Medical Staff Bulletin

Phone Numbers

Directory assistance
(203) 688-4242

Patient information
(203) 688-4177

Adult emergency
(203) 688-2222

Children's emergency
(203) 688-3333

Admitting
(203) 688-2221

Children's admitting
(203) 688-3331

Psychiatric admitting
(203) 688-9907

Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202

November/December 2008

Contents

Message from the Chief of Staff
Performance management update
Safe Patient Flow Initiative update
Smilow construction update
New no-smoking policy, boundaries approved
Dr. Hanson elected to YNHH Board of Trustees
New website, guide for YNH telecommunications; patient phone numbers to change
Defibrillators now installed throughout hospital

Message from the Chief of Staff
A prominent article in The New York Times on October 1, 2008, notified the public that "Medicare Won’t Pay for Medical Errors." For 2009, these conditions include:

Foreign objects retained after surgery
Air embolism
Stages III and IV pressure ulcers (absent on admission)
Falls and other trauma
Catheter-associated urinary tract infections
Vascular catheter-associated infections
Diabetic ketoacidosis (absent on admission)
Mediastinitis after CABG surgery
Surgical site infections after orthopedic and bariatric surgery
DVT/PE after orthopedic procedures

CMS has made it clear that important cost savings are not expected from this rule (maybe $20 million of $110 billion budget) but is sending a message that preventable complications must indeed be prevented.

In addition, CMS will be expanding the measures which hospitals must report. Already, for three common conditions — heart attack, heart failure, and pneumonia — we report on 18 measures as well as seven more related to surgical care. CMS, moreover, calculates and reports our mortality rates for AMI, heart failure, and pneumonia and the satisfaction of our patients in the HCAHPS survey. In FY 2010, CMS will add another 13 measures, bringing the total to 42! More on these in the future.

Thus, transparency of hospital safety and outcomes will be increasing significantly as will unfunded reporting mandates. All of this activity notwithstanding, the Medical Staff must fully embrace its responsibility to provide oversight and remediation of those adverse events which are not publicly reported but which materially affect individual patients. The recently constituted and new standing committee of the Medical Board, the Institutional Practice Quality and Peer Review Committee, is fully engaged in this task. Findings of this committee, chaired by the Medical Staff president, will be reported to the Medical Board and to the Patient Safety and Clinical Quality Committee of the YNHH Board of Trustees. Moreover, when root cause analysis indicates variant practice by clinicians, these analyses will be shared with the Medical Board Credentials Committee for possible action.

Performance management update
At left are our usual CORE measures that are reported to CMS and the Joint Commission each month. As noted in the Chief of Staff’s comments on the first page, this list will be growing in the next year and we will be discussing more about that growth in future issues.

Safe Patient Flow Initiative update
You may have heard or read about a new project at YNHH called the Safe Patient Flow Initiative. This is intended to streamline and improve the flow of patients through our hospital. Since July, a multidisciplinary team — including performance improvement staff, medical staff, nursing staff and pharmacy staff — has been performing observations, time-motion studies and in-depth analysis to streamline patient movement while ensuring patient safety.

How does patient flow impact on patient safety? When patients are not placed in the right bed in an expedient fashion or when patients board for long periods of time in the Emergency Department, they are placed at risk for developing pressure ulcers or delays in care initiation. Improving efficiency around bed turnover and earlier discharge times allow us to move patients into the correct level of care more quickly and more accurately.

Since July, a number of changes have been instituted as a part of this project. We have changed how transporters are deployed through the hospital, thereby reducing transport time. The housekeeping schedule is undergoing a major change and there will be a substantial increase in their number, with dedicated staff to support rapid bed cleaning and turnover. This will have a direct impact on general cleanliness and will reduce the time it takes to ready the room for the next patient. On many inpatient units, you will see new 52" LCD screens with patient name, room number, attending name, discharge status (likely, possible or unlikely for discharge today), and clinical nurse assigned, including that clinical nurse’s Spectralink phone number. We have improved communication and discharge times by notifying the nursing staff and care coordinators that a patient is likely to go home. In addition, the patient’s nurse and Spectralink phone number is available on SCM if you add this selection to your column headings (select "view" then "column selection").

We are approximately halfway through this improvement project. We plan to implement the current changes on additional units. We are also in the process of performing observations and developing improvement strategies for the Emergency Department and the operating rooms. Sandy Bacon is taking a leadership role in this project, with substantial assistance from Dr. Susannah Bernheim, Joan Rimar and Lorraine Lee. Congratulations to them and to all of the staff who have worked so hard to make this Safe Patient Flow Initiative successful to date.

If you have any questions about performance improvement initiatives or this project, please do not hesitate to call Tom Balcezak at 688-1343

Smilow construction update
Construction of the new Smilow Cancer Hospital is continuing on schedule and on budget. The Connecticut Office of Health Care Access (OHCA) has granted YNHH a modification of its original Certificate of Need for the project so that YNHH can now build and open levels 9 and 10 of the building — even though they had originally been intended for future use. These two non-oncology floors will each contain 28 beds, and will substantially relieve the pressure on ICU and step-down beds on the adult medical and surgery services. YNHH now has over 893 beds open; when Smilow opens, the number of staffed beds will increase to 966

New no-smoking policy, boundaries approved
On Thursday, January 1, 2009, the hospital’s new tobacco-free policy goes into effect at the main campus. The tobacco-free policy applies to all employees, volunteers, patients, vendors and visitors. The map below shows areas owned, leased or maintained by YNHH, including parking garages, surface parking lots and sidewalks where smoking will no longer be allowed. Additionally, smoking will not be permitted in vehicles parked on hospital property. The "butt hut" at the 20 York Street entrance and all smoking receptacles on YNHH grounds will be removed before January 1.

YNHH is also working with owners and managers of satellite locations — such as Shoreline Medical Center, Church Street South, 300 George Street, 425 George Street, 40-60 Temple, One Church Street and Long Wharf — on designating them tobacco-free. The Medical Staff will be apprised as those decisions are made. The map indicates the no-smoking boundaries in and around the hospital’s main campus.

Dr. Hanson elected to YNHH Board of Trustees
Dr. Thomas M. Hanson, an attending physician on the YNHH Medical Staff, was one of four new trustees elected to YNHH board at the annual meeting on October 22. Dr. Hanson is a founding partner of Obstetrics, Gynecology, and Menopause Physicians, P.C, a general OB/GYN, infertility and menopause practice with locations in New Haven, Guilford and Essex, CT. He is an associate clinical professor of OB/GYN at Yale School of Medicine. Dr. Hanson graduated from Dartmouth College and received his MD from Columbia University College of Physicians and Surgeons. He served his internship at Roosevelt Hospital in New York and OB/GYN residency at Yale-New Haven Hospital, where he was chief resident. He also earned a master’s degree in healthcare administration from the University of New Haven.

The other new trustees are Thomas B. Ketchum, Thanasis M. Molokotos and Diane F. Petra.

New website, guide for YNH telecommunications; patient phone numbers to change
YNHH’s Information Systems & Technology Telecommunications department has created a new web page to help employees and physicians better use the hospital’s telecommunications services. The web page, at http://intranet/ynhhs/ist/telecom, includes user guides to telephones, cell phones, pagers, patient phones, the Smart Web and Smart Speech staff directories, Smart paging, TV services, audio and video conferences and how to report telephone problems.

Please note that all patient phone numbers at YNHH will change in the first quarter of 2009. The new exchange number will be 936- instead of 688-.

Defibrillators now installed throughout hospital
YNHH has installed more than 60 automatic external defibrillators (AEDs) on patient care units, employee areas (including the basements of the East, South and West pavilions) and public spaces (such as the Atrium and Yale Physicians Building). Staff were trained on the AEDs in November but even untrained bystanders can use the clearly marked, lime green devices which carry explicit directions and audiovisual prompts.

The new AEDs are fully compatible with full-function defibrillators. When a team responds to a code call, the AED paddles can be quickly plugged into the full-function defibrillators. Contiguous patient care units — such as general medicine units on 5-5 and 5-7 — now each have an AED and share a full-function defibrillator.

Chief of Staff
Peter N. Herbert, MD

Associate Chief of Staff
Thomas J. Balcezak, MD

Assistant Chief of Staff
Victor A. Morris, MD

Medical Board Officers

President
Leo M. Cooney, MD

President-Elect
Thomas F. Sweeney MD

Secretary
Lynda E. Rosenfeld, MD

Past President
Brett J. Gerstenhaber

Medical Board Members
Stephan Ariyan, MD
Michael C. Bennick, MD
James A. Brink, MD
Richard D'Aquila
Richard L. Edelson, MD
Jack A. Elias, MD
John A. Federico, MD
Patricia Sue Fitzsimons, RN, PhD
Gary E. Friedlaender, MD
Peter M. Glazer, MD
Peter N. Herbert, MD
Joni Hansson, MD
David G. Hesse, MD
Roberta L. Hines, MD
Margaret K. Hostetter, MD
Lee Jung, MD
Suzanne P. LaGarde, MD
Charles J. Lockwood, MD
Marc E. Mann, MD
Jon S. Morrow, MD, PhD
Michael J. Murphy, MD
Michael K. O'Brien, MD, PhD
Joel S. Silidker, MD
Suher Baker, DMD
William H. Sledge, MD
Brian R. Smith, MD
Dennis D. Spencer, MD
Harold H. Tara, MD
James C. Tsai, MD
Robert Udelsman, MD
Fred R. Volkmar, MD
Gary R. Wanerka, MD
Lawrence J. Wartel, MD
Stephen G. Waxman, MD, PhD
Norman S. Werdiger, MD
Joseph H. Zelson, MD

Refer items for the next issue of Medical Staff Bulletin via phone, fax, e-mail or mail to:
Peter N. Herbert, MD
1063 Clinic Building
P: (203) 688-2604, F: (203) 688-7152
herbertpn@ynhh.org
or
Katie Murphy
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
Katie.Murphy@ynhh.org

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Last revised: Jan. 5, 2008 (dh)