We have BIG news. Last week, the Rory Staunton Foundation for Sepsis Prevention was awarded a major federal government contract, administered by the U.S. Department of Health and Human Service’s BARDA DRIVe program. The contract will partially fund a groundbreaking initiative to combat maternal sepsis, a leading cause of maternal death in the United States. The U.S. has the highest rate of maternal death in the developed world with black women three times more likely to die as a result of pregnancy than white women.
What We’ll Be Doing:
Working with New York State Department of Health to analyze existing data around maternal sepsis and identify risk factors for women, including demographics and hospital procedures;
Developing a database of information on maternal sepsis that will become an unparalleled resource in informing public policy on the issue;
Improving delivery of care to new and expectant mothers;
Guiding education and awareness for patients and providers through the development of a suite of educational services including webinars and public service announcements;
Coordinating a multi-sector coalition of state and federal organizations to reduce maternal mortality rates;
Stopping maternal and neonatal sepsis in its tracks.
How You Can Help.
We are immensely proud of the project we have developed to end maternal and neonatal sepsis. We are taking a strong stand to ensure that no woman or infant dies as a result of pregnancy and childbirth, particularly in a country as wealthy and medically advanced as the United States. If you feel as we do, please consider contributing to this critical work. Your donation will go directly to our work in preventing the deaths of women and their infant children during pregnancy and after childbirth.
Thank you for your continued support. It is because of you that we will continue our battle to end sepsis.
During International Infectious Disease Week, the Rory Staunton Foundations’ Medical Advisor, Dr. Martin Doerfler, Discusses Whoopi Goldberg’s Sepsis Survival and the Importance of Vaccinations.
Earlier this year, Whoopi Goldberg was hospitalized with an episode of Sepsis and Septic Shock caused by Pneumonia that brought her “close to leaving the earth”, in her words. Many people have heard of pneumonia, which is an infection of the airspaces of the lung. Many more have never heard of Sepsis, which is a potentially life-threatening condition caused by the body’s response to an infection, or Septic Shock, which is the most severe form of Sepsis when an individual’s Blood Pressure is dangerously low and oxygen does not get to the bodies tissues leading to organ injury and possibly death.
Infections like Pneumonia or Urinary Tract Infections (UTI) are the most common causes of Sepsis. Of the two, Sepsis from Pneumonia is more likely to lead to death, making Ms. Goldberg’s announcement all the more gratifying that her medical care was able to prevent such a terrible outcome. Though we do not know what less severe injuries she may have sustained and certainly wish her a speedy and complete recovery.
With the news of Whoopi Goldberg’s illness and recovery it is important to remind people that Pneumococcal Pneumonia, one of the most common causes of Pneumonia can be prevented by Vaccination. Pneumococcal vaccination is recommended by the CDC for children less than 2 and adults 65 and older as well as all individuals with certain medical conditions or who smoke cigarettes. It is also important to note, as we enter Flu Season that pneumonia can be a complication of the Flu which all individuals should consider receiving the Flu Vaccine as early in the season as practical.
Infections are common. Sepsis can result from nearly any significant infection. Know the signs:
– Rapid breathing and fast heartbeat
– Pale or mottled skin
– Confusion or sleepiness
– Fever and chills
– Feeling the sickest you’ve ever felt
– Extreme pain
Wash Your Hands – It’s Easy and It Saves Lives
As International Infectious Disease Week is upon us it is critically important to remember that most infections can be prevented by simply washing your hands. You can protect yourself, your family and everyone around you by using soap and water.
When you have a cold, the flu or are not feeling well, wash.
Do the same when you are around someone or taking care of someone else that feels the same way.
Before you treat a wound, wash your hands and make sure you wash the wound and wash your hands again after.
You know the drill! After using the bathroom, changing a dirty diaper, touching a questionable surface, using cutting boards and the list goes on.
Let’s make the common sense approach a lot more common!
Because it stops the spread of germs and is the most effective method to stop the spread of disease.
Jay and Sue Stull are true inspirations to us here at the Foundation. After Sue’s battle with sepsis left her a quadruple amputee, they began a quest to raise awareness of sepsis and ensure others were spared their fate. We are proud to present their story.
Jay and Sue were “Living the Dream” in Choctaw, Oklahoma along with their sons, Tyler and Devin, and three dogs (four-legged kids actually), Kia, TJ and Tonka. Jay met Sue in 1999 while stationed at Langley Air Force Base, Virginia and as they say the rest is history. Jay retired from the United States Air Force in 2010 after serving 26 years, including 3 deployments, and they stayed in the local area so Tyler and Devin could finish high school in Choctaw.
Sue was a Circulation Clerk at the Choctaw Public Library, her “dream” job considering she is an avid reader with an out-going personality. She worked there for 18 months before getting ill in August 2014. With the upcoming school year just 2 weeks away, Jay, Sue and Devin went to an afternoon movie and dinner on Sue’s day off. Late evening on Wednesday, August 6, 2014 Sue started experiencing fever/chills, body pain, particularly in her neck, and a sore throat. She continued feeling ill on Thursday, unable to sleep and experiencing restlessness throughout the day and evening. Little did we know that our lives would forever be changed in just a few short days and that this would be the last time we would have a “normal” family outing.
Jay took her to the ER at approximately 1:30 AM on Friday where she was seen in less than 10 minutes. During this examination, Sue’s heart rate was 117, her blood pressure was 91/54, she rated her pain a 9 out of 10, was slightly dehydrated, and had little to no urine output. Although she did not have a fever at the time of this ER visit, she had alternated between chills and a fever of 101.1 to 102.1 during the previous 24 hours, which was reported to the ER staff. After testing negative on a rapid strep throat test, the ER doctor diagnosed Sue with a viral infection and prescribed cough syrup with Codeine…despite showing several symptoms of sepsis and even the onset of severe sepsis, the ER doctor failed to recognize all of these critical red flags and as a result our lives would be changed forever!
On Friday, Sue felt worse on Friday, but the doctor told us she would feel worse before she started feeling better. By Saturday morning, Sue had started experiencing nauseousness and diarrhea, so Jay rushed her back to the ER a second time. Despite excruciating pain and severe weakness, Sue insisted on not using a wheelchair, instead walking into the ER with a tremendous amount of assistance from Jay. Within 5-10 minutes of checking into the ER, Sue walked to the examining room, again with a tremendous amount of assistance from Jay. Unbeknownst to us, this would be the last time Sue would ever walk on her own two feet…
The second ER doctor said he thought Sue had urosepsis from a urinary tract infection and told us she needed to be transported to the ICU. By now, the pain in Sue’s arms was excruciating and her blood pressure was 68/42. Sue was transported to the ICU by ambulance, sirens blaring and lights flashing. Jay went home to pick up Tyler and they headed to the ICU. Sue was receiving broad spectrum IV antibiotics and pain killers, which masked the criticality of her condition and gave us a false sense of security…no one in the ICU told Jay how sick Sue really was. At Sue’s urging, Jay and Tyler left for home shortly after 6:00 PM with strict orders to get something to eat, rent a movie and bring Sue’s Nook on Sunday so she could read.
When he got home, Jay started researching sepsis, high heart rate, low blood pressure, and no urine output and was horrified by what he was reading! The symptoms for septic shock were consistent with what Sue presented, including no urine output and dangerously low blood pressure. The mortality rate for people in septic shock was 40%-70%! How could this be? Sue was in a fight for her life…Jay immediately left to go back to the ICU to be with Sue. He arrived shortly after 9:30 PM and stayed with Sue until 2:30 AM, ensuring she was sleeping soundly before the nurse told him to go home and get some rest.
Jay arrived back at the ICU at approximately 9:00 AM Sunday morning to spend the day with Sue. He was shocked when Sue’s RN quickly pulled him aside and explained that she had crashed and was now on a ventilator. The reality that Sue had at best a 50% chance of survival hit Jay hard, and after spending some time with Sue he began the dreaded process of notifying family. Jay spent the next 30 hours by Sue’s bedside, vowing to not let her be by herself again…he lived in the hospital for pretty much the next 30 days.
Sue and Jay were in an all-out war on sepsis! If Sue was going to survive, this was going to be a 24/7 proposition until further notice. Relying on his military background, Jay established a strict set of rules for Sue’s ICU room. Unless directed by a doctor or nurse to leave the room, Sue was never to be left alone. Negativity and crying were not allowed in her room; if you wanted to cry, that was fine, but do it in the waiting room. Do not wear black-colored clothing in her room as this signifies death, instead wear bright or colorful shirts, or better yet your Team Sue shirt.
After 3 days in the ICU, doctors told us to say our final goodbyes as Sue was given less than a 5% chance of survival…her kidneys had failed, her lungs had failed, her liver had failed, she had a heart attack and 10 ounces of fluid on her left lung. At approximately 7:00 PM on Tuesday, August 12th, Jay told Sue about the infection that was ravaging her body and let her know that if she didn’t want to fight any more she just needed to let him know. Sue shot Jay a dirty look that said loud and clear she wasn’t ready to give up. A few minutes later our prayers for a “miracle of miracles” arrived in the form of an intravenous immunoglobulins (IVIG) treatment. Sue was administered the IVIG treatment Tuesday evening and by Wednesday morning her platelet count had significantly increased and other key blood components showed signs of stabilizing.
Over the next 10 days, Sue’s condition gradually improved, but it became readily apparent that she would require bilateral below-elbow and bilateral below-knee amputations…Sue would be a quadruple amputee! Following her amputations in September 2014, Sue was admitted to the Jim Thorpe Rehabilitation Center Southwest Complex to begin the grueling recovery process. She spent 30 days at Jim Thorpe where her therapists did a phenomenal job re-teaching her how to do the most basic tasks and strengthening her body for the next step in her recovery, the long and arduous process of prosthetic legs and arms.
In mid-November, Sue and Jay headed to the Center for Intrepid in San Antonio TX for physical therapy, occupational therapy, and prosthetics. A dedicated and awesome group of professionals helped jump start Sue’s recovery. On December 10, 2014, less than 3 months after her amputations, Sue walked for the first time on her prosthetic legs! Sue and Jay returned home for the Christmas break and quickly realized that home is where they needed to be. While this was initially a major setback, it soon became obvious there was a different plan in store for us.
In the middle of January 2015, Sue and Jay met with Hanger Clinic to discuss prosthetic care options. Sue started lower extremity prosthetics with Hanger in early February and by May she was walking over a mile around our neighborhood. While Sue has regained her mobility with her prosthetic legs, the upper extremity process would prove significantly more difficult. She completed occupational therapy at Jim Thorpe Northwest Rehabilitation Center in March 2016 and now uses her myoelectric hands as needed for specific tasks. Sue has shown an incredible will to live in beating septic shock and reclaiming her life and independence back has proven that no obstacle is too big to overcome!
We encourage everyone to be an advocate for their own healthcare, to understand the signs and symptoms of sepsis, what constitutes a high heart rate and low blood pressure, and ask questions. If you exhibit the signs of sepsis and don’t feel well, go to the ER, request a blood test, and don’t be afraid to ask if it could be sepsis…
Over the past 5 years, we’ve worked hard to raise sepsis and limb loss awareness, and in 2018 we were honored with a Global Sepsis Award. Along the way we’ve skydived, rode the OKC rapids, swam with manatees, walked in several 5Ks, hiked Gloss State Mountain, and most importantly lived our life!
Maternal sepsis is a leading cause of maternal death in the United States. The maternal mortality rate in the U.S. is the highest of any developed country. Read April’s story.
On Saturday, September 2, 2017, I delivered a healthy baby boy and I was the happiest woman on earth. My husband and I had prayed for this child for years and this was going to be the start of our new adventure. What I did not know then was that this adventure was going to have a very rough start, one that still leaves me with nightmares.
On the day I was supposed to be discharged from the hospital I began to feel sick. I began to experience fever, chills, overall feeling of weakness, became short of breath, and felt like my heart was racing. I told my doctors all of my symptoms, but was quickly brushed off and was told that I was likely “just anxious about being a new mother.” Some tests were run and my White Blood Cell (WBC) count was higher than the previous tests, but again I was brushed off and told, “An elevated WBC count is normal after child birth.” When I was shivering from my fever, I was told to take a hot shower and one doctor even turned the thermostat in my room up to 80 degrees to stop the shivering. When my fever turned to sweats a nurse brought me a fan, again I was not taken seriously. Over the next few days I would continue to complain to doctors, but I continued to be ignored. One doctor even told me I was being “crazy” and needed to “stop”.
After doctors had given me enough Ibuprofen to make my fever go away for a while, they told me my new mom anxieties would likely go away when I got home and they sent me home with a prescription for anxiety medication. Not being a medical professional, or knowing what an elevated heart rate, fever, and elevated white blood cell count meant, I naively believed the doctors, that I would feel better once I got home.
Upon going home my symptoms did not improve. I continued to take the prescribed medications, including the anxiety medication prescribed by the doctor. My heart continued to race and I could not sleep or care for my newborn baby. Within about 36 hours of being released from the hospital, I couldn’t take it anymore and returned to the hospital first thing 9/08/17. On the way to the hospital I told my mother about the doctor telling me I was “acting crazy”, and was second guessing going back for fear that I would be told the same thing and sent home again. I am thankful my mom kept driving and insisted I get checked out. After a short stay in triage I was admitted into the hospital due to suspicions of an infection. Over the next 24 hours in Labor and Delivery my condition did not improve, I got progressively sicker and sicker as each hour passed. I went to the hospital to get better, instead I laid there getting worse. The OBGYN doctors had no real answers for my family. In the early morning hours of 9/09/17, I was finally taken to the ICU by a nurse from a different department who looked at my labs and knew something was extremely wrong. Had he not taken quick action, there is no doubt I would not have survived another 24 hours in the Labor and Delivery unit.
Over the next 2 weeks I would be treated for sepsis, endometritis, septic shock, and all the other issues that go along with those, I.E.. kidney failure, shock liver, unstable blood pressure, pulmonary edema, blood clots, and the list goes on. I don’t remember much from my 9 days in the ICU and my earliest memories of waking up from my medically induced coma are filled with nothing but confusion. Where was my son? Did I even have a baby? Was that a dream? Whose hand did I trace the letters “C-R-U-Z” in to when I had a tube in down my throat?
I would later learn that was my mother’s hand that I traced my son’s name in to and that was one of the very first things I did when I woke up. As I started to become more aware my family and doctors carefully tried to explain to me that I had developed an infection of an unknown source. That was the very first time that I had ever heard the word, “sepsis.” At the time, I had no idea what septic shock even meant. I was very confused. I had no idea that I had literally just escaped death. I had no idea that during my time in ICU the doctors told my family to call those closest to me to say their goodbyes. I had no idea that my husband had to think about how he was going to raise his son without a mother. I had no idea that my son came so close to growing up without his mama. I had no idea what I had survived had killed so many others.
My husband recently visited another hospital in our area and noticed several posters about the symptoms of sepsis and we all talk about how if we had seen that information what might have been different. I constantly find myself saying, “I wish I had known about sepsis.”
Although my story of being a new mom got off to a rough start, today I am a happy, healthy, mama to a silly, smart, and sometimes a bit of a wild child boy. On the days when I get upset about missing out on the first month of dirty diapers, midnight feedings, and sweet baby cuddles I am reminded that not all who experience sepsis are as lucky as me. Now more than ever, I hear stories about people who have lost limbs, had severe long-term problems, and even died from sepsis. Throughout my one month stay in the hospital I constantly heard from medical professionals how “rare” sepsis is, but as I have done more research I am realizing sepsis really isn’t rare at all.
As I continue to share my story I find people just don’t know what sepsis is. I try to stress to everyone that while my sepsis experience was related to child birth, sepsis can affect anyone from something as small as a cut on your finger.
My goal in sharing my story is to help educate others about the symptoms of sepsis and the importance of advocating for your own health or the health of those around you. Because sepsis can affect anyone I want to help raise awareness across all audiences, but my experience has led me to have a special place in my heart for mothers-to-be. I I hope that more OBGYN teams will educate themselves on sepsis so that no family has to go through what mine did and even more so, I hope that pregnant women learn the symptoms and stand their ground if they feel that something is not right.
By April Andrea Chavez
Through our partnership with the American Federation of Teachers (AFT), the Rory Staunton Foundation offers comprehensive K-12 sepsis education lessons on the AFT’s Share My Lesson platform.
Teaching our children to protect themselves and their communities from infection and recognize the signs of sepsis is an important part of combating the condition. Read our blog on the AFT website and download the lessons here:
Leading health organizations and experts agree that lives can be saved when patients and healthcare professionals are able to recognize sepsis symptoms early on and receive or provide the right treatment. It’s important to make sepsis a household name so that when symptoms strike, people know to ask, “Could it be sepsis?”
This sepsis prevention curriculum will help you educate your students about this major health issue. Not only will today’s children be responsible for their own healthcare decisions as they grow up, but they will also become the doctors, nurses and other medical professionals of tomorrow.
The lessons below, which are aligned to various national standards, were created by teachers with experience teaching about sepsis in their own classrooms.
We urge you to share this sepsis prevention curriculum—full of engaging, standards-aligned preK-12 lessons—with your students during Sepsis Awareness Month and beyond, and join the coalition of educators, health professionals, legislators and families dedicated to spreading the word about sepsis in order to save lives. Get started with this two-minute sepsis tutorial, and then check out the lessons below, available at Share My Lesson and the Rory Staunton Foundation for Sepsis Prevention.
Tomorrow on World Sepsis Day, the world will get loud and explode with lifesaving messages about sepsis.
Our beautiful son Rory died on April 1, 2012-five months before the first World Sepsis Day. When he died sepsis was killing over 250,000 Americans annually, mutilating thousands of others. The world was largely silent about sepsis at that time-those who knew, did not disseminate the information; nobody told us about the killer in our midst. In fact, it was only at our urging and after many “heated” discussions that CDC posted their first sepsis web page in 2014.
When the explosion of information takes place tomorrow, some of us will fall silent in memory.
…It was Saturday, late March 2012 and Rory was in ICU. We had brought him to his doctor and the hospital on Thursday with a temperature and bearing all the symptoms of sepsis, we were desperately looking for help, we didn’t know about sepsis- “Go home!” we were told, “he will be fine.” On Friday night as his symptoms worsened we made a frantic dash to the hospital where he was admitted to ICU.
On Saturday morning, desperate to pick up some belongings, I returned home, a taxi waited outside. A little 10- year-old girl was sat on our couch, her beautiful eyes pierced mine.
“Mom, is Rory getting better?” Kathleen, Rory’s sister asked.
I didn’t really know how to answer, my brain was screaming, I didn’t know what was wrong with him! He had been a 5”9” healthy boy days before. He was now in ICU! I could only tell the truth…
“He’s not getting any better and he’s not getting any worse” I said.
“Will he be ok?” she asked, her eyes pleading.
“There are great doctors and nurses with him,” I said
“OK mom” she whispered.
As I left, I saw his best friend, his little sister begin to make a “Welcome Home Rory” poster as she settled in for the wait.
Rory got worse very quickly and died from sepsis. He did not come home.
Please listen to the noise tomorrow, you can save a life and bring someone home.
A report published yesterday in the prestigious Journal of the American Medical Association confirms for the first time that New York’s mandatory sepsis regulations are directly responsible for the significant decline in sepsis deaths in the state. After comparing sepsis admission records from New York State and four control states, the researchers found that sepsis mortality rates dropped further and faster in New York than in the control states following the adoption of the regulations. Researchers from the University of Pittsburgh have now proven that holistic, evidence-based protocols are the most effective tool we have to reduce the sepsis death toll.
These new findings have profound implications for how individual states and the federal government address the sepsis crisis, which kills more Americans that breast cancer, prostate cancer, opioid overdoses, and AIDS combined and is the most expensive condition treated in US hospitals. You can read our press release on the study’s findings here.
The report has garnered extensive media interest: A segment that aired yesterday on NPR’s All Things Considered, the country’s most listened to drive time news radio program, featured interviews with Orlaith Staunton and the study’s lead author, Dr, Jeremy Kahn from the University of Pittsburgh. You can listen to the full segment here.
The evidence is clear: sepsis protocols that include training within hospitals and public reporting of sepsis data are the most effective tool we have in the fight against sepsis. We will continue to fight for protocols in every state and we ask you to join us. Contact us to receive a toolkit with all the information you need to see protocols implemented in your state or make a tax deductible donation to the Rory Staunton Foundation to help us continue this vital work.
Our heartfelt thanks for your continued support.
Cormach Murrihy from Rockland County, New York, died tragically this weekend. Cormach was a shining light in the Irish community in New York and was a great supporter in our fight against sepsis.
Since Rory’s death, Cormach and his family have helped us get the message of the dangers of sepsis into the public arena. Just last year Cian Murrihy, Cormac’s 8-years-old son donated his $7,000 First Communion money towards the recovery of 19-year-old volunteer firefighter, Will McCue, who lost both his hands, a foot, and his right leg to septic shock.
We are saddened by Cormach’s passing and our thoughts are with his family especially his wife Vivienne, son Cian, and daughter Caoimhe.
A new study published in the Journal of Health Affairs shows more patients are receiving timely sepsis interventions in New York State, resulting in lowered mortality rates–but uncovers concerning racial disparities in quality of care.
New research found that hospitals with more black patients saw much smaller increases in compliance with new sepsis protocols than hospitals that treat mainly white patients, highlighting a need to evaluate the effects of quality improvement projects for minority groups.
PROVIDENCE, R.I.[Brown University] – The New York Sepsis Initiative was launched in 2014 with the goal of improving the prompt identification and treatment of sepsis. A new study has found that while the program has improved care over all, there were racial and ethnic disparities in the implementation of the best-practice protocols.
Sepsis is a life-threatening condition that occurs when the body’s extreme response to an infection triggers a chain reaction, said Dr. Mitchell Levy, a professor of medicine and chief of the division of Pulmonary, Critical Care and Sleep Medicine at Brown University’s Warren Alpert Medical School. “Even with the best care, the mortality rate is between 15 and 25 percent.”
Early identification and treatment of sepsis is essential for saving lives, and the multi-stage best practices for sepsis identification and treatment were codified in the New York Sepsis Initiative’s protocols. The new research, published Monday, July 1 in the July issue of the journal Health Affairs, found that during the first 27 months of the initiative, the percent of patients who received the complete 3-hour-long, best-practice protocol increased from 60.7 percent to 72.1 percent. At the same time, the in-hospital mortality rates for sepsis patients decreased from 25.4 percent to 21.3 percent, which aligned with prior research by Levy, who is also the medical director of the Medical Intensive Care Unit at Rhode Island Hospital.
However, the paper highlights a disparity in sepsis care between black and white patients.
Specifically, during the first 27 months of the initiative, black patients only experienced an increase of 5.3 percentage points in the completion of the best-practice protocol, while white patients experienced an increase of 14 percentage points. Hispanic and Asian patients experienced an increase of 6.7 and 8.4 percentage points respectively.
Being aware of these disparities is critical because the Centers for Medicare and Medicaid Services is considering trying sepsis protocol completion rates to hospital reimbursement, said Dr. Amal Trivedi, senior author on the paper and a professor at Brown’s School of Public Health and medical school. “If our study findings extend beyond New York, it raises concerns about the possibility of these quality improvement initiatives for sepsis exacerbating racial disparities in care.”
The researchers found that hospitals that serve higher proportions of black patients had smaller improvements in protocol completion. Within the same hospital, white and black patients received similar care, in terms of protocol completion rates, Trivedi said.
Prior research found that minority-serving hospitals tend to have more financial stress, fewer resources and less infrastructure to devote toward quality improvement measures, which is likely the reason why minority-serving hospitals had smaller improvements in sepsis protocol completion, Trivedi said. These hospitals also tend to treat more uninsured patients and those on Medicaid.
After adjusting for risks, such as type of infection, age and other chronic health conditions, the team did not find a statistically significant change in hospital mortality rates between racial and ethnic groups, despite the disparities in care delivery. During the first three months of the initiative, 25.8 percent of white sepsis patients and 25.4 percent of black sepsis patients died while in the hospital. Two years into the initiative, 21.3 percent of white sepsis patients and 23.1 percent of black sepsis patients died while in the hospital.
“Our work highlights the need for state and federal policy makers to anticipate and monitor the effects that quality improvement projects, such as the New York State Sepsis Initiative, have on racial and ethnic minority groups,” said Dr. Keith Corl, first author on the paper and an assistant professor of medicine in the division of Pulmonary, Critical Care and Sleep Medicineat Warren Alpert Medical School. “Racial and ethnic minority groups can get left behind. Knowing this, it is our job to better design and monitor these programs to ensure racial and ethnic minority patients realize the same benefits as white patients.”
Trivedi added that in order to improve health equity, policymakers may need to devote additional funding to under-resourced hospitals that experience challenges in improving sepsis care so that their performances can match that of other hospitals.
Other authors on the paper include Gary Phillips, a statistical consultant who is retired from Ohio State University; Kathleen Terry, a senior director at IPRO, a non-profit health care improvement organization; and Dr. Marcus Friedrich, the chief medical officer of the Office of Quality and Patient Safety at the New York State Department of Health. The research was approved by the New York State Department of Health’s Institutional Review Board.
The research was supported by a fellowship from the Department of Veterans Affairs as well as internal Warren Alpert Medical School funding.