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Medical Staff Bullietin

January/February 2009

Contents

A message from Marna Borgstrom, CEO, and Peter Herbert, MD, Chief of Staff

Although it is barely a month old, this new year promises to be a rugged one for our country, our state and undoubtedly, for our doctors and hospitals. President Obama has emphasized the need to transform U.S. health care, and current economic conditions will create a uniquely receptive environment. An articulated goal is to make some form of health insurance universally available, while reducing the total amount spent on health care. This is a tall order.

In Connecticut, many hospitals are struggling as patient demand is stagnant or declining, the numbers of uninsured and underinsured are rising and market losses have negatively impacted hospital balance sheets and impaired access to capital.

Fortunately, YNHH has enjoyed consistent growth and demand for our services and, by managing our expenses carefully, we have done relatively well. But we are not immune to the consequences of a very contracted economy. We too have lost significant assets and are not able to access the debt market for projects we had hoped to begin this year. While our operating performance is very close to budget thus far, we will be bringing on significant additional expenses related to the opening of Smilow (staff and the associated debt service expense) and it will be more difficult to perform according to our original projections.

To ensure Yale-New Haven's continued success, we are working with all of our employees and members of our medical staff to carefully monitor and control our expenses by adjusting operating budgets to reflect actual changes in demand. We are working to standardize processes and technologies to reduce variation-related expense. We are also re-evaluating all planned capital expenditures. This is necessary both to preserve cash and to assure that the most important technology and facility plans can continue as close as possible to what was originally planned.

We will not waiver from our commitment to continue to enhance the quality and the safety of the health care we provide to our patients. But we need your help and support to make sure that we can meet that goal and remain a financially healthy and vibrant organization.

On-line consultations largely off-line

We noted last month a new Medical Staff regulation requiring dictation of initial consultation notes. After three weeks, only a minority are appearing in Sunrise Clinical Manager, most others still being handwritten. The expected turnaround time for dictated consult notes is four hours. The dictation work type is "work type '15.'" Those typed into the system, of course, appear immediately. As with other documents, trainees may dictate or type notes in preparation for the attending to edit. We encourage specialties to create consultation templates in SCM, customized to the needs of individual services. Those interested in doing so should contact Dr. Nidhi Shah (nidhi.shah@ynhh.org).

Performance management update

At left are our CORE measures that are reported to CMS and the Joint Commission each month —this time for September 2008. Although we continue to perform quite well in almost all measures, with some month-to-month variability, we still have significant room for improvement in CHF discharge instructions and home management plans for pediatric asthma. For the majority of the remaining measures, we are either at the 90th percentile consistently or miss it by one or two cases each month.

What's new for 2009? Many of you have already seen the CMS 30-day mortality measures for AMI, heart failure and pneumonia. In these measures, we have performed either at or above the national average. In 2009, CMS will publicly report a 30-day readmission measure for heart failure, followed shortly by a 30-day readmission measure for acute myocardial infarction and pneumonia. An additional new metric for 2009 will assess perioperative beta blocker use in patients who chronically take beta blockers. As these measure sets expand, we will work to improve performance within the service lines, as well as with population-specific and clinical practice specific operations-councils.

Beginning in 2009, and important for Medical Staff to be aware of, is a change in CMS payment rules. There is now a set of "No Pay Events" that are no longer reimbursed by Medicare. This list is relatively short for 2009 but is expected to expand and impact physician reimbursement in the years to come. Among the more common of these events are Stage III and IV pressure ulcers acquired in a hospital, trauma and injuries (falls in hospital), hospital-acquired catheter associated urinary tract infections, and hospital-acquired vascular catheter associated blood stream infections. In addition, the state of Connecticut is paying close attention to hospital-acquired infections (HAIs). At the start of 2008, Connecticut began mandating reporting of intensive care unit catheter related bloodstream infections. It is likely that mandatory state reporting of other HAIs will follow this year. Since 2006, mandatory adverse event reporting has included a long list of "never events," one of which is death or disability due to a hospital-acquired infection.

HIV testing reminder

All Medical Staff are reminded that, in Connecticut, testing any patient for HIV requires written consent from the patient. There are only a couple of exceptions. In the case of an occupational exposure to the blood or body fluids of a patient, all personnel should report to the hospital's Occupational Health Service (OHS) for guidance. OHS is located on the first floor of the East Pavilion. In order to test the source patient's blood, the patient must still be asked to consent to HIV testing. This should usually be done by a patient's attending or whoever has the closest relationship with a patient. In the event the patient refuses, he or she should be informed that there is a process which may allow the blood to be tested even over his/her objection and that if there is a result he/she should know about, we will provide that information. If a patient is unable to consent to testing for more than 24 hours (e.g., is unconscious or demented), that should be noted and the information provided to OHS. OHS will then initiate the process of convening the exposure evaluation committee. If the criteria for significant exposure are met after the healthcare worker has filed a report of injury, and if the caregiver is HIV seronegative, permission for testing will usually be granted.

2009 Doctor's Day celebrated on April 2

YNHH will celebrate National Doctor's Day with a buffet lunch in the special events area of the East Pavilion cafeteria on Thursday, April 2, from noon-1 p.m. If you are interested in attending, please RSVP to the Department of Physician Services at 688-2615.

New no-smoking policy

The hospital's new tobacco-free policy, which took effect on January 1, applies to employees, volunteers, patients and visitors, and includes parking garages and lots owned or leased by the hospital. If a newly admitted patient is a smoker, the admitting nurse will contact the appropriate physician to assess the need for nicotine replacement therapy. Other resources available for patients include referrals to various smoking cessation organizations. Community physicians have also been advised of the policy and will hopefully share the information with their patients before admission to YNHH.

If you would like to order brochures about the new policy and resources for patients and visitors, please call the Document Center and ask for form F5972. Brochures for employees (F5971) and pads of maps outlining the no-smoking boundaries (F 5981) are also available.

YNHH receives national honor for organ donation

The U.S. Department of Health and Human Services (HHS) recently awarded a Medal of Honor for Organ Donation to Yale-New Haven Hospital for successfully increasing its organ donation rates. This marks the third consecutive year that YNHH received the medal, which HHS has awarded since 2005. YNHH is one of 412 American hospitals recognized for achieving and sustaining a donation rate of 75 percent or more from medically suitable, deceased donors.

YNHH ICU nurses and other staff have been trained to properly refer potential donors to the New England Organ Bank (NEOB). They work with the hospital's critical care physicians and NEOB counselors to conduct appropriate discussions with families to obtain consent from the family. Since January 1, 2008, YNHH has transplanted 31 organs and has had 11 organ donors, an increase from 26 organ transplants and nine organ donors in 2007. Currently, more than 100,000 Americans are on the national waiting list for organ transplants — almost 4,200 in New England, more than 900 in Connecticut and nearly 600 at YNHH.

Supporting nursing colleagues on verbal orders

It has been a long-standing policy at Yale-New Haven Hospital that verbal orders should be used only in emergent circumstances. This is possible if the physician, APRN or PA caring for the patient enters orders for medications, restraints or other care in a timely fashion. Nursing staff, particularly in the ICUs, are frequently given verbal orders for things such as IV infusions, restraints or other treatments that are not emergent. As Medical Staff members, it is vitally important that we support our nursing colleagues in the care of our patients and ensure that we are providing written orders in a timely and efficient fashion.

Hospital's MRI Center upgrades scanners, extends hours

The hospital's MRI Center, located in the basement of the Clinic Building, performed more than 20,000 inpatient and outpatient exams last year. To keep pace with advancing technology, the MRI Center will begin replacing three of its scanners with some of the most advanced imaging equipment available in the world. This phase of the project will be complete by May.

To provide uninterrupted service to all internal and external customers during this time, the MRI Center has added evening hours on weekends and will station an MRI van at the hospital's Long Wharf facility, 150 Sargent Drive, in mid-March. During renovation, MRI Center hours are 7 a.m.-11:30 p.m., seven days a week.

2009 Patient Safety and Clinical Quality Conference on May 14

The Yale New Haven Health System 2009 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held on Thursday, May 14, at Harkness Auditorium. The conference will provide an opportunity for individuals throughout YNHHS to meet and discuss projects and plans related to patient safety and performance management activities. This year's speaker is Tom Kelley, general manager of the global design consultancy firm, IDEO, and an expert in fostering a culture of creativity and continuous innovation for safety and quality. He will speak about the role of innovation in patient safety and quality during hard times. Kelley is the author of The Art of Innovation and The Ten Faces of Innovation. To register or for more information, please contact Darriell Rolka in Performance Management at 203-688-8692 or darriell.rolka@ynhh.org

Pediatric rehabilitation services move to Long Wharf

Yale-New Haven Children's Hospital pediatric rehabilitation services has moved to One Long Wharf Drive in New Haven, Suite 130. This outpatient department was formerly located on the second floor of the West Pavilion. The program offers physical therapy, occupational therapy and speech language pathology services for children of all ages. The new facility is fully wheelchair accessible and has additional private treatment rooms and free parking. The telephone number remains the same — 688-7994.

Welcome, New Medical Staff

November

Ana Maria Apoltan, MD; Attending, Internal Medicine
Angelina Noami Chambers, CNM; Affiliated, Obstetrics & Gynecology
Alison Annette Considine, MD, MPH; Associate, Anesthesiology
Kavita Dhodapkar, MD; Attending, Pediatrics
Keri Ellen Discepolo, DDS; Associate, Dentistry
Kamberlyn Dunbar, APRN; Affiliated, Internal Medicine
Abha R. Gupta, MD, PhD; Attending, Pediatrics
Allison Felice Hirschman, PA; Affiliated, Surgery
Shari A. Jackson, MD; Attending, Pediatrics
Sihem Khelifa, MD; Associate, Pathology
Lindsay Jean Kozicz, PA; Affiliated, Internal Medicine
Angie Y. Lee, MD; Attending, Obstetrics & Gynecology
Angelique Wolf Levi, MD; Attending, Pathology
Ashley S. Roman, MD; Visiting, Obstetrics & Gynecology
Muziana S. Quadir, MD; Attending, Internal Medicine
Casey Braitsch Rosen-Carole, MD, MPH; Associate, Pediatrics
Richard A. Rosencrantz, MD; Attending, Pediatrics
Erin Nicole Ruppe, APRN; Affiliated, Internal Medicine
Ozlen Saglam, MD; Attending, Pathology
Michael James Sheehan, MD; Associate, Pediatrics
Michael Simons, MD; Attending, Internal Medicine
Gabriel Vorobiof, MD; Attending, Internal Medicine
Emily Ai-Hua Wang, MD; Attending, Internal Medicine
Dawn Renee Errera Wehrum, CNM; Affiliated, Obstetrics & Gynecology
Jason Wilder, DO; Visiting, Dermatology

December

Diana Lopez Agosto, APRN; Affiliated, Internal Medicine
Meera Manhendra Berkowitz, APRN; Affiliated, Internal Medicine
Sarah Margaret Canavan, MD; Attending, Internal Medicine
William Edward Huggins, PA; Affiliated, Surgery
Christa Ann Jennings, APRN; Affiliated, Surgery
John Killinger, CNA; Affiliated, Anesthesiology
Jo R. Kremer, MD; Attending, Psychiatry
Adrienne Berge Loth, APRN; Affiliated, Pediatrics
John Sexton, CNA; Affiliated, Anesthesiology
Tyler Shepard, CNA; Affiliated, Anesthesiology
Samantha R. Wennerberg, PA; Affiliated, Neurology
Lynne Alison Wolfe, APRN; Affiliated, Pediatrics

January 2009

Adebowale Joel Adeniran, MD; Attending, Pathology
Pamela Allen, CNA; Affiliated, Anesthesiology
Betty Bohannon, CNA; Affiliated, Anesthesiology
Judson Brewer, MD; Associate, Psychiatry
Lindsay Christine Burke, APRN; Affiliated, Surgery
Umer M. Darr, MD; Attending, Surgery
Hillary Drumm, APRN; Affiliated, Internal Medicine
Mark Anthony Giles, CNA; Affiliated, Anesthesiology
Amy L. Glick, APRN; Affiliated, Surgery
Adam Bradley Landman, MD; Associate, Surgery
Antonio D.S. Lopez, MD; Attending, Internal Medicine
Jeffrey R. Lukish, MD; Attending, Surgery
Michael B. Marchildon, MD; Attending, Surgery
Haakon Berge Nygaard, MD; Associate, Neurology
Pinar Oray-Schrom, MD; Attending, Internal Medicine
Nesrine Afif Rizk, MD; Attending, Internal Medicine



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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