Tracy Bertiz, DNP, ACNP-BC, CHFN

The Center for Nursing Research and Innovation at Mount Sinai recently interviewed Tracy Bertiz, DNP, ACNP-BC, CHFN, Nurse Practitioner at Mount Sinai Fuster Heart Hospital, about her quality improvement initiative, “Improvement of Nurses’ Ability in Addressing Low Health Literacy to Reduce Hospital Readmission in Adult Heart Failure Patients.” Presented as a poster at Nursing Research Day 2023, the findings were published last month as an abstract in the journal Practical Implementation of Nursing Science. 

What sparked the idea behind your project?

As a Cardiology Nurse Practitioner, I’ve always considered the frequent hospital readmission of our heart failure patients a big challenge. We call them our “frequent flyers.” We have multiple initiatives addressing this issue, but the readmission rate has remained high in spite of our best efforts. Since health literacy can play a large role in the gaps in care experienced by heart failure patients, my project team and I decided to teach nurses and other care team providers how to assess health literacy, and how to use targeted communication strategies to help patients better understand discharge instructions. We chose to work with staff at Mount Sinai’s Transitions of Care Center (TOCC) because of their important connection to patients as they move from one setting to another. Our goal was to decrease the 30-day heart failure readmission rate by training the care team to first assess the health literacy of their patients, and then to offer practical discharge instructions tailored to each individual’s level of understanding. We found that patients benefitted from their care providers using simple language, which helped them develop self-efficacy and better navigate the health care system.

*The above is a sample from the virtual training.

How did teamwork help make the project a success?

The TOCC team was a catalyst for change, and the teamwork we built helped us achieve remarkable results. Additionally, the commitment of the TOCC to close the gaps in care for patients transitioning from hospital to home helped make this project sustainable. I want to acknowledge my Doctor of Nursing Practice (DNP) project team, Tara Cortes, PhD, RN, FAAN, and Chenjuan Ma, PhD, RN, at the NYU Rory Meyers College of Nursing. Their constant mentoring helped me succeed in this endeavor. I also want to recognize the leadership and staff at the TOCC: Esther Pandey, DNP, MS, RN, System Vice President of Care Transitions; Carl Jin, MSN, MPA, RN, Director of Clinical Services; Arzellra Walters, MA, CPNP, RN, Nurse Manager; and the Center’s fantastic nurses. They were instrumental in implementing the initiative. This project would not have materialized without them.

What have you learned from your project?

I have learned that TOCC nurses play a significant role as frontline health care coaches for patients across the Mount Sinai Health System. Effective communication is critical to patients’ adherence to their medications, regular follow-up with health care providers, and self-care of chronic medical conditions.

What new ideas are you hoping to pursue after this experience?

I want to continue to gather and share insights about the importance of assessing health literacy in all patients, regardless of their educational background. Awareness of health literacy can enable care providers to communicate more effectively, but this is only one part of the equation. I think it’s also important to assess patient self-efficacy after receiving instructions targeted to their health literacy level. I would like to investigate whether particular methods of teaching are effective in driving change in patient outcomes.

What advice would you give other Mount Sinai nurses who are thinking of starting a similar project or submitting an abstract?

Mount Sinai nurses who want to start a project must be passionate about their topic to sustain their effort through the intervention period and beyond. Getting other people involved is difficult if your project does not add value for them, so you need to offer something to generate “buy-in” from all the stakeholders involved. In addition, you need to have a clinical mentor who cares about the outcome of your project, and you have to take advantage of the resources available at Mount Sinai, such as the Nursing Project Approval Council at the Center for Nursing Research and Innovation.

Joseph Krivoruk, BSN, CCRN

Joseph Krivoruk, BSN, CCRN, is a critical care nurse in the Intensive Care Unit (ICU) at Mount Sinai Brooklyn. During his 10 years at the hospital, he has witnessed the death of patients in his care. He is often the first health care provider a deceased’s family encounters, so he has played an important role consoling family members and offering emotional support. But Joseph long felt he wanted to do more. “I wanted families to know that although it isn’t our family member, we, as staff on the unit, understand the sadness and frustration, and we sympathize with their loss.”

The seed for an idea to do more was actually planted 14 years ago, when Joseph’s grandmother passed away from a brain hemorrhage and he was given a copy of her last CT scan. “Giving families something tangible to remember their loved one by seemed meaningful, it felt right.”

Through the spring and summer of 2023, Joseph and his family had a series of ailments and losses. During this time, he came across another hospital that gave a similar “take home” gift to families of children in the ICU. He shared his thoughts about such a gift with his manager, Jacqueline Callender, MPH, CCRN, and the Director of ICU, Ilse Martinez Espina, MD. In October 2023, the first “Message in the Bottle”—a printout of a patient’s last good heart rhythm, placed in a small bottle with a sympathy note—was given to a family member, and was positively received. The family appreciated being able to hold onto their loved one’s last heartbeat.

Message in a Bottle keepsake

Joseph’s journey into his current role hasn’t been straightforward. He began his career as an emergency medical services professional and eventually entered nursing school. “When my grandmother was ill, it became clear to me that nursing care is about dignity and safety.”  His first nursing job was in home care hospice, where, Joseph says, these lessons of dignity and the values of acknowledging family, were reaffirmed. They are, he says, among the personal life lessons he often shares with nursing students and newly hired nurses at Mount Sinai.

Temi Elegbede, BSN, RN

Najma Jean, Front End Supervisor, Clinical Neurosciences at Mount Sinai-Union Square, was working in her office when she heard a strange sound in the adjoining waiting room, like someone gasping for air.  She ran out, and her instincts proved correct: a patient was choking on something they ate. Najma ran back to the office suite and notified Temi Elegbede, BSN, RN, Manager, Patient Care Services.

“Temi immediately sprang into action, running out to the patient,” Najma recounts. “This was a terrifying situation for most of us, as the patient clearly was having difficulty breathing and speaking, but Temi took over with incredible ease and care, calming our team. He performed a successful Heimlich maneuver, and everything was instantly okay.”

Eumenide Vernet, MSN, RN, Senior Director of Nursing for Ambulatory Services, Mount Sinai-Union Square, is Temi’s supervisor. “Temi is known for doing the right thing, at the right time, right where he is,” she says. “All his training and experience kicked in when he came to this patient’s side. Always cool and collected, he intervened decisively with lifesaving results. We all think it’s a huge deal that he saved a person’s life, but to him, he did what he was supposed to do and is wondering what the fuss is all about.”

Temi, a Mount Sinai nurse since 2019, is indeed humble. “This is what I am trained to do,” he explains, “and I take my education seriously. In situations like these, you have to remind yourself that you have been equipped with the necessary problem-solving skills and be confident you can resolve even the most serious issues facing patients.”