Recharge Rooms

By Bethany Marshall

In late March 2020, Mirelle Phillips knew a seismic earthquake had erupted globally for healthcare workers and it would only be a matter of time until the tsunami hit. In this case, the tidal wave would be the long-term mental health implications of battling COVID-19.

Physician burnout, defined as a work-related syndrome involving emotional exhaustion, de-personalization, and a sense of reduced personal accomplishment, had already reached global epidemic levels. The 2018 Survey of America’s Physicians Practice Patterns and Perspectives reported that 78% of physicians had burnout, an increase of 4% since 2016.

Phillips’ design and technology firm, Studio Elsewhere, was focused on developing mixed-reality environments in collaboration with neuroscientists in hospitals that supported the evaluation and treatment of brain health issues, working with a range of patients who suffered from stroke to severe depression and anxiety. Through her work, she discovered that one of the ways of improving the overall patient experience was to first focus on the provider. She worked with Dr. David Putrino, Mount Sinai’s Director of Innovation of Rehabilitation and Human Performance, to design and develop a Recharge Room – an enriched mixed-reality environment specifically tailored to the psychosocial needs of physicians and staff at a hospital to address burnout. They planned a pilot of the Recharge Room for high-needs ICU and ER workers.

Then, almost overnight, a huge number of physicians and nurses became ICU workers once New York City became the global epicenter of the first surge. Dr. Putrino and Phillips quickly worked together to transform his 3,000-square-foot laboratory into a relief hub for staff with three Recharge Rooms. Word of mouth quickly spread through the hospitals about a space in the basement where workers could leave their units for a few minutes and be transported to a beach at sunset or rainforest. During surge, the center was receiving on average, over 300 visits from staff per day. “We would hear so many stories unfold inside the rooms during that time about the trauma workers were facing in their units. They were also isolated from the rest of their communities, so it became quite a profound experience for them to sit around a virtual campfire and talk about what they were going through and know they weren’t alone,” Phillips shared. For Dr. Dahlia Rizk, the Head of Hospital Medicine at Mount Sinai Beth Israel, the intervention couldn’t have come at a better time. “Each day we were faced with stress and uncertainty as there was still so much unknown about the disease. I had to be separated from my family and young children so that I wasn’t putting them in danger everyday coming home from the hospital. Then I heard about Mirelle’s work from David and knew what a gift it could be for our staff. I quickly brought it to our President so that her team could install it in the hospital.”

When Phillips was shown the site, she noticed an emergency triage tent that had previously been used for patients and now was vacant. When she walked in, she immediately could envision it transformed into a sanctuary for workers.

“When she told me what she was thinking, it was hard at first to imagine,” Nicole Porto, the Director of Patient Experience for Mount Sinai Downtown, remembered. “The tent was cold, sterile, with fluorescent lights. It was hard to imagine it becoming a space anyone would want to go to during their break. But I had full confidence and trust in Mirelle’s vision and knew she and her team could make something special.”

Over a weekend, the Studio Elsewhere team transformed the triage tent into a multi-sensory oasis, filled with silk trees and experiences staff could choose through voice-activation. “It was a fairly intuitive concept, the tent actually already had a cocoon shape, so we were able to create the feeling of being in a welcoming, comfortable space with the experiences, lighting and aroma.”

The space was an instant hit not just for physicians and nurses, but all staff, including EMS members and security personnel.

“I love seeing the diversity of roles when you walk into any of our Recharge Rooms. It’s designed to be a space without hierarchy, particularly because these issues impacting mental health extend

across all workers in a hospital.” Phillips noted that support services like environmental service workers were the unsung heros, often left out of the ‘frontline hero’ vocabulary, but at-risk on a normal basis in their jobs.

Over at the VA Hampton hospital, Chaplain Carol DuFresne had been researching ways to bring something specifically to the environment services team at the hospital, many who were former veterans. “When Chaplain Carol called me out about bringing the Recharge Room to that specific population, it was like getting the phone call I had hoped for. Our goal is to partner with incredible people like her who see an application in their own community that could really benefit from this intervention,” said Phillips, who comes from a veteran family and grew up near MacDill Air Force base in Tampa, Florida.

Phillips recognizes that our societal view of physician burnout also can be misleading. “Most physicians enter medicine as a calling, rather than a simple career choice. They are service-oriented and their primary focus is ensuring the best care for their patients. They’re

already a highly resourceful and resilient community by nature. I think what we are also seeing is symptomatic of the moral injury they’ve sustained, which the pandemic became a tipping point.”

Since the first surge, Phillips and her team at Studio Elsewhere have partnered with over 40 hospitals across the nation and worked with hundreds of hospital leaders from teams like Nursing, Spiritual Care, Patient Experience and Well-Being and Resilience, to evolve and deepen the resource. Her colleagues at Studio Elsewhere are a talented interdisciplinary team of engineers, creative technologists, designers, and artists who develop the technology and custom multi-sensory experiences that include immersive visuals, music, lighting and aroma. The team creates the content themselves by shooting in various nature-based landscapes and collaborating with the acclaimed composer and violinist, Tim Fain, on custom scores for each experience.

“The work has a fascinating balance of translating cutting-edge research we have with our neuroscience and clinical partners with the artistry of the experience itself,” Phillips said. “It’s a symbiotic relationship. Something coming up a lot right now for healthcare workers is a struggle with purpose and tapping into it as a north star when they’re facing competing issues on a daily basis that prevent them from doing what ultimately fulfills them. We know their day is full of withdrawals for their brain-body budget, so we design for a deposit.”

Dr. Mar Cortes, a neuroscientist overseeing a clinical study of the Recharge Room at Mount Sinai, is working to better understand the neural underpinnings of the intervention. “We’re using a battery of different neurophysiological measurements including EEGs to understand the why, how, and when of what we’re seeing from the pre and post surveys.’’ In November 2020, she and Dr. Putrino authored a study of the impacts of the rooms on workers demonstrating a 60% reduction in short term stress after a 15-minute session.

“I can see the applications of this work in every part of the hospital, not only to help manage stress, anxiety, and depression but to transform the entire experience of what care can feel like,” said Dr. Cortes.

Since 2021, an alarming trend has been the staff shortages with thousands of nurses and other staff leaving for traveling nurse positions or the career all together. Phillips was asked a lot about how much the Recharge Rooms would be needed outside of the COVID-19 crisis.

“I think we’re actually just seeing the tip of the iceberg right now. None of these problems will be going away anytime soon and will require a robust federal response. I’m very happy to see the progress organizations like the Lorna Breen Heroes Foundation have made with Congress to pass the Dr. Lorna Breen Health Care Provider Protection Act.” Phillips said. The Act’s central focus is to reduce and prevent suicide, burnout and mental and beahvioral health conditions among health care professionals, and is named in honor of New York City ER doctor Lorna Breen, who died by suicide on April 26, 2020.

This year Studio Elsewhere plans to expand the Recharge Rooms to more hospitals across the US and internationally, while also focusing on innovation projects to benefit patients and their caregivers living with brain health issues like dementia and traumatic brain injury, and also early childhood and youth interventions for anxiety and depression.

“What I’ve come to realize is that there are only two categories of Americans right now – those who are dealing with a mental health issue directly or within their inner circle, and those who have yet to. It will require tremendous collective effort and ingenuity to overcome,” Phillips reflects. “At the same time, there is a joy in that collective and collaborative work with others. It’s tangible and long-term. It certainly has given me a deeper purpose in showing up every day to my community and knowing we can make a meaningful difference together.” •

Helping Your Organization Meet the Upcoming Challenges of the Tobacco Epidemic

By Jody Nicoloso, BS, and Frank T. Leone, MD, MS

Introduction

There are approximately 34 million people who currently smoke cigarettes in the United States.(1) One-third to one-half of those people will eventually die of a preventable tobacco-related disease, typically 10 years earlier than people who do not smoke cigarettes.(2) The toll of death and disability related to tobacco use is enormous, accounting for a staggering number of excess hospital days, millions of potential life-years lost and over $50 billion in attributable healthcare costs annually.(3)

Generally, when we think about the preventable consequences of tobacco dependence on our patients, our minds focus on the steps our patients might take to prevent these outcomes. Alternatively, it’s fair to ask which American institution, if not healthcare, is in the best position to take on the responsibility of doing more to prevent more of those preventable deaths? Relative to the emphasis placed on population-based controls, efforts to increase the ability of healthcare systems to provide effective case treatment have been comparatively weak, and have traditionally been placed low on experts’ lists of tobacco control priorities.(4,5)

But if not us, then who?

Getting ahead of the tobacco epidemic involves seeing the problem as not just a behavioral antecedent to downstream illness, but rather as a complex current illness resulting from pathologic distortions in brain biology induced by exposure to nicotine.(6) Organizations that can successfully incorporate the treatment of tobacco dependence into their day-to-day routines of providing high-quality care transcend the traditional boundaries of disease-focused interventions and address the root threat to their patients’ long-term well-being. Professional societies from across the spectrum of medicine have published treatment guidelines incorporating tobacco dependence into workflow, and have identified the billing and documentation requirements necessary to sustaining their efforts.(7,8) The evidence base has established effective, multi-disciplinary care of tobacco dependence as an important provider benchmark, with systematic approaches to incorporating tobacco dependence treatment into care pathways as an important step toward ensuring best possible outcomes.

The Philadelphia County Medical Society (PCMS) has taken on a leadership role in promoting the evolution of tobacco care in our region by partnering with a variety of other healthcare entities to guide the development and implementation of the new regional STAR Accreditation (Smoking Treatment Accreditation and Recognition). Along with other partners like the Greater Philadelphia Business Coalition on Health, Aetna Better Health of Pennsylvania, Health Partners Plans and Community Care Behavioral Health, PCMS has joined Health Promotion Council (HPC) and the University of Pennsylvania to identify systematic methods by which healthcare organizations might improve the continuity of care between providers and increase the rate at which patients receive evidence-based pharmacotherapies for tobacco dependence. PCMS members will have the opportunity to provider leadership at home, helping to guide their organizations toward achieving this important quality distinction.

Why a tobacco treatment accreditation?

Accreditation is a visible signal of the organization’s professionalism and commitment to the highest standards of community-based, comprehensive care. The HPC STAR Accreditation recognizes the

wide variety of tobacco-related activities that can happen within a healthcare organization, aimed at improving the lives of the community members they serve. IMPACT Accreditation does not require adherence to any pre-defined method or mechanism of tobacco treatment integration. Applicant organizations are expected to be unique in their makeup and consequently unique in their approach to integration.

There are five care domains that are used to identify those organizations that offer truly superior care to their constituents. General Operations relate to the processes put in place by the organization aimed at accurately identifying and documenting tobacco dependence among the patients served. Given that details of tobacco use history may be essential to developing and implementing an integrated treatment plan, organizations are asked to describe their policies regarding current use patterns, past abstinence attempts, and severity of tobacco dependence. Organizations are also asked to describe the process used for implementing comprehensive tobacco dependence Treatment Planning, including the evidence-based guideline used to guide pharmacotherapy decision-making, and the manner in which treatment planning is integrated into the care pathways of other illnesses or conditions. Accredited organizations are expected to utilize Professional Personnel with qualifications commensurate with their assigned tasks, including access to supervisory personnel and ongoing training and professional development. Given that effective multi-disciplinary care relies on Communication, the methods used for inter-staff communication across departments and locations are critical to delivering services to high-prevalence communities. Because STAR Accredited organizations each have their own unique character, each applicant organization has the opportunity to identify their own particular Focused Expertise or facility that they believe exemplifies the organization’s pursuit of a fully-integrated model of care. For example, organizations may choose to highlight their efforts to refine marketing or patient messaging, their systematic methods for facilitating physician involvement, their unique approach to tobacco-related clinical training or continuing medical education, or their use of complex health information algorithms to identify, track and treat tobacco dependent patients.

What qualifies as a STAR-eligible healthcare organization?

Healthcare organizations eligible for STAR Accreditation can be variously described. The fundamental characteristics of an eligible organization include: • Responsible for the care of persons with diagnosed conditions / disorders. • Reimbursed for care through third-party payer. • Accountable to the public for outcomes of care. • Utilizes multi-disciplinary teams to provide care. • Prescriptive authority within Pennsylvania.

Examples of STAR-eligible organizations include, but are not limited to: • Cancer centers, cardiovascular or pulmonary disease centers, recovery care organizations or other similar centers of excellence • Inpatient behavioral or physical health facilities • Entire health systems

How does STAR Accreditation add value to the organization?

STAR Accreditation improves the quality of care by promoting focused attention on tobacco dependence. Tobacco dependence interventions improve survival, reduce readmissions, shorten hospital stays, prevent exacerbations, improve patient satisfaction, lower overall costs of care and improve quality of life. Accreditation creates a level of distinction that adds brand-value, easily recognized by payors and purchasers, provides a vehicle for patient-facing promotion and raises the organization’s stature as a concerned, proactive member of the surrounding community. Upon achieving STAR Accreditation, organizations can show off their proactive stance. Partnering with HPC, the organization becomes the subject of press releases, web-based promotion, high-visibility banners and signage advertising their community credentials, and a variety of leave-behind hard copy materials that raise the visibility of the organization within the health promotion space.

How PCMS members can make a difference

PCMS members have always been recognized as leaders in their local medical community. The value of membership is intrinsic to our members’ ability to share ideas and promote growth in patient care. Our members make up a variety of “organizations” that would qualify for STAR Accreditation. Finding ways to help your organization achieve this important distinction would add significant value to the organization’s community outreach, and help to elevate the organization as a recognized leader in providing comprehensive care to community members. PCMS members strive to deliver top-notch care to their patients, and STAR Accreditation is a mechanism by which organizations can get free technical assistance to achieve their tobacco goals.

Understanding smoking as an addiction can fundamentally change the frame within which we treat our patients. Enriching our interventions has the potential to increase our confidence when dealing with a seemingly intractable problem and minimizes the potential for frustrating smoking conversations. Confidence is equally important for patients; PCMS members assist their organizations by increasing the confidence that patients feel when dealing with this sensitive problem. Finally, when Accredited organizations become the norm, arguments can be made to support improved reimbursement for these efforts.

To learn more about tobacco dependence, or to discuss how you might help your organization become STAR Accredited, please contact the Comprehensive Smoking Treatment Program at the University of Pennsylvania by calling 1-888-PENN-STOP or email to: pennstop@uphs.upenn.edu. •