NYC Health + Hospitals/Kings County (formerly Kings County Hospital Center) was established in 1831, and remains a vital “safety net” hospital for the people of Brooklyn and New York City. Located in Central Brooklyn, Kings County is a Level I trauma center with extensive services, including inpatient and outpatient services, behavioral health, emergency services, and a wide range of specialty clinics.
The Family Planning Clinic at Kings County is the oldest in the NYC Health + Hospitals system. The clinic was started in 1958 at a time when contraceptive services were still banned in the city hospital system. Today, the Kings County Family Planning Practice provides a broad range of contraceptive methods, including pregnancy testing, and STI, and HIV counseling and testing, as well as breast and cervical cancer screening.
In 2012, the NYS Department of Health (NYS DOH) released a report highlighting contraceptive coverage rates by agency, based on Performance Measure 7 (eligible female clients leaving with an effective method of contraception). At the time of the report, 71.9% of eligible (i.e., not pregnant, seeking pregnant, or infertile) females served by NYC Health + Hospitals/Kings County left with effective or highly effective contraception--below what the hospital expected. The team immediately held its first team meeting, agreeing that all staff members who came in contact with clients would support the provision of education on effective and highly effective contraception. In their effort to improve the rate of contraceptive coverage, the team at NYC Health + Hospitals/Kings County established multi-faceted approach to improvement, which included:
- Providing all new or method change clients with “one-on-one” education counseling
- Evaluating and documenting the reason why a client chooses not to leave with an effective FDA-approved method of contraception, assuring no logistical and financial barriers exist
- Working alongside with the NYS COE on adopting continuous quality improvement (CQI) principles to improve and monitor Performance Measure 7
- Attending NYS COE cluster trainings to network with other agencies around Performance Measure 7
The NYC Health + Hospitals/Kings County Family Planning Team has empowered staff with the ability to stop and ask for a quick huddle if there is a need for clarity on an issue or an unusual occurrence requires immediate attention. The team maintains continuous monitoring of the practice of providing contraception to clients, including front-line staff interactions, telephone inquiries, walk-in contraception inquiries, as well as assuring the nurse and health educator counsel all new and annual clients. Clinic Visit Records (CVR) are also monitored weekly for accuracy.
One of the challenges that the team continues to face is managing pregnancy test clients, because they utilize the hospital’s walk-in service. Due to scheduling limitations, clients who test negative for pregnancy and are interested in contraception are often not able to access an effective method of contraception on the same day of their pregnancy test. The team is currently exploring strategies to link 100% of their eligible negative pregnancy test clients to same-day contraceptive services.
As a result, all NYC Health + Hospitals/Kings County staff who interacting with the clients provide education and answer questions within their scope of practice regarding all the available FDA-approved methods of contraception. The percentage of eligible clients who are leaving the clinic with an effective or highly effective contraceptive method increased to 98%, a level that NYC Health + Hospitals/Kings County has maintained since 2013.