The campaign for hand hygiene compliance at Yale-New Haven Hospital has entered a new phase — with citations to be issued for non-compliance. YNHH initiated the campaign to obtain 100 percent compliance with hand hygiene eight years ago. Initial progress was dramatic, with rates increasing from about 40 to 80 percent over the first two years. We were confident of our progress because anonymous observers made 20 observations each month on every inpatient care unit. Hand hygiene was particularly impressive after patient contact and somewhat less impressive before patient contact.
Progress over the last six years has been less than initially seen but always moving in the right direction. Many nursing units have regularly seen total compliance (before and after patient contact) exceeding 90 percent and success was evident among nursing, physician and other staffs. Still, as a hospital, we owe both patients and their families 100 percent compliance with simple measures that will lower their chance of suffering hospital-acquired infections.
We are certain that everyone who contacts patients in the Emergency Departments, operating rooms, procedure rooms, laboratories, clinics and nursing units understands why hand hygiene is so important. The topic has been addressed in orientation, videos, publications and presentations to all staff members. Still, about 10 percent of staff have not accepted the message or do not understand that hand hygiene is required, not just recommended. To these staff members, including members of the Medical Staff, we have asked senior managers to issue citations. An image of such a citation is included here in the Medical Staff Bulletin. These citations will be sent to the appropriate Senior Vice Presidents who will determine appropriate actions. Since non-compliance places patients at risk, repeat offenders will be subject to progressive discipline, up to and including referral to the Medical Staff Credentials Committee.
YNHH commitment to patient safety is absolute. It is likely in the future that personal accountability, as demonstrated in the Hand Hygiene/Contact Precautions citations, will be extended to other critical areas, including time outs, adherence to the universal protocols and others where negligence can threaten patient welfare.
In the column to the left, we have been presenting the month-by-month data for our CMS/TJC core measures. Last month we presented a three month roll-up for these measures, and we will continue to do that in order to free up space to show other hospital quality measures and to provide statistics reflecting secular trends.
This month we are presenting new data, reported by CMS on April 9, 2010, for 30-Day Risk Standardized Mortality and Readmission rates for three common disorders: acute myocardial infarction (AMI); heart failure (HF); and pneumonia (PN).
We are pleased that our performance was better than the average U.S. rate for all three mortality measures. In fact, we were one of only 95 hospitals in the country who were above the national average for mortality in AMI; one of only 199 for CHF; and one of only 222 for PN.
The data for readmission rates is a different story. Our readmission rate for AMI is no different than the national rate; however our readmission rate for heart failure and pneumonia is worse than the national rate.
The key drivers behind our high readmission rates are not so clear. We do know that our recent decrease in average length of stay and improvement in 11 a.m. discharge rates have not resulted in an increase in readmissions. Patients with shorter lengths of stay and earlier in-the-day discharge actually have a lower readmission rate. Additionally, a very small number of patients account for a very large number of readmissions, and the best predictive factor of a future readmission is a past readmission.
A small number of well done studies have demonstrated some success at reducing readmissions. Successful interventions have fallen into four categories:
- Enhanced care and support during care transition;
- Improved patient education and self-management support;
- Improved patient education and self-management support;Multidisciplinary team management; and
- Improved patient education and self-management support;Patient centered care planning at the end of life.
The Care Coordination staff, led by Kathy Tynan-McKiernan, follows up every discharge at Yale-New Haven Hospital with a telephone call asking about the care transition. Issues and problems are followed up by the floor nursing staff and/or other members of the care team, as needed. Physicians are notified when their patients are readmitted within seven days by Dr. Bill Crede from Quality Improvement Support Services. In addition, we are piloting several other initiatives to improve care transition. These will be described when outcomes are available.
If you have any questions regarding any of this data or related issues, please call Dr. Tom Balcezak at 688.1343.
At its April 7 meeting, the Medical Board considered whether Medical Staff dues should continue to be charged to members of the attending, associate and courtesy Medical Staff. Dues were established in 2001 and have been used to fund stipends for Medical Staff members who serve as officers as well as for programs that support the training and education of House Staff and fellows and initiatives that encourage collaboration between Medical Staff and trainees. In 2009, the Medical Staff dues were reduced to $50. The Medical Board voted in favor of continuing to collect dues and to increase the annual dues amount for 2010 back to $100 per Medical Staff member in the aforementioned categories.
Dues collected each year from members of the active and courtesy staffs are placed into a fund held by the Medical Staff and administered through the Medical Board. The fund provides annual stipends to the Medical Staff President and Secretary/Credentials Chair. Additionally, each year, members of the Medical Staff receive an application to apply for funding for projects that support the Medical or House Staff or their efforts to improve local, national or international health. Below is a summary of the requests approved for funding in 2010.
- Harkness gym membership for House Staff and clinical fellows
- Educational (conference attendance / publications) support for clinical fellows
- Entering the workforce seminar for House Staff
- Community Health Care Van
- Medical missions abroad by Medical Staff members from plastic surgery, general surgery and digestive diseases
- Medical Center Orchestra
- Project Access/New Haven
- Pediatric International Health Curriculum
- Ray Wong, MD Scholarship
- Yale/Harvard tailgate event
- Pediatrics "Adopt-a-doc" home visit program
- Habitat for Humanity
- Donations to support AmeriCares and Medical Staff in their relief efforts to Haiti
The new Boutique at Smilow Cancer Hospital, which opened in mid-May, offers breast prostheses and specialized apparel for women who have had a mastectomy, hair alternatives, products to manage symptoms of lymphedema and much more. Located right off the Smilow Cancer Hospital lobby on Park Street in New Haven, the Boutique is open to the public and patients who have received treatment at other hospitals. The Boutique hours are Monday-Friday, 9 a.m. to 5 p.m.; Saturdays by appointment. Telephone: 203-200-CARE (2273).
The Nuclear Medicine Department, which recently relocated to Smilow Cancer Hospital, has expanded its PET/CT capability. YNHH has purchased two new GE PET/CT scanners with the latest state-of-the art technology and is able to accommodate many more patients.
A PET/CT scan provides the information of a PET and a CT scan. Merging the data permits irregularities on either scan to be better characterized. Approved indications are brain metabolic and perfusion evaluation and various malignancies, including breast, colorectal, head/neck, lung, melanoma, lymphoma, thyroid, small cell lung, ovarian, cervical sarcoma, testicular, pancreatic and multiple myeloma. For more information or to make a patient referral, contact Nuclear Medicine at 203-200-5610.
Yale-New Haven Hospital and Yale Medical Group have collaborated on developing a transfer center which will facilitate patient transfers to the hospital. Under the direction of Dr. Victor Morris, a new access phone number and process will be created within the hospital bed management department. Called Y-ACCESS, the service offers a single toll free phone number that will be available to physicians around the clock and staffed by clinicians to ensure seamless transfer of patients to the medical center, as well as ongoing communication between the referring and receiving physicians. Over the summer, Drs. Ronald Vender and Victor Morris will be meeting with and updating clinical leadership about the new center. More detailed information about Y-ACCESS will be available over the next few weeks.
Medical identity theft is on the rise nationwide. It commonly occurs when someone falsely uses another person's name, social security number, health insurance identification or benefits information in order to obtain medical services or products or reimbursement from insurers. To protect our patients, we all need to be familiar with the new Federal Trade Commission (FTC) requirements to prevent identity theft. Hospitals are subject to the FTC's "Red Flags" Rule requiring the adoption of written prevention programs designed to prevent, detect and mitigate medical identity theft. Enforcement of these new requirements began June 1, 2010.
The Hospital has developed an identity theft program which includes policies that identify, detect and respond to "red flags" - patterns, practices, activities or incidents that potentially implicate identity theft. Please take time to view the policy on the YNHH Intranet: "Policies;" "YNHH Administrative Policy and Procedure Manual;" "Non-Clinical Policies;" "Identity Theft Program, NC: I-6."
The Health Information Management Department now offers dictation services for Inpatient History & Physical using the Health Information Management Department (Medical Records) dictation system. Once the report is transcribed, a copy will be uploaded to ChartView, Sunrise
Clinical Manager (SCM), Centricity and MD Link. A copy will automatically be faxed to your office.
Please dial 688-6406 (internally) or 203-688-6406 (externally) to access the dictation system:
- Enter Work Type No. #9 (History & Physical) < followed by the # key.
- When prompted, for Subject No., Enter the Medical Record Number followed by the # key>
- Begin with an introduction of dictator; e.g. "This is Doctor [NAME] dictating a History and Physical on [NAME].
- If you have questions, please contact Elaine Tarini, senior manager, Record Analysis/Transcription at 203.688.2224 or Maria Frey, transcription supervisor at 203.688.3398.
The hospital and medical school are conducting a search for a new Chief of Cardiothoracic Surgery. In the interim, John Elefteriades, MD, has agreed to retain responsibility for the academic and research initiatives of the Section until a new Section Chief is chosen. Dr. Elefteriades was recently named director of the newly formed Yale-New Haven Aortic Institute.
Sabet Hashim, MD, has accepted a new role as Interim Clinical Chief of Cardiac Surgery. In this position, Dr. Hashim will have overall responsibility for all aspects of clinical care in the section, including matters related to clinical program and faculty development. He will also serve as the section's representative on the Executive Committee of the Yale-New Haven Heart and Vascular Center.
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