Slowing down the revolving door: SAAS/NIATx Summit workshop

Stuyvesant Square Chemical Dependency Services, a division of Beth Israel Medical Center (BIMC) in New York City, serves a diverse population of high-risk patients.  Many of them are readmitted to the detoxification program every month.  Kristina Monti, supervisor of the Detoxification Service, and Joy Demos, assistant supervisor,  were aware of the high costs associated with these frequent readmissions—and the patients’ limited success with short or long-term recovery. 

Kristina and Joy’s workshop at the 2012 SAAS National Conference and NIATx Summit, “How to Prevent Re-admission to High Cost Services,” described the change project they launched to address this issue.

Kristina and Joy used data on the division’s 4,200 annual admissions to select 20 patients who were frequently readmitted. A close examination of costs showed that yearly care for each of just two of the 20 was nearly a half-million dollars.  Over the course of six months, a change team would track those 20 patients to provide continuity of care. Kristina and Joy believed that better care management for these patients would reduce their readmissions, increased their potential for recovery, and lower costs for BMIC. 

To implement the project, titled “The Special Teams Project,” Kristina and Joy set clear goals, relied on data, and defined how they would measure success.  They launched a public relations campaign to secure buy-in from staff in multiple disciplines.   

“Staff were getting burned out by seeing the same patients over and over again. We asked for their input about who should be involved.  This helped create buy-in,” says Joy. 

Strategies the change team tested over the course of the six-month project included:

• Assigning each patient to the same counselor—so a readmitted patient sees the same counselor consistently  
• Inviting all disciplines to participate in case conferences and the intervention process
• Launching a monthly journal club—inviting all disciplines to discuss literature pertinent to patient care and the project

Kristina and Joy have found that the Special Teams approach has enhanced case management at all levels of care.  Staff involved have become more invested in patient outcomes.  To develop partnerships essential for the success of this large project, the team made presentations to other departments at Beth Israel Medical Center, including Social Work and the Emergency Department. They also partnered with the local homeless shelter and other treatment providers to increase the flow of information about patient care.

Successes of the project include a decrease in discharges against medical advice, reduced emergency department costs, and an increase in staff morale.

Says Kristina: “Some of the staff who were seeing the high-utilizers had been feeling that they weren’t doing their jobs well—this project helped them see that they could have a positive impact on high-need patients.”

And even more rewarding for Kristina and Joy is that some of the high-risk patients have achieved the greatest length of continuous abstinence since the onset of their addiction.

As first-time presenters at the 2012 SAAS Annual Conference and NIATx Summit, Kristina and Joy appreciated the support they received. “It was great not having to worry about setting up our presentation, and having a moderator and volunteers on hand was extremely helpful.” 

 “The agenda was very well organized and allowed adequate time to connect with other attendees, “ adds Kristina.  In fact, some of the attendees at the workshop included staff from Bellevue Hospital, just a few blocks away from BMIC. “They’re interested in implementing a form of our project in their organization.  The conference definitely gave us a chance to connect that we would not have had otherwise.”

The PowerPoint for “How to prevent readmission to high-cost services” is available for viewing at the SAAS-NIATx conference page. 

Figure 1: Joy Demos (l) and Kristina Monti of Beth Israel Medical Center presented "How to reduce admissions to high-cost services" at the 2012 NIATx Summit.