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Medical Staff Bulletin


April / May 2011


Contents

A message from the Chief of Staff

Yale-New Haven Hospital and the Hospital of St. Raphael (HSR) recently announced the signing of a letter of intent to consider integrating the two hospitals. There already has been considerable discussion with the Medical Staff about how this evolved but the background is worth restating. Almost a year ago, with no particular model or approach in mind, we began discussing how best to deliver care on selected services to avoid unnecessary duplication of resources and future investments. Over several months, it became clear that HSR felt compelled to join a regional or national partner to continue its mission. Options were explored. Ultimately, HSR senior management, board and sponsors, The Sisters of Charity of St. Elizabeth, recommended that integration with YNHH was the best way to ensure that HSR would continue fulfilling its founding purpose, caring for the elderly and poor in our community.

While HSR clearly has a strategic imperative, YNHH leadership also concluded that this was a unique opportunity to enhance healthcare access, cost effectiveness and quality in the New Haven region and beyond. Clearly, large efficiencies could be accomplished and the pressure on YNHH bed resources could be reduced. More importantly, united we could turn our attention to challenges of healthcare reform such as medical homes and broader accountability for care and outcomes. Currently there exist far too many barriers to our capacity to care for a population, but the success of an integration could break down many of these barriers.

Many have assumed this integration of two great hospitals is already decided but, in truth, we have just embarked on due diligence to determine its feasibility. If we conclude that integration makes sense, we will sign a definitive agreement in a few months and then begin a most arduous regulatory process. If we fail at any stage, one thing is certain: HSR will take another route and this opportunity will not present again in our lifetime.

Epic time is now

We have completed the second of four phases of the Epic EMR development, that dealing with "collaborative build and validation." Over 900 clinical and operations people have participated (community specialists, YSM faculty and chief residents). The next three months will be devoted to "build and adoption" and from July through September, we will engage in "testing and training." In October, we will begin bringing up ambulatory sites. Now is the best time to contact Dr. Steve Schlossberg, 203-688-4100 or steven.schlossberg@ynhh.org, and signal your practice's desire to be an early adopter. Before the YNHH inpatient services go live in Epic in 2013, all Attendings will spend 1.2 hours training on the system. There is no logical reason why they should have an independent office EMR. As noted in earlier mailings, prices and contracts are finalized. Our goal is "No practice left behind."

YNHH initiates reminder system to improve defibrillator therapy for patients at risk for sudden cardiac death

Implantable cardioverter-defibrillators have been well-demonstrated to save lives when used as primary prevention in patients with clinical characteristics indicative of high risk of sudden cardiac death, most importantly, a depressed ejection fraction. Current guidelines from the American Heart Association, American College of Cardiology and Heart Rhythm Society recommend use of ICDs for primary prevention in patients whose EF is

Sabina Lim, MD, to lead Yale-New Haven Psychiatric Hospital

Sabina Lim, MD, MPH, has been named administrative director of Yale-New Haven Psychiatric Hospital (YNHPH). Dr. Lim has worked in psychiatry at Yale-New Haven since 2005. She has been associate medical director of YNHPH since 2009 and acting administrative director since 2010. She is an assistant clinical professor of Psychiatry at Yale School of Medicine. Dr. Lim earned her BS from the University of Michigan, her Master's in Public Health from Columbia University, and her medical degree from State University of New York at Buffalo School of Medicine. She completed her psychiatry residency at Yale-New Haven Hospital and served as chief resident. She became the residency site training director for YNHPH and the associate residency program director for the Department of Psychiatry.

Attending Notes

John Leventhal, MD, medical director of child abuse programs and child abuse prevention programs at Yale-New Haven Children's Hospital, has been awarded the Miller-Sarkin Mentoring Award by the American Academy of Pediatrics (AAP). The award will be presented during the Pediatric Academic Societies annual meeting in Denver later this spring. The award honors the work of physicians Steven Miller and Richard Sarkin, who were killed in an airplane crash in Missouri in October 2004. Both were highly respected for promoting humanism and professionalism in medicine.

YNHH seeking advocacy support from staff, medical staff

The Hospital's Department of Community and Government Relations is looking for help from staff and members of the Medical Staff in grass-roots lobbying. Government officials in Hartford are in the process of creating the state of Connecticut's budget for the next two years. As part of his budget proposal, the Governor has proposed a 5.5 percent tax on hospitals and elimination of the uncompensated care pools. As the state's largest provider of care to uninsured and Medicaid patients, these proposals will result in a significant loss of much needed funding for Yale New Haven Hospital. If you would like to send an email or a postcard, contact Community and Government Relations at 203-688-2503.

The School of Medicine hosts bicentennial symposium April 28, 29

The School of Medicine will be celebrating its 200th anniversary with a symposium, "Biomedicine in the New Century," in Harkness Auditorium on Thursday and Friday, April 28 and 29. This event is open to the public. The school invites the entire YNHH and health system community, including community and referring physicians. Thursday speakers include: David Baltimore, PhD; Elizabeth H. Blackburn, PhD; Elaine Fuchs, PhD; Eric R. Kandel, MD; Sir Michael Marmot, PhD; Phillip A. Sharp, PhD; Harold E. Varmus, MD; and Huda Y. Zoghbi, MD. Friday speakers include: Michael S. Brown, MD; Robert M. Califf, MD; Joseph L. Goldstein, MD; Peter S. Kim, PhD; Robert J. Lefkowitz, MD; Susan L. Lindquist, PhD; and Charles L. Sawyers, MD. The symposium is free and open to the public. For details, visit http://medicine.yale.edu/ysm200/news/symposium.aspx

Plans to help alleviate bed capacity issues

YNHH is taking several steps to help deal with a record high census over the past few months. Patients who do not appear to require hospital-level care, but who require observation and short-term treatment, currently receive care on a number of inpatient units. To increase efficiency of their care and related documentation, as well as to create inpatient beds for those of higher complexity, a 26-bed observation unit will be established on EP 5-7. While 5-7 is being renovated, eight temporary observation beds will open on EP 6-7 on May 2. On July 1, EP 5-7 will open with 14 beds, and will expand to 26 beds on October 1. The observation unit will have no impact on YNHH licensed beds and ultimately will care for 13 general medical and 13 cardiac patients. Medical oversight will be provided by a Hospitalist, with general medicine and cardiac PAs.

A 25-bed short-stay medicine unit on 4-7 is also helping to free up more beds in the Hospital. A Hospitalist team cares for the short-stay patients and is responsible for their efficient discharge.

In addition, YNHH plans to submit a certificate of need application to the state Office of Health Care Access later this spring to request an additional 70 beds. We will keep you updated on the progress of this.

Home health care and attending responsibility

The Patient Protection and Affordable Care Act has imposed new physician documentation requirements if patients are to receive home healthcare services. Simply stated, attending physicians must evaluate patients, face-to-face, determine if indeed patients will be homebound and require services, and then document this fact and order the services. Physicians may ask physician assistants, nurse practitioners, clinical nurse specialists or certified nurse midwives (but not physicians in training) to do the face-to-face evaluation, but nevertheless must verify the need and document this on the W-10. Dr. Herbert has sent practical details for the W-10 to all members of the medical staff which, if misplaced, can be obtained by calling 203-688-2604.

191 YNHH physicians among Connecticut Magazine's "top docs"

The April 2011 issue of Connecticut Magazine has named 191 YNHH physicians among the best in the state in its annual "Top Doctors" issue. The YNHH physicians, who practice in a wide range of specialties, were among 837 doctors throughout the state selected from the results of a questionnaire sent to 5,000 Connecticut physicians and then combined with Connecticut Magazine's surveys from 2008-2010. In this year's survey, the focus was on eight specialties, including four new areas: bariatric medicine, nephrology, plastic and reconstructive surgery and pulmonary medicine, and spans 25 areas of expertise, from allergy and immunology to urology. To view the YNHH physicians on the list, go to Newsroom at www.ynhh.org

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