access to nutritious The first was a man who had blood drawn at Coney Island food have a far greater impact on well-being than medical care. Hospital, where Dr. Raju was medical director more than a decade ago. When the results came back that evening, they Dr. Raju started building a team to tackle those social revealed an electrolyte imbalance so dangerous the patient determinants when he came to Northwell in 2016. “We have to would almost certainly die without immediate treatment. The treat the whole person and not just the disease,” Dr. Raju said. staff dropped everything to try to contact him. “That is the only way to improve outcomes.”

But he’d given a fake phone number and address, probably Food as medicine because he was undocumented and feared deportation. “We never found him,” Dr. Raju said. “He just became part of New The Office of Community Health Investment’s first pilot projects York’s statistics.” have just started implementing real change.

One of the most basic social determinants of health is access to “She had two options – go get nutritious food, as in: Do you reliably have it? Studies show that 1.3 million people in communities served by Northwell are food chemotherapy and be homeless, insecure (that is, they don’t always have enough nutritious food). or stay in the home and die of People who lack food security can need longer hospital stays and are more likely to need readmission. So the Office of Community cancer” — Ram Raju, MD Health Investment is collaborating with Long Island Jewish (LIJ) Valley Stream and Long Island Harvest on a new project called a Food as Health Center, where food is dispensed like medicine. The second encounter was with a woman who had breast cancer. Dr. Raju knew she was counting on chemotherapy to help her The newly launched Food as Health Center identifies patients beat the disease, so he was surprised when he heard that she’d who are food-insecure and provides a three-day supply of abandoned treatment. The patient’s reason proved tragically nutritious food; follows up to ensure they’re getting the nutrition simple: Her landlord wanted to evict her in order to raise the rent, they need; and assists eligible patients with enrolling in the and had told her he would change the locks on her apartment the federal Supplemental Nutrition Assistance Program (SNAP). A next time she left. registered dietician provides guidance on eating right for their health condition. “The hope is that this will help some of the “She had two options — go get chemotherapy and be homeless, most vulnerable in our community get healthier faster and stay or stay in the home and die of cancer,” Dr. Raju said. “She chose healthier longer,” said Stephen Bello, PA, executive director at LIJ to stay.” Valley Stream.

14 2018, Volume 2 | The New Standard Supercharging the fight against opioids Ultimately, these efforts — plus others, including a planned interactive digital platform that will provide patients with Staten Island struggles with an epidemic of opioid abuse more information about diet and lifestyle changes that can help with than any other borough. In 2015, it ranked highest among the their medical conditions — may result in more effective care, boroughs for rate of death from overdose. with fewer interventions and lower doses of medication.

The Office of Community Health Investment is working “Right now, in medicine, it’s like we’re pulling people out of a with Staten Island Borough President James Oddo, Jonathan river,” Dr. Raju said. “All our skills and research just allow us to pull Morgenstern, PhD, director of addiction treatment at Northwell people out of the river faster. What we’re saying with this new and other experts to develop a data-driven strategy to prevent, approach is: Let’s go upstream and see why people are falling treat and reverse opioid abuse throughout the borough. into the river in the first place. Let’s try to fix that.” Supporting clinical and nonclinical efforts that are already underway, the initiative will help Mr. Oddo determine the most effective path forward.

“We believe that rallying all of the important efforts on Staten Location, location, location: Island around a set of clear, quantifiable priorities will allow us to make the most headway in this fight,” said Mr. Oddo. “That’s “You lose 10 years of your life why we’re working with this team to identify key measures of progress in our battle against the opioid crisis.” because you live on the wrong side of the tracks.” — Ram Raju, MD Harnessing the power of information The team in the Office of Community Health Investment is also developing the Northwell Health Social Vulnerability Index (SVI) Rego Park — another tool that will help the health system better treat and Life expectancy: 84 prevent disease. Using a variety of data from sources like the years US Census Bureau and the US Department of Agriculture (which tracks food deserts), the SVI will identify the biggest barriers to staying well in each of the census tracts in Northwell Health’s service area, such as homelessness, hunger or crime that makes it unsafe to go outside for exercise. At the same time, internal data, such as records of past appointments, will shed light on a 6 miles patient’s health history. The index will help Northwell get the biggest return from its community investment dollars. It will also allow clinicians to treat their patients more effectively.

“If a patient comes in and the treatment isn’t working, often the Brownsville first thing a clinician will do is prescribe more medication,” said Life expectancy: 74 years Dr. Raju. “But if the patient is living under a bridge, he’s not going to be able to take the medication. The most important treatment might be to refer the patient to the Long Island Coalition for the Homeless.”

2018, Volume 2 | The New Standard 15 Ms. Cobb is a community health worker, a member of the first graduating class of Northwell Health’s From the Community, Making For the Community Program. The new program improves Northwell’s ability to reach neighborhoods with fewer economic opportunities. It trains and teaches community job-seekers and connects them with entry-level positions in which they can serve healthy their friends and neighbors. The approach packs a one-two punch. First, it offers the new health workers a path to financial security, one of the connections strongest influencers of overall health. Studies show that when it comes to health and well-being, the conditions of By Lisa Davis someone’s daily life — like having a safe place to live and enough to eat — are more important than even the best medical care. Second, the program provides community members with trusted advocates who intimately understand the challenges they face in trying to stay healthy.

Farnita Cobb is good at getting people “We started the program because we wanted to be a better partner to the communities that we serve,” said Kristofer Smith, to talk to her. She’s not a doctor or MD, senior vice president of population health management. Dr. nurse, but in her position in complex Smith oversees Health Solutions, Northwell’s care management organization. Health Solutions is leading the community health care management at the Ambulatory worker program in partnership with the health system’s Office of Community Health Investment. “Northwell is the largest private Care Unit at Long Island Jewish (LIJ) employer in New York. Improving our hiring pipeline is a good Medical Center, she’s often the person a way to improve the welfare of our communities.” patient will turn to and say, “I know you Ms. Cobb never would have even thought of becoming community health worker if not for a run of bad luck. She has a already explained this, but I still don’t GED and nearly enough college credits to become a paralegal, but understand.” If someone isn’t following her plans were upended when her marriage went bad and she left her husband. She wound up homeless with her twins, who the doctor’s instructions — maybe he’s were then 12 years old. only taking his medication every other “I was at the Department of Social Services begging for shelter,” day, or maybe she’s not checking her Ms. Cobb said. “Somebody overheard me and said, ‘Northwell’s over there hiring.’ Well, they were wrong — it was just an blood sugar regularly — Ms. Cobb will sit informational meeting to tell people about the new community health worker program. But I was so aggravated I sat through it down, like one friend talking to another, anyway to calm my nerves, because I was like, ‘What am I going and find out why. to do after 4 o’clock when I leave here?’”

Ms. Cobb and her kids got temporary housing. Then, to her surprise, the community health worker team called to invite her to an interview. In March, she finished the intensive program of classes and field training. Her on-site work was at Northwell Health. Some of the other trainees also had internships at Northwell, while others worked at the Long Island Federally Qualified Health Center; Glory House, in Hempstead; or Choice for All, in Roosevelt.

Like Ms. Cobb, program graduates come from neighborhoods that are among the most economically distressed areas of Long Island — Freeport, Roosevelt, Hempstead. Members of 16 2018, Volume 2 | The New Standard these communities have high rates of chronic diseases like from her neighbors and friends. “They know who I am and they diabetes, hypertension and heart disease, said Ariel Hayes, know I’m at Northwell. I’m not a nurse — I’m the same single senior administrative director of Health Solutions programs. The mother that you see here. I’m the same one with the food stamp community health workers add a whole new dimension to their card. I made it, so now they can follow. I get so many calls, you care, she said. would think I’m a doctor.”

“We have lots of providers who are passionate about helping On the phone, at church and on the streets of her neighborhood, people with diabetes or other chronic conditions,” Ms. Hayes Ms. Cobb passes on the healthy living information she learned in said. “But they have never had to decide between paying for the Community Health Worker program and at work at Northwell. medication or putting food on the table. So they may not even She and her neighbors support each other as they create do-it- think to ask if that’s an issue. Now, we have a group of health yourself exercise sessions and other healthy interventions. care professionals who understand those social factors and can recognize them immediately in their neighbors. That builds trust “I started something for all of us single parents. Each week we get and can prevent a huge amount of suffering.” together and one watches the kids for 15 minutes while the rest of us do a walk. Then the next one watches, and we walk. The eating They’ve been there habits, the walking — you can see the stress come off.”

Ms. Cobb recognizes how much it matters to her patients that Ms. Cobb appreciates her training and is proud to help her she knows where they’re coming from. At LIJ’s Ambulatory Care patients and her community. Unit, she works with those who have serious and often complex medical conditions, helping them understand their medical “I would like to enhance my skills so I know more words when instructions and troubleshooting potential problems. the doctors talk. But I don’t want to sound too professional — that’s not how I want to talk to people who have not been to a “I reinforce. I encourage. I let them know that I’m not just going doctor for three or four years. They can see that I’m the neighbor to call them once a month,” she said. “I say, ‘Tell me how often up the street or the aunty or that friend next door that you can you want me to call you.’ I love it when they say, ‘Can you call me just tell the truth to. Once they let the burden off and they’re not back in three days to see how I’m doing with my fingerstick?’ ashamed, that’s when you see the change.

“I love it when they say, ‘Yes, Farnita, I walked from my “I work from nine to five for Northwell, and from 7:30 to 10 at bedroom and back. Yes, I started eating my salads. Yes, I night in my community. And I’m fulfilled. I’m more than satisfied.” downloaded the app that you gave me to quit smoking.’ It makes you get a little religious.” For the Community, By the Community was made possible by a $750,000 grant from JPMorgan Chase. It will fund the training of Ms. Cobb’s work isn’t done when she leaves the hospital each up to four classes a year through 2020. day. As soon as she gets back home, she starts fielding questions 2018, Volume 2 | The New Standard 17 Northwell project identifies HIV hot spots Collaboration with community leaders helps to remove barriers to care. By Betty Olt

Hempstead, Westbury and Huntington RED Cap queries, collects and analyzes The team identifies where new HIV Station, plus Rosedale and surrounding information on mental health, substance diagnoses and sexually transmitted Eastern Queens areas, are local HIV hot use, housing status and other social infections are occurring, said Dr. McGowan. spots, according to Joseph McGowan, MD, issues, said Dr. McGowan, who also serves “We know where those who don’t have medical director of the Center for AIDS as professor at the Center for Health viral suppression live. We are working with Research and Treatment (CART) at North Innovations and Outcomes Research at the community leaders to determine how to Shore University Hospital. Feinstein Institute for Medical Research. reach those affected and ways to engage “We’ve linked the information to levels them in care. We must work together to Dr. McGowan and his team at CART of treatment compliance, adherence to remove barriers to care.” developed an extensive survey and appointments and viral suppression rates.” online software called RED Cap to collect Manhattan resident Jeffrey Kemp, 35, and analyze epidemiologic data from The work has gained attention from has been living with HIV for 15 years, but Northwell Health and the New York State the US Centers for Disease Control and only recently attained an undetectable Department of Health AIDS Institute. RED Prevention, which recently invited Dr. viral load with treatment at CART and Cap produced heat maps of locations with McGowan to Atlanta to share his team’s GET! This HIPAA-compliant mobile the highest incidence of HIV and other data and response plan. app was developed as part of the New sexually transmitted diseases. York State Department of Health AIDS

GET! helped Mr. Kemp significantly reduce his viral load. CART is the only New York State program to offer the HIPAA-compliant app.

18 2018, Volume 2 | The New Standard Institute’s YGetIt? Project. The only are an estimated 1,000 residents with we communicate and motivate has to site in New York State and one of nine undiagnosed HIV. be in the correct cultural context,” Dr. nationwide selected for the app, CART McGowan said. “In that regard we are recently achieved the milestone enrolling CART’s new research will help identify the looking to recruit popular opinion leaders more than 100 GET! users. best approach to reduce health disparities within the communities most affected in low-income communities and improve by HIV to instruct us in the best ways to Mr. Kemp called the app “a life saver.” health care access. Many of the health engage hard to reach persons living with It kept him on track with doctor disparities that Dr. McGowan’s team or at risk for HIV infection. appointments, medication reminders and identified reflect the social determinants lab results. Like other app users, he can of health, such as income, housing status, North Shore University Hospital’s Center securely text peer educators for questions food security, trauma, and incarceration. for AIDS Research and Treatment is the and support. CART care teams will focus resources and largest New York State-designated AIDS interventions on those with a history of center on Long Island, treating 2,200 Northwell is pursuing several community domestic violence, suicide, post-traumatic patients. Over the past 15 years, the initiatives to encourage free HIV testing, stress disorder, substance abuse, mental center has seen a 10 percent annual said Jessica Clark, CART community health issues and other factors that increase in its HIV caseload. “Our mobilization coordinator. Projects include increase the risk of contracting the virus approach is unique,” Dr. McGowan said. a new collaboration with Walgreens in and reduce care compliance among those “We need to get interventions into the targeted communities to offer ongoing, living with HIV. community, learn the root causes of free HIV testing on Northwell’s mobile health care disparities and communicate medical van, educating women in high- “As we delve into the outcome disparities and act more effectively.” risk neighborhoods and other outreach that we see among our patients, it efforts. On Long Island alone, there has become clear to us that the way First-in-the-world robotic surgery for collapsed trachea repair By Margarita Oksenkrug

Lenox Hill Hospital surgeons are the first “Open surgery for a collapsed trachea has and pneumonia. He visited numerous in the world to repair a collapsed trachea been successful for certain patients in the specialists and underwent many tests, using a fully robotic, minimally-invasive past. But our study has shown that the but no one provided the right diagnosis. technique. Tracheobronchomalacia (TBM), minimally-invasive robotic procedure is a debilitating condition that weakens the unequivocally the superior option for this Eventually, a dynamic computed airway walls, has been treated historically complex, high-risk population,” said Dr. tomography (CT) scan showed that through open, invasive surgery. Lazzaro, who has specialized in minimally- Mr. McGurk’s trachea had significantly invasive surgery for more than 20 years. deteriorated and would close up as he Under the direction of Richard Lazzaro, breathed. He was referred to Dr. Lazzaro, MD, the hospital’s chief of thoracic One of those patients, Richard McGurk, who determined that Mr. McGurk was a surgery, the Lenox Hill team conducted 64, is breathing easier after undergoing good candidate for the trial. a trial designed to examine the safety the robotic procedure in August 2017. The and efficacy of the new robot-assisted Farmingdale resident first noticed that “From the day I came home, I couldn’t surgical technique. A cohort of 42 patients something was wrong three years ago believe the difference. I was able to lie participated. The results demonstrated when he developed a persistent cough down and go to sleep,” said Mr. McGurk. fewer postoperative complications, that prevented him from sleeping. He “I couldn’t be happier. It’s amazing, it’s a improved outcomes and quicker recovery wasn’t able to lie down for more than 15 game-changer.” when compared to traditional surgery. minutes without having a coughing fit Dr. Lazzaro presented the findings at and began sitting up in a chair to sleep. the American Association of Thoracic Mr. McGurk soon began to get monthly Surgeons’ recent conference in San Diego. sinus infections, and then bronchitis 2018, Volume 2 | The New Standard 19 Too much of a good thing? Sometimes, fewer medications are better. By Lisa Davis

Prescribing the right medicine is one of the most important “As a doctor, I know that it’s easier to start a medication than it things a doctor can do for a patient. Equally important: de- is to stop one, particularly if a patient isn’t having obvious side prescribing a drug that’s no longer appropriate. effects,” Dr. Hirschwerk said. “We often use evidence-based guidelines to prescribe, but those types of guidelines don’t exist Unfortunately, deprescribing doesn’t happen nearly enough, for deprescribing. And there are often competing demands for said infectious disease specialist David Hirschwerk, MD, the physician’s attention during a patient’s visit. So Northwell has executive vice chair of medicine at North Shore University developed a deprescribing process that can help.” Hospital and Long Island Jewish (LIJ) Medical Center. That means that large numbers of people stay on medicines that The initial focus of Northwell Health’s deprescribing program may quietly do more harm than good. is on drugs called proton-pump inhibitors, or PPIs, one of the top-selling drugs in the United States. PPIs are often used The problem is most common for the elderly. In 2013, almost 20 when someone has an ulcer or suffers from severe or frequent percent of those 65 and older were prescribed medication with heartburn. They’re pretty safe, but some studies suggest that risks that outweighed the probable benefit. But it can happen to their risk edges up the longer you take them. For instance, anyone, especially when a drug is taken for a long period. taking a PPI for a long time may make it more likely that you’ll

Dr. Hirschwerk counsels a patient on medications.

20 2018, Volume 2 | The New Standard break a hip. You may also be at greater risk of developing a Clostridium difficile infection, which can cause life-threatening inflammation of the colon. Long-term PPI use may make it more likely that you will come down with food poisoning from a microbe like Salmonella. Long-term meds: These creeping risks caught the attention of the Institute for Healthcare Improvement (IHI), a nonprofit that Northwell works what you should know with on efforts to improve patient safety. IHI routinely scours the world for best practices that might be worth importing. The organization has found that many countries’ health care professionals routinely run a risk-versus-reward check when patients take medications for a while. They then work to Deprescribing is especially important for older adults, who eliminate drugs that don’t measure up. are more likely to take numerous medications and are at greater risk of side effects and drug interactions. The problem Was that practice worth adopting at Northwell? of polypharmacy — when someone takes five or more medications — is only getting worse, said Maria Torroella “I thought it was a real need for us, and also practical and Carney, MD, Northwell’s chief of geriatric and palliative doable,” said Mark Jarrett, MD, the health system’s associate medicine and medical director of post-acute services. chief medical officer and chief quality officer, and a former member of the IHI global innovations committee. “So we decided “Earlier in my career, people would bring me their to go forward with a project at Northwell.” medications in a pillbox for Sunday through Saturday,” Dr. Carney said. “Now, we’re seeing individuals with cases the The Northwell Department of Medicine started small, first size of fishing tackle boxes, with multiple levels.” running a pilot in a skilled nursing facility and then at the Division of Internal Medicine’s primary care clinic in Manhasset. Whatever your age, it’s best to top taking any medicine you don’t need. Help to get your medications under control with “People can be nervous about stopping a drug, especially if it a few simple steps: originally helped with a real problem, like pain,” said Dr. Hirschwerk, who spearheaded the deprescribing project. “Sometimes you If you take it, bring it with you. Take all your prescription have to motivate somebody to stop drug therapy just as much drugs and over-the-counter remedies with you when you as you had to motivate them to initiate it.” go to the doctor. That includes supplements, too. Keep them in their original containers so your physician doesn’t The process worked. Almost 12 percent of the clinic patients were have to guess about ingredients or dose. regularly taking a PPI when the project began in July 2017. By this January, it was 8 percent — exceeding the original goal of a Use a single source. Getting medicine from one pharmacy 20-percent reduction. “We’re not aiming to get to zero,” said — in your neighborhood or by mail-order — allows your Dr. Hirschwerk. “For some patients, there are real indications to pharmacist to flag potential interactions or other safety stay on a PPI long-term.” concerns. “Ask if there are any medications that are duplicates or could be harmful, or if there’s anything you The initiative is already rolling out at other sites. LIJ’s Ambulatory should address with your physician,” said Dr. Carney. Care Unit adopted it in February, and LIJ Valley Stream is developing an inpatient pilot. Check in with your doctor. At least once a year, sit with your doctor and discuss everything you take. And review your The key is to establish a clear, sustainable process for regular meds after an illness, especially if you’ve been hospitalized. medication review for patients without unduly burdening “People often get confused when they go home after the physicians, said Dr. Jarrett. hospital,” Dr. Carney said. “Should they continue what they were on in the hospital or go back to what they had been And anyone can review their prescriptions with their primary care taking before? It’s important to talk all this through with physician. “It’s all about the concept of ‘First, do no harm,’” said your physician after a hospitalization, so you don’t keep Dr. Hirschwerk. “We want to get people off of medications if the taking medications you no longer need.” risk outweighs the benefits.”

2018, Volume 2 | The New Standard 21 Fall prevention helps older adults maintain health and mobility Falls can devastate older adults, so Northwell’s working to prevent them.

Seniors are avoiding painful mishaps that would send them to Participants learn gentle moves that help to improve strength the Emergency Department with Northwell Health’s fall- and and coordination, which diminish over time in older adults. Tai chi injury-prevention efforts. improves focus and boosts confidence, too. Combined, the four elements help to prevent falls. Northwell trauma clinicians have found that falls are the leading cause of the injuries they treat, said Omar Shareef Bholat, “We have evidence from the Journal of the American Geriatrics MD, associate director of critical care surgery at North Shore Society that says the program reduces a community-dwelling older University Hospital (NSUH) and chair of the Northwell Health adult’s risk of falls by 70 percent,” Ms. Dunckley said. Trauma Institute’s Fall and Injury Prevention and Outreach Committee. “Fifty-five percent of what we do is take care of geriatric falls,” he said. The problem of falling Geriatric falls can have devastating, ongoing effects. “Once Key elements of the initiative, which began in 2014, are courses someone falls, the risk of falling again in the next year is 35 called Stepping On and Tai Chi for Arthritis. percent,” said Dr. Bholat. A stay in the hospital further weakens muscles and bones. First introduced to Northwell in 2011 by the Office of Community and Public Health, Stepping On classes typically take place “The first time they come in, they might have a broken hip or at public libraries and other neighborhood gathering spots. ribs. The next time it could be broken vertebrae in their neck or Besides seven weeks of balance and strength exercise an intracranial bleed,” said Dr. Bholat. “So we see that injuries instruction from a PT, participants get safety tips for inside the are progressive.” home and out, speak to a pharmacist about how medications and supplements can affect their risk of falling, learn more For people who end up in the hospital, rehabilitation addresses about the importance of vitamin D and calcium, and learn how issues of building strength and agility and education helps to low vision can contribute to falls. improve safety at home.

“We give class members a baseline knowledge and behavior “As a community, Northwell wants to get ahead of the problem test at week 1 and again at week 7” to monitor progress in the of falling as the Baby Boomers age,” said Ms. Dunckley. The evidence-based program, said Catherine Dunckley, coordinator health system offers community workshops in addition to of administrative operations in the trauma critical care at NSUH. Stepping On and Tai Chi for Arthritis. Soon, another program will She remembered a participant who couldn’t perform any moves launch for people in rehab. at first “without holding on for dear life.” She added, “He did the exercises every day faithfully and by the end, he could do it all Northwell’s Trauma Institute has extended the health system’s without holding on.” ability to improve education and awareness. “We’ve developed a network of injury prevention colleagues across the system, sharing Some benefits aren’t merely physical. “Many older adults are so information, helping each other with programs,” Dr. Bholat said. isolated,” said Ms. Dunckley. “This becomes an important social outlet.” Classmates discuss ways they’ve modified their homes, At NSUH, Ms. Dunckley visits trauma patients over age 65 who sharing contractor phone numbers and product resources. are ready for discharge to discuss their fall risk. As a master Northwell follows up with Stepping On graduates after three trainer for Stepping On, she’s expanding the program’s reach by months. They show remarkable improvement, especially when training others. they continue to practice their exercises consistently. “We’re slowly but surely expanding our reach so we can make a While Stepping On is a wide-ranging program, Tai Chi for Arthritis really meaningful impact,” Ms. Dunckley said, “because we know is exercise-focused for older people with good mobility, according these programs work.” to Ms. Dunckley. The eight-week class meets twice a week. 22 2018, Volume 2 | The New Standard Stop the Bleed, save a life Transforming bystanders into lifesavers.

Rochelle Goncalves, RN, an orthopedic Quick-acting bystanders do not replace surgical trauma nurse at North Shore first responders or medical personnel in University Hospital, was driving home from emergencies, but they bridge a crucial work on an unseasonably warm November gap, said Mr. Dackow. The training is evening two years ago. “I saw lights coming a practical advantage for rare mass toward me on the Wantagh Parkway. A van casualty situations, when first responders had flipped over and hit another car. I just simply can’t get to everyone in time. First instinctively pulled over.” responders recognize that bystanders like Ms. Goncalves can make the difference A man emerged from the van with his arm between life and death. missing below the elbow. Ms. Goncalves had to act fast. She helped the injured man to lie Local schools, churches and other down and, using a jacket, tied a tourniquet community spots host B-Con, and Mr. above his wound. Within five minutes, Dackow estimates he has trained upwards The essentials paramedics arrived and took over. She of 2,500 people to date. “We’ve trained learned later that she saved his life. security staff at Suffolk Community In case of an accident or injury, College and Long Island University. We’re first be sure of your safety and As a nurse, Ms. Goncalves knew what going to Jones Beach this year to train surroundings. Then call 911 or get to do. But proper training can equip any security personnel for Live Nation [the someone else to do so. bystander to do the same. concert promoter].” He has shared B-Con information with an exhaustive list of The progressive steps to stop Bleeding-control skills are schools, churches and malls, and is ready bleeding are: to go anyplace he’s invited. for everyone 1. Identify the source of the Stop the Bleed is a national awareness- Bleeding-control skills are also important bleeding and expose the wound raising campaign about the importance when everyday scenarios go bad, such as (by opening or removing clothing of ordinary people knowing how to help accidents on playing fields, during yard over the wound, for example). someone who is bleeding. The Obama work or on the road. This will allow you to find hidden Administration launched Stop the or more extensive injuries. Bleed in October 2015. Since then, the Campaign advocates hope to install Stop campaign spurred Bleeding Control for the Bleed kits in public places, alongside 2. Using bandages or any type of Bystanders (B-Con), a course developed automatic external defibrillators (AEDs). clean clothing to cover or pack by the American College of Surgeons and Kits contain instructions, gloves, special the wound. Apply direct pressure the National Association of Emergency bleeding-control gauze and tourniquets. with both hands until medical Medical Technicians. Northwell Health responders relieve you. trauma specialists offer B-Con throughout Overcoming the “ick factor” can be a Long Island. challenge, but Mr. Dakow overcomes it. 3. Apply a tourniquet. Tightly “Some of what we are teaching feels gross wind a strap placed above the The people who should learn bleeding- to some people,” he said. “But when you wound (such as on an arm or leg) control basics are the same ones who understand how effective training can be, and twist it until the bleeding should learn CPR — which is everyone, the less taboo it starts to seem, and more stops. Bleeding-control kits said Tim Dackow, RN, coordinator of people realize how they really do need contain tourniquets, or you can trauma injury prevention and emergency it. You start to appreciate that having a improvise one from clothing. medical services outreach at Southside bleeding kit around is a good thing.” Hospital. Mr. Dakow teaches B-Con to law For free B-Con training, call the enforcement officers, security personnel, Northwell Trauma Institute at teachers and administrators — really, (516) 321-8280. Find more anyone who is interested. information at BleedingControl.org.

2018, Volume 2 | The New Standard 23 Nurse gets under leukemia patient’s skin A seasoned bone marrow transplant nurse becomes intimately involved with the life-saving process. By Chris Gasiewski

For 20-plus years, Abigail Slaven, RN, has witnessed children A regular blood donor, Ms. Slaven hadn’t considered donating rebound from grave illness after they receive a bone marrow marrow until then. Her experience at Cohen Children’s certainly transplant. She recently donated 1,400 cubic centimeters of influenced her decision. bone marrow at North Shore University Hospital to help save an anonymous adult with leukemia. “We get to know our patients and their families very well,” said Ms. Slaven. Originally from Los Angeles, she met her husband Donating bone marrow can be draining. Yet Ms. Slaven quickly while working as a visiting nurse at Huntington Hospital. “It’s a felt the rewarding impact of her generosity despite some initial very interesting type of nursing — really rewarding, in fact. We pain and a little fatigue after her procedure. have good outcomes.”

“I would do it again,” she said. “It’s very hard to match someone. A cotton swab of the inside of her cheek put Ms. Slaven on the Usually, you match a complete stranger. I hope others become bone marrow registry. part of the bone marrow registry. It could be the only option in saving someone’s life.” “I got a phone call in August [2017] that I matched someone,” she said. “You don’t get any info. They just ask if you are still willing to donate. For a split second, you think ‘Wow, this is pretty crazy.’ I’ve Donating life seen the [bone marrow] harvest before. I was frightened, but at Ms. Slaven, assistant nurse manager of pediatric hematology/ the same time, as a nurse you are part of saving lives each day.” oncology at Cohen Children’s Medical Center, first considered donating bone marrow during a 2016 blood drive at Long Island Ms. Slaven completed the required blood work and physical Jewish Medical Center. The National Marrow Donor Program was examination to schedule her donation — all at Northwell there, promoting its Be the Match campaign. Health facilities.

24 2018, Volume 2 | The New Standard “It was interesting,” she said. “I became a patient and went to Monter Cancer Center for another physical exam and blood work.” US News Ms. Slaven donated bone marrow 10 days later at North Shore University Hospital. Doctors removed bone marrow from two areas in her hips while she received general anesthesia. Ms. Slaven recognizes is anemic, so recovery took six hours.

“I felt pretty cruddy for a few days, but it wasn’t bad at all,” she Cohen Children’s said. “It took me about a week to feel completely normal again.

Cohen Children’s Medical Center has earned Top 50 national What’s next? rankings for exceptional care in eight pediatric specialties, according Full recovery takes about three weeks, but Ms. Slaven felt better to US News & World Report‘s 2018-19 Best Children’s Hospitals. much sooner. Nine months after her bone marrow donation, she got a card from the leukemia patient who received her bone US News has listed the children’s hospital as one of the best in marrow donation. The patient wrote that she is healing and the country for 12 consecutive years. thinks about Ms. Slaven everyday. Cohen Children’s best ranking was in pediatric urology — 12th Encouraging others to donate marrow has become a personal in the country. US News ranked the hospital 20th nationwide for mission for her. pediatric orthopedics, a significant jump from last year when the hospital was ranked 35th. Other prominent US News national “This was a unique opportunity,” she said. “No one else in this rankings this year include : world could help this person. And if she didn’t get the transplant –– Neurology and neurosurgery, 27th she could die. I hope and pray that she survives and is well.” –– Pulmonology, 29th –– Neonatology, 32nd See more Cohen Children’s heroes in the –– Diabetes and endocrine disorders, 40th –– Gastroenterology/GI surgery, 42nd hospital’s annual report: bit.ly/ccmc-rept. –– Nephrology, 48th

“US News’ latest survey results underscore the progress we’ve made in improving clinical outcomes,” said Charles Schleien, Bone marrow MD, executive director of Cohen Children’s, senior vice president and executive director of pediatric services at Northwell Health. “Our results this year demonstrate the commitment of our transplant 101 clinical teams, researchers and our highly-skilled nursing staff, which holds Magnet designation from the American Nurses’ People who need a bone marrow transplant have had a Credentialing Center — the only children’s hospital in New York disease relapse, or are at risk for one. Damaged, destroyed, State to earn that distinction.” infected or tainted bone marrow is replaced when blood stem cells travel to the bone marrow. The infused stem cells begin their job of producing new blood cells and promoting See more about the rankings growth of new bone marrow. at bit.ly/best-kids-care.

Bone marrow transplants are highly effective in treating blood cancers like leukemia or lymphoma, bone marrow diseases like aplastic anemia and other immune system or genetic diseases like sickle cell disease.

According to the National Bone Marrow Program, the most common transplants are: autologous, which uses your blood- forming cells, and allogeneic, which uses donated blood- forming cells. Haploidentical is a type of allogeneic transplant.

2018, Volume 2 | The New Standard 25 Why I serve: Katrina Aronoff Serving everywhere she turns, including on the ground in Puerto Rico after Hurricane Maria. As told to Chris Gasiewski

For as long as I could remember, I always wanted to be in the In 2004, I joined Long Island Jewish Medical Center. But even as Coast Guard. Serving my country is a passion. Helping others is a I had my daughters, Evelyn [9] and Alina [12], something was way of life. missing. The Coast Guard was calling and I joined the reserves at 32 years old. Perhaps that’s why I entered health care. My position as chief radiation therapist at Phelps Hospital allows me to spend a lot of time with patients, sometimes six to seven weeks rather than Boot camp just when they get sick. Boot camp is not easy. It’s definitely not easy. I had to lose weight and get in shape. So, I enrolled in the Direct Entry Petty Officer I knew early on in life that I would enter health care and pursued it Training Course (DEPOT) in Cape May, NJ. DEPOT was intense and while studying at Suffolk University in Boston. I met my husband, is designed for professionals who have had prior military training Ethan, there, and we later planted our family’s flag in New York. or a bachelor’s degree from a university or college.

By the end of boot camp, I was in such good shape that I performed well in physical training exercises, even beating all “I volunteered for everything ... female participants and most males in one endurance-based drill. It was two hours of straight physical training with the final test But it was in Puerto Rico after awarding whomever could do the most push-ups in 30 seconds. I Hurricane Maria that changed did 12 and finished fourth overall out of 30 men and women. Typically, Coast Guard Reserves drill one weekend each month my life.” — Katrina Arnoff and have two weeks of active duty each year. Out of boot camp, I was stationed at Shinnecock, NY, pushing real hard to become

26 2018, Volume 2 | The New Standard certified and get on the boats. I volunteered for everything — On a trip from San Juan to Condado — the next town over — I saw an auxiliary flight to take pictures of our area of responsibility, police running away from a situation. It didn’t look good, so I got five months at Boatswain Mate school in Virginia and a trip to out my vehicle and ran. I found a man on the ground and started Burlington, VT, for a law enforcement operation. But it was in asking questions. I determined he was severely dehydrated Puerto Rico after Hurricane Maria that changed my life. so I put him into recovery position. The Navy then showed up and started an IV. They also did an EKG [electrocardiogram]. Simultaneously, a friend of this man began having seizures and Everything was brown. needed medical attention. I’ve never seen anything like it. A second situation occurred while I was in a car with a shipmate. I originally volunteered to join Northwell’s effort to assist Puerto I saw a woman collapse. Her husband propped her up on his Rico after the hurricane [the health system sent 27 nurses, legs and tapped her cheek gently. I introduced myself and asked physicians, medics, EMTs and other clinicians and administrators if I could lower her to the ground. She had no pulse and was to help]. The same day I found out I wasn’t going with Northwell, not breathing. I told my shipmate to call 911. I started chest the Coast Guard called. Karma, I guess. compressions and got her back. When people are revived, they make this horrible sucking sound. It’s chilling. I had two days to get ready, but nothing could prepare you for the devastation the island experienced. When we flew over While performing chest compression, I collected information Puerto Rico everything was brown. I’ve never seen anything like from her husband. She has a prior history of health problems, it. The water was brown. The island was brown. You could see a was on medication and had alcohol that night. I performed ring of brown water around the island. CPR/chest compression on her four times. Each time she lost consciousness and I saw the light leave her eyes. On the last The airport was wall-to-wall people. People were trying to cycle, I was able to bring her back. I turned her on her side into escape. When we were picked up, the chief said, “Welcome to the the recovery position. It took the volunteer fire fighters 40 suck” before taking us to Sector San Juan. minutes to arrive on scene and transport her to the hospital.

The devastation was even more apparent on land. Billboards Two days later, the restaurant owner made a phone call and put were snapped in half and piercing out of someone’s house. Roads me in contact with the patient on the other end. She is alive and were missing. A lot of people had trouble bringing in supplies. We well. I was very relieved to hear that she was OK. Working at a answered medivac calls for people drinking the water and dying. In hospital, you have a team to lean on and medical equipment to fact, one of the pilots drank tap water a few weeks in and suffered help support you when a stressful situation presents itself. That a chemical burn from the bleach [used to treat the water]. night I was by myself with no aid, no clinical team and no medical equipment. It was the longest 40 minutes of my life. I primarily worked situational planning: reporting daily operations and sending out medivac requests, working with I received a commendation medal from the Coast Guard for my FEMA [Federal Emergency Management Agency] to get medical efforts in Puerto Rico. It was a truly humbling experience. attention and ensuring the delivery of food, water and tarps to civilians. We provided wellness checks. What’s next? Infectious spirit My next goal is to become an officer in the Coast Guard. I want to develop a CPR and First Aid program within the Coast Guard that The spirit of the people of Puerto Rico blew me away. Towns enables community responders in areas of distress to have the worked together to cook for another. They painted the flag on confidence to know what to do during an emergency and to not downed trees. hesitate to act when the need arises.

While the dire conditions in Puerto Rico can be demoralizing, the I also love my job as a radiation therapist and being in the Coast faith among the people is infectious. They are good people, and I Guard Reserves. I want my daughters to know that no matter how was able to help save a few lives while down there. old you are or because you are female, you can accomplish anything.

2018, Volume 2 | The New Standard 27 From left: Davon Gass, Kelly Mahafly, RN, Katrina Aronoff and Ming Chan.

rank of third-class petty officer and boat swain mate. (see feature on page 26) Annual event honors –– Ming Chan, a security officer at Long Island Jewish Medical Center who military members and vets served for five years as a mechanic in the Army. Providing tangible support. –– Davon Gass, a patient care associate at Lenox Hill Hospital who served for six years as a hospital corpsman in the Navy. Amid the pomp of a full color guard, director of Northwell’s Office of Military –– Kelly Mahafly, RN, an operating room high-ranking military officials and and Veterans’ Liaison Services and veteran nurse at Glen Cove Hospital who veterans recently joined Northwell of a foreign conflict. He emphasized fulfilled the same role for six years in Health executives at a special dinner to the importance of the health system’s the Army. honor members of the military. continued employee education about –– Joseph Altidor, a food service worker serving vets “while increasing community at North Shore University Hospital Former Army Undersecretary Patrick awareness that veterans deserve the who served for eight years in the Murphy keynoted the Fleet Week highest quality of care that we can offer.” Marine Corps, including a tour in occasion, which took place at One World Kuwait as a sergeant. Trade Center. Michael Dowling, the For the 11th consecutive year, Mr. Dowling health system’s president and CEO, presented on-staff veterans with checks “I don’t think we do enough for veterans,” recognized “all Marines, sailors and Coast for the differential between their military Mr. Dowling he said. “And I don’t think Guard service members” and “all of our pay and the Northwell salaries they would we appreciate their sacrifices enough.” soldiers and airmen.” have received if they had not gone on Their teamwork and compassion military leave. Since 2008, 42 employees are examples for all Northwell staff The health system has addressed the have received more than $1.7 million members, he added. needs of returning veterans and their through the health system’s supplemental families for more than a decade. This pay benefit. This year’s recipients were: The health system hired 500-plus veterans recent event reaffirms Northwell’s –– Katrina Aronoff, chief radiation therapist in 2017, up from 417 in 2016. Learn more dedication to their health and at Phelps Hospital who served for five about Northwell Health’s Military and employment, according to Juan Serrano, years in the Coast Guard and holds the Veterans’ Liaison Services at (516) 719-3125.

28 2018, Volume 2 | The New Standard Independence Day Chris Levi lost both legs and sustained additional injuries while fighting in Operation Iraqi Freedom. His new smart home will help him live in comfort. By Chris Gasiewski

Strong. Humble. A warrior. Chris Levi is all who has received the Purple Heart among “My plans are too long for this of these. Most of all, he is a family man. other military honors. “When I came conversation,” he said. “There are binders home from Iraq, my family surrounded and binders.” Atop the list is obtaining Through a wide smile, he often refers to me. Then Holbrook surrounded my family. his license to become an investment them as his bedrock. Even as he moved Then Suffolk County supported us. adviser and taking the Series 7 and Series into his first house on July 3, the former 66 exams. Regardless of his pursuits, his Army corporal deflected all efforts to put Mr. Levi needed to soak in the moment spirit promises to shine. the spotlight on him. as he sat on his living room couch for the first time. His future plans are as “I don’t feel like I deserve any of this but inspiring, as are his demeanor. I do hope I earned it,” Mr. Levi said. “I’m more excited that I get to see the faces of my nieces, my mother, my sister and all of the people who care about me. Anywhere I can hang out with my nieces and my family, I feel at home.”

He now has a home of his own, thanks to the Stephen Siller Tunnel to Towers Foundation and a bevy of additional supporters including Northwell Health, which donated $100,000 toward the project. The foundation builds mortgage- free smart homes for catastrophically injured service members.

Mr. Levi’s three-bedroom, two-and- a-half-bath ranch includes the latest technologies that provide independence in comfortable surroundings. He said the new house will help him socialize more easily with loved ones and expand his ability to use his wheelchair, which will relieve stress on his prosthetic legs.

Never losing faith Despite his injuries, Mr. Levi’s hope never vanished. He says it actually became stronger since that fateful day. “I’m proud to be an American. And I’m proud to be a New Yorker. And I’m very proud to be a Long Islander,” said Mr. Levi, 2018, Volume 2 | The New Standard 29 Advancing care in Guyana A new residency program is establishing the practice of radiology. By Lisa Davis

Northwell Health already touches millions “This program will really advance health Guyana and Georgetown Public Hospital, of lives in the New York metro area. Now it’s care in our country,” said Angelita Sue, Guyana’s largest hospital. improving health care for a whole country. MD, one of the program participants. “Right now, doctors often have to do Doctors at Georgetown Public Hospital The health system is helping to build the procedures blindly, just depending on reached out to RAD-AID for help in first radiology residency program in the their eyes and clinical judgment, because launching a radiology program. David Caribbean nation of Guyana. it’s so hard to get imaging studies. Having Axelrod, MD, an interventional radiologist a radiology program, and having imaging at Huntington Hospital, was volunteering Last November, Northwell welcomed five more available to the public, will allow for RAD-AID at the time. He remembers Guyanese medical residents for a six- doctors to act faster and make decisions brainstorming with Gillian Battino, MD, month imaging immersion course at North more accurately.” director of RAD-AID Latin America, about Shore University Hospital and Long Island the most effective way to start. Jewish Medical Center. The cohort returned Northwell didn’t tackle the effort alone. Its home this spring to begin another 2 1/2 collaborators were RAD-AID, a nonprofit “Jill thought it would be best to immerse years of study to become their country’s that improves access to medical imaging several physicians in an American first home-grown radiologists. in developing countries, the University of program, since they didn’t have a model

30 2018, Volume 2 | The New Standard for a radiology program back home,” Dr. The residents arrived in November, ill- radiology residents and one travelled to Axelrod said. “Before she even finished, I equipped for cold weather. At that time Georgetown in the spring. said, ‘What about Northwell?’” of year, the temperature in Guyana’s capital rarely goes below the mid-70s. Ultimately, the program will succeed by It was a natural fit, not just because Donations of coats, sweaters, boots making itself unnecessary, its leaders said. Northwell offers an extensive radiology and cash immediately poured in from The first group of students is key to that program, but also because Queens is home Northwell staff members, Dr. Davis said. planned obsolescence. to a large Guyanese community. Radiology The first residents returned to Guyana faculty, techs, administrative staff and in April and a second group will arrive “They will be the leaders of radiology residents are enthusiastic supporters later this year, according to Lawrence in their country, and eventually they’ll as well, said Lawrence Davis, MD, who Smith, MD, Northwell’s physician-in- become the instructors for generations of recently retired as vice chair of radiology chief and founding dean of the Zucker radiologists,” said Dr. Davis. “When you at NSUH and LIJ and director of the health School of Medicine at Hofstra/Northwell. think about the impact they’re going to system’s Radiology Residency Program. The health system is also developing a have, we can’t even count the number of Dr. Davis developed the curriculum for the global health elective for its own senior lives they’re going to save.” Guyanese residents with Dr. Battino.

Northwell Health Walks raise $725,000+ Pediatric, cancer and cardiac care took center stage recently at four Northwell Health Walk events. Nearly 5,000 participants laced up, raising more than $725,000 for the Katz Institute for Women’s Health and Cohen Children’s Medical Center. The four 5K courses spanned the metro New York area — at the Tanger Outlets in Riverhead, Jones Beach State Park, the Midland Beach Promenade on Staten Island and Franklin D. Roosevelt Park in Yorktown Heights. Since inception, Northwell Health Walks have raised nearly $4 million.

2018, Volume 2 | The New Standard 31 Around the system: LIJ Valley Stream The gift of life

A Long Island Jewish Valley Stream Hospital (LIJVS) staff member is happy to be alive after surviving six brain aneurysms.

Billy Brodgon Simmons, patient family experience coordinator, collapsed at the hospital’s first annual Christmas tree lighting in December. Colleagues rushed him to the Emergency Department.

“Dr. Hoang, one of our emergency medicine doctors, did a masterful job of maintaining his blood pressure,” said Joseph Marino, MD, medical director at LIJVS, who secured Mr. Simmons’ airway with a breathing tube.

A computed tomography (CT) scan showed that confirmed Mr. Simmons was bleeding in the brain, and an ambulance brought him to North Shore University Hospital (NSUH) for neurosurgical care.

“When Mr. Simmons came in, he had six brain aneurysms, which is very unusual for a young man of 29,” said Amir Dehdashti MD, director of cerebrovascular neurosurgery at NSUH. He was taken immediately into surgery and treated for four of them, including the one that was hemorrhaging.

Mr. Simmons underwent further surgery at NSUH in the months afterward, followed by rehabilitation therapy at Glen Cove Hospital, but it was the medical staff at LIJ Valley Stream anchored the chain of care that saved his life. “I am so grateful for that,” Mr. Simmons said.

Learn more about Mr. Simmons’ incredible story From right, Mr. Simmons with his mother, Donna Brogdon Simmons by visiting bit.ly/6survivor.

Around the system: Staten Island University Hospital Easing care for devastating illnesses

Staten Island adults with debilitating neuromuscular conditions Those who live with conditions such as muscular dystrophy can access care at one location at Staten Island University or amyotrophic lateral sclerosis (ALS) can meet with the Hospital’s new Comprehensive Neuromuscular Program. multidisciplinary team of neuromuscular disease specialists plus physical, occupational and respiratory therapists and “It’s always better to come and see our team all together in one speech and language pathologists on the first Friday of every setting, so you don’t have to travel from site to site,” said Edward month. Staff members also provide direction on accessing Yu, MD, the neurologist who leads the program, which is the first resources and support, and assist with obtaining medication of its kind in Richmond County. and adaptive equipment.

32 2018, Volume 2 | The New Standard Around the system: North Shore University Hospital and Mather Hospital Two more Northwell hospitals gain Magnet recognition

The American Nurses Credentialing Center (ANCC) recently designated North Shore University Hospital (NSUH) and Mather Hospital as Magnet hospitals.

NSUH and Mather achieved the recognition by passing a rigorous, lengthy process that requires leadership and staff participation. Fewer than 500 hospitals worldwide — about eight percent — have achieved this designation.

“This level of nursing excellence takes From left, Mather officials react to the news of Magnet recertification: Kenneth transformational leadership, workforce Roberts, president; Brandy Feliu, RN, assistant vice president, nursing professional empowerment, innovation, research, development; Marie Mulligan, RN, PhD, chief nursing officer and vice president for exemplary care at the bedside and the nursing; and Maureen Altieri, RN, director of service excellence and Magnet. tireless dedication of our incredible nurses,” said Alessandro Bellucci, MD, executive director at NSUH.

Marie Mulligan, RN, PhD, Mather’s vice president for nursing and chief nursing officer, expressed her gratitude for the dedication of all staff members, and added that the hospital is also a recent recipient the Nurse Exemplar Award from the American Society for Pain Management Nursing.

Health care organizations and their communities benefit from Magnet recognition with improved patient experience, better outcomes and higher job satisfaction for nurses, according to the ANCC.

Northwell Health’s other Magnet hospitals include Cohen Children’s Medical Center, Huntington Hospital, Kerri Ann Scanlon, RN, NSUH’s chief nursing officer and Northwell Health’s deputy Long Island Jewish Medical Center and chief nurse executive, cheered with hundreds of nurses and executives when they Northern Westchester Hospital. learned the hospital achieved Magnet status.

2018, Volume 2 | The New Standard 33 From left: Mr. Bardsley and a Spectrum staff member showed a recent project to Mr. Boffa. A customized partnership Vocational program employs young people on the autism spectrum.

Two Northwell Health hospitals are spectrum disorder, who may otherwise be LIJ benefits from a reduction in costs for spiffing up with a local apparel-decorating contending with the challenges of finding high-quality items compared to other business. a job, explained Mr. Boffa. The partnership vendors, said Mr. Boffa. Furthermore, the gives back to the community and helps nonprofit’s turnaround time for large Spectrum Designs provides gainful Spectrum staff to do more and feel valued orders is much faster in a pinch. employment to teens and young adults in the community. “Northwell is the on the autism spectrum. North Shore kind of place that can align itself with “I look forward to continuing our University Hospital and Long Island Jewish Spectrum Design’s vision,” he said. partnership for the betterment of both (LIJ) Medical Center work with the Port organizations, the community and the Washington nonprofit to receive custom- The estimated unemployment rate special team at Spectrum,” Mr. Boffa said. embroidered white coats plus special- for those on the autism spectrum is event clothing. 70 to 90 percent, according to Patrick Visit Spectrum Designs Bardsley, Spectrum’s cofounder and “It’s proven to be a feel-good partnership CEO. “We’ve created a sustainable work with Northwell at that benefits both groups in multiple place for them,” he said, adding that bit.ly/spectrum-partners. ways,” said Chris Boffa, executive director having Northwell Health as a client took of hospital operations at LIJ. Spectrum to the next level. “We have the support of a reputable organization,” said Using Spectrum services adds value to Mr. Bardsley. the lives of young people with autism

34 2018, Volume 2 | The New Standard Spotlight on organ and tissue transplants

p. 36 Long Island’s new organ transplant destination p. 38 The complex art of liver transplantation p. 40 The evolution of sight-saving p. 42 Stem cell transplants offer “Reason to Believe” p. 44 Good news for NY’s heart transplant patients

2018, Volume 2 | The New Standard 35 Long Island’s new organ-transplant destination Northwell Health is making it happen through scientific innovation that’s guided by a transplant chief with a plan. By Brian Mulligan

A cell phone rings. The man wearing improve access for Long Islanders.” He “We also opened the Pediatric Kidney mahogany cowboy boots apologizes added that the number of Northwell’s Transplant Program at Cohen Children’s profusely but he has to take a call. adult kidney transplants have nearly Medical Center and we’ve done seven. The doubled in one year — from 34 to 65. results have been spectacular.” That’s understandable. As Northwell Health’s vice chair of surgery and director “There are small kidney transplant of solid organ transplantation, Lewis programs on the Island but we wanted A warming trend Teperman, MD, knows that one of the to change that. On Long Island, heart The art and science of transplantation certainties of life is this: When a vital organ transplantation didn’t exist, liver doesn’t have always depended on organ becomes available, his phone will ring. yet exist, and pediatric transplantation preservation. Northwell is innovating to of any kind didn’t exist. None of it really improve current standards. “This call is important,” he says, winking. existed until we started it. But they will all And it is. exist under Northwell. It’s a very forward- “When you take an organ out of the body, thinking approach.” it only has a certain amount of time to He hangs up and smiles. It’s the natural exist. We apply a preservation solution and byproduct of a successful outcome. The cool the organ,” Dr. Teperman said. “We good news is that Dr. Teperman smiles Eliminating hardship [Northwell] have this idea that instead of a lot. Back in 2016, he joined Northwell Prior to joining the health system, Dr. cooling it, maybe we should keep it warm Health to launch a new liver transplant Teperman founded NYU Langone’s Organ instead. If we pump the organ with blood program. Now, the born-and-bred New Transplant Center in Manhattan. While and give it nutrients, maybe we can keep Yorker is helping to make the health system he served there for 27 years, 40 percent it out of the body longer, assess it and take a destination for transplant services. That of his patients came from Long Island. injured organs and nurse them back to includes liver, heart, kidney, bone marrow, “Patients went to the city because they health to use for transplantation.” autologous islet cells and more. had to,” he said. “It’s a huge hardship for these patients to come back and forth from Once devices for warm organ But cowboy boots? In New York? Manhattan in terms of time, money and preservation receive licensing in America, family issues.” Northwell will put them into use, Dr. “Been wearing them since my high school Teperman said. It’s one of the reasons he days in the Bronx,” Dr. Teperman says. More than 120,000 people in the US await is so confident the health system will be Manhasset may not be the Wild West organ transplantation. “More than 10 the Northeast’s leading destination for but when it comes to transplant services, percent of that list is in New York,” he said. transplant services. Long Island remains largely unchartered “The majority of these patients come from territory. So maybe a cowboy mentality Northwell just because of the breadth and “Northwell has come up with an and those boots will come in handy. scope of our facilities and service area. innovative idea to increase donation. Our eICU [electronic ICU] helps nurses and “I was recruited to make Northwell The number of adults that Northwell’s doctors remotely take care of patients the best transplant program in the Kidney Transplant Program has doubled, and can also identify early on whether Northeast,” Dr. Teperman said. “There is and will likely increase another 25 percent someone may be a donor candidate. Time certainly an opportunity to do that and this year, according to Dr. Teperman. is of the essence in these cases. The eICU 36 2018, Volume 2 | The New Standard Spotlight on organ and tissue transplants

lets us connect with the procurement agency LiveOnNY. Quicker notifications mean we can take people to the OR quicker to secure and transplant donated organs quicker.”

Also on the docket, he said, is a greater investment in living transplantation: “We need living donation because there are not enough donors in the US.” Dr. Teperman added that 35,000 people are transplanted in the US. The rest — about 85,000 — don’t. “We’re devising new techniques to do living donor liver transplant because the liver is a unique organ that can grow back. At the end of nine months, there are two whole livers. It is absolutely something Northwell is committed to doing.”

Know-how makes all the difference Dr. Teperman says he would stack up the It has increased the number of live donors That balance of art, science and ingenuity Northwell with any other organ transplant that are looking to Northwell.” is already apparent in Northwell’s program. program. “We’ve already changed the It’s why Dr. Teperman is so confident the way living renal transplantation is done One key to transplantation services health system will be the transplant center here in New York. One of the surgeons we is immunosuppression expertise, Dr. others will look to emulate in breadth, recruited is Ahmed Fahmy.” Teperman said. “Using these medications scope and quality of service. so patients can live a lifetime is the The associate chief of transplant surgery goal. We have the expertise to make With a perfect combination of New for Northwell, Dr. Fahmy developed patients more tolerant to the organ York swagger and cowboy sensibility, Dr a technique called single-port donor transplanted and be weaned off some Teperman smiles. “The vision here is that nephrectomy, which uses a small belly- of the medication. That’s the art of we’ll be at the forefront of transplant button incision to remove a kidney. transplantation.” medicine. We’re proud of that. If imitation “He’s done 25 of them here already,” Dr. is the sincerest form of flattery, I do Teperman said. “No one else does them on believe everyone else will be copying us.” the Island. He’s an outstanding surgeon.

2018, Volume 2 | The New Standard 37 The complex art of liver transplantation New York State has given Northwell a green light to develop a liver transplant program. What happens next? By Chris Gasiewski

Well before 8 a.m. one recent morning, chair of transplantation. “You will be evaluated by nurses, surgeons, physicians, social workers, nutritionists. It’s a real process.” Henry Bodenheimer, Jr., MD, settled Dr. Teperman is on the board of the United Network for Organ into his office in the Sandra Atlas Bass Sharing (UNOS), which provides regulations for solid organ Center for Liver Diseases. Before patient transplants along with the US Centers for Medicare and Medicaid Services. UNOS divides the nation into 11 regions visiting hours begin, he typically focuses (New York is in Region 9). on nonclinical job responsibilities. “The regulations state that you have to have a ‘list meeting’ These days, he said, there’s much to do. where doctors present a patient’s medical, social, psychological and nutrition issues,” Dr. Teperman said. “The federal government wants to ensure that the transplantation has the As medical director of Northwell Health’s new Liver Transplant greatest chance of success.” Program, Dr. Bodenheimer is helping to construct a world- class program to treat chronic liver disease. Northwell will fill a The complex process is highly regulated, and it takes months to get major void by providing Long Island’s only adult liver transplant on a transplant list. Eligibility largely comes from each candidate’s program, making it easier for those who must now travel to model of end-stage liver disease (MELD) score. Scores range from Manhattan and beyond for the procedure and treatment. six to 40; six equates to a 0 and a score of 40-plus means you’re too sick for a transplant. When an organ becomes available, you “We are seeing patients who have advanced liver disease and are must be the first person on the list. The higher your MELD score, going for transplantation in the New York area,” Dr. Bodenheimer the higher your likelihood to be offered a liver transplant. said. “We need to structure our clinical capability to be able to evaluate those patients here and get them listed. That will await Liver preservation and living donation the formal start of the program.” One unique aspect to liver transplantation is that the organ The liver transplant process actually grows back, and Dr. Teperman has developed living donation techniques now in use. Much goes on behind the scenes to develop a liver transplant program and complete the actual procedure. It takes diligence, Improvements in preservation solutions now provide larger skill and tireless coordination. windows for organ procurement, according to Dr. Teperman. He cited a recent clinical trial in Western Europe that demonstrated This spring, more than 14,000 people were on the national liver- that a liver can last longer between harvest and transplant — up transplant waiting list, including 1,100 in New York State. David to 24 hours — when stored in an OrganOx. The system keeps the Bernstein, MD, chief of hepatology at North Shore University liver warm, unlike the standard practice of cooling the organ. Hospital and Long Island Jewish Medical Center and head of the Bass Center for Liver Diseases, said 50 to 100 of the center’s The research may boost the number of liver donations for those patients are on a liver transplant list. who need one. “You could take an injured organ and nurse it back to health for transplantation,” Dr. Teperman said. “[The study] So how do you get a liver transplant? looked at organs that are discarded — not used in people — placing them in this warm preservation device and nursing them “If there is a good transplant service center around, you will be back to health. They work perfectly — much better than with the referred to a specialist,” said Lewis Teperman, MD, Northwell’s vice preservation solutions we use now.”

38 2018, Volume 2 | The New Standard Spotlight on organ and tissue transplants

While Dr. Teperman and his colleagues await FDA approval transplants. There’s a terrible shortage in New York because for the OrganOx device, living donations remain the key to heart disease, kidney disease and liver disease have a higher liver transplants. There’s a critical donor shortage in the US, incidence in cities.” so Northwell works with LiveOnNY as its donor procurement agency. Dr. Teperman said the health system is also monitoring Donation is critical to any transplant program’s survival, eICU patients for early identification of donor candidates. according to Dr. Bodenheimer. He added, “There are not enough livers to meet the transplant needs,” he said. “We need public “We are able to take the people to the operating room quicker,” awareness, and health care providers to be accepting and he said. “Ten percent of all people in the US needing transplants promote organ donation. We can’t leverage transplant capability live in New York. Out of that 10 percent, only 30 percent get if we can’t grow organ donation.”

2018, Volume 2 | The New Standard 39 The evolution of sight-saving Broad, extensive experience in corneal transplants. By Chris Gasiewski

Robert Sohovich regained his sight through “I have multiple titles going at the same As the year progressed, cataracts caused cataract surgery and corneal transplant. His time,” said the Flushing resident. “It’s sort Mr. Sohovich’s sight to decline. His 20/25 vision is evidence of the progress in of like a buffet — whatever mood I’m in.” daytime vision was normal, but at night he the corneal transplant field. saw more halos than a Pink Floyd concert. In summer 2017, he tackled The Last Lion, Now retired from his position as human a three-volume, 3,000-plus page Winston “Bright lights were very annoying,” he resources controller for a major media Churchill biography. “It took me about said. “It can be difficult to drive at night company, Mr. Sohovich is an avid reader. He four-and-a-half months to finish. It wasn’t because of the oncoming vehicles.” habitually juggles several books at once. a continuous read, but I worked at it pretty well.” The condition led Mr. Sohovich to Carolyn Shih, MD, director of clinical research and

40 2018, Volume 2 | The New Standard Spotlight on organ and tissue transplants

With DSAEK, ophthalmologists insert 90- to 100-micron-thick donor tissue through “I’ve worn glasses to correct my a three- or four-millimeter incision on the side of the cornea. “We lift the graft with vision for 55 years and I no longer an air bubble which rises and tamponades the new donor to the host cornea,” Dr. need them.” — Mr. Sohovich Shih said. “And without glue or without stitches, it will stick by itself.” refractive surgery in Northwell Health’s and technology. “In the old days, you Department of Ophthalmology. Dr. Shih used to cut out corneal scars or diseased DSAEK patients can see 20/40 after three identified the cataracts, plus a condition corneas with a cookie-cutter blade called months — a significant improvement called Fuch’s dystrophy, which is failure a trephine,” she said. “Then we would take compared to results of earlier transplant of the corneal pump cells — the eyes’ another trephine, cut a donor button, and procedures, Dr. Shih said. windshields — that creates a film and blurs sew it in with many sutures. Those are vision. Mr. Sohovich needed a transplant. called penetrating keratoplasties.” 20/20 vision returns Dr. Shih removed his cataracts and Penetrating keratoplasty (PK) originated DMEK, the most recently developed performed the corneal transplant known decades ago and is still performed procedure, uses a sheet of pump cells as Descemet’s membrane endothelial regularly. PK is reserved for individuals that is 10-15 microns thick. Like DSAEK, keratoplasty (DMEK) in March and April with scarred or very severe opacities in an ophthalmologist makes an incision, 2018. By early May, Mr. Sohovich’s vision their corneas. removes the endothelium and Descemet was 20/25. membrane and inserts a fine layer of A newer form of transplant, endothelial pump cells. The thin layer requires an “It is absolutely amazing,” said Mr. keratoplasty (EK), has become a more incision of 2.75 to 3.5 millimeter and may Sohovich. “I’ve worn glasses to correct common way to restore vision. EK can need only one stitch. my vision for 55 years and I no longer help individuals with conditions such as need them. It’s almost like a miracle.” Fuch’s dystrophy, bullous keratopathy, “DMEK patients may be on their back for a He praised Cecilia Francisquini, surgical iridocorneal endothelial (ICE) syndrome or week whereas DSAEK patients are on their coordinator, and others in the health other endothelial disorders. back for three days. But these patients system’s Department of Ophthalmology get back 20/20 vision as opposed to 20/40 for his seamless experience. There are two types of EK – Descemet’s vision,” Dr. Shih said. stripping automated endothelial keratoplasty (DSAEK) and DMEK. Both have Few doctors perform DMEK due to its Seven times the revolutionized corneal transplantation. complexity, she added, but the Northwell specialists Department of Ophthalmology has “The cornea is like an onion,” Dr. Shih said. performed about 100 of them. The health Corneas serve as windshields for the eyes, “The innermost layer facing the iris is a system’s corneal specialists also perform so they need to be clear for you to see. pump layer. It’s supposed to pump out deep anterior lamellar keratoplasty Infection or scarring from a blow to the excess water. The rest of the layers are (DALK), removing all except the innermost eye are the typical reasons for needing a nice and clear. You have a finite number corneal layers when that layer is healthy transplant. The health system’s roster of of pump cells and can lose them with age, and unscarred. cornea specialists make Northwell unique, previous eye surgery or conditions like according to Dr. Shih. “We have seven,” Fuch’s dystrophy.” The conditions make “Our goal is to provide the latest she said. “Most places have one.” you feel like you are looking through a technology and the best options for steamy haze and may cause severe glare healing our patients and helping them to The Department of Ophthalmology is at around lights at night. see again,” Dr. Shih said. the forefront of transplant techniques 2018, Volume 2 | The New Standard 41 marrow, where blood cells are made. Before administering high-dose chemo, Dr. Stem cell transplants Bayer’s team collects the patient’s stem cells, which are essentially the seeds that can regrow and repopulate bone marrow offer “Reason to Believe” after treatment. ...as progress continues. Allogeneic stem cell transplantation harnesses the donor’s immune system By Brian Mulligan to fight disease. “We are trying to grow the donor’s bone marrow in the patient and ultimately the donor’s bone marrow will take over production of the patient’s blood and the donor’s immune system will When Bruce Springsteen “the Boss” sings, Grit, determination take over the patient’s immune system.” Ruthee Lu Bayer, MD, not only listens — she acts. She has never met New Jersey’s and advances in care favorite son, but his words and music Grit and determination serve patients Covering the bases have always inspired the hematologist/ and their physicians well when it comes Northwell participates in all aspects of oncologist from Yonkers. to battling blood cancers. And with transplantation. When a patient needs an new advancements in medicine, stem allogeneic transplant, the health system “I always find a reason to believe,” she cell transplantation has become more turns to a donor registry like the Be the says, quoting a favorite lyric. “I’m a die- accessible. “People had looked at bone Match Registry, which has more than hard fan and draw a lot of inspiration marrow/stem cell transplantation as a last 9.5 million volunteer donors. Allogeneic from him. I try to pass that inspiration on resort for blood cancers,” Dr. Bayer said. transplants are performed for diseases to my patients.” “The process has become safer and safer that like AML (acute myeloid leukemia), with more advances in medicine. Now, ALL (acute lymphocyte leukemia), MDS Dr. Bayer, director of stem cell these procedures are offered to high-risk (myelodysplastic syndrome), in addition transplantation at the Northwell Health patients as initial treatments.” to hematologic malignancies and Cancer Institute, has overcome personal refractory lymphomas. trauma. She was born with fibular Dr. Bayer oversees the Don Monti Bone hemimelia, a birth defect characterized by Marrow and Stem Cell Transplantation “We also do allogeneic transplants for a missing (full or partial) fibular bone, limb Program at North Shore University Hospital nonmalignant diseases like aplastic anemia length discrepancies and foot and knee (NSUH), which provides both autologous and sickle cell,” Dr. Bayer said. “One of deformities. “I had 22 surgeries as a kid transplants, using the patient’s own stem the biggest hurdles for these patients is and spent a quarter of my childhood in a cells and allogeneic transplants, where finding a donor. We are participating in cast. I always wanted to be an orthopedic donor stem cells are utilized. a clinical trial through the Bone Marrow surgeon but I couldn’t handle the physical Transplant Clinical Trial Network, doing aspect of it.” The goal with autologous transplants is to haploidentical transplants with sickle cell intensify the dose of chemotherapy. “If we disease patients. It’s very exciting.” Instead, after watching her grandmother can escalate the amount of chemotherapy battle breast cancer, she decided to be we administer, we can increase the The haploidentical transplant, which a cancer specialist. “I enjoy taking care chances of a cure,” Dr. Bayer said. means half-matched, is one of the biggest of patients in crisis,” she said. “It’s when advances in stem cell transplantation to people are at their worst that we can be Higher-dose chemotherapy kills cancer occur in the last five years, she said. “We at our best. That is what our program cells but winds up “shutting off” bone really are able to find donors for all of our strives to do.”

Cohen Children’s Medical Center has helped countless families since 1991 by performing stem cell transplants for a variety of conditions, including bone marrow failure syndromes. Abigail Slaven, RN, assistant nurse manager of pediatric hematology/oncology at the children’s hospital, was inspired to donate bone marrow. See her story on page 24.

42 2018, Volume 2 | The New Standard Spotlight on organ and tissue transplants

patients in need. Before the half donor In the end, she says, quality is the name recovers and can return to living a match process was perfected, there were of the game. The program’s accreditation relatively normal life. The other type patients we were not able to offer this from the Foundation for the Accreditation of success is when the patient doesn’t potentially curative option to because of Cellular Therapies, American respond well to treatment, but family there was not a donor. Now, we are able Association of Blood Bank, and consistent members “are at peace that we’ve done to find donors for those patients.” inspections by New York State and the US everything we possible could.” Food and Drug Administration speak to During the annual Don Monti Memorial that quality commitment. Research Foundation’s annual Celebration “The sisterhood of Life Dinner, donors and recipients of transplants” “We are held to a high standard though meet, and attendees celebrate births, these organizations. They review our engagements and marriages. “We had The Northwell Stem Cell Transplant outcomes, morbidity and mortality. We are 450 people last year — all autologous and Program began in 1987 and has helped very committed to the inspection process allogeneic patients, donors, caregivers more than 3,000 individuals since then. because it has allowed the program to and staff. We’re always trying to spread “We see very sick people. But there is hope become as successful as it is today.” the good word.” because there is a chance for longterm survival and cure. We are the sisterhood of There are two ways to measure success, transplants here,” she said of the staff. Dr. Bayer said. In one, the patient

2018, Volume 2 | The New Standard 43 Spotlight on organ and tissue transplants

Good news for NY’s heart transplant patients Change is in the air. By Brian Lima, MD

Things are looking up for New York State We’ve already seen progress. Last year, residents with heart failure. Long Island’s more than 84,000 New Yorkers signed up first heart transplant program is now open with the Donate Life Registry — a positive at Northwell Health and New York has put and important step. increased emphasis on statewide organ- donor registration. Long Island’s first Heart When it comes to matters of the heart, Transplant Program we’d do well to consider the numbers. About 360 New York residents await Equally important is a change that heart transplants, making our state’s touches Long Islanders. Northwell Health, waiting list one of the longest in the which has referred 40 percent of the heart country, according to the nonprofit United transplant cases to Manhattan facilities, Network for Organ Sharing. received state approval to perform heart transplant surgeries. It’s a first on Long The state’s overall organ-donor Island, and a lifesaver for 7.5 million registration rate is the third-lowest people who were otherwise forced to of commuting time and travel expenses to in the US. That’s partly because many travel to Manhattan or the Bronx for this that is an unnecessary burden. who live in the five boroughs don’t have complicated process. driver’s licenses – 57 percent, according Thankfully, Long Islanders with heart to 2016 New York State Department of To the uninitiated, traveling to New failure can now receive transplant services Motor Vehicles figures and planning data. York City for life-saving care might not here at home. That means the state lacks one of the seem like a big deal. But ask any Nassau easiest, most convenient ways to register or Suffolk family whose loved one has Proximity to high-quality care also as an organ donor. Because donations received a new heart and you will begin means benefitting from the latest are prioritized based on geographical to understand the significant burden on technological advances — good things proximity, New Yorkers are at a massive patients and caregivers. for those with advanced heart failure. disadvantage. Our doctors use not only cutting-edge That’s because post-transplant follow-up tools for procedures, but also employ But that is changing. In October 2017, Gov. care is more than a little overwhelming. advanced programs to better identify Andrew M. Cuomo announced measures In the first month after transplantation, potential donors. And the sooner doctors to increase organ donations across New the heart recipient must make weekly can identify candidates for donation, the York, directing state agencies to provide doctor visits; for the next six months or greater the chance they can save a life. new ways to register as an organ donor. so, monthly follow-up appointments are standard. Adding an hour or two (or more) This op-ed originally appeared in Newsday.

44 2018, Volume 2 | The New Standard Immediate care on Fire Island For medical assistance during a summer holiday on Fire Island, choose from a Northwell Health Immediate Care Center in Cherry Grove, seen at left ([631] 597-6767), or Ocean Beach ([631] 583-8548). Advanced health care practitioners provide help for minor injuries and, in some cases, life- saving care. Both are open every day through Labor Day weekend: Monday through Friday, 9 to 11am and 4 to 6pm; and weekends, 9am to noon and 3 to 6pm.

Around the system: Cohen Children’s Medical Center More time for gravely sick kids

Children with an aggressive form of until their radiation tapers to a level that neuroblastoma are living longer at is safe for others. Visiting parents stay Cohen Children’s Medical Center. The behind a lead shield and wear a device to hospital offers a hard-to-access therapy monitor their exposure. Two-way audio/ that destroys neuroblastoma cells with visual equipment in an adjoining room metaiodobenzylguanidine (MIBG), an lets family members safely interact with intravenously delivered radioactive their loved one. provide MIBG, and Cohen Children’s is one compound. of the few in the tristate area to offer it. Conventional treatment cures 50 to 60 “MIBG is different from conventional percent of kids with neuroblastoma. But The hospital offers the treatment radiation therapy,” said Jonathan Fish, MD, when a child has high-risk neuroblastoma program with support from Christina and a pediatric oncologist/hematologist at the that relapses or is unresponsive, MIBG can Angelo Kostaris, who lost their daughter, hospital. Unlike delivering high-energy extend a high quality of life for months or Anastasia, to neuroblastoma in July external radiation, “the infusions makes years, according to Dr. Fish. 2015. Anastasia needed to travel out- the children we treat emit radiation.” of-state for MIBG therapy. Her parents Nationally, researchers are close to founded Anastasia’s Legacy to fast-track Administering the MIBG dose takes just incorporating high-dose MIBG as part of the creation of an MIBG program within minutes, but the radiation works for a first-line treatment for newly diagnosed Cohen Children’s Division of Pediatric solid three to seven days. Children stay kids. with the goal of improving cure rate. Hematology/Oncology and Stem Cell in a lead-walled room during treatment, Only a handful of hospitals nationwide Transplantation.

2018, Volume 2 | The New Standard 45 Around the system: Lenox Hill Hospital Dorothy Emer, 44, breathed a sigh of relief this past April when she showed no evidence of brain cancer in a magnetic Resolving a resonance imaging (MRI) scan. The Bronx resident experienced dramatic progress since January 2018, when a sudden, severe headache left her paralyzed on her dramatic health crisis left side. Her husband drove Ms. Emer to Lenox Hill Hospital, where an MRI revealed a large mass pressing on the brain region that controls movement on the left side.

Jason Ellis, MD, and John Boockvar, MD, neurosurgeons at the hospital’s Brain Tumor Center, removed the tumor, preserving Ms. Emer’s motor function. Dr. Ellis reported that beside the large tumor that the surgical team removed completely, the mother of three also had three smaller tumors in different areas of her brain.

“Since they were very small, we decided that the best way to treat them was to use the Gamma Knife,” he said. Gamma Knife delivers a precisely targeted, high-dose treatment, a significant difference compared to the multiple doses that typify traditional radiation therapy.

“The Gamma Knife allows maximal destruction of the cancer while sparing the surrounding healthy brain tissue,” said Dr. Ellis. He and Anuj Goenka, MD, radiation oncologist at Lenox Hill, performed the Gamma Knife procedure in February.

The team now monitors Ms. Emer’s progress, pleased with her From left, Ms. Emer with her children Matthew, Mikayla promising response to multimodality treatment. and Nicholas.

Around the system: Southside Hospital A convenient new specialty pharmacy

Getting immediate access to prescriptions after a hospital stay can be difficult. Southside Hospital is changing that dynamic with its new Vivo Health Pharmacy. Discharged patients can pick up prescriptions on their way home when they pass through the front lobby.

“We wanted to make it as easy as possible for patients to have what they need to continue their healing process when they go home,” said Donna Moravick, NP, executive director of the hospital. A 24-hour clinical call center, Vivo Health Pharmacy is accredited as a specialty pharmacy by the Utilization Review Accreditation Commission (URAC). Specialty pharmacies help difficult to access. Northwell Health also operates Vivo Health those with complex and chronic diseases that often require pharmacies at North Shore University Hospital and Monter medication that can be expensive, complicated to adhere to, or Cancer Center.

46 2018, Volume 2 | The New Standard Cancer Survivors’ Day 2018 “The one thing that cancer taught me to do is to celebrate every day. Life is joyous…we all need to remember this,” said Carmen Marc Valvo, fashion designer and colon cancer survivor. Mr. Valvo was the keynote speaker at the 12th Annual Don Monti Cancer Survivors’ Day, held recently outside the Monter Cancer Center in Lake Success. More than 1,400 survivors and their loved ones attended the celebration, made possible by the Don Monti Memorial Research Foundation.

Around the system: Huntington Hospital Improving the childbirth experience

“Expanding a family is one of the most memorable experiences a person can have,” said Gerard Brogan Jr., MD, executive director of Huntington Hospital. “We take that very seriously.”

Huntington is now offering women a “gentle C section.” It allows mothers to see their babies as they are being born and gives them immediate skin-to-skin contact — possibilities that don’t exist with a traditional cesarean.

“Starting the mother-baby bonding experience as soon as possible has been shown to be beneficial with breastfeeding,” said Michell Kramer, MD, chair of ob/gyn at Huntington. He added that it can even help prevent or reduce postpartum depression.

Also enhancing bonding and breastfeeding success is couplet care (also called “rooming in”), also available at Huntington. Couplet care lets newborns and moms stay in the same private hospital room.

2018, Volume 2 | The New Standard 47 A fast, noninvasive test for endometriosis? Cellular differences may open the door. By Emily Ng

A recent discovery may pave the way ROSE researches the genetic basis and patients’ stem cells showed impaired for rapid, noninvasive diagnosis of cellular activity of the disorder. ROSE decidualization, a process that endometriosis, plus treatment that’s more volunteers include healthy women and prepares the uterus from embryonic effective and less painful. those with endometriosis who provide implantation. peripheral and menstrual blood samples Endometriosis is a chronic, frequently for long-term biobank storage, which The scientists are using their observations painful condition in which uterine tissue enables study now and in the future. to develop a noninvasive diagnostic test grows outside the womb, typically in the for endometriosis and to learn more about abdominal cavity or on internal organs. Molecular Medicine, a peer-reviewed the biology of this devastating disorder. It can cause infertility or necessitate a journal published by the Feinstein hysterectomy early in life for about 176 Institute, has published the endometriosis “Instead of having to undergo surgery million women globally who suffer from study, which focused on the role of for an accurate diagnosis, these findings the disorder. stromal fibroblasts (a stem cell found will enable us to develop a rapid test in menstrual blood discharge) and the for endometriosis based on menstrual Researchers at the Feinstein Institute for immune system. blood, which is easily collected,” said Dr. Medical Research found that a particular Gregersen. The new test would show feature of blood cells in menstrual The cause of endometriosis is unknown, physicians whether a woman is at risk discharge indicates when a woman has said Dr. Metz. She added that a common for developing endometriosis and start endometriosis. A simple test takes a few theory is that retrograde menstruation treatment sooner, he said. It will also help days to identify that cellular feature, (when menstrual discharge enters the them monitor responses to treatment. which is a dramatic improvement over abdominal cavity instead of exiting the current options. body) is at the root of the problem. “This is a chronic, complex condition,” Dr. Gregersen said, “and improved Because symptoms of endometriosis “Almost all women experience some understanding through studying menstrual mimic those of other conditions, it’s retrograde menstruation, but we’re discharge can drive personalization of new not unusual for it to take up to 10 years unsure why the endometrial tissue therapies. This work also highlights the for a woman to get the right diagnosis. latches onto the abdominal wall and importance of research participants. Our Furthermore, confirmation requires internal organs and grows in some ROSE volunteers are helping to improve the invasive surgery that many patients put women,” she said. “We found that stem lives of women across the globe.” off. An early and noninvasive diagnostic cells in the menstrual blood of women method promises less suffering plus with endometriosis are very different Drs. Metz and Gregersen plan to continue better long-term outcomes. from those of healthy women.” their research. The will work to develop this diagnostic method for clinical use Feinstein Institute scientists — Christine Compared to healthy participants, and improve basic understanding of the Metz, PhD, director of faculty affairs at the Dr. Metz and her colleagues observed biology and genetics of endometriosis in Center for Biomedical Science, and Peter women with endometriosis had order to discover new and more effective Gregersen, MD, director of the Robert significantly fewer uterine natural killer therapies. Their ongoing research is S. Boas Center for Genomics & Human (uNK) cells in their menstrual discharge. supported through $500,000 funding from Genetics, working with Laura Warren, They also observed that endometriosis Northwell Health (see next page). an MD-PhD student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell – made the discovery See more discoveries that are transforming treatment in as part of the Research Out-Smarts the Feinstein Institute annual report: bit.ly/research-rept. Endometriosis (ROSE) Program.

48 2018, Volume 2 | The New Standard Innovation Challenge winners Inventive concepts will advance patient care.

The ingenuity of Northwell Health staff members recently got The idea taps into the Internet of Things — tools, devices, a boost to the tune of $1.2 million. The funding was part of appliances, vehicles and more that connect and share data — to Northwell Health Innovation Challenge: Made for Big Ideas. allow a more seamless patient experience. Northwell Health’s information technology department will begin an internal trial by Colleagues from throughout the health system submitted 121 the end of the summer. Adoption could move quickly from there. entries, and seven teams made it to the finals: the opportunity to pitch their projects. Two entries received $100,000: “Automation of Quality Assurance Procedures for Radiation Treatment for Cancer Patients” by Yijian The winners and first runners-up received $500,000 each to Cao, PhD, Henry Chou, PhD, Anurag Sharma and Jameson Baker, bring their concepts to market. Peter Gregersen, MD, and PhD, and “Smarter Radiation Oncology” by Louis Potters, MD. Christine Metz, PhD, created a noninvasive method to diagnose endometriosis (see previous page for more). Three remaining finalist teams will work with internal resources to advance their concepts and potentially qualify as finalists for The first runner-ups were Vishwanath Anantraman, next year’s Innovation Challenge: Jill Rabin, MD, and Katherine MD, Northwell’s chief innovation architect, and Michael Farner, MD, for “PALS: Patient Access Linen System”; Stephanie Oppenheim, MD, the health system’s chief medical information Kubow, Tomasz Batok, Nancy Copperman, Khadeja Kausar, officer, for EMRBot. The invention will facilitate personal Amer Saati, Udai Tambar and Sabina Zak for “Northwell Health interaction between clinicians and patients. It will give the Social Vulnerability Index”; and Rajiv Sharma, MD, Andrew option of using voice and natural language text messages to Elkind, Adam Riegel, PhD, Xin Qian, PhD, and Hani Gaballa, PhD interface with electronic medical records (EMRs) rather than a for “Total Body Irradiation Technique.” computer keyboard to enter data during patient visits. “EMRBot will restore the human, face-to-face interaction that electronic health records have slowly eroded,” said Dr. Anantraman. 2018, Volume 2 | The New Standard 49 “New” organ was right under our noses ...and skin and digestive tract and... By Heather Ball Mayer

A researcher from the Feinstein Institute discovery will open up new research The field of medical research has had for Medical Research and his collaborators pathways for inflammation and cancer concepts of a larger interstitial space made big news recently when they progression,” said Dr. Benias. “We are before, though details were unspecified. identified a “new” human organ. Petros optimistic that with what we learned, The Nature: Scientific Reports paper is the Constantinos Benias, MD, who also serves we’ll soon be able to study and target the first to define the interstitium as an organ as director of gastroenterology at North interstitial space for diagnosis of disease — in fact, one of the largest in the body. Shore University Hospital, is co-lead and perhaps for novel personalized author of the research, published in treatments.” The interstitium is a series of fluid-filled Nature: Scientific Reports. spaces that’s supported by meshwork of strong, flexible connective tissue proteins What was previously believed to be layers Nuts and bolts beneath the skin’s surface. It lines the of dense, connective tissues is actually of the interstitium digestive tract, lungs and urinary systems, interconnected, fluid-filled compartments and surrounds arteries, veins and the — a structure that qualifies as a bodily Cells contain half of the body’s fluid, with fascia between muscles. organ, Dr. Benias and his colleagues found. about a seventh inside the heart, blood vessels, lymph nodes and lymph vessels. The structure may explain why cancer “This discovery is extremely exciting The remaining fluid is “interstitial.” Until that invades the interstitium is much because we’ve defined novel now, the interstitium was defined as a more likely to spread, Dr. Benias and his microanatomy and have laid the “third space” between cells. However, colleagues believe. The team also found groundwork for how this may begin to that explanation did not account for the that interstitium cells change with age, explain cancer spread, inflammation massive amount of body fluid stored which may contribute to wrinkling skin, and scarring of connective tissue. This outside of the vascular system. stiffening limbs, and the progression of fibrotic, sclerotic and inflammatory diseases.

Technological advances played an important part in making the discovery. Techniques in processing tissue from surgery and biopsies to view tissue under a microscope dramatically alters and collapses the structure of the interstitium.

In contrast, Dr. Benias and his colleagues used probe-based confocal laser endomicroscopy to examine tissue on a cellular level, in real time during endoscopy procedures. Dr. Benias collaborated with Mount Sinai Beth Israel Medical Center, NYU School of Medicine, and University of Pennsylvania. A National Institutes of Health grant (DK081523) in Illustration of the fluid-filled space supported by a network of part funded their work. collagen bundles lined on one side with cells.

Illustration by Jill Gregory and courtesy of Mount Sinai Health System

50 2018, Volume 2 | The New Standard Watch the big day at bit.ly/np-grads.

Kathleen Gallo, RN, PhD, FAAN, Northwell Health’s senior vice president and chief learning officer and the school’s founding Congrats, grads! dean, joined the health system’s President and CEO Michael Dowling and Hofstra University President Stuart Rabinowitz at First class completes advanced a convocation for the class. nursing program created in 2015. “Lead and pursue excellence,” Dr. Gallo told her students. “Never forget that you are the one and only inaugural class, and you have an awesome responsibility.”

The inaugural graduating class of nurse practitioners (NPs) from The event drew a standing-room-only crowd to the Medical the Hofstra Northwell School of Graduate Nursing and Physician Education Theater at the Donald and Barbara Zucker School Assistant Studies recently celebrated their achievement. of Medicine at Hofstra/Northwell. The students officially graduated two days later, during commencement exercises on The cohort of 28 — most of them full-time Northwell Health the Hempstead campus. employees — earned Master of Science degrees. Eighteen specialized in acute care and 10 are now family nurse “I can’t believe that this day has finally come!” said Christian Velez, practitioners. The three-year, part-time program also offers an RN, NP, a critical-care nurse at Huntington Hospital. “I hope to adult-gerontology concentration. put this degree and training to use to make a stronger impact in health care and on patient outcomes.”

2018, Volume 2 | The New Standard 51 Zucker School of Medicine mints new MDs New physicians and scientists embark on their careers.

Ninety-one students recently completed their studies at the Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell.

The fourth graduating class includes students who were the first to receive the combined MD/PhD from the Zucker School of Medicine. The diverse group includes Jonathan Preminger, MD, whose science and business savvy led him to invent an efficient, everyday product to keep lab coats sanitized; Jasmine Otkins, MD, who was raised by her grandparents on the south side of Chicago and plans to give back and inspire her community; Tyler Lopachin, MD, a naval officer sworn to the new rank of lieutenant; and Justin Pereira, Dr. Pereira sang the national anthem for the commencement. MD, who was a professional actor during his childhood.

The new physicians and scientists “It is important to remember the people celebrated at a ceremony at the Toni and Martin Sosnoff Theater, John Cranford to thank for today who are not in this Adams Playhouse at Hofstra University. audience — your patients.” — Dr. Smith “Today we celebrate the individuals of the graduating Class of 2018,” said student speaker, Danielle Aronowitz, MD, during her commencement speech. “No matter are Northwell’s leading lifetime donors audience — your patients,” said Dr. Smith where we go, we will never forget where and have bestowed $61 million to support in his address. “Each day, your connection, we came from and who we learned from.” the next generation of professionals in attention, and care of people will make medicine, research, and nursing, including the journey [in medicine] all worthwhile — Commencement proceedings were $50 million earmarked for medical one patient at a time.” presided by Stuart Rabinowitz, president student scholarships. The Zucker School of Hofstra University; Michael Dowling, of Medicine (formerly Hofstra Northwell In July, the 2018 alumni will enter president and CEO of Northwell Health; School of Medicine) was renamed in the residency programs in 15 different states and Lawrence G. Smith, MD, dean of the couple’s honor last fall in recognition of and 22 specialty areas, including 29 Zucker School of Medicine. Also attending their advocacy and support. newly minted physicians who will begin their first commencement ceremony their careers at Northwell Health. were long-time New York philanthropists “It is important to remember the people Donald and Barbara Zucker. The couple to thank for today who are not in this

52 2018, Volume 2 | The New Standard 2018 Elmezzi Honors

Two physicians recently earned doctorates Annette Lee, PhD, dean of the graduate Vagus Nerve Stimulation: In vitro and in from the Elmezzi Graduate School of school. “Our two most recent graduates vivo Evaluation of Galantamine in a Model Molecular Medicine. Caroline Maloney, personify this mission.” of Auto-Inflammation.” MD, PhD, and Ibrahim Mughrabi, MD, PhD, celebrated their accomplishment during Dr. Maloney investigated how gefitinib, a Also during the ceremony, the graduate commencement exercises at the Feinstein US Food and Drug Administration (FDA) school presented honorary degrees Institute for Medical Research. approved drug, can be repurposed to to Mina Bissell, PhD, distinguished prevent the spread of cancer after surgical scientist of biological systems and The Elmezzi Graduate School of Molecular removal of osteosarcoma, a common bone engineering in the Lawrence Berkeley Medicine is a PhD program for physicians cancer. Her thesis is entitled, “The Role National Laboratory, and Anthony who wish to pursue biomedical research of Receptor Interacting Protein Kinase Zador, PhD, professor of biology and careers. The curriculum includes conducting 2 in Macrophage-Promoted Invasion chair of neuroscience at Cold Spring biomedical research in Feinstein Institute Metastasis in Osteosarcoma.” Harbor Laboratory. Dr. Bissell studies labs and pursuing new therapeutic the role of extracellular matrix and approaches and diagnostic tools. Dr. Mughrabi examined the FDA-approved microenvironment in regulation of tissue- drug galantamine as a pharmacological specific gene expression in breast cancer. “The Elmezzi Graduate School of stimulus of the vagus nerve to reduce Dr. Zador studies how brain circuitry gives Molecular Medicine transforms physicians inflammation. His thesis is entitled, “The rise to complex behavior. into scientists who cure disease,” said Suppression by Chronic Pharmacological

2018, Volume 2 | The New Standard 53 Residential substance abuse treatment center coming to Calverton Joint venture will also comprise outpatient sites and app-based assistance By Diane O’Donnell

Northwell Health has entered a joint venture to build a multi- The staff’s national reputation and the new center’s clinical million dollar substance abuse disorder residential facility with and research capabilities will draw patients from throughout the Engel Burman Group, a developer of the Bristal Assisted the region and the country, according to Andrew Drazan, an Living Communities. Engel Burman partner in this venture. “Over five hundred Long Islanders died in 2017 from opioids,” he said. “This facility Based in Calverton, the 40-acre site will comprise six new buildings will help fill a major gap in substance abuse treatment in our with 80 beds — 20 for medically supervised detoxification, 40 community.” for residential treatment and 20 for extended aftercare. The estimated completion date for construction is late 2019. The venture will also include new outpatient facilities in Nassau, Suffolk, Manhattan and Westchester. The project will also “We intend to make this facility a center for addiction research develop a digital platform to provide remote access to a recovery and treatment together, which is the first of its kind in this coach and counselor, and an app that gives patients on-demand country attached to a major health system,” said Jonathan access to resources. Morgenstern, PhD, director of substance abuse services at Northwell Health. “We will continue to follow our clients even after they’ve completed their treatment, so we’ll have outcome information The health system will incorporate clinical and academic on them for years to come to track their long-term progress,” resources from the Zucker School of Medicine at Hofstra/ said Dr. Morgenstern. “Because we’re starting this program Northwell, the Feinstein Institute for Medical Research, Zucker from scratch, we can employ the best evidence-based medicine Hillside Hospital and South Oaks Hospital to combine addiction and the latest technologies that are available, recognizing that research with alternative treatments and care. recovery is a complicated and long-term process.”

“Having patients down the hall from researchers is very rare in addiction treatment centers,” Dr. Morgenstern said.

54 2018, Volume 2 | The New Standard New spaces

The health system will incorporate clinical and academic Northwell Health has opened the Center for Wellness and resources from the Zucker School of Medicine at Hofstra/ Integrative Medicine in Roslyn, a holistic care space with a Northwell, the Feinstein Institute for Medical Research, Zucker multidisciplinary staff. Cofounded as Practice and donated by Lisa Hillside Hospital and South Oaks Hospital to combine addiction Langer, PhD, with Stanley Asnis, MD, chief of joint replacement research with alternative treatments and care. The joint venture and reconstruction at North Shore University Hospital, the will also develop a digital platform that will provide remote facility offers classes and programs in yoga, Pilates, meditation, access to a recovery coach and counselor, and an app that gives acupuncture, nutrition counseling and reiki. patients on-demand access to resources. Northwell Health Physician Partners (NHPP) has opened New York Gov. Andrew Cuomo has allocated $30 million to a multi-specialty medical practice on Sunrise Highway in fund renovations to create state-of-the-art laboratories and Lynbrook. The space houses 70 staff members, including 14 engineering facilities for the Feinstein Institute for Medical physicians in disciplines such as cardiology, family medicine, Research. The renovations, taking place at 350 Community Drive gastroenterology, internal medicine and pulmonology, plus in Manhasset, will support current and prospective researchers in general, urological and vascular surgeons. molecular medicine and bioelectronic medicine. The Northwell Health Ice Center at Eisenhower Park is home to a Northwell Health has invested in a 20-acre property at 1 Marcus new STARS (Sports Therapy and Rehabilitation Services) Center. Avenue in New Hyde Park. The 103,000-square-foot office The center serves as the official physical therapy provider of practice building stands directly north of Long Island Jewish Medical facility of the New York Islanders. Eight clinicians support the Center, a proximity that enables Northwell to expand the Islanders’ medical team and also provide community members with hospital’s services for Nassau and Queens County residents. sports therapy, physical therapy, orthopedic rehab, back and spine care, joint replacement therapy, plus fracture and trauma care.

Around the system: Glen Cove Hospital Chef Challenge 2018

Glen Cove Hospital recently hosted Northwell Health’s Seventh Jeffrey Jacobs, a consultant for Northwell Ventures. Challenge Annual Chef Challenge. Chefs and registered dieticians from 16 winners were Chefs Thomas Mencaccini from Long Island Jewish health system facilities competed in a competition modelled Medical Center, Carole Hilly from Plainview Hospital, Claudia after the TV series “Chopped.” Competition judges included Natalio from Lenox Hill Hospital and Nick Pagerie from Phelps Michelin Star Chef Bruno Tison, the health system’s vice president Hospital for their eggplant tofu Napoleon with mango sweet of food services and corporate chef; Sven Gierlinger, Northwell’s pepper coulis; seared day boat scallop with roasted fennel and vice president and chief experience officer; Joseph Moscola, the citrus salad; and banana and strawberries zabaione dessert. health system’s senior vice president and chief people officer; and 2018, Volume 2 | The New Standard 55 New to Northwell Partnerships that expand access to care

The health system has formed a four-year status, insurance, education and income radiation exposure. This reduces the risk research partnership with the Nieman levels. The goal is to develop imaging of side effects and improves quality of life. Institute to establish the Harvey L. best practices in order to inform imaging- Nieman Health Policy Program for Clinical reimbursement policies and improve The New York State Department of Health Effectiveness and Outcomes Research at access to care. has approved the Visiting Nurse Association Northwell Health. The new entity extends of Hudson Valley (VNA) to join with the Imaging Clinical Effectiveness and A new health system affiliation with Northwell Health. The partnership expands Outcomes Research Program (iCEOR) in ProCure Proton Therapy Center, shown the scope of home care services that the Northwell’s Department of Radiology. below in Somerset, NJ, allows Northwell health system delivers to Westchester and The Nieman Health Policy Program will Health Cancer Institute radiation Putnam County residents. VNA’s 350 staff analyze improved health outcomes oncologists to offer proton beam therapy. members home services such as skilled plus imaging patterns according to age, Proton therapy targets tumors while nursing, physical, occupational and speech gender, race/ethnicity, socioeconomic limiting healthy tissue and organs’ therapy to about 6,000 patients.

Looking forward, looking back

Northwell Health emerged during a critical time in medicine. The organization is thriving because it has anticipated and adapted to changes in health care. Northwell Health: Shaping the Future of Health Care gives perspective on the people and circumstances that incubated the health system and set the stage for its growth and success. For a free copy, email [email protected].

56 2018, Volume 2 | The New Standard Celebrating Women’s Health 2018

Registry at the Feinstein Institute for Medical Research. Her Good health is no accident. research includes three ongoing clinical trials on DBA, a rare, congenital bone marrow failure syndrome. Four hundred women gained –– Diana Martins-Welch, MD — Tita Monti Award for Outstanding Community that insight during the 2018 Education Dr. Martins-Welch is an attending Celebrating Women’s Health geriatrician and palliative medicine specialist who has dedicated her event, presented by the Katz career to caring for some of the most vulnerable people. Institute for Women’s Health. –– Zennobia Broan, MD — Sharon Joyce Schlanger Award for Outstanding Entitled “Just one more thing...you,” the biannual conference Community Service welcomed Jennifer Ashton, MD, chief medical correspondent for As medical director of Northwell ABC News and Good Morning America, as keynote speaker. Health Solutions and vice president of population health management, Dr. Workshops equipped several hundred attendees to take charge Brown leads community and care- of their health while showcasing some of Northwell Health’s transformation initiatives. Of special experts in nutrition, fitness, screenings, care options and more. note is a program she developed for high-risk patients as they transition from hospitals to the community. Another highlight: Five peer-selected physicians received awards for consistently modelling commitment to patients and clinical Log onto bit.ly/katz-learning4me to keep up with ongoing excellence. Each honor bears the name of a longtime Northwell programs from the Katz Institute for Women’s Health. supporter and advocate.

–– Karen Black, MD — Sandra Atlas Bass Award for Clinical Excellence Chair of neuro-radiology at the Donald and Barbara School of Medicine at Hofstra/Northwell, Dr. Black consistently proved her willingness to go above and beyond traditional realms to deliver top-notch patient care. –– Mangala Narasimhan, MD — Ann Gottlieb Award for Excellence in Teaching Dr. Narasimhan, regional director for Critical Care Medicine, is nationally and internationally recognized as a pioneer and educator in the new fields of critical care ultrasonography and advanced critical care echocardiography. –– Adrianna Vlachos, MD — Lorinda de Roulet Award for Excellence in Research Head of Cohen Children’s Medical Center’s Bone Marrow Failure Program, Dr. Vlachos also serves as director of Keynote speaker at the Katz Institute for Women’s Health semi-annual the Diamond Blackfan Anemia (DBA) Celebrating Women’s Health event was Jennifer Ashton, MD, chief medical correspondent for ABC News and Good Morning America. 2018, Volume 2 | The New Standard 57 New York’s “best” Team Talent crowned champs includes 200+ Team Talent beat Westbury Wombats, 8 to 5, in 14 innings to capture Northwell Health’s first coed softball league championship. Thirty teams from Northwell doctors across the health system competed during the spring league. See more photos from the season when you join the Northwell Life Facebook group. New York magazine has named 213 Northwell Health affiliated physicians in its “New York’s Best Doctors” issue for 2018. The magazine compiled the list based on peer-reviewed surveys managed This is a great place to work by Castle Connolly Medical Ltd. This year, 1,390 Tri-State physicians from dozens Northwell Health is one of the Top DiversityInc also recognized the health specialties made the list. Seventy of Five Hospitals and Health Systems for system as a Top Company for LGBT the doctors belong to Northwell Health Diversity, according DiversityInc’s latest Employees, making Northwell one of only Physician Partners, the health system’s rankings. This is sixth consecutive year two health systems nationwide with the medical group practice. Primary hospital that Northwell’s strategy to address designation. This first-time designation affiliations and the number of physicians the health needs of the diverse stems from performance metrics and on the list are: communities it serves by focusing on Northwell’s relationship with LGBT staff diversity, inclusion and health equity has and community members. Cohen Children’s Medical Center (14) earned this distinction. Huntington Hospital (1) Furthermore, the Human Rights Lenox Hill Hospital (84) Campaign Foundation’s 2018 Healthcare Long Island Jewish (LIJ) Forest Hills (1) Equality Index honored 19 Northwell LIJ Medical Center (8) hospitals as Leaders in LGBTQ Maimonides Medical Center (21) Healthcare Equality. The 11th annual Manhattan Eye, Ear and Throat survey is a national benchmarking Hospital (20) tool that evaluates patient, visitation Mather Memorial Hospital (1) and employment policies for LGBTQ North Shore University Hospital (15) inclusiveness. Northern Westchester Hospital (31) Phelps Memorial Hospital Center (1) Fortune and its partner Great Place to Staten Island University Hospital (14) Work have named Northwell as one of Syosset Hospital (1) the Best Places to Work in Health Care. Zucker Hillside Hospital (1) Northwell ranked second in the Northeast and 13th nationally for its strong sense of See New York magazine’s full list at mission and employee camaraderie. bit.ly/2018nybest.

58 2018, Volume 2 | The New Standard Mission possible Making an impact in the DR Pulmonologist pursues a lifelong goal.

Last autumn, Ernest Vomero, MD, had déjà vu – the good kind.

It happened in the Dominican Republic, at the Hospital Municipal El Cercado. Dr. Vomero, codirector of pulmonology at Huntington Hospital, was on a mission there with a group from St. Edward’s the Confessor Roman Catholic Church in Syosset.

It was his second time in the country. On a solo mission in 2014, he treated 100 patients in one week amid unsanitary conditions with little electricity and no running water.

He was pleasantly surprised on his recent trip to see a newly renovated building with running water and functional Dr. Vomero tended to patients in the refurbished Hospital Municipal El Cercado. bathrooms — plus a few old friends. the island nation cemented that calling. “One gentleman that I saw four years Besides treating patients, Dr. Vomero Dr. Vomero hopes to establish a long- ago came back to see me again,” Dr. gave two presentations to physicians in term relationship between Northwell Vomero told Long Islander News. “He the village to discuss current treatments Health and El Cercado. He envisions remembered me, got all excited and and techniques for asthma and chronic opportunities for students at the Zucker hugged me and everything. That’s a cool obstructive pulmonary disease. School of Medicine at Hofstra/Northwell thing, to go to a foreign country and see to help patients through telemedicine that you’ve made some type of impact on Embarking on medical missions was and assist El Cercado doctors in viewing a person’s life.” always a desire for him. Returning to patient records.

Give and receive Sample rates and benefits: An intro to charitable gift annuities Age Gift annuity rates 60 4.7% You come to Northwell Health for Northwell will make quarterly payments 65 5.1% cutting-edge and compassionate care. to her for her life. And even better, part of 70 5.6% We rely on the generosity of our friends her payments will be tax-free. Ultimately, — many who experienced this care her gift will support Northwell’s Cancer 75 6.2% as patients — to help us maintain our Institute, where this donor was a patient. 80 7.3% exceptionally high standards. 85 8.3% Northwell’s competitive rates for a one- 90 9.5% For example, a Northwell supporter life annuity range from 4.7 percent at 60 recently opted to make a gift — her years old to 9.5 percent at 90 years old. Find out about your rate and specific second one — that provides her with a The minimum gift is $10,000. A couple benefits. Call Shawn Mroz at (516) 321-6260 fixed income stream for life. With this can benefit from this type of gift It’s also or email [email protected]. option, called a charitable gift annuity, possible to create a two-life annuity, so. 2018, Volume 2 | The New Standard 59 NON-PROFIT ORG. U.S. POSTAGE PAID LEOMINSTER, MA PERMIT NO. 17

2000 Marcus Avenue Lake Success, NY 11042

Visit northwell.edu/ PresidentsAwards to see this year’s winners.

60 2018, Volume 2 | The New Standard