System Spotlight: Northwell Health

Heather Wojtarowicz

GEDC’s new System Spotlight Series will share the great work that member organizations are doing in the field of geriatric emergency medicine.

Through the pursuit of GEDA accreditation, implementation of meaningful QI initiatives, and provision of educational resources for clinicians, health systems that take advantage of GEDC membership are setting the standard for outstanding geriatric emergency medicine.

Based in the New York Metropolitan area, Northwell Health consists of 23 hospitals and 18 emergency departments, one of which is a pediatric emergency department. The system includes approximately 5,000 physicians and 85,000 employees in total, making Northwell Health the largest not-for-profit employer in the State of New York. Northwell Health’s emergency departments account for about 850,000 visits per year, with one third of those visits involving patients over the age of 65. All 17 of Northwell Health’s eligible emergency departments earned level 3 GEDA accreditation in 2019. Since that time, select hospitals in the system have applied for level 2 and level 1 accreditation. Currently, Glen Cove Hospital holds level 1 GEDA accreditation.

Northwell Health’s journey to achieving GEDA accreditation for all 17 of its emergency departments began with a simple inquiry. Sarah Healey Herod, assistant vice president of operations for emergency medicine, asked Teresa Amato, M.D., director of geriatric emergency medicine and vice president of resource management, about pursuing accreditation for the emergency department where Amato then worked.

As the two talked through the process of accreditation, the idea struck. What if, instead of pursuing GEDA accreditation for just one emergency department, they pursued accreditation for all 17?

“Any adult who shows up at one of our emergency departments should get equal care,” Amato said. “It shouldn’t matter if it’s a community site, if it’s an academic site. Wouldn’t it be really great if we made some kind of standard for the entire health system?”

Of course, the accreditation process wasn’t as simple as the question that started it. Looking back, Amato recalled the difficulty of convincing every site in the system of the importance of earning GEDA accreditation, noting it was sometimes a struggle to get the message to the right people.

“If you’re going to try to take this on as a health system, you’ve got to really look at your resources,” Amato said. “You have to be very mindful of strategies and make sure that whatever you’re doing is in alignment with leadership, whether it’s at the site, or it’s at a regional level.”

Amato credited Northwell Health’s success with accreditation to the organization’s commitment to providing outstanding care for older adults, noting that President and CEO Michael Dowling has collaborated with New York State on projects in this area. And as the largest not-for-profit employer in New York, Northwell Health strives to set the standard for healthcare.

“We really felt that because of our footprint, it was important that we took the lead on geriatric care,” Amato said. “Obviously, by the volume that we have, but again, with these 85,000 employees who also have family members who are in that age group, we felt like we had an obligation to really be on the forefront of this project.”

According to Amato, Northwell utilized GEDC’s resources and expertise throughout the accreditation process, especially when it came to managing the nuances of applications for their individual hospitals so that they would also reflect the value of the health system as a whole.

“Things that we just thought we understood, we clearly didn’t, so I think that was really helpful,” Amato said.

Now that every Northwell emergency department boasts at least level 3 GEDA accreditation, the health system continues to rely on GEDC for educational resources to share with its Geriatric Emergency Medicine (GEM) Committee.

The GEM Committee, which consists of at least one provider and one nurse from each of Northwell’s emergency departments, meets quarterly to share best practices and success stories in geriatric care. Often, Northwell uses GEDC materials and experts for inspiration.

“It’s a valuable resource for content, and it’s a valuable resource for connections to other health systems,” Amato said.

One systemwide initiative that originated with the GEM committee was integrating goals of care conversations with an emergency department physician within the first hour of an older adult’s emergency department visit. The conversation begins by asking the patient what matters most to them, part of the 4Ms framework. The second part of the conversation seeks to define who helps the patient with healthcare decisions in order to establish a line of communication.

The data from this initiative speaks for itself – older adult patients who engaged in a goals of care conversation with an emergency physician within the first hour of their emergency department visit had fewer 72-hour return visits and 30-day revisits, and those who were admitted to the hospital had shorter stays.

“When you talk about ROI, people always think they have to put money into something and get something out on the other side,” Amato said. “To me, a goals of care conversation costs you probably nothing but a little bit of time, but downstream, it generates so many positive outcomes.”

Though getting all 17 Northwell Health emergency departments accredited was a rigorous process, Amato and Healey Herod have witnessed the significance of establishing a systemwide standard of care for older adult patients who visit Northwell Health hospitals.

“Some health systems need to go one by one, but in our case, by sheer effort we were able to get every ED done at relatively the same time,” Amato said. “It was definitely challenging, and it’s one approach, but that doesn’t mean it’s a fit for everybody. I would say this to health systems – there is value in getting all of your EDs at least to some level of accreditation, just so you have a baseline of how you should treat older adults.”

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