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Medical Staff Bulletin

January/February 2010

Contents

A message from the Chief of Staff

A happy and especially healthy New Year to all members of the Medical Staff. The bad economic times of 2009 should soon be receding in memory. We hope you and your loved ones will require only preventive healthcare services in the next year.

My personal New Year's resolution in 2010 bears a striking resemblance to many others in the last decade. I wish to do everything possible to make patient care at YNHH as safe and as effective as possible. Safety, the prevention of avoidable harm, is paramount to our mission and can be improved. The required cultural change is the alignment and commitment of all caregivers to this goal. Accomplishing this with a staff of several thousand is no small feat and is still only partially achieved 10 years after the publication of "To Err is Human."

I do believe we have created an environment and articulated a passion for patient safety that has changed much in the last 10 years. We have paid attention to public concern. We have created a performance management function that has effected great compliance with safe practices of the National Quality Forum and pursued the National Patient Safety Goals. We have engaged in many initiatives to reduce hospital-acquired infections, made great strides in prevention of pressure ulcers, and very creatively addressed the issue of adequate hand-off communication among caregivers.

In some areas, we have much to do. Compliance with "time outs" in areas outside the operating rooms is a work-in-progress; emergency department congestion needs both short- and long-term solutions; and willingness of nurses and resident physicians to use the chain of command to ensure timely, needed interventions still requires deep acknowledgement that tradition must change.

In 2010, we will depend less on hospital-wide organized efforts to accomplish our safety goals and devote more resources at the unit level to resolve recognized problems in patient safety. We will fill the holes in the Swiss cheese one at a time.

Yale-New Haven sending medical experts and supplies to Haiti

A team of Yale-New Haven Hospital and Yale School of Medicine physicians and medical professionals trained in disaster response is on its way to earthquake-ravaged Haiti. In addition to providing trauma and surgical expertise, the physicians are carrying humanitarian aid that includes donated medical equipment and supplies to help thousands of people and prevent further spread of infection.

The team, flying on an aircraft donated by Corporate Aircraft Responding in Emergencies (CARE), left on January 26 and is expected to remain in Haiti for about two weeks, working with the Boston-based Partners in Health. The Yale team consists of: Gregory Luke Larkin, MD, emergency medicine; Peter Boone, MD, orthopaedics, St. Vincent's Hospital, Bridgeport; Ralph Jean-Mary, emergency department; Tom Kimberly, APRN, emergency department; Donald MacMillan, PA, emergency department; and Nousheh Saidi, MD, anesthesiology.

YNHH has pledged $5,000 to a fund that the Community Foundation for Greater New Haven will administer for relief and reconstruction in Haiti. Additionally, the hospital collected medical equipment and supplies worth more than $25,000 that were shipped to Haiti via AmeriCares.

Hand hygiene update

While hand hygiene awareness at YNHH has increased, we need to continue to improve compliance rates. During fiscal year 2009, our hand hygiene compliance before patient contact was 81 percent and after patient contact it was 91.1 percent. During the first quarter of FY10, overall compliance for all staff has been 84.9 percent before patient contact and 89.9 percent after. During that same time period, the physician-specific hand hygiene compliance rate was 82.6 percent before patient contact and 86.6 percent after patient contact — both lower than the overall staff average.

Last year, YNHH launched the hand hygiene coaching program, and to date, more than 250 front line staff across various services have been trained as hand hygiene coaches. Part of the coach's role is to work with colleagues and remind them to perform hand hygiene. Please be receptive if a coach approaches you with a reminder about hand hygiene. Several physicians have been trained as coaches. If you are interested in becoming a hand hygiene coach, contact Dr. Louise Dembry at dembry@ynhh.org

YNHH's hand hygiene video, "It's In Our Hands," is available to all staff on the YNHH intranet: Go to the hospital home page and click on the link for YNHH Channel.. Or, if you would like to view it on a DVD, contact your department or section chief, all of whom have copies.

Dr. Morris to head new initiative

Under the direction of the Chief of Staff's office, YNHH has created Physician and Patient Access Services to develop a consistent, streamlined patient transfer process for all departments. Victor Morris, MD, medical director of the Hospitalist Service and associate Chief of Staff, has been promoted to the position of administrative director for the new service. Dr. Morris will lead all aspects of an enhanced system for improving patient access and bed assignment at YNHH. He will direct the implementation of a dedicated Access and Transfer Center — a first for Yale-New Haven and an important component in our efforts to serve as a destination hospital. He will continue to chair the hospital-wide Safe Patient Flow Executive Committee.

Dr. Morris received his BS from Stanford University and his MD from University of California, San Diego. He served his residency in internal medicine at YNHH, and was appointed chief resident. In 1994, he became the first assistant chief of staff; simultaneously, he worked with Dr. Leo Cooney, medical director of care coordination. He has provided oversight to the Internal Medicine Consult Service and, since 2000, has been medical director of clinical effectiveness. His responsibilities have been expanded regularly to include oversight of all bed resources at YNHH and the direction of the Hospitalist Service, which has experienced dramatic growth under his leadership. He has won numerous teaching awards, including the Teacher of the Year, awarded by the internal medicine house staff.

YNHH establishes Aortic Disease Institute

YNHH has established an Aortic Disease Institute that will be dedicated to both clinical care of patients with aortic aneurysms and research of aortic diseases. The new institute will be led by John A. Elefteriades, MD, chief of the section of cardiac surgery, William W.L. Glenn Professor of Cardiothoracic Surgery at Yale School of Medicine, and an internationally known aortic surgeon.

For more than a decade, Dr. Elefteriades and his research team at Yale have studied aortic diseases — affecting thousands of patients. The Aortic Disease Institute will be one of the first, if not the very first, such formally designated institute. It is one of the largest centers in the world for clinical care of patients with aneurysms and will be one of the most active centers for basic science and clinical research in aortic diseases.

Post-Smilow bed planning

More than a year of planning and preparation has gone into the post-Smilow bed allocation at YNHH. The driving force has been to "get the patient into the right bed the first time." Both physician and hospital leadership were engaged in the bed planning process — including chairs/chiefs of all departments and sections, management, service line leaders and others. The groups examined service-specific patient volume, ensuring an adequate number of beds for all services, the best allocation of space, and future growth needs.

Key goals were to move all oncology beds to Smilow; enhance the patient care environment with increased private rooms and elimination of all triple bed rooms in the other pavilions; increase the number of YNHH ICU beds; cohort beds along a service line model; and right-size medicine and surgery units. The process utilized occupancy planning targets to minimize off-service placements, maximize capacity for direct admissions, ensure safe emergency department flow and optimize new staffing patterns at the unit level to address patient day allocations and caregiver hour requirements.

As patients begin to be relocated to the inpatient Smilow units, implementation of the new bed plan will be staggered throughout 2010.

YNHHS annual Joint Commission accreditation update

The Department of Performance Management will present the YNHHS annual Joint Commission accreditation update on Thursday, February 11, 7:30 a.m. -4:30 p.m. in Harkness Auditorium. VHA will provide a custom education program for Yale New Haven Health System on Joint Commission accreditation. The program will identify changes in the continuous accreditation process, outline revised hospital standards and describe the National Patient Safety Goals for hospitals. Dr. Mark Donavan, a former TJC surveyor, and Ms. Diana Scott, RN, VHA accreditation consultant, will be the speakers. To register online, go to the Yale New Haven Health System intranet and scroll down the home page for the article on "Joint Commission accreditation update." For additional information, contact Ella D. Williams, 203-688-8692 or ella.williams@ynhh.org

2010 Patient Safety and Clinical Quality Conference set for May 6

The 2010 Yale New Haven Health System Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held on Thursday May 6, at the Trumbull Marriott Hotel. The conference provides an opportunity for individuals throughout YNHHS to meet and discuss activities related to patient safety and quality. This year, Matt Williams, executive vice president at the Martin Agency, will speak about methods to promote engagement in the quality and safety message. The YNHHS Performance Management Department invites you to present your project at the 2010 Conference. The deadline for the project abstract is February 15. For abstract submission guidelines and registration details, contact Darriell Rolka at 203-688-8692 or darriell.rolka@ynhh.org

Laboratory Medicine implements new information system

On February 7, YNHH Laboratory Medicine will implement a new comprehensive laboratory information system that will provide more functionality, scanning of complex results into SCM, streamlined centralized tracking of specimens, improved turnaround times, and improved printed reports. Within the hospital, most of these changes should be transparent to users of SCM and Centricity, although there should be improvements in some aspects of test display. In other news, the department of Laboratory Medicine will be moving to the new 55 Park Street building in April.

Advanced Vascular Imaging Services opens

Yale-New Haven's accredited Advanced Vascular Imaging Services program has officially opened, combining the resources of the main Diagnostic Radiology group and the outpatient services of Temple Radiology to provide advanced technology and expertise to diagnose vascular disease. Venous and arterial evaluations will be provided, including abdominal aortic aneurysm and cerebral vascular evaluations. Renal dialysis access site and vein mapping services are also available. Patients diagnosed with vascular disease can be treated at the physician's request by the multidisciplinary team of physicians and nurses at the Heart and Vascular Center.

The imaging labs are located at the main campus in the North Pavilion, Long Wharf Medical Center and Shoreline Medical Center. To schedule a patient exam, physicians should call (203) 688-2433 in New Haven or (203) 453-7272 in Guilford.

Influenza update

YNHH Occupational Health Services (OHS) continues to offer both 2009 H1N1 vaccine and seasonal flu vaccine, at no cost to members of the Medical Staff. You can stop by OHS on the first floor of the East Pavilion (past the Max Taffel Room) anytime between 7:30 a.m. and 4:15 p.m., Monday through Friday.

While nearly all influenza which has circulated to date in the U.S. has been the 2009 H1N1 (Swine) flu strain, there have been sporadic reports of seasonal influenza in both the U.S. and abroad. It is not possible to predict when or how much seasonal influenza will circulate in the coming months, and we urge all staff who have patient contact be vaccinated.

Ambulatory Electronic Medical Records (AMR)

One of the most exciting and challenging aspects of the American Recovery and Reinvestment Act of 2009 is the stimulus for physicians and hospitals to develop AMRs. The provision of partial support for AMR "meaningful-use" implementation was coupled with the threat of reduced future Medicare reimbursement for those left behind.

YNHH and Yale School of Medicine undertook a search over several months for an AMR that would provide a full spectrum of functions, including a patient portal, and would be inter-operable across the continuum of care, including community and university physician offices. We are very close to a decision on the best system for our hospital and its physicians and should shortly have information on implementation and costs.

Patient privacy reminder

As part of Service Excellence, YNHH has convened a Patient Privacy Committee, which is examining ways to help protect patients' privacy and the confidentiality of their protected health information. All members of the Medical Staff are reminded not to discuss patient information in public areas, such as elevators, lobbies or cafeterias. When in patient rooms, please ask the patient for permission to discuss his/her care in front of anyone else in the room. Close doors, draw curtains and lower your voice when possible.

New East Haven blood station

YNHH has opened a new blood draw station at 317 Foxon Road, East Haven. It is open M-F, 7 a.m.-4 p.m. (closed 12:30-1:30 p.m.). This draw station can fulfill requisitions from other labs; major insurances are accepted and no appointment is necessary. Phone: 203-466-5550.

YNHH accredited as Chest Pain Center

YNHH has received a three-year accreditation as a "Chest Pain Center with PCI" from the Society of Chest Pain Centers (SCPC), a non-profit international society dedicated to improving care for patients with acute coronary syndromes. The hospital underwent a full-day site visit in late November. The rigorous accreditation process examines the hospital and its policies, processes and performance measures for diagnosing and treating patients with acute coronary syndrome. Yale-New Haven is the first and only hospital in Connecticut to receive Cycle III accreditation — the highest designation given by the SCPC.

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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