Medicine
Medical care at Silvercrest must rise to a higher than typical standard because of the many and complex medical problems of our resident population. Our residents and patients include individuals with neurological and neuromuscular conditions, cardiac
disease, respiratory failure, degenerative disease processes, and a variety of other
challenging conditions.
The backbone of the Medicine department is provided by our staff of geriatricians and nurse practitioners, who see to the majority of the needs of our rehab and long term care residents. Together with VP of Medical Services and geriatrician, Dr. Daniel Russo, Silvercrest employs a second, full-time geriatrics specialist and three part-time geriatricians, each present for 4 hours daily. Four additional fee for service doctors, (two geriatricians and two internists) are also present on site daily, and all doctors participate in the weekend call schedule for the facility. Our Geriatrics group, most of whom are on staff at New York Hospital Queens, is reinforced by three graduate level internists who train in the combined, Silvercrest-New York Hospital Queens Geriatrics fellowship.
The specialty care needs of our general population is met by the regular attendance of practitioners from New York Hospital Queens. Among those making regular visits are:
- Acupuncturist: Every Wednesday
- Cardiologist: Monthly and as needed
- Dentist: Weekly on Wednesdays
- Neurologist: Monthly and as needed
- Nutritionist: Weekly
- Optometrist: Twice monthly
- Orthopedist: Weekly on Tuesdays
- Pain Specialist: Weekly on Mondays
- Physiatrist: Twice monthly on Wednesdays
- Podiatrists (3): Each weekly
- Psychiatrist: Twice weekly (Tuesday and Friday)
- Psychologist 1: Four days each week
- Psychologist 2: Two days each week
- Pulmonologist: Four days each week
Along with those specialists making regular visits comes an additional group who are available on an as needed basis. These include practitioners from audiology, otolaryngology, gastroenterology, hematology/oncology, infectious diseases, surgery and urology.
Award-winning Programs
Silvercrest cares for the most compromised residents and patients found in our geographic region. Consequently, at any given time, approximately 33% or more of our patients require artificial nutrition and hydration. A review of available medical literature for such groups indicates that complication rates associated with percutaneous endoscopic gastrostomy ("PEG") tubes range from 10% to 70%. Although published data from long term care settings has been very limited, our experiences identified a broad spectrum of generally minor complications along with isolated cases of a more significant nature. View PEG placement
As a result, Silvercrest began a two-year evolutionary process, beginning in
2003, that led to the development of a proactive resident/patient safety
program for the long-term management of PEG
tubes. The Occurrence Review Committee (ORC) began to review
all gastrostomy tube dislodgements as a part of the overall accident/
incident investigation and root cause analysis (RCA) processes. A multi-disciplinary team that included the gastrostomy tube vendor was created. Investigating and identifying root causes for PEG related problems led to :
- revising systems and implementing new processes
- instituting new educational measures for staff
- revising policies and procedures
- establishing facility benchmarks, and
- putting in place continuing improvement activities
Among the important products of this process were new protocols for dealing promptly with tube dislodgements as well as for standardized, scheduled gastrostomy tube change, (see graphic above). The Silvercrest effort produced a significant lowering of tube dislodgement rates and of the need for tube-related hospitalizations. This work led the New York State Department of Health to award Silvercrest the 2006 Patient Safety Award.
Expert Wound Care
Because Silvercrest residents are at high risk for pressure ulcers, the facility has declared a "war on sores" by instituting ground-breaking prevention and treatment methods. Although a significant number of residents do have some form of pressure sore, almost none of them is acquired at Silvercrest, (see Quality Care). Significant progress has been made in speeding the healing of established sores through the efforts of our multi-disciplinary wound care team. Led by Vohra wound care physicians, the team of nurses, nutrition staff and therapists rounds twice weekly to see and treat every affected resident. This process re-confirms what has long been known about therapy for decubitus ulcers... namely that the single most important factor in achieving healing is regular attention to the wound by skilled personnel.
Care for Kidney Patients
Silvercrest has recently welcomed to its staff a renowned group of nephrologists.
These specialists from New York Hospital Queens and the Trude Weishaupt Memorial Dialysis Center bring a new dimension to medical care at Silvercrest and will help us develop
the groundwork needed for our future, on-site dialysis facility. Although some years away, (see Future at Silvercrest), the Silvercrest dialysis center will one day make possible the in-house delivery of hemodialysis treatments for our residents affected by end-stage renal disease. Importantly, and in the meantime, the presence of our new nephrology team will help us provide better and more coordinated care for both those with milder kidney impairment, as well as others presently needing regular transport to outside hemodialysis centers.
The Palliative Care Team
Silvercrest provides hospice care to qualifying individuals with the assistance of Visiting Nurse Service of New York (VNSNY) . Through this program, VNSNY is able to provide the same services for many of our residents that it does within the homes of countless others in the community.
Sadly, not all people dealing with end-of-life concerns qualify for insurance-supported
hospice care. It is for those who do not that the Silvercrest Palliative
Care Team makes a real difference. The attending physician is joined by
our chaplain, nurse practitioner, social workers, rehabilitation experts
and pain specialist in the coordination of care that is needed to see that
life ends in comfort and with dignity.
An important part of this process is seeing to the needs of family as well, and Silvercrest team members do all they can to provide the needed support. Our Therapeutic Recreation department often plays a central role in assisting families with service arrangements, and where needed, provides the means and location right within Silvercrest for memorial activities.
