At Mount Sinai, active collaboration with department stakeholders drives the efforts of the Health Equity Data Assessment (HEDA) team to advance health equity through data-driven initiatives.
Yvette Calderon, MD
Yvette Calderon, MD, Vice President and Dean for Equity in Clinical Care at the Icahn School of Medicine at Mount Sinai, recently discussed how the Emergency Department (ED) partnered with the HEDA team to apply an equity lens to evaluate Left Without Being Seen (LWBS) patients.
Together, they are reviewing data integrity in emergency medical records and applying an equity lens to effect meaningful change.
“This commitment underscores Mount Sinai’s ongoing dedication to fostering health equity through collaborative, data-informed strategies,” said Pamela Y. Abner, MPA, CPXP, Senior Vice President and Chief Diversity Operations Officer in the Office for Diversity and Inclusion, and Health Equity Officer for the Mount Sinai Health System.
LWBS is defined as a patient leaving the ED before completing a medical screening exam. When this metric is not met, it can represent quality and safety concerns, according to Lyndia Hayden, Senior Director, Data Integrity and Equity Analytics.
LWBS patients may also have an undiagnosed medical condition and may experience undesirable health outcomes outside of the hospital. Hospitals can also face penalties if they fail to meet certain quality metrics, like LWBS. The Centers for Medicare & Medicaid Services can reduce reimbursement rates for hospitals that do not meet these standards, having a direct impact on the hospital revenue stream.
On average, non-white patients tend to have a disproportionally higher rate of LWBS than white patients. As such, LWBS must be examined through an equity lens to ensure optimal patient outcomes for all patients.
Dr. Calderon emphasized the critical role of data integrity as a foundational step before delving into metrics analysis. With invaluable support from the HEAD Hub, the Department of Emergency Medicine at Icahn Mount Sinai implemented a comprehensive dashboard system, empowering ED service lines across the Mount Sinai Health System to closely monitor performance indicators, identify key drivers, and establish clear accountability measures.
For example, guided by these insights, each ED tailored interventions to their unique context, with initiatives such as Provider-in-Triage (PIT) protocols, mandatory unconscious bias training, and enhanced education for registration staff on demographic data collection emerging as effective strategies at Mount Sinai Beth Israel.
This work was presented to the Joint Commission during the Mount Sinai Downtown survey. It impressed the surveyors to see that Mount Sinai had already started integrating the new standard from the Joint Commission.
“The data integrity piece had to happen first before we could look at any of the metrics,” said Dr. Calderon. “Through diligent implementation, these interventions have proven instrumental in addressing pertinent issues within the emergency departments that identified a need.”