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Collaborative Care Councils
Get Results
By Kathleen Waton
Theodore J. (“T.J.”)
Vlavianos, LMHC, and his
fellow collaborative care council
members streamlined the
admissions process last year at
The Zucker Hillside Hospital,
improving orienting patients
to the 33-bed adult acute care
psychiatric unit, introducing
treatment team members and
discharging patients. They
introduced addressing patient
concerns twice a day. Their
success was reflected in higher
continued on page 75
Zucker Hillside Enhances Calming Environment
By Kathleen Waton
GLEN OAKS — A comprehensive
program to reduce impulsive behavior
in patients at The Zucker Hillside
Hospital is moving the hospital closer
to becoming restraint-free.
The workhorse of the program
is DASA (Dynamic Appraisal
of Situational Aggression), a
computerized assessment tool that
predicts patients who are most likely
to exhibit seven high-risk symptoms:
negative attitudes, impulsivity,
irritability, verbal threats, sensitivity
to perceived provocation, being
easily angered when requests are
made and unwillingness to follow
directions.
Nurses and other clinicians
score each patient on the criteria
over a 24-hour period. “Anyone on
the multidisciplinary team can check
off the seven points,” said Marybeth
McManus, RN, associate executive
director of patient care services.
The night nurse enters the
scores into the electronic health
record. Each patient scoring three
or more on the DASA is listed on a
computerized report automatically
sent each morning to nursing
leaders and others who use it to
guide staffing, admissions, care
plans and other decisions.
To ward off high-risk episodes
before they occur, patient engagement
specialists (PES) — team members
specially trained in deescalation
and communication skills — are
dispatched to the appropriate units.
The PES team is the latest addition to
the initiative. Under RN supervision,
they engage patients in diversionary
activities, such as talking and
walking with them, playing chess or
listening to music to calm patients
and redirect behavior.
The user-friendly DASA has
been in use approximately a year.
It was piloted on a 20-bed adult
inpatient unit for two months in
the autumn of 2010, and then
implemented on five other adult units
and the hospital’s adolescent pavilion.
The program has been very
successful in keeping patients and
staff safe and creating a calmer
atmosphere at Zucker Hillside. In
2011, the hospital “decreased the use
of restraints by almost 90 percent
without increasing our seclusion
rate,” Ms. McManus said. “That
puts us well on our way to meeting
our overarching goal of providing a
therapeutic healing environment that
is serene and calming.”
Making a Vision
Reality
A decade ago, Maureen
White, RN, senior vice president
and chief nurse executive,
pondered how to involve frontline
staff more in decisionmaking,
to meet patient needs
and to help make the North
Shore-LIJ Health System more
agile in responding to change. “An
empowering environment” was
essential, Ms. White said, “one
in which people feel comfortable
saying, ‘This doesn’t work,’ and
proposing solutions.”
To support Ms. White’s
vision, in 2007, Plainview
Hospital piloted collaborative
care councils, the same
year Lily Thomas, PhD, RN,
vice president, system
nursing research, introduced
TeamSTEPPS, an evidence-based
communication tool.
Devised by the Agency
for Healthcare Research and
Quality (AHRQ), the tool fosters
teamwork, “because teamwork is
correlated with patient safety,” Dr.
Thomas said. “It allows everyone
to speak up in a way that puts the
patient first.”
Today, more than 30,000
staff members are trained in
TeamSTEPPS, and more than 300
councils are active throughout
the health system. They are
“still in early development,”
according to Ms. White. “People
are still getting used to the
power of the councils and the
differences they can make. But I
feel the networking has improved
communication and is bringing
us closer to a workforce that can
turn on a dime. Healthcare is not
known for rapid cycle change
[but] in our fifth year we’re
seeing dramatic changes.”
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