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Medical Staff Bullietin

April/May 2009

Contents

A message from the Chief of Staff

YNHH has established a tentative goal of achieving an entirely electronic inpatient medical record (EMR) by spring 2010. This will coincide with our occupancy of the inpatient units in Smilow Cancer Hospital. A task force, with considerable physician and nursing participation, has been charged with oversight of this project. This group is receiving operational support from our chief medical information officers Drs. Allen Hsiao and Nidhi Shah, from Lisa Stump who leads the nursing documentation effort, and from Marcia Dobrowski, RN, in Clinical Information Systems.

Atention: Medical Staff
and Affiliated Medical Staff

If you have changed your office address, phone or fax number, home address or phone number, mobile phone number or pager number, please contact the Department of Physician Services at (203) 688-2615 or email the information to: Physician Services.

This initiative presents considerable challenges as well as unique opportunities. The achievement of an entirely legible medical record alone justifies the effort. Even more exciting is the unique opportunity to ask fundamental questions about the core content of the record, responsibility and accountability for critical elements and identification of key recipients of information and specification of their needs, greatly minimizing redundancy. Simultaneously, this should ultimately improve the efficiency and quality of our care.

Several of us involved in the EMR project realize this is a great opportunity to enhance the communication between physicians and nurses whose coordination and collaboration is essential for effective patient care. We too often function as separate estates, practicing our own disciplines, and too seldom do we adequately share plans, perspectives or even work. Patients regularly share their observations that we act as individual disciplines rather than as a care "team." Changing paradigms of inpatient care through development of a common EMR will deeply challenge ingrained aspects of our cultures. Many of us with four or more decades in hospital practice realize that precious little has changed over the last five decades. If we can agree to sacrifice a good number of sacred cows, however, we may be able to better our own lives and those of our patients while preserving the essence of an academic-community medical center.

Smilow physician campaign underway

Drs. Joseph Piepmeier and Peter Herbert have accepted responsibility for chairing a physician campaign for the new Smilow Cancer Hospital. The overall campaign, a joint effort of Yale-New Haven Hospital and Yale School of Medicine, is within $7 million of achieving its goal of $100 million. It is hoped that the physician campaign, as important symbolically as it is financially, will raise $1 million. If just 100 medical staff members pledge $10,000 over three to five years, the physician will reach its goal. Contributing physicians will be recognized in a special way in Smilow. Contributions will also be recognized equally by the Hospital and School. Most medical staff members should receive information about the campaign in the mail. You can also contact the YNHH Office of Development at 688-9644 or email giving@ynhh.org for additional information.

Safe patient flow initiative update

YNHH launched the safe patient flow initiative last summer to build upon previous throughput efforts by achieving earlier time of day discharges, reducing Adult Emergency Department (AED) over-crowding and preventing delays in the Operating Rooms or Post-Anesthesia Care Units (PACU). The primary objective is to ensure that the right patient is admitted to the right bed at the right time.

Although the effort is focused on patient safety, it has demonstrated that both patient satisfaction and efficiency/productivity improvements can occur in tandem with safety. The initiative has support at all levels of the organization. Unlike department-specific performance improvement work, the safe patient flow initiative spans many departments. The methodology includes the following steps:

  • Area profile development
  • Process mapping
  • Observations — categorization of "lost time" opportunities
  • Method change score card development (proposed improvements)
  • Daily operating report creation and tracking (measures of success)
  • Cascade of meetings to drive and sustain change

Since the initiative was launched, we have reduced wait time for admissions, increased the number of patients admitted to the first choice unit, improved communication and hand-offs, and improved patient satisfaction and efficiency in key areas. In many respects, the work has just started and will continue to tackle new challenges. There will be iterations of the steps above until the teams believe the processes can no longer be improved further.

Accomplishments to date include:

  • AED time from book to admit is 14 percent faster (11 minutes)
  • Median LOS to treat and admit AED patients has been reduced by 17 minutes
  • PACU delays reduced by 25 minutes
  • 7 percent reduction in PACU delays
  • Improved patient experience with the speed of discharge on selected patient care units

The next set of projects will focus on ICUs and step-down bed availability.

Process for discharge-dependent ultrasound examinations

The YNHH ultrasound service has developed the means to quickly accommodate sonograms for patients who are awaiting discharge. If a patient's discharge is pending completion of an ultrasound examination, the following protocol should be followed:

  1. The requesting physician must select "discharge-dependent" in the SCM order form (under "requested times").
  2. An order for discharge must be on the chart prior to ordering the examination.

Requests for discharge-dependent ultrasounds ordered between 7 a.m. and 5 p.m. will be scheduled within four hours from placement of the order. Requests for discharge-dependent ultrasounds placed between 5 p.m. and 7 a.m. will be scheduled for the first three hours of the next day shift, between the hours of 8 and 11 a.m. For more information, contact the ultrasound section at 688-9402 or nancy.cavallaro@ynhh.org

Dr. Baker named chief of Dentistry

Dr. Suher Baker has accepted the position of chief of Dentistry. Dr. Baker came to YNHH in 2006 and has served as interim chief of Dentistry since June 2008. She received a Bachelor of Dental Science Degree (BDS) from Baghdad University, Doctor of Dental Medicine (DMD) from the University of Pennsylvania and MS from the University of Michigan and completed a special needs residency program at Albert Einstein College of Medicine and Helen Hayes Hospital. She additionally trained in dental anesthesia at the University of California, Los Angeles School of Dentistry. Dr. Baker is board-certified in pediatric dentistry and dental anesthesiology. As chief, Dr. Baker is responsible for the entire Dental Department, including the general residency program, the HSR-affiliated oral maxillofacial residency program and the pediatric dental residency program.

YNHH attending staff national honors

In May, Dr. Ronald Angoff, attending physician in general pediatrics at YNHH and clinical professor of pediatrics and Child Study Center, received the National Community Pediatric Teaching Award from the Academic Pediatric Association (APA) and the American Academy of Pediatrics. This award highlights the career of a community pediatrician who has dedicated his/her career to the teaching of medical students and residents.

Last May, Dr. John M. Leventhal, attending physician in general pediatrics at YNHH and professor of pediatrics and Child Study Center, received the George Armstrong Award from the Academic Pediatric Association at the annual Pediatric Academic Societies meeting. Recipients of this award are honored as outstanding teachers and contributors to the knowledge of the care of children. George Armstrong, one of the fathers of modern pediatrics, established the first dispensary for children in London in 1769.

Dr. Stephen Waxman, chief/chair of Neurology and the Bridget M. Flaherty Professor of Neurology, Neurobiology and Pharmacology, received the highest scientific honor of the U.S. Department of Veterans Affairs — the William S. Middleton Award for Outstanding Achievement in Biomedical Research. Additionally, Dr. Waxman will receive the Physiological Society's annual prize in the U.K. in July. Dr. Waxman is being honored for his research on spinal cord injury, multiple sclerosis and painful nerve injuries.

YNHH opens new radiology office in Hamden

In early June, Yale-New Haven opens a new ACR-accredited imaging facility at 2560 Dixwell Avenue in Hamden. Temple Radiology's Hamden location offers diagnostic imaging, 64-slice computed tomography (CT) imaging, including exams to study coronary arteries, diagnostic and screening mammography, ultrasound, fluoroscopy and ultrasound-guided biopsies, performed by board-certified radiologists. The new service offers physicians fast report turnaround; stat reports; radiologist availability for phone consultations; report access via fax, mail or online; image options, including film, CD or online through PACS. The hours at the Dixwell Avenue radiology site are

  • M-F, 7:30 a.m.-5 p.m. and Sat., 8 a.m.-noon. The hours for digital mammography are: M-F, 8 a.m.- 5 p.m.
  • M-Thu. evenings, 5:30-8 p.m. and Sat., 7-10:30 a.m. To schedule an appointment, please call (203) 248-4567.

Lab testing change

Effective June 1, 2009, the YNHH Hematology laboratory will change to a new thromboplastin reagent, innovin. As a result, abnormal prothrombin times (PT) will be noticeably longer compared to previous values. However, the international normalized ratio (INR) which compensates for thromboplastin reagent variation in the monitoring of coumadin (warfarin) therapy will be approximately the same. We are switching to this recombinant reagent because it will be available unaltered in the future and, because of its improved sensitivity to coumadin, the INR will be less variable and more accurate. While already the standard of care at YNHH, it is important to reiterate that one must monitor individuals receiving oral anticoagulant therapy with the INR value, NOT the PT result in seconds. Full information on this reagent will soon be available on the clinical workstations. Please contact Henry Rinder, MD, henry.rinder@yale.edu, with any questions about this laboratory testing or therapeutic INR range guidelines.

New IFE healthcare simulation center:

The Yale New Haven Health System Institute for Excellence has opened the new, multidisciplinary SYN:APSE healthcare simulation center at 730 Howard Avenue, with a satellite location in West Pavilion 733, to provide physicians, nurses and other caregivers with simulation training. These settings simulate realistic clinical situations, using controlled medical events and high fidelity simulators. This modality can be used to train staff, improve multidisciplinary teamwork, test new procedures or equipment, conduct competency assessments or provide experience with high acuity, low frequency situations. The patient simulators breathe, speak, blink, sweat, bleed and respond physiologically to medications. The simulation environment can be designed to resemble an inpatient room, an ICU setting, operating room, emergency department area or an outpatient exam room. The training scenario can be video-recorded and reviewed by the group in an adjacent classroom. For a brochure or more information, contact simulation coordinator Roxanne Niblack at 688-9565, or medical director Stephanie Sudikoff, MD, at stephanie.sudikoff@yale.edu.

YNHH establishes hardship fund for employees

Yale-New Haven Hospital has established an employee hardship fund to provide short-term financial assistance to employees with immediate, serious and temporary financial hardships. Eligible employees may apply for one award of up to $2,000 in a 12-month period. An employee hardship fund committee reviews applications for assistance in a confidential process. The hospital's senior management staff provided the initial seed money for the fund. Members of the Medical Staff who are interested in making a donation may contact the Development Office at 688-YNHH and a contribution form is on the Human Resources section of the YNHH intranet at:
http://hr.ynhh.org/newynhh/HardShip_Fund_ContributionForm.pdf
along with a description of the fund, a Q & A, and an application form.

Call Center physician update reminder

The Yale New Haven Health Physician Referral Service (Call Center) is currently mailing the annual physician updates to all community doctors. Please be sure to complete your changes and return them to the Call Center by fax at (203) 688-5444 or mail them to the YNHHS Call Center at 48 York Street, New Haven, CT 06510.


December 2008 Performance
AMI # YNHH% Nat. 90%
ASA at arriv. 10/10 100 100
ASA at D/C 23/24 96 100
B-Block at arriv. 5/5 100 100
B-Block at D/C 12/13 92 100
ACEI at D/C 0/0 N/A 100
PCI <120 min 2/2 100 92
Smoking cess. 2/2 100 100
 
CHF # YNHH% Nat. 90%
LVEF assess. 23/24 96 100
ACEI at D/C 1/2 50 100
Smoking cess. 7/7 100 100
D/C instr. given 16/17 94 97
 
Pneumonia # YNHH % Nat. 90%
02 assess. at arriv. 15/15 100 100
Pneum. vac. given 7/8 88 97
Abx given <6 hrs 8/11 73 94
Abx given <4 hrs 9/11 82 100
Smoking cess. 6/6 100 100
Blood cx before abx 12/12 100 100
    Initial (non-ICU)
Selection Abx 6/8 75 97
Influenza vaccine 13/14 93 99
 
SIP # YNHH % Nat. 90%
Proph Abx 1 hr 24/25 96 97
Abx selection 26/26 100 99
Proph Abx D/C 19/20 95 97
DVT proph ordered 15/16 94 97
DVT proph given 15/16 94 95
 
Pedi asthma # YNHH % Nat. 90%
Inpatient relievers 17/18 94 98
Inpatient steroids 16/17 94 98
Home mgmt plan 13/18 72 89


Welcome, New Medical Staff

March

Jesse Michael Adams, CNA; Affiliated, Anesthesiology
Jayleen P. Azcona, MD; Attending, Psychiatry
Steven Leonard Bernstein, MD; Attending, Surgery
Gregory Patrick Cain, CNA; Affiliated, Anesthesiology
Neil David Cullam, CNA; Affiliated, Anesthesiology
Helmuth W. Gahbauer, MD; Attending, Diagnostic Radiology
John Kevin Kickey, PA; Affiliated, Internal Medicine
Rebecca Elizabeth Jarnes, CNA; Affiliated, Anesthesiology
Monika S. Laurans, PA; Affiliated, Neurosurgery
Ronald L. Miller, MD; Attending, Internal Medicine
Theresa Allen Molisse, MD; Attending, Internal Medicine
Jonathan Puchalski, MD; Attending, Internal Medicine
Rhonda Leigh Sawyer, PA; Affiliated, Pediatrics
Michael James Seneca, CNA; Affiliated, Anesthesiology
Craig Alan Thompson, MD; Attending, Internal Medicine
Ashley Noelle Vaughn, CNA; Affiliated, Anesthesiology
Belinda Voiles, CNA; Affiliated, Anesthesiology
Diane Volz, CNA; Affiliated, Anesthesiology
Thomas Wong, MD; Associate, Anesthesiology



Leadership

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
Suher Baker, DMD
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
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

Katie Murphy
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
Katie.Murphy@ynhh.org

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