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Medical Staff Bullietin

November 2009

Contents

A message from the Chief of Staff

Six months ago, I wrote that we were developing plans to move from our hybrid (electronic and paper) medical records to a fully electronic medical record (EMR) in the next few months. Several departments and areas are already well along. The Pediatric Intensive Care Unit has done all physician documentation online for more than a year. The Trauma Service has been creating electronic progress notes for several months. The teaching (firm) services in the Department of Medicine have done all physician documentation online since the new academic year began in July, and the Hospitalist Service will soon follow next month. A systematic process to bring all attending physicians on board will begin soon. Currently, the YNHH Clinical Information System staff has been conducting training sessions in the physician lounge on the second Tuesday of each month from 6:30 to 8 a.m. An expanded schedule will soon be developed and communicated, consistent with each department's plans.

Our CMIOs, Drs. Nidhi Shah and Allen Hsiao, have worked with departments and sections to create and code more than 50 templates for SCM physician documentation. Each clinical department has identified one or more champions to lead the effort to come online. The agreed goal is to have physicians in every department doing electronic documentation by June 1, 2010. To this end, we plan to work with all resident and attending staffs in each department to accomplish this goal over the next six months.

In the meantime, we will work out protocols to bring scanned paper documents into the electronic record and deal with major process issues including lists, hand-offs, daily clinical viewers, and the dilemma presented by the capacity to forward and "cut and paste" documentation. We ultimately aim to create more effective, efficient and secure communication among all clinicians.

Patient and family centered care efforts underway

YNHH has embraced Patient and Family Centered Care hospital-wide and as our designated nursing model of care. The Patient and Family Centered Care Steering Committee is co-chaired by Drs. Peter Herbert and Sue Fitzsimons, with Jeannette Hodge and Cheryl Hoey as the department heads responsible for overseeing the implementation of patient and family centered care. Essentially, this is a commitment to patients and families in the planning and delivery of care. The core concepts of patient and family centered care include dignity and respect, information sharing, participation and collaboration. YNHH has three patient and family advisory councils (YNHH, YNH Children's Hospital and Smilow Cancer Hospital). The councils are comprised of patients, family members, members of hospital administration and members of the medical staff and nursing staff. Their focus is to work together to improve the patient experience. If you have questions or suggestions or would like to be more involved in the effort, contact Dr. Herbert.

Performance management update

At left are our publicly reported performance measures that are available at hospitalcompare.gov.

This year, we have set aggressive improvement targets in hand hygiene performance. Hand hygiene compliance hospital-wide, for the last quarter of our fiscal year 2009, was 85.4% before patient contact and 93.1% after patient contact. This is below our goal of 95%, but does represent a substantial improvement over each of the past seven years. In order to meet our goal in the coming year, a hand hygiene coach program has been launched throughout the institution and we are asking staff to provide a gentle but firm reminder to others who are observed not disinfecting their hands. These volunteer coaches come from a variety of clinical and support services and are deployed throughout the institution. From time to time, you may see these coaches or be approached by them and encouraged to disinfect your hands. We ask that you be gracious and open to these reminders and understand that we have made this a priority at Yale-New Haven Hospital. An outstanding hand hygiene program is absolutely essential and the cornerstone of efforts to prevent hospital-acquired infections. If you have any questions regarding any of this data or related issues, please call Dr. Tom Balcezak at 203-688-1343.

H1N1 and seasonal flu updates

YNHH continues to monitor the H1N1 and seasonal flu situation closely. As of November 1, the hospital restricted persons under the age of 18 from visiting and will reassess the restriction as the respiratory virus season continues to unfold. Adult visitors with fever, cough, sore throat, sneezing, runny nose or body aches are requested not to visit until their symptoms have resolved.

Starting in mid-October, cases of influenza-like illness and H1N1 flu have increased rapidly in Connecticut. YNHH admitted more than 40 patients with H1N1 flu in October and we expect the number of admissions for H1N1 to increase in November.

Unfortunately, HINI vaccine is arriving at a much slower pace than originally projected by the federal government. Connecticut has received less than one-quarter of the supply it had anticipated by early November, and YNHH, like other Connecticut hospitals, has received only limited quantities. The hospital follows Centers for Disease Control and Prevention (CDC) guidelines on prioritization of who should receive vaccine first. We have begun vaccinating the highest priority individuals, and we will vaccinate additional groups as more vaccine arrives on a weekly basis. We anticipate that eventually there will be enough vaccine for all patients and healthcare workers who wish to receive it.

We have taken steps to prepare for the possibility that the pandemic might strain our services. We have stockpiled personal protective equipment and supplies of medications and developed staffing plans for coverage in case a large number of staff are home sick, as well as clinical plans to handle large patient surges.

You can access up-to-date general information on 2009 HINI influenza and YNHH-specific guidance and information by clicking on the "HINI flu information" link on the YNHH intranet home page or on the Clinical Workstation by clicking on "Flu Resources."

Accreditation update

The Connecticut Department of Public Health (DPH), the Center for Medicare and Medicaid Services, and The Joint Commission are our main institutional accrediting bodies. We are also accredited for specific or subspecialty services by a large number of organizations, including the College of American Pathologists, the American College of Surgeons, the Nuclear Regulatory Commission, etc. Moreover, we embrace the recommendations made by these organizations in our attempt to continuously improve our services. We believe these organizations provide a vital function in validating the safety and quality of care we deliver.

We recently underwent a successful visit by the College of American Pathologists to our hospital-based labs, and an institutional licensure review by the Department of Public Health (DPH). In both of these surveys, we performed extremely well. However, some deficiencies were found and surveyors communicated recommendations. We are working to correct those deficiencies, and we ask that you follow hospital policies on dating and timing of notes, on hand hygiene and contact precaution compliance, and on adherence to time-out and other peri-procedural protocols. Your cooperation is vitally important for both the safety of our patients and for the continued accreditation of our institution and programs.

We are anticipating an unannounced visit from The Joint Commission some time in the next 12 months. This will be likely combined with a Joint Commission extension survey visit that will assess the care delivered in the 500,000 square feet of the new Smilow Cancer Hospital. As in the past, we will continue to conduct rigorous biweekly, house-wide unannounced Mock Surveys. Through these Mock Surveys, we occasionally find issues or concerns which we address through changes in policies, procedures, reminders or changes in our systems (e.g., electronic medical record). We provide communication with our large and diverse medical staff through this Medical Staff Bulletin, through direct mailings to physicians homes, and wherever possible, use of e-mail notification. If your contact information has recently changed, please call the Department of Physician Services at 203-688-2615 to correct this information.

Discharge medications

It is important that physicians no longer include discharge medications in their dictated discharge summaries. We made this request a few months ago, but it is still occurring. Centers for Medicare and Medicaid Services has notified us that our discharge summaries and official discharge medication lists are frequently at variance. Medical Records has noted several physicians who continue to dictate discharge medications. The official discharge medication list is completed on the nursing unit at the time of discharge. If you want to make any changes to it, you should communicate the change to the patient's follow-up physician or recommend the change in the body of the dictated summary.

Attention Medical Staff and Affiliated Medical Staff members

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

Report all equipment/device-related events

Hospitals are mandated to report events in which patients are harmed related to the use of medical devices. Medical devices are defined broadly and include disposable items, such as IV catheters, and plastic pieces of anesthesia circuits, as well as large mechanical or electrical devices like infusion pumps and ventilators. Hospitals must report to the FDA events which involve patient harm, even if a problem occurred due to incorrect usage. The hospital may also make voluntary reports to the FDA about malfunctioning devices even when no patient harm occurs. These reports ensure that manufacturers are aware of problems and are addressing them. Staff should therefore report all devices that have malfunctioned or are defective, or which are difficult or confusing to use.

Whenever a device is broken it should be removed from service and Clinical Engineering contacted via the Service Response Center, 688-9000. If a patient is harmed and a device was involved, notify your manager who will keep the device in his/her office pending appropriate notification being made. You should also complete an online event report (Peminic) - available on the clinical workstation under event reporting/equipment-related and you or your manager should call the Legal and Risk Services Department (688-2291). Never throw the device away or keep using it. Devices should be tagged and marked as having a Peminic report associated with them before they are sent to Clinical Engineering.

Failure to report mandatory events can result in a fine of $15,000 per occurrence or even criminal penalties. Voluntary reports help to improve device quality and patient safety.

Dr. Karen Santucci named chief of pediatric emergency

Karen Ann Santucci, MD, medical director of the Yale-New Haven Children's Hospital pediatric emergency department, has been appointed section chief of pediatric emergency medicine.

Dr. Santucci is an associate professor of pediatrics at Yale School of Medicine and has been an attending physician at YNHCH since 1999. She previously held emergency physician positions at Hasbro Children's Hospital in Providence, RI; Staten Island University Hospital in NY; and Kings County Hospital Center in Brooklyn, NY. After completing her undergraduate education at the College of Mount Saint Vincent, Dr. Santucci earned her medical degree at the State University of New York in Brooklyn. She completed her postgraduate training at Brown University.

NEW CME requirement for Connecticut state licensure

In addition to infectious disease, risk management, sexual assault and domestic violence, physicians licensed in Connecticut must also have one contact hour (50 minutes) of education in cultural competency every two years. This requirement begins with license registration periods beginning Oct. 1, 2010. The Yale School of Medicine CME office is working on adding online training in cultural competency. (See www.cme.yale.edu, under "online learning.")

More YNHH telephone changes

To meet the growing calling needs of state residents and businesses, Connecticut residents now have to use the area code when dialing local calls. Also, AT&T has added two new area codes in Connecticut. Area code 475 will be added to the area served by area code 203, and 959 will be added to the area served by 860. Callers still have to add "1" before long distance calls. The new 10-digit dialing will affect cell phones, fax machines, alarm systems, address books and call forwarding. If you have questions or need help, email the telephone management office at telecom.tmo@ynhh.org or call 688-2767.

Also, calls to Bridgeport and Greenwich hospitals are no longer long distance calls. They will be considered internal calls and just require seven digits.

Skin and wound care consultation update

Knowing that skin is our largest organ, it would make sense that skin assessment and care management would then be one of our biggest challenges. Skin and wound care consults may be made to Clinical Nursing Specialists during regular working hours Monday - Friday 8 a.m. - 4 p.m. Please consult Plastics during the night, weekend or holiday shifts for skin and wound management consults.

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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