St. John's Riverside Hospital

Lenore Paterno, BSN-BC, is a board certified cardiac rehabilitation nurse and the Director of Cardiac Rehabilitation Services at St. John's Riverside Hospital in Yonkers, New York. A past president of the Southeast Region, New York State Association of Cardiac and Pulmonary Rehabilitation, she functions as the Tobacco Control Coordinator for St. John's Riverside Hospital, and participates in the POWR (Putnam, Orange, Westchester and Rockland counties) Against Tobacco Coalition. She is active in St. John's Riverside's quality improvement efforts and reports on a quarterly basis to the hospital's Performance Improvement Division. Paterno was an active participant in the IPRO-led, CMS-funded AMI Depression project, which began in 2002 and ended last year.

When that project began, few cardiac rehabilitation centers had processes in place to adequately identify and manage patients who were at risk for depression. Under her leadership, the rates of depression screening and follow-up for patients in her cardiac rehabilitation center dramatically improved. By the end of the project, 91% of the medical records sampled evidenced documentation of adequate depression screening, up from 0% at baseline. In addition, 75% of patients who were determined to be "at risk" for depression had documentation of follow-up, up from 0% at baseline. Paterno reports that all patients at the St. John's Hospital Cardiac Rehabilitation Center continue to receive depression screening. In addition, physicians of all patients with a positive depression screen are notified using a fax-back form. Physicians of patients whose depression severity falls in the moderate to severe ranges receive additional telephone contact.

Paterno was asked to bring her performance improvement skills to the general patient population to improve the rates of smoking cessation counseling provided to current or recent smokers admitted to St. John's Hospital. This has proven to be a challenge requiring a much broader level of hospital support. Paterno increased the number of hospital staff eligible to provide smoking cessation counseling, and developed a one-hour smoking cessation counseling training session which teaches aspects of the Public Health Service Clinical Guidelines. This includes the 5As and 5Rs, along with Motivational Interviewing techniques she learned at IPRO-sponsored training sessions. Nurses completing the program receive continuing education credit for attending Paterno's program. For more information contact Ms. Paterno at (914) 964-4928.