← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Driving Nursing Innovation and Throughput Excellence at SUNY Upstate with Scott Jessie
00:17:49
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief, breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Scott Jesse, Chief Nursing Officer at SUNY Upstate University Hospital. Scott, it's a pleasure to have you on the podcast today.
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C
Thanks for having me, Laura.
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B
Absolutely. Now, I am looking forward to our discussion and really learning more about some of the things you're doing at SUNY Upstate, as well as your perspective on growth and development in the future. But before we dive in, can you tell us a little bit more about yourself and SUNY Upstate?
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C
Absolutely. Very excited to do that. So my name is Scott Jesse. I am the Chief Nursing Officer here at SUNY Upstate Medical University. We are a large academic medical center with a community hospital and a children's hospital as well. We are right smack dab in the middle of Upstate New York and we cover a huge geographic area all the way from Canada to Pennsylvania. We cover about 2 million lives. We have a large hospital presence, the largest in the region, and we have a large ambulatory practice and footprint as well. We're actually the second busiest trauma center in the state. We're a level one adult and peds trauma center and a burn center, among many other specialty care things that we provide. We're also part of suny, which is the State University of New York. It's actually the largest public education system in the country for higher education. There's 64 campuses and we are one of three SUNY hospitals which we take a lot of pride in. We have a College of Medicine, College of Nursing, College of Graduate Studies, and a College of Health Professions as well. And my division in particular, we have about 3,500 FTEs. We're the biggest part of the hospital workforce. We take a lot of pride in that. We take a lot of pride in the care that we deliver. We are magnet designated. We just got our second magnet designation last month. That was quite a process and very, very excited to celebrate that as well.
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B
That's incredible. And what a great, honored recognition to have that magnet designation. Congratulations. And I can imagine that was a huge part of what you were working on last year. But when you think about the different initiatives that go into all of those things, what was the most important one that you led, what did you do and what were the results?
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C
Yeah, that's a great question. I mean, as an overall achievement, certainly our magnet redesignation was our biggest goal for the year and we achieved that. And it was certainly a lot of work. But it's rewarding going through the magnet process to really be able to highlight and show the incredible work your team does every day, day in and day out. And that consistency they have, it's just remarkable. We got our first designation during the peak of COVID 19. So our magnet survey and the process was all done virtually and we got to do it all in person this time. And it was wonderful to really be able to show off what upstate nursing does. So that was amazing. For the year though, we focused on picking one's really hard, I guess, but I'll maybe highlight two quickly. We focused on a couple of things. We built out our throughput operations center, which very excited about our throughput operations center. It's like a NASA mission control. Honestly. It's off site, it's about 2,500 square feet and it's where all of our transfer center bed management and our virtual nursing activity operates out of. We started in depth working on the concepts of a transfer center in the late 20 teens. Like 2018, 2019. Then Covid happened in life. But we actually started a pop up command center operations center during COVID We just took over a 10 by 12 foot conference room, put a bunch of computers in there and kind of started doing the work. As a proof of concept, it proved to be very valuable. So we fully committed to building out a really nice space to do this work. And now this space has a whole wall of very large monitors that show all sorts of throughput movement and activity in real time throughout our whole organization. There's live stream cameras that show our helipad and our emergency department entrances. We have an EMS dispatcher in there, our bed managers who manage all the patient places placement work out of that center, and our transfer center nurses. One of the beautiful things about that activity is they all work next to each other so they can have real time conversations. When the transfer center gets a call about acute transfer, the bed manager can listen in and see what's going on. And they actually have different colored Lights that can clue in. The transfer center nurse can turn on their lights so that the bed manager knows they should be paying attention to that call to start doing some work behind the scenes. So it can really help save a lot of time. They also help manage and address where we should dispatch our EVS services when we're in a really acute pinch, which bed should get cleaned first, etc. And then our virtual nurses work out of there as well. And one of the other neat features out of out of the transfer center or the throughput operations center is we have a doc that works 24 hours a day. We have a doc on, and we actually call them the talk doc. And they help with all of our transfers and talk with all the incoming physicians and providers that are looking for a higher level of care. So it has helped really streamline a lot of the things we do and raised a lot of visibility of different places that we can shave. Minutes and minutes matter. It doesn't sound like a lot, but when you add up those minutes, you get to be saving days and days and days, a month of bedtime. And it really helps improve efficiency and increase capacity across our system. So that was one of our most exciting efforts. That was a lot of years of planning to get the throughput operations center open, but we are so proud of it, and it has become quite a popular place in our organization. People travel out there to see it all the time because it's such a neat operational activity. The other thing that I would say we spent a lot of time and effort on was kicking off kind of our homegrown virtual nursing effort. We started slow and simple with that process, and we started with virtual discharges across the system. And then we added in virtual admissions. We have a small team, about five FTEs of nurses who do this right now. And they focus on ED patients for the admissions. And then discharges are screened by the floor nurses. They connect with the virtual nurses, and the people who are eligible for virtual discharge potentially get the virtual discharge. We have seen some great results, even though we're doing this early on and we haven't done it with a big capital investment in terms of technology. We use our EPIC system, and we actually use the patient's own device. We send them a text message, they open the link, and they're able to do their virtual meeting with the nurse. But we've seen on the discharge side, we're seeing a Savings of about 40 minutes of bedtime bedside time for the nurses. And on the admission side, we're seeing a savings of about 30 minutes of bedside nurse time. And it's a very different experience when you're on a busy especially med surg unit and you know, the evening shift work, all of the admissions come and having your patients come up with their admission work done is a very different experience than having to do all of that work when they arrive. So it's a big improvement for staff satisfaction and efficiency. And the quality of the work is really good. We've actually seen, we've been tracking our readmission rates for our virtual discharges. And the readmission rates for virtual discharges are about half the rate of a regular in person discharge, believe it or not. Because the nurses have the time to go into the chart and really thoroughly evaluate everything from a discharge perspective. And they, before they even begin with the patient, they clarify and correct any issues or follow up with the provider if there's not questions on medications, et cetera. So it's, it's really thorough and it's quite high quality. And we're really proud of that team. And the fact that they get to work out of the throughput center with their other colleagues really has been wonderful for us as a system.
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B
That's really cool to hear about, I think all of the technology integration into the care setting, it seems like it's making a big difference on a variety of fronts, both for the providers as well as the patients, and making sure things are moving efficiently and being able to deliver the best care possible. And I think, especially when you're talking about the virtual nursing, I know a lot of organizations have been trying to stand that up in a more significant way and put the right investments there. And so it seems like you've been able to make progress there, which is exciting to see. I'm curious, looking ahead, what are some of the big priorities as well as headwinds that you're focused on?
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C
Sure. So we definitely are looking to expand our virtual program. That's one of the priorities we will have carrying on for the next couple years. Most likely we want to be able to do more services with our virtual nurses. We're looking at doing some med reconciliation efforts, being an expert on call nurse resource to a newer nurse who has questions before they go to do a procedure or talk with a patient, perhaps doing some dual sign offs for medications, for high risk medications, integrating our rover work with EPIC into our virtual nursing system and also partnering with other services, perhaps virtual case management, access to patients, pharmacy, being able to virtually pop into a room. So we don't see it just as a nursing Initiative across the system. We started out that way, but we definitely see that it will likely expand. And we certainly know that we will have to invest in the capital and the infrastructure at some point to really do this well with the cameras in the rooms and things like that. That's kind of the longer term plan. So we're excited about that for sure. A few other things across the system that we're definitely going to focus on. We have an amazing chief quality officer and he is determined to get us to four and then five stars. We're a three star organization currently and super excited where we're at. We've made a lot of improvement. We are on the trajectory to get there. So that's an exciting focus for us as well. And then I think like everybody else in the country, we all have our eye on what's going to happen with finances and reimbursement and HR1 bill. And you know, what's the real impact going to be? In New York State in particular, labor costs since 2022 have gone up about 23%. Well outpacing one, reimbursement and two, inflation. So our labor costs are a big, big deal for us. But with the HR1 bill and the end of ACA subsidies and the impact of that, we're looking at what everybody's looking at. How much more uncompensated care is there going to be? How much more lost revenue will there be? Just the other day read a report from the Robert Woods Johnson foundation that suggested up to 32 billion in lost revenue and up to 6.3 billion in new uncompensated care in New York. That's a scary thing to hear about for sure. And I think that's true of everybody across the country. In New York, about half of the hospitals in the state are at a zero or negative margin already. And 70% of those hospitals across the state, of all the hospitals have reported that they don't really have the margin to sustain or increase the capacity to provide more care across the region. 60% of the rural hospitals in our state are at risk of closure. So there's a lot of concern. In New York, the estimate is about 1.5 million people may end up uninsured with changes with the ACA subsidies. That's a lot more people to potentially be seeking uncompensated care in emergency departments. Our emergency departments already suffer from significant overcrowding and capacity challenges, certainly in the larger areas of the state. So to think about that, many more people perhaps seeking ED care as their only Source of care is going to be a concern for everybody. So all of the. All of the financial risk that's out there is a big deal for everyone in health care. I think every system in the country has got their eye on it. I know there's proposed legislation to perhaps bring back ACA subsidies. The House has passed a resolution. The Senate's working on their own version right now. But nobody knows where that's going to end up. And it is a real risk, for sure. And then I think the other big, big thing for us that we know we have to continue to tackle is workforce shortage, the nursing workforce. Obviously, as a chief nursing officer, I pay a lot of attention to that topic. It's significant. And we know that, you know, in five years, shortage is estimated to be about 250,000 nurses. In 10 years, it drops to about 150,000. But we got to get through those five and 10 years, and that's a big shortage. But we really also are paying a lot of attention to seeing our hospitalists. For example, there's a huge shortage of hospitalists nationally in 10 years. They're estimating like a 21% shortage of hospitals across the country. And in many hospitals, ours included, our hospitals carry the largest load of patients. We also see shortages across anesthesia, radiology. Anesthesia is projected to be like a 20% shortage within the next 10 years. That's crippling. Every hospital in the country obviously needs anesthesia, needs radiology. So these huge physician shortages are just compounding and worsening the workforce issues that health care is seeing. There's no doubt about that. Some good news, maybe with that, though, is the advanced practice roles are doing well, and there actually is going to be, if. If there is such a thing, a surplus in health care workforce. I've never really quite seen that, but at least the government's projecting there's going to be a decent supply of nurse practitioners, physicians, assistants, and CRNAs, which is huge, given the anesthesia shortage over the next five to 10 years. So they will help offset some of that. But those are real risks for all healthcare organizations across the board and for access and just the quality of care that people are going to be able to get, you know, if we can't do procedures and surgeries without anesthesiologists or CRNAs. So those are huge things that are kind of on our radar. Those are headwinds we know we're facing as we go into the next year and years to come.
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B
That's fascinating to hear. And I know that provider shortage you know, is definitely a huge, huge challenge across the board. I think when you're looking at that and, you know, the last couple of minutes here, what do you think the hardest thing you'll have to do will be in the next year, as well as. Whereas you're seeing growth come from.
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C
Yeah, sure. So we have a hard thing and a growth thing tied together. We were very lucky last year. It was last year, now 2025, we were given 454, $450 million from the state to build a new emergency department and burn unit as part of our organization. That's the largest single site project we've ever had in our organization. And our current emergency department is woefully undersized. So that is a major, major focus for us as we project out this year and into the next five years of building that out. It will change the region for sure when it comes to all different aspects of how people seek care, get care, and what our organization can do for the region. So we're very excited about that. But it's going to be intense work, there's no doubt. We also, in upstate New York, we, in the next five years, are going to have a tremendous investment in capital in a construction project by Micron, the microchip company who is investing $100 billion to build four microchip fabrication plants about 10 miles north of Syracuse, right here where we are. It's going to bring about 50,000 jobs and somewhere between 85 to 100,000 people to the region. So our region is preparing for this tremendous growth of people and the need for the infrastructure to support that. And part of that infrastructure is healthcare. Right. And it's not going to be just us. It'll be all the healthcare providers in our region meeting those needs. But that's going to require growth. So we're thinking a lot about our ambulatory plans, how and where we can position ourselves from an ambulatory perspective to. To continue to meet the need, one, for the shift from inpatient to outpatient care that is ongoing and for this new need that is coming in particular for the children that are going to come to the region with their families. From that, we are almost exclusively the pediatric provider, certainly for acute care and a lot of our ambulatory care. So we know we'll have to grow in that aspect, but we're going to have to match the growth needs and meet those growth needs for adults as well. So we have a lot of thought about how we will plan to do that from an ambulatory footprint and perspective. And like many other things we're focused on. We have a hospital home program. We're looking to grow our virtual nursing. Like I said, we're looking to expand. We have a pretty robust AI program. We use drones for quite a bit of things. We deliver meds to beds via drone in our organization. And we're building a new lab off site where we actually are going to fly specimens from our hospitals to the lab, which is pretty cool. We're excited about that. So we have a lot going on. We're a pretty innovative and very neat organization. Our CEO, Dr. Corona, pushes us constantly to push the envelope and think of how we can do things different. We take a lot of pride in that.
- [17:12]
B
Absolutely. That's so wonderful to hear. Scott, thank you so much for joining us on the podcast today. This has been an amazing conversation and I look forward to seeing you at our annual meeting in April. I know that you'll be speaking on a panel and we can dig deeper into many of these themes and just continue to grow and connect and learn from each other. So I'm looking forward to it.
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C
I am as well. It's going to be a great time. Thanks for having me.