Contents - August/September 2011
A message from the Chief of Staff
A decade ago, when YNHH created a Patient Safety Task Force, we identified four programs for initial focus: Patient Safety Culture, Medication Safety, Hand Hygiene and Patient Identification. Amazingly, these remain works-in-progress, which speak volumes about the complexity of performance improvement in healthcare. We still regularly evaluate our culture of safety, and nurses and physicians indicate we have more to do before every clinical staff member considers patient safety the first priority.
This summer we established focus groups throughout our nursing units to fully evaluate where we can make progress. Medication Safety initially concentrated on high-risk medications, particularly narcotics and anticoagulants. Much energy is now being directed towards chemotherapeutic agents, an effort led by senior clinicians in Smilow. In addition, our pharmacy is carefully monitoring the proper use of "smart" infusion pumps which contain a drug library and both "soft" and "hard" limit alerts. There has been a dramatic improvement in the drug library utilization rate, from 60 percent to 84 percent over the last four months.
Hand Hygiene compliance is currently at 94.5 percent when we average rates before and after patient contact. While earlier campaigns to improve hand hygiene had an inpatient focus, now ambulatory areas, including the Emergency Department, have picked up the baton.
Patient Identification at its onset was centered on ensuring that all inpatients had a legible wrist ID bracelet throughout their hospital stay. The initiative was considerably broadened over the years to include mandatory use of two identifiers before procedures or treatments; and more recently, the initiative was expanded to ensure compliance with the "Time Out" protocol. This month we dispatched two observers to more than 100 inpatient and outpatient care sites to review current practices in patient identification and to collect many local policies related to this matter. In more than 30 percent of observations, good practices were not followed and we will be undertaking an institution-wide effort to standardize policies and practices. Physicians generally did better verifying identity than did other clinicians, but there remains room for improvement to avoid real harm to patients.
Save the date — October 22 — Yale-New Haven Medical Center Cabaret
The Yale-New Haven Hospital Auxiliary is sponsoring an Evening of Cabaret talent show, featuring the "I.V. League Stars of Yale-New Haven Hospital and Yale School of Medicine," on Saturday, October 22, at 7:30 pm in Harkness Auditorium. A patron reception begins at 5:30 pm in the Medical Historical Library. The honorary co-chairs are Marna P. Borgstrom, president and CEO, YNHH, and Robert Alpern, MD, dean, Yale School of Medicine. Admission to the show is $25 and to the patron reception is $100 (includes show). For more information or to RSVP, contact the Auxiliary at email@example.com or 203.688.5717.
Performance management update
At left are the CMS/TJC core measures for the most recently available three-month period. Comparing ourselves to the national 90th percentile for each measure, we continue to perform well while there is room for improvement. In bold are the 11 measures that will determine our outcome in the CMS Value-Based Purchasing (VBP) program. Recall this is a pay-for-performance program that will link Medicare payment to quality performance in acute care hospitals. The performance period that determines our VBP payment began July 1, 2011. Two measures have been particularly challenging, specifically the 6 a.m. post-op glucose after cardiac surgery and the prescription of beta blockers in the perioperative period. In July, pharmacists and pharmacy residents began to help ensure that either the correct care is given, or if contraindications are present, that the latter are documented.
Our 30-day readmission rates for CHF, AMI, and pneumonia, as of July 2011, will also partly determine our Medicare payments. We have higher-than-average readmission rates and may experience a payment reduction. Discharges after July 2011 will impact payment since our historical performance is worse than the national average. A multidisciplinary hospital-wide Readmissions Committee, chaired by Drs. Leora Horwitz and Grace Jenq, has been working over the past year to address our readmission rate. We have discussed the elements of this program in the past, and now are beginning to see reductions in CHF readmissions but not pneumonia readmissions. YNHH underwent a Department of Public Health (DPH) licensure evaluation in July and the visit went very well. The DPH spent a total of 26 surveyor days over one week at YNHH, exited with many complimentary observations about the care delivered here, and relicensed the institution for two years. This was an extremely positive outcome for the organization reflecting efforts of our staff and medical staff over the past year. Many thanks for your help with these initiatives and for your care of our patients.
If you have any questions or concerns, please do not hesitate to contact Tom Balcezak, MD, at 203.688.1343.
YNHH Heart and Vascular Center offering promising clinical advances
YNHH’s Heart and Vascular Center offers innovative treatments to patients, most recently in the areas of aortic stenosis and heart failure.
YNHH is one of 40 centers participating in the CoreValve trial to evaluate a new, non-surgical alternative to open-heart surgery for patients with severe aortic stenosis. The CoreValve System offers minimally invasive, non-surgical treatment for patients with severe aortic stenosis who are at high risk or ineligible for open-heart surgery. The new valve replacement procedure channels a catheter with a prosthetic valve through the femoral artery to reach the heart. Craig Thompson, MD, and John Elefteriades, MD, are the principal investigators.
The Center for Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplantation provides comprehensive evaluation, management and treatment for patients with heart failure. Under the direction of Abeel A. Mangi, MD, the center is one of a handful of programs in New England certified by The Joint Commission to implant left ventricular assist devices into patients with end-stage heart failure as a permanent or destination therapy.
155 is new emergency phone number for YNHH; emergency codes also change
The emergency telephone number for all of Yale-New Haven Hospital’s inpatient and outpatient facilities will change from 911 to 155 on October 3. Do not dial 9 before the 155, since 155 is an internal number only. This includes any areas of the hospital that use the 688- and the 200- telephone prefixes — including:
- U.S. News & World Report
- South Pavilion
- North Pavilion (Smilow)
- West Pavilion (YNHCH)
- New Haven Unit
- Yale-New Haven Psychiatric Hospital
- Primary Care Center
- 55 Park Street
- 2 Howe Street
- 150 Sargent Drive
- One Long Wharf
- 40-60 Temple Street
- 300 George Street
- 425 George Street
- Medical Center South
- 1 Church Street
- Howard Avenue properties
- Infant Toddler Center
The YNHH areas which have 688- phone numbers in the Yale Physicians Buildings will also change to 155. In addition, three of our major emergency codes will change:
- Fire (formerly Order #1) will become Code Red
- Adult resuscitation (formerly Code 5) will become Code Blue.
- Pediatric medical emergency (formerly Code 7) will become Code White.
- Disaster code will remain the same: Code D.
There are several important reasons for the changes: to comply with CT Department of Public Safety requirements; to begin the move toward standardization of emergency phone numbers and code names for all three Yale New Haven Health System hospitals; and to use codes that are more nationally accepted.
Walk-through demonstrations show benefits of Epic in hospital setting
Last month, nearly 500 physicians, nurses and staff members from YNHHS hospitals learned how the Epic electronic medical record and related software will work in the hospital setting. Presentations, led by physician, clinical and operational subject matter experts from the hospitals, highlighted key Epic features and the benefits of a fully integrated electronic medical record and revenue cycle/access applications.
Two exciting features of Epic demonstrated were barcode scanning of medications and e-signature pads. Barcode technology will ensure that the five "rights" of drug administration — the right patient, drug, dose, route and time — are satisfied. E-signature pads will provide the ability to capture patient signatures electronically on HIPAA forms and other registration documents, including patient consent for anesthesia prior to surgery.
One of the most novel features, demonstrated by one of our patient-family advisors, was access to the MyChart patient portal that allows patients to see results and other portions of their medical records, stay up-to-date on their current health issues and communicate with their physicians. MyChart can dispense discharge instructions, including diet and activity recommendations.
We are pleased to welcome four independent community affiliates who have signed Epic agreements with YNHHS: Asis Medical of New Haven; Preston Lurie, MD, PC of Rye Brook, NY; Main Street Medical (Chioma Nwangwu, MD) of West Haven; and Obstetrics, Gynecology & Menopause Physicians, PC (Thomas Hanson, MD, and Steve Fleischman, MD) of New Haven.
If you are interested in reviewing the service agreement or want to have an in-office Epic EMR demonstration, please contact Project Epic at 203.200.EPIC.
YNHH handles record inpatient census through Safe Patient Flow
On Wednesday, July 27, YNHH had a contact census of 1,021 patients and a midnight census at 940 — an all-time record. But the Safe Patient Flow initiative, implemented in 2008, demonstrated its effectiveness and enabled the hospital to safely handle the extremely high numbers of patients we have had over the past 14 months, particularly this summer. Despite the high volume, there have been no cancelled surgeries and no emergency department diversions.
Safe Patient Flow anticipated the growth in volume and put several plans in place:
- 11 a.m. discharges have increased from about 9 percent to over 20 percent, allowing for faster bed-turnover
- Sophisticated software allows patient transporters to function within a geographic zone rather than respond to as-needed calls that might be a distance away
- Sophisticated bed management software flags the status of every bed in the hospital and alerts environmental services staff to clean rooms as soon as they are available
- When necessary, use of double and triple rooms, as well as converted solaria
- The new 14-bed observation unit on EP 5-7
- The 28-bed short-stay medicine unit on EP 4-7
- Careful patient triage in the emergency department and appropriate use of the new Y-Access transfer center that helps physicians from outside YNHH transfer and admit patients
New pediatric transplant unit opens on West Pavilion 8
A new Children’s Transplant Unit opened on 8 West Pavilion in July to care for children who have had liver, kidney and bone marrow transplants. The medical director is Deborah Chirnomas, MD. Interim patient service managers are Lucy Lano, RN, and Rebecca Ciaburri, RN.
Attending and leadership notes
- Rosemarie Fisher, MD, associate dean of graduate medical education and professor of medicine (digestive diseases), received the highest honor bestowed on internal medicine educators, the Dema C. Daley Founders Award, by the Association of Program Directors of Internal Medicine. Dr. Fisher is also the new chair-elect of the Council of Academic Societies (CAS), one of three leadership councils of the AAMC, along with the Council of Deans and the Council of Teaching Hospitals and Health Systems. The CAS is presently comprised of nearly 90 academic societies devoted to biomedical and behavioral research, medical education and patient care.
- Marna P. Borgstrom, president and CEO of Yale-New Haven Hospital, was named to the 17-member Association of American Medical Colleges (AAMC) 2010-2011 board of directors. Marna will serve a two-year term on the AAMC governing board, which represents all 133 U.S.-accredited and 17 Canadian-accredited medical schools. She recently became chair-elect of The Council of Teaching Hospitals administrative board, and will become chair in November 2012. Marna was also elected to the board of directors of the Coalition to Protect America’s Health Care, effective November 2011.
Dr. Hellenbrand appointed chief of pediatric cardiology
William E. Hellenbrand, MD has been appointed chief of the section of Pediatric Cardiology effective September 1, 2011. Dr. Hellenbrand is well known to many at Yale School of Medicine and Yale-New Haven Hospital, having begun his clinical training as a resident in Pediatrics at Yale-New Haven. For the past five years, Bill has served as the Chief of Pediatric Cardiology at Columbia University Medical Center and Weill Cornell Medical Center. Prior to joining Columbia, Bill served as Clinical Director of Pediatric Cardiology at Yale, and rose through the ranks to become Professor of Pediatrics and Diagnostic Imaging.
Dr. Hellenbrand is one of the top pediatric interventional cardiologists in the world. He has been a pioneer in the development and implementation of new, innovative devices and techniques in catheterization. Dr. Hellenbrand will be collaborating with colleagues in Surgery to build a new statewide program in congenital heart surgery in collaboration with Connecticut Children’s Medical Center.
David Yuh, MD, appointed new chief of section of Cardiothoracic Surgery
David Yuh, MD, has been appointed chief and chair of the section of cardiothoracic surgery at YNHH and Yale School of Medicine. Dr. Yuh was previously director of cardiac surgical robotics and director of cardiac surgical research at Johns Hopkins. He specializes in minimally invasive robotic surgery, as well as all types of adult cardiac surgery, including heart transplantation and the implantation of mechanical cardiac assist devices. Dr. Yuh’s research interests are in the development of robotic sensory feedback capabilities and computerized motion-tracking recognition to enhance surgical robotic training. His other research focus is in improving cardiac surgical outcomes in elderly patients. Dr. Yuh received his undergraduate and medical degrees from Stanford University. He completed residencies in general and cardiothoracic surgery at the Stanford University Medical Center.
First Dr. Magen Marcus Hospital Medicine Symposium — September 25
The First Annual Dr. Magen Marcus Hospital Medicine Symposium will be held at the Anlyan Center on Sunday, September 25, sponsored by the YNHH Hospitalist Service and the Yale School of Medicine department of Medicine. The program offers 5 AMA PRA Category 1 Credits. For more information, call 203.785.4578 , or register online at cme.yale.edu.
Kimberly Davis, MD, named surgical director, performance and quality improvement
Kimberly A. Davis, MD, Trauma medical director for YNHH and associate professor of Surgery, section chief of trauma, surgical critical care and surgical emergencies at Yale School of Medicine, has been named surgical director, performance and quality improvement, surgical services. In this new position, Dr. Davis will be responsible for the design and implementation of quality and patient safety initiatives for the Surgical Services. She has also been appointed YNHH’s surgeon champion of the National Surgical Quality Improvement Program of the American College of Surgeons. Dr. Davis earned her BS from Yale University and MD from Albany Medical College. She completed her residency at Rhode Island Hospital, before serving a fellowship in trauma and surgical critical care at the University of Tennessee.
Yale-New Haven Hospital is recognized again by U.S. News & World Report
YNHH has been ranked at the national level in 12 of the 16 specialties surveyed. YNHH is the only hospital in Connecticut to be included in the U.S. News listings. Three specialties were ranked in the nation’s top 10: diabetes and endocrinology at #8; geriatrics at #10; and psychiatry at #10. Nine specialties were also ranked among the best in the nation: cancer; ear, nose and throat; gastroenterology; gynecology; heart and heart surgery; kidney disorders; neurology and neurosurgery; pulmonology; and urology. The entire national listing is available online at www.usnews.com/besthospitals.
November 30 program on Joint Commission accreditation
YNHHS Performance Management Department has engaged VHA to provide a custom education program for Yale New Haven Health System on Joint Commission Accreditation. The main objectives of this program are to: identify changes in and improvements to the continuous accreditation process; learn about the new and revised hospital standards; describe national patient safety goals for hospitals. This program is appropriate for staff involved in the accreditation process, medical staff officers, nurse administrators, performance management specialists, risk managers and department managers in clinical and support services. This year the conference will be held on Wednesday, Nov. 30, from 7:30 a.m. to 4:30 p.m. at the Trumbull Marriott.
YNHH vaccination abstract wins at Zaccagnino quality and safety conference
At the 2011 Yale New Haven Health System Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference, Yale-New Haven Hospital’s winning abstract was "Improving the Rate of Post-Partum Tdap Vaccination." The goal of the project was to protect infants from pertussis by increasing post-partum vaccinations of Tdap — tetanus, diphtheria and pertussis. Members of the winning YNHH team included Jeff Topal, MD, attending physician, Infectious Diseases; Marjorie Lazarre, PharmD, manager, Pharmacy Services; Lindsey Klish, PharmD, pharmacy resident, and Sarah Arnold, supervisor, both of Inpatient Pharmacy; Elizabeth O'Mara, patient services manager, Maternity and Well Baby Unit; Lorraine Lee, RPh, director, Pharmacy Services; and Thomas Balcezak, MD, associate chief of staff and vice president, Performance Management.
Norman G. Roth named chief operating officer of Bridgeport Hospital
Norm Roth has been named the chief operating officer of Bridgeport Hospital and senior vice president of Yale New Haven Health System, effective Sept. 1. He succeeds Hope Juckel-Regan, who retired at the end of June. Roth has been with Yale-New Haven Hospital since 1979, most recently as senior vice president for administration. He joined YNHH as the administrative director for emergency services and has since held a variety of posts, including director of unit service management, associate administrator, assistant vice president and vice president for administration. His accomplishments include the planning, design and completion of the 500,000 square foot Smilow Cancer Hospital, while maintaining responsibility for engineering, environmental services, facilities services, laboratory services, pathology, perioperative services, radiology and security. Prior to his joining Yale-New Haven Hospital, Roth held positions at Blue Cross/Blue Shield of Connecticut and the Veterans Administration Hospital in West Haven. Roth earned a bachelor’s degree in political science from the American University in Washington and a master’s degree in health care and hospital administration from George Washington University.