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Blythedale Children's Hospital is a specialty children’s hospital located in Westchester County and dedicated to the diagnosis, care and treatment of children and adolescents with complex medical and rehabilitative needs. Blythedale is a leader in developing innovative, multi-disciplinary programs.
This Community Service Plan was prepared to meet the requirements of Section 2803 of the NYS Public Health Law, in accordance with updated guidance provided by the NYS Department of Health, as well as the Internal Revenue Service’s Section 501 (r) requirements for a Hospital Community Health Needs Assessment.
As directed by the State Health Department, Blythedale’s 2013 Community Service Plan addresses health improvement priorities from the State’s Prevention Agenda, including those selected by a coalition of local community hospitals and other community representatives convened by the Westchester County Department of Health. However, as a specialty hospital serving children and adolescents, one of the priorities identified by the Westchester County Department of Health was not within Blythedale’s mission and scope. Thus Blythedale has selected another priority from the State’s Prevention Agenda which addresses an issue of concern to Blythedale’s community of referring hospitals.
Blythedale Children’s Hospital is dedicated to improving the health and quality of life of children. We change the lives of children with complex medical illnesses and disabling conditions through superb multi-disciplinary care, teaching, research and advocacy programs.
We are the only specialty children’s hospital in New York State that provides the highest level of multi-disciplinary medical care and rehabilitation for children with complex medical illnesses and conditions. Working collaboratively in an environment that fosters excellence, our goal is to improve each patient’s overall health, independence and quality of life, as well as provide hope to patients and families through superior outcomes—without regard to religion, race or ability to pay.
HOSPITAL SERVICE AREA
As a specialty children’s hospital, Blythedale’s service area is widespread, with patients coming from the entire southern portion of New York State, as well as adjacent areas of New Jersey and Connecticut: 60% New York City, 28% Hudson Valley, 8% Long Island and 4% Out of State.
Since the vast majority of admissions to Blythedale come by referral from other hospitals, particularly the large medical centers in the metropolitan New York and Hudson Valley area, Blythedale’s sense of need for services largely emanates from its community of referring hospitals and their physicians.
Blythedale’s patient population reflects the ethnic and racial diversity of its large service area, as illustrated by its 2012 inpatient population: 5% Asian, 27% Black or African-American, 40% Hispanic or Latino, 20% White and 8% Other.
To address this diversity, the Hospital provides staff training in cultural diversity, interpreter services, dietary variety and other accommodations to support families from different cultural backgrounds while their children are patients at Blythedale.
COLLABORATIVE PLANNING PROCESS
In addition to its referring hospitals, Blythedale also works closely with a variety of local agencies, notably the Westchester, Rockland and Putnam County Departments of Health, and the Westchester Child Health Advocacy Network, to identify community health priorities relevant to Blythedale’s mission and services.
In January 2013, the Westchester County Department of Health convened a workgroup of local hospitals to select two priorities from the State’s Prevention Agenda and collaboratively develop plans to address these priorities as part of the County Health Department’s Community Health Assessment and the hospitals’ Community Service Plans. In addition to workgroup meetings, the County Health Department also held a Health Care Summit on August 10th to gather additional community input. (See Appendix 1 for a more complete description of the county health planning process, a listing of workgroup meeting dates, participating agencies, as well as a list of attendees at the August 10th Health Care Summit.)
IDENTIFICATION OF PUBLIC HEALTH PRIORITIES
Based on discussions at both workgroup meetings and the August 10th Health Care Summit, the following goals were selected as county-wide priorities:
- Promote Healthy Women, Infants and Children by increasing breastfeeding.
- Prevent Chronic Disease by decreasing the percent of Blacks and Hispanics dying prematurely from heart related deaths.
As noted above, the second priority initiative identified by the coalition assembled by the Westchester County Department of Health, related to chronic disease in the adult population, is not within Blythedale’s mission and scope. Thus Blythedale has selected another priority from the State’s Prevention Agenda which addresses an issue of concern to Blythedale’s community of referring hospitals: prevent hospital acquired infections, specifically reducing infections caused by multidrug-resistant organisms (MDROs).
PLANS OF ACTION
#1 Prevention Agenda Goal: Increase the proportion of NYS babies who are breastfed
Only 43% of New York State infants were exclusively breastfed while in the hospital and breastfeeding rates diminish post-hospital discharge and over time. Breastfeeding has been shown to reduce the risk of various conditions over time in children, as well as reduce the risk to the breastfeeding mother of conditions such as breast cancer, type 2 diabetes, obesity and other conditions.
While Blythedale is not a "birth hospital,” it does care for infants whose mothers have chosen to feed their children breast milk. In its new infant inpatient unit, the Hospital included a modern lactation room with private facilities for mothers to pump breast milk. A dedicated refrigerator is available for its storage, as well as a hospital-grade breast pump and supplies. The Hospital’s physicians, nursing and social work staff and clinical dietician work with nursing mothers to facilitate this process. Blythedale human resources policies also support staff members who are nursing mothers.
While medical issues often create barriers to breastfeeding that are unique to Blythedale’s patients, Blythedale plans to enhance its program of support to new mothers so that those who have chosen to breastfeed continue to do so as long as possible during their child’s stay at Blythedale and have the necessary resources to do so upon discharge. As the Hospital serves a broad racial and ethnic cross-section of patients, this initiative will, to the extent possible, address disparities in breast milk feeding "success rates.” Blythedale will also seek to promote and support breast feeding among its staff members who are new mothers.
- By 2017, Blythedale will increase by 10% the percentage of breastfeeding mothers of infants admitted to the hospital who are still breastfeeding at discharge.
- By 2017, Blythedale will increase by 10% the percentage of employees who are new mothers who utilize the Hospital’s facilities to support their breastfeeding.
Interventions and Activities
1. Promote awareness of benefits of breastfeeding with staff and patients’ families by:
- Creating an educational resource binder for breastfeeding mothers to be placed in the Hospital’s lactation room and Family Resource Center
- Creating a self learning module on supporting breastfeeding mothers for medical and nursing staff to complete annually
- Collaborating with the Human Resources Department to promote and support breastfeeding in the work-placeEnhance staff knowledge and education of supportive techniques related to lactation by sponsoring annual in-services for Blythedale staff by La Leche League instructors
2. Enhance staff knowledge and education of supportive techniques related to lactation by sponsoring annual in-services for Blythedale staff by La Leche League instructors.
3. Identify and develop plans to address any racial, ethnic and economic disparities, as well as complex medical issues, which result in barriers to breastfeeding.
4. Support lactating mothers in continuing and improving their lactation status during their child’s hospitalization at Blythedale:
- Collect 2014 baseline data on incidence of breastfeeding by mothers of Blythedale infant patients (including information on race and ethnicity) so as to be better able to set meaningful and measurable objectives and track the impact of interventions
- Utilize a lactation consultant to provide individual counseling as needed
- Improve documentation of breast milk provision in Hospital’s electronic health record so as to be able to better track formula vs. breast milk provision
- Obtain and distribute discharge breastfeeding/nursing bags to encourage continued breastfeeding after discharge from Blythedale
- Refer interested mothers to lactation consultants in the community in preparation for discharge so that supports are available as needed.
- The number, percentage and duration (in months) of patients admitted and subsequently discharged who receive some form of breast milk.
- The number and percentage of staff members who are new mothers who utilize Blythedale’s lactation facilities
- The proportion of black and Hispanic breastfeeding mothers
#2 Prevention Agenda Goal: Reduce infections caused by multidrug-resistant organisms (MDROs)
Healthcare associated infections are the focus of many initiatives at the federal, state and hospital level. Of the various types of healthcare associated infections, those caused by multidrug-resistant organisms are the most appropriate target for Blythedale’s efforts.
As have all hospitals, Blythedale has had an aggressive infection control program to address all causes of healthcare associated infections. This program has been extremely successful in controlling the incidence of such infections, critically important with Blythedale’s population of children with complex medical conditions. (In 2011 the rate was 0.5, in 2012, 0.4). However, it requires constant vigilance to maintain this low rate. Blythedale will continue to seek ways to improve its ability to reduce infections caused by multi-drug resistant organisms.
Objective: By 2017, Blythedale will maintain an incidence rate of less than 1.0 per 1,000 patient days for hospital-onset multi-drug resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) infections and multi-drug-resistant gram-negative bacterial infections.
Interventions and Activities
- Use ultraviolet light disinfection to reduce amount of microbial contamination of environmental services in patient care areas
- Maintain an active hand hygiene program, including education in hand hygiene and its importance in reducing the spread of infections
- Place patients identified with a MDRO on contact precautions in a private room or cohorted with patients with the same resistant organism.
- Perform and review screening cultures for patients with past history of infection/colonization with a resistant organism, upon admission and when medically indicated due to a change in medical status
- Provide staff education on MDROs, including routine feedback and data on infection rates
4. Policies and Procedures
- Maintain policies and procedures to insure proper administration of antibiotics so as to limit MDRO development
- As necessary, revise policies and procedures to reflect changes in the U.S. Center for Disease Control’s guidelines.
- 100% terminal cleaning of all rooms (at patient discharge or transfer), as well as of isolation rooms bi-weekly
- 100% compliance with annual education, surveillance and antibiotic administration policies
- Hand hygiene compliance rate = 90% or above
- Quarterly reports will be made to the Infection Prevention and Control committee and information on HAIs will be posted on the Hospital’s Intranet and on each nursing unit
DISSEMINATION OF THIS REPORT TO THE PUBLIC
Details on Blythedale’s community health programs and other hospital services are regularly featured on the Hospital’s website and in the Hospital’s newsletter. This Community Service Plan will be posted on Blythedale’s website.
OTHER BLYTHEDALE COMMUNITY SERVICE HIGHLIGHTS
Blythedale has provided a significant amount of community benefit programs, as evidenced through a variety of programs and services, including:
Eat Well, Be Well: To help reduce the prevalence of childhood obesity and prevent its long-term negative health effects, over the past seven years Blythedale has brought into numerous school districts throughout Westchester, Rockland and Putnam Counties its Eat Well, Be Well school-based nutrition education program. This program, with funding support from Kohl’s Department Stores, provides school staff and students with the tools necessary to help children develop healthy eating habits through a comprehensive curriculum developed by Blythedale’s registered dietitians. This program has reached more than 50,000 students, as well as parents and school staff, with information on how to make food and lifestyle choices that will promote healthy living for a lifetime.
Injury Prevention: As part of its injury prevention activities, Blythedale sponsors fitting and installation checks for both regular and special-needs car seats on site at the Hospital, and Hospital staff have served as instructors in car seat technologist training courses in the lower Hudson Valley.
CPR Training Center: Blythedale has been a Community Training Center for the American Heart Association, providing training in Heartsaver CPR (cardio-pulmonary resuscitation), Heartsaver AED (automated external defibrillator) and Heartsaver First Aid. In addition to Blythedale staff, those trained include health care professionals, members of local police and fire departments, students at area schools and staff from various community agencies. Blythedale has also offered Pediatric CPR training for the community and health care professionals, and is a certified Pediatric Advanced Life Support (PALS) Training Center.
First Responder Training Program: Blythedale, in coordination with the Westchester Regional EMS Office, Westchester County Department of Environmental Services, and the NYS EMS for Children Program, has developed a special pediatric CME series for first responders of the Westchester EMS region. The series covers subjects vital to first responders, including traumatic brain injury, autism, technology and care of the infant or child, child abuse/neglect and child/infant safety during transfer. The courses are presented by Blythedale clinical experts, including physicians, nurses, therapists and other clinical experts.
MEDICAID SERVICES, CHARITY CARE AND OTHER HOSPITAL FINANCIAL ASSISTANCE
As a major funder of services for children with special health care needs, Medicaid is a significant (75%) source of primary or secondary coverage for the majority of Blythedale’s patients.
Consistent with its mission and federal and State requirements (Public Health Law 2807(k)(9-a)), Blythedale has developed guidelines that delineate the circumstances and procedures under which free or reduced cost care is available. (See Appendix 2 for Blythedale’s Financial Assistance Policies and Procedures.) These guidelines are made available to all families upon registration, and Hospital staff provide counseling as necessary. Patients are also notified of Blythedale’s Charity Care policies through notices on the Hospital’s website and posters in English and Spanish in the Hospital’s lobby and in patient registration and waiting areas. Interpretation services are available for patients needing information in languages other than English.
All patients having difficulty paying their bills are directed to Hospital staff who assist the family in completing a financial assessment and try to qualify the patient for assistance. Blythedale’s Patient Assistance Fund and other special funds are also used to help children with various items where family resources are limited and insurance does not cover.
Westchester County Health Planning Team
January – October 2013
On December 10, 2012 the New York State Health Commissioner Dr. Nirav Shah sent letters to all county health departments and local hospitals requesting within each County the joint collaboration with the development of the community health assessment and health improvement plans required for submission by November 15, 2013. Specifically, Commissioner Shah asked hospitals and local health departments to work together with local community partners on assessing community needs, identifying at least two local priorities, one of which should address a health disparity, and developing a plan to address the identified priorities.
To help support and coordinate this collaboration, the Westchester County Department of Health (WCDH) invited all sixteen Westchester County hospitals to attend a kick-off meeting on January 31, 2013. In addition, the three Federally Qualified Health Centers were also invited to attend. The meeting was held at the Westchester County Department of Health (10 County Center Road in White Plains).
At the first meeting Sherlita Amler, MD, Westchester County Commissioner of Health, welcomed all participants to the meeting. WCDH provided a brief overview of the prior planning process and the new requirements for both the health department and the hospitals specific to the development of community health assessments and community health improvement plans. The Planning Team supported working collaboratively on this project and during the past ten months has demonstrated its commitment by attendance at monthly meetings, participation in two conference calls and hosting a Health Summit entitled "Working Together Toward a Healthier Westchester.” In addition, the team has shared information, resources and updates through email and phone calls.
The team conducted an extensive review of all the health indicators contained in the Prevention Agenda. For each indicator, the team reviewed whether the County was below, meeting or exceeding the state established targets/goals, the estimated number of people affected by each indicator (when available), the County’s overall ranking for the indicator compared to other New York Counties, and the performance range within the State. The team often requested the Westchester County Department of Health to provide additional reports/analysis, including data at a sub-County level to allow a more complete understanding of the problem.
In addition to a thorough review of the data, the priorities selected included consideration of priorities that were attainable and that aligned with each agency’s mission and service area. With the diversity and the number of hospitals in the County, it was quite challenging for the team to select its priorities especially when for a number of indicators the data revealed only certain parts of the County being impacted. After careful deliberation and discussions, the following two priorities were selected:
1. Increasing Breastfeeding (Focus Area: Promote Healthy Women, Infants and Children) and
2. Decrease the Percentage of Blacks and Hispanics Dying Prematurely from Heart- related Deaths (Focus Area: Prevent Chronic Disease)
The team developed an agency profile that was distributed to community partners. The profile requested each agency to provide general agency information, such as hours of operations, office locations and service areas, as well as to include current activities, training and policies in place to support the selected priorities and any new activities planned. The team also invited community partners to a half-day summit that was devoted to sharing current activities/programs and to discuss what could be done to address the selected health priorities.
As part of its ongoing commitment to addressing the identified health priorities, the team is planning to continue meeting to review progress in implementing the improvement plans developed by each agency, to work together, when applicable, on planned activities, to discuss barriers to implementation and consider new strategies that could be adopted. The Team is also planning to regularly convene the attendees from the health summit to provide input and support on project implementation.
Click here to view Community Health Planning Meetings, the Planning Committee and the Stakeholders Health Planning Summit Participants.
Click here to view the Charity Policy and Procedure.