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Medical Staff Bulletin

Contents — December 2011 - January 2012

A message from the Chief of Staff

We wish all members of the Yale-New Haven Hospital Medical Staff a healthy and prosperous 2012. Thank you for so much support in 2011, particularly in your care of our patients and our efforts to make patient care here safer and more efficient. This has been the busiest year in the history of the Hospital. We had a midnight census of greater than 820 patients every month in 2011 (with the exception of the December lull), and a contact census of greater than 1,000 patients on many days. We managed these high volumes without compromise of service because of interdepartmental efforts to coordinate discharge in the morning rather than in the late afternoon. In 2011 the Y-Access line, permitting ready transfer from other hospitals, became fully functional and accepted more than 3,500 transfers. Meeting the needs of neighboring hospitals would have been impossible if inpatient discharges were not well coordinated.

2011 was also the beginning of a new era of public reporting of quality metrics. The Centers for Medicare and Medicaid Services (CMS) launched programs ostensibly to pay for performance. One aspect of this, called value-based purchasing (VBP), defined rewards and penalties based on four medical and seven surgical measures. We are doing well on most of these measures, with the exception of prophylactic antibiotic selection before surgery (94% in our most recently reported month) and perioperative use of beta blockers (most recently 86%). Nearly 100% compliance is necessary to avoid penalties.

A second element of VBP is HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) where data reflect communication by our doctors and nurses, our responsiveness to patient needs and pain control, the cleanliness and quietness of the hospital, the adequacy of discharge information and the overall hospital rating. For any credit at all, CMS established a threshold score which is actually the median of all hospitals reporting. In no category of performance is YNHH currently below that threshold. In fact, for the last four months, YNHH has been at the CMS benchmark (95th percentile) in nurse communication, pain management, and overall hospital rating as judged by our patients. Moreover, physician communication is closing in on the national benchmark.

Another CMS pay-for-performance program targets readmissions of Medicare patients within 30 days. While post-acute care has never been the expected province of hospitals, we are nonetheless challenged to establish systems to minimize readmissions for the benefit of both patients and the economy of the healthcare system. The initial focus is on patients with congestive heart failure (CHF), myocardial infarction (AMI), and pneumonia. To date, we have made dramatic progress with CHF and AMI but pneumonia cases, often from ECFs, remain a problem.

In 2012, all of Yale New Haven Health System will see a renewed focus on hand hygiene, catheter-associated blood and urinary tract infections, and time outs/universal protocol before procedures. We will also drive standards for patient identification in both inpatient and outpatient settings. In all of these initiatives, we will need leadership from the Medical Staff and will be most grateful for your support. Thank you.

Physician practices enjoying Epic benefits

The Epic information and electronic medical record system continues to expand and more physician practices join each week. Yale Internal Medicine Associates (YIMA) was the first physician practice to go live with Epic in October, followed by Yale Diabetes Center and two Northeast Medical Group (NEMG) practices in November. Seventeen physicians are using the Epic EMR. From e-prescribing to documenting medications and allergies to transcription, the physicians and staff are growing comfortable with the applications and gaining proficiency, with 24/7 telephone support from the Epic team. The physicians using Epic are closing 80 percent of their encounters the same day of patient visits and prescribing nearly 90 percent of medications electronically. Transcriptions come back to physicians in about 90 minutes on average.

Ninety providers representing community practices have committed to using Epic by the summer of 2012. To date, over 235 patients have enrolled in the MyChart patient portal and about three more patients enroll in MyChart each day. MyChart is also now available to patients on iPhones and Androids.

Throughout 2012 and 2013, the Epic project team will continue to roll out the EMR to NEMG and Yale Medical Group practices, as well as to physicians in the community who contract with YNHHS to use Epic. With the project on track to go live at Greenwich Hospital in April, enrollment for training of Greenwich Hospital physicians and staff is underway and classes begin in February. In addition to the skills that they will gain from the training, physicians will earn CME credits for every hour of Epic class time. Yale-New Haven Hospital will go live on Epic in February 2013 and Bridgeport Hospital will follow in June of the same year.

Cardiac Rehabilitation Center completes its first year

YNHH's Cardiac Rehabilitation Center in Branford has completed its first year of service. Candidates for rehabilitation have come with a wide variety of diagnoses involving the heart and great vessels, and range in age from teenagers to octogenarians. In addition to treating coronary artery disease patients with coronary stents or bypass surgery, the center also serves those who have had valve replacements, aneurysm resections, left ventricular assist devices and heart transplants.

The program, certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, is under the direction of Dr. Michael Remetz, and includes a staff of five exercise physiologists who provide continuous monitoring while patients are exercising. In addition, patients are under the supervision of a physician staff that includes clinical cardiologists, interventional cardiologists and a cardiothoracic surgeon so that all aspects of a patient's care can be addressed.

A course of rehabilitation consists of 36 sessions that focus on aerobic exercise, resistance training, the use of free weights and stretching exercises. Videos and handouts instruct patients in stress management and modification of risk factors. A staff nutritionist meets with each patient to offer dietary instruction to aid in weight management, and control of cholesterol and diabetes.

Because of increasing evidence that cardiac rehabilitation makes a significant difference in patient outcomes, the center is instituting a database so that information can be retrieved and collated for clinical and statistical purposes.

Located in Branford at 84 North Main Street, the center is open from 8 a.m.- 7 p.m. on Mondays, Tuesdays and Thursdays, and from 8 a.m.-3 p.m. on Wednesdays and Fridays. For information, please call 203-483-3107.

New physician practices join NEMG

The Northeast Medical Group (NEMG) has completed its first anniversary as a network within Yale New Haven Health System and its membership now includes more than 350 physicians. NEMG is designed to create opportunities for better collaboration, quality of care and physician alignment. In addition to hospitalists at all three YNHHS hospitals, members of Northeast Medical Group include individual and group practices from Guilford, CT to Rye Book, NY:

  • Cardiology: Cardiovascular Services of Greenwich; Cardiac Specialists, PC (Fairfield, Danbury, Milford, Ridgefield and Trumbull)
  • Family Practice: Andrew Cutney, MD; Westport Family Medicine; Huntington Walk-In Center; Bhawna Gupta, MD
  • General Surgery: Breast Care Services of Greenwich; General Surgeons of Greater Bridgeport; Andrew Kenler, MD; Mill Hill Surgical Associates; Mary T. Pronovost, MD; Scott Thornton, MD
  • Geriatrics: Center for Geriatrics; Yale-New Haven Geriatrics
  • Hyperbaric Medicine: Greenwich Hyperbaric & Wound Care
  • Medical Oncology: Hematology & Oncology Associates of Greenwich
  • Internal Medicine: Joseph Evangelista, MD; Greenwich Internal Medicine; Charles Kochan, MD & David Lauren, DO; John H. Machledt, Jr., MD and Kristan Sikorski, MD; Shoreline Internal Medicine; Southern Connecticut Internal Medicine
  • Nutrition and Endocrinology: Greenwich Weight Loss and Diabetes Center
  • Obstetrics/Gynecology: Judy L. Boslow, MD; Joseph Cuteri, MD & Lindsey Bruce, MD; Greenwich Perinatology, PC
  • Pain Management: Pain Consulting Services
  • Pediatrics: Pediatric Associates of Rye Brook, NY
  • Pediatric Cardiology & Pulmonology: NEMG Pediatric Specialties
  • Podiatry: Bridgeport Podiatry
  • Radiation Oncology: NEMG Radiation Oncology of Greenwich
  • Rheumatology: Greenwich Rheumatology

Members of the Medical Staff who would like more information about NEMG can contact chief executive officer Robert Nordgren, MD, at 203-384-4391 or robert.nordgren@ynhh.org.

Smilow Cancer Hospital receives LEED certification

The U.S. Green Building Council has awarded LEED® (Leadership in Energy and Environmental Design) certification to Smilow Cancer Hospital in recognition of its successful sustainable design and construction strategies. The LEED Green Building Rating System™ is the nationally accepted benchmark for the design, construction and operation of high performance green buildings. Smilow's sustainable features include: optimum circulation of natural light in its lobbies, corridors and waiting areas to reduce energy consumption; use of occupancy sensors in non-patient spaces to further reduce energy usage; pumps with variable speed drives and room pressure monitors to reduce power usage for enhanced air supply. The facility also has upgraded air handling units which provide improved indoor air quality, low-flow water fixtures, low VOC (volatile organic compounds) paints and finishes, easy-to-clean solid surface finishes and epoxy paints in operating rooms to combat infections effectively.

Patient protected health information (PHI)

Please remember that documents containing patient names and other identifiers must be protected based upon the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Please make sure to dispose of such documents properly and do not leave them in areas that are accessible to individuals who are not involved in the patient's care. In the event that you print such materials for use in the Medical Staff lounge, please discard them in the confidential shred boxes before you leave.

New medical director for Maternal Special Care Unit

Sonya S. Abdel-Razeq, MD, has been named medical director of the YNHH Maternal Special Care Unit. She received her MD degree from the University at Buffalo School of Medicine in 2001. After completing an OB/Gyn residency at the University of Buffalo, she came to Yale for fellowships in maternal fetal medicine and surgical critical care and surgical emergencies before joining the faculty. Her clinical interests include maternal and fetal physiology and critical care obstetrics, with special interests in bacterial infection and inflammation, and management of critically ill obstetric patients.

Dr. Schwartz named interim chief of OB/Gyn

Peter E. Schwartz, MD, John Slade Ely Professor of Obstetrics, Gynecology and Reproductive Sciences, and vice chair, Gynecology, has been named interim chief of Obstetrics and Gynecology. Dr. Schwartz, a leader in the field of gynecologic oncology, received his medical degree from Albert Einstein College of Medicine and completed residency training at Yale-New Haven Hospital. He completed his fellowship in gynecologic oncology at MD Anderson Hospital and was appointed to the Medical Staff at YNHH in 1975. He has previously served as director of gynecologic oncology at YNHH and YSM, and both acting chair and vice chair of OB/Gyn.

Medical Oncology & Hematology, PC integrates with Smilow

As of January 1, 2012, the oncologists and staff — about 120 employees, including 25 nurses, two APRNs and 11 PCAs — of Medical Oncology & Hematology, PC (MOH), Connecticut's largest cancer practice, have integrated into Smilow Cancer Hospital at Yale-New Haven. Approximately 15,000 patients were treated by MOH oncologists in 2011. The 18 oncologists, all now members of the YNHH Medical Staff, Yale Cancer Center and Yale Medical Group, will continue to treat patients in the former MOH offices in Derby, Guilford, Hamden, New Haven, Orange and Waterbury, as well as at Smilow Cancer Hospital. Now called Smilow Cancer Hospital Care Centers, the seven sites offer chemotherapy on-site with concurrent radiation therapy available at most locations. Patients will also benefit from the resources of Smilow Cancer Hospital and increased access to cancer research and clinical trials through Yale Cancer Center

In addition to these seven sites, a Smilow Cancer Hospital Ambulatory Care Center will open on the Greenwich Hospital campus later this month.

Pediatric Dentistry Center moves to 1 Long Wharf

YNHH's Pediatric Dentistry Center has moved from 860 Howard Avenue to 1 Long Wharf Drive — a larger, modern facility with ample free surface parking and access to public transportation. The center provides comprehensive oral healthcare services, including fillings, crowns and emergency care and preventive care for children and adolescents up to age 21, and offers expertise with children with special needs and disabilities.

Dr. Peter Schulam named chief/chair of Urology

Peter G. Schulam, MD, PhD, has been appointed inaugural chief of the new Department of Urology at Yale-New Haven Hospital (YNHH) and chair of the department at Yale School of Medicine (YSM). Previously a section within the Department of Surgery, Urology has recently been elevated to departmental status.

Dr. Schulam joins us from the Ronald Reagan Medical Center at University of California at Los Angeles (UCLA) where he was vice chair of Urology, chief of the division of Endourology and minimally invasive surgery and director of both the kidney stone treatment center and the surgical living kidney donor program. Dr. Schulam was also a professor of urology and founder and co-director of the Center for Advanced Surgical and Interventional Technology.

Dr. Schulam has longstanding clinical interests in adrenal disorders, bladder, prostate and kidney cancer, donor neprhectomy, kidney stones and kidney reconstruction, and is nationally known for his expertise in minimally invasive surgery and laparoscopic techniques.

A native of New Haven, Dr. Schulam was a recipient of the Medical Scientist Training Program award and received his medical degree as well as his PhD in Immunology at Baylor College of Medicine in Houston. He completed his urology residency at the Johns Hopkins Hospital, Baltimore, Maryland.

We offer our sincere gratitude to Dr. Robert M. Weiss, Donald Guthrie Professor of Surgery, Urology, for his leadership of the section of Urology within the Department of Surgery. Dr. Weiss has served as chief of Urology, director of the Urology residency program, and director of the pediatric urology program for 25 years. From 1999-2001, he was the interim chair of the Department of Surgery and from 2004-2006, he was president of the YNHH Medical Staff. Dr. Weiss will continue in his active urology practice and laboratory research which received one of the Obama Challenge Grants and focuses on targeted siRNA nanotechnology for intravesical treatment of urologic diseases.

Admission of high-risk patients

Yale-New Haven Hospital has a higher than national readmission rate. To address our high rate of readmissions, we have created a new tool to identify patients at high risk for readmission. These patients are identified in the SCM banner by the abbreviation HRSK. They either have had more than four admissions in six months or have a primary or secondary diagnosis of congestive heart failure (CHF).

Admissions to medicine are monitored daily. If a high-risk (HRSK) patient is admitted, the attending physician and care coordinator are notified via e-mail and asked to create an integrated care plan note in SCM prior to discharge. The purpose of this note is to help future caregivers, especially in the Emergency Department, with the care of these patients by sharing the established plan of care and expectations.

If a HRSK patient is admitted to your service, please talk to the primary nurse and the care coordinator about the care plan and work with them to develop the integrated care plan note, or revise it if one already exists.

Bridgeport Hospital pediatric services become part of YNHCH

We anticipate that as of February 1, 2012, Bridgeport Hospital's pediatric services will become part of Yale-New Haven Children's Hospital (YNHCH). The certificate of need filed by YNHCH with the state Office of Health Care Access on July 29 was approved in early December.

The integration creates two inpatient campuses for Yale-New Haven Children's Hospital, operating under the YNHH license and designated as Yale-New Haven Children's Hospital. It incorporates the 42 general pediatric and newborn intensive care unit beds at Bridgeport Hospital, increasing the number total of licensed pediatric beds at YNHCH from 201 to 243. It also includes the pediatric clinic currently located at Bridgeport Hospital. The newborn nursery will remain on the Bridgeport Hospital license. Bridgeport Hospital pediatricians have become credentialed at YNHH and other pediatric staff members are now YNHH employees. Bridgeport Hospital's pediatric residency program is already integrated with YNHH.

This initiative, bringing together the state's first and third largest providers of pediatric services, is in keeping with the national shift in pediatric hospital care to larger integrated pediatric networks. It will help standardize best practices, coordinate care and use a single electronic medical record to link physicians and patients in acute, ambulatory and rehabilitation settings.

Synergy and transition teams formed

As we await the regulatory review of our proposed acquisition of the Hospital of Saint Raphael (HSR), initial implementation planning has begun. The objective of the implementation planning process is to develop a comprehensive, culturally and clinically acceptable operating plan for two inpatient campuses at Yale-New Haven Hospital, in accordance with the approved vision statement, guiding principles and the identified synergy of operating as one organization.

To that end, a number of committees has been initiated, including a Medical Governance and Clinical Services Planning Committee led by Marna Borgstrom, Richard D'Aquila, Christopher O'Connor, Alan Kliger, MD, and Peter Herbert, MD. This committee will engage experts from the YNHH and HSR leadership in reviewing medical staff governance, service integration, hospital-based specialties and GME programs. Other recently formed groups include the Yale-New Haven Hospital Transition Planning Committee; the Yale-New Haven Hospital Executive Leadership Team; the Hospital of Saint Raphael Senior Leadership Team; and the Synergy Core Team.

Smilow Breast Center receives national accreditation

The Breast Center at Smilow Cancer Hospital has been granted a three-year full accreditation by the National Accreditation Program for Breast Centers (NAPBC), administered by the American College of Surgeons. The Smilow Breast Center is the only National Cancer Institute-designated comprehensive cancer center in the Northeast with the NAPBC accreditation. NAPBC accreditation is only given to those centers that have voluntarily committed to providing the highest level of quality breast care and undergo a rigorous evaluation process. During the survey, the center demonstrated compliance with NAPBC standards, including proficient center leadership, clinical management, research, community outreach, professional education and quality improvement.

YNHH sponsors two more Habitat for Humanity houses

YNHH is sponsoring construction of its fifth and sixth Habitat for Humanity houses in the Hill neighborhood. The Hospital, in conjunction with the Medical Staff, first began sponsoring and volunteering to work on local Habitat homes in 2008. The two latest houses are located at 34 and 38 Vernon Street. Members of them Medical Staff, their office staffs and family or friends are invited to volunteer to work on the houses, Tuesdays through Saturdays, 9 a.m. to 4 p.m. Contact Jennifer Bowers, YNHH Employee Relations assistant, 203-688-2402, to find out more about volunteering.

Yale-New Haven now has MRI service 24/7

With increasing reliance on MRI as a diagnostic tool, YNHH has expanded its magnetic resonance imaging (MRI) service to 24 hours a day, seven days a week. The around-the-clock service can better accommodate patients during the day, resulting in a decrease in wait times and improved patient satisfaction. Yale-New Haven currently operates eight MRI units on the main campus: three in Diagnostic Radiology in Smilow, three in the MRI Center in the Clinic Building, one in the Breast Center and one in the Smilow OR. The hospital also offers MRI services in Shoreline Medical Center and Temple Medical Center.

YNHH 2010 Community Benefits Report now online

YNHH has published its 2010 Community Benefits Report online at www.ynhh.org under the Community heading. The report showcases the hospital's contributions to the New Haven community. In addition to a variety of community-based programs and services, YNHH helped manage $196 million in financial and in-kind contributions in 2010 through various programs designed to improve access to care, promote overall health, provide health and healthcare career education and create a healthier community.

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