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Medical Staff Bulletin

January/February 2013

Contents - January/February 2013

A message from the Chief of Staff

Let me begin by wishing all YNHH Medical Staff a healthy New Year. Without health there will not be much happiness.

2013 has come rushing at YNHH, with influenza and respiratory illnesses creating record censuses on both the York Street (YSC) and St. Raphael campuses (SRC). Great credit is due Dr. Victor Morris and the bed management staff for their patience and creativity in optimizing use of resources and avoiding paralysis in our emergency departments and operating rooms. We are fortunate that the vast majority of clinical staff received influenza vaccine (estimated to be about 62 percent effective), protecting themselves and our patients.

While the federal government has taken one step back from the fiscal cliff and the sustainable growth rate penalty for physicians (10th consecutive year without true corrective action), withering effects are occurring and more are threatened in the health care sphere. The current Connecticut state budget estimates a deficit of $400 million and our hospitals are expected to manage $103 million in Medicaid payment reductions in the current fiscal year. Yale-New Haven's share of that is almost $21 million retroactive to November 1, 2012. Moreover, if this level of reduction is carried into the biennial budget, it will translate into an ongoing $26 million per year reduction for YNHH beginning in July 2013. On the federal level, the planned 2 percent Medicare sequestration cuts are unlikely to be imposed, but rather replaced by larger reductions in other Medicare payments, including graduate medical education and hospital ambulatory care.

Epic Go-Live at YNHH is scheduled for February 1, 2013, and, to date, more than 9,000 individuals have attended training classes. Physicians not completing training will be unable to practice on the YSC after February 1. Registration for SRC classes began on January 1, and the deadline for registration there is February 18.

On January 30, all current inpatients at the York Street campus will be loaded into Epic with height, weight and allergy information and on January 31, nurses and pharmacists will enter inpatient orders. SCM, CEMR and POINTS will be shut off at 8 p.m. on the 31st, conversion teams will validate correct translation of orders from SCM to Epic, and by 4 a.m. (or earlier), Epic will pop up on work stations throughout YSC. Throughout the 31st, patients will receive ID bands with Epic Bar Code. More than 200 analysts in our Command Center will deal with problems, and a Security Command Center will be in Children's Hospital room 290 to reset passwords. Super users and specialized Epic resource staff wearing purple shirts will assist you on every nursing unit, day and night. You can re-review your online Epic 300 video courses, Epic Care Inpatient Quick Start Guide, and get engaged on Epic Playground to hone your skills. The Epic skillport can be directly accessed from your home computer (ynhhs.skillport.com) and opened using the ID provided in your Epic class and the generic password "epictrain." See also message below on special customization and review sessions.

May the force be with us!

Performance Management update

The New Year brings the prospect of new opportunity and resolutions. The key opportunities and resolutions for Performance Management in 2013 are: 1) to successfully execute our everyday readiness plan for successful Joint Commission and Department of Public Health licensure surveys; 2) to continuously improve our hospital acquired infection program, striving to eliminate central line-associated blood stream infections, surgical site infections and catheter-associated urinary tract infections; and 3) to maximize our performance across both campuses in publicly reported and other fiscally incented measures, such as the Value Based Purchasing Program and the unexpected Readmissions Program.

Led by Victoria Dahl Vickers, RN, full implementation of an everyday readiness plan has been effectuated. We standardized our policies so we can align practices across both campuses over the coming months. Our policy standardization work began prior to the integration back in May 2012, when over the course of the summer greater than 3,000 Saint Raphael Campus policies were assessed with subsequent plans developed that categorized the normalization work needed. These plans were then carried out by the diligent work of a bi-campus taskforce led by Susan Carter. A comprehensive plan to complete mock surveys, documented into a central database called Sentact, has been rolled out with training and deployment of many volunteers. All of this work is to assure that we are providing the best quality care, treatment and services across both campuses which will be tested during a Joint Commission survey in the next few months.

John Boyce, MD, Hospital epidemiologist, lending his experience and expertise in infection prevention, is managing our second resolution. In the first 100 days, Dr. Boyce, Dr. Jonathan Siner and Francine Lorusso, RN, have begun the long and hard work of normalizing best practices in Central Line Associated Blood Stream Infections (CLABSI) care with the goal of achieving the exceptional results that St. Raphael's has actualized in the past years. To date, this has included visitation to each of the campuses committees, standardization of kits and checklists and active participation with the Healthcare System for the CVAD maintenance policy. More information will be forthcoming from this team as we test, standardize and spread across units on the York Street campus. One of the demonstration units, 6-7 (led by John Roberts, MD, and Jockey Gorero, RN) has implemented most of these changes and has been more than 150 days without a CLABSI.

To address the third resolution mentioned, the left hand column displays the familiar Yale- New Haven Hospital performance measures for the measurement period of January 2012- September 2012. Beginning with September data, this includes the St. Raphael Campus which has been sampled into the denominator of all the performance measures and the registries. Staff at bothcampuses have worked diligently to assure that integration is seamless and that plans for 2013 are actively managed to assure optimal performance. This structure of bi-campus planning has been extended to the Transitions in Care program, for which a large part of this work addresses unexpected readmissions. Grace Jenq, MD, is the champion for both YNHH and the Health System, and is actively partnering with such physician leaders as Drs. Samuel Hahn, Ian Schwartz and Leora Horwitz across both campuses and the University to positively impact this important organizational program in the coming year. The Medical Staff will hear more about this program in the next edition. It is important to note that the issues of practice normalization may contribute to performance results. To this end, Quality Improvement Support Services is working to standardize concurrent review processes while Accreditation, Safety and Regulatory Affairs is working with clinical staff to standardize practices to policy changes, education and competency assessment.

This is an exciting time of new interventions, initiatives and opportunities for continuous improvement. If you have any questions, please contact Tom Balcezak, 203.688.1343.

YNHH celebrates Doctors' Day March 28

In honor of National Doctors' Day, Yale-New Haven Hospital will recognize and show its appreciation to the members of the Medical Staff by holding a buffet breakfast on Thursday, March 28, from 6:30 to 8:30 a.m. This year the celebration will be held at both campuses simultaneously: 20 York Street campus in the East Pavilion cafeteria special events area and Saint Raphael campus in the Physicians' Lounge, Main 1.

Smilow Cancer Hospital opens campus at Greenwich Hospital

Yale-New Haven's Smilow Cancer Hospital opened a new campus at Greenwich Hospital on January 22, allowing Yale Cancer Center subspecialists to work collaboratively with leading oncologists and specialists from Greenwich in the hospital's advanced and newly renovated facilities. Yale Cancer Center also has numerous clinical trials available, many of which will now be open to patients receiving care at the Greenwich Hospital Campus.

Greenwich Hospital currently offers a full array of cancer services, including medical oncology, radiation oncology, diagnostic radiology, surgery, a dedicated breast center and support services. With the opening of the Smilow campus at Greenwich, Yale Cancer Center specialists in prostate and genitourinary, head and neck, gynecologic, and brain cancers will be available for patient appointments immediately. Additional specialists will follow later this year.

In addition to Smilow Cancer Hospital's main campus in New Haven and its new campus at Greenwich Hospital, it also has nine cancer care centers located in convenient locations across the region. The care centers give Smilow clinicians the ability to deliver high-quality health care to patients in the communities where they live.

New director of Nursing and Patient Care Services named at YNHCH

Marianne Hatfield, MSN, RN, has been named director of Nursing and Patient Care Services of Yale-New Haven Children's Hospital. Hatfield worked at Children's Hospital of Atlanta (CHOA), the Children's Service for Emory University, since 2000, first as a staff nurse and most recently as service line administrator for emergency, transport and transfer services Prior to joining CHOA, she was a PICU staff nurse at Johns Hopkins. Many thanks to the outstanding leadership provided by Marcelle Applewhaite, RN, and most recently, Susan Maxwell, RN, who served as interim directors during the search.

Richard Stahl, MD, named YNHHS vice president, clinical services

Richard Stahl, MD, has been named vice president, clinical services, for Yale New Haven Health System. In his new role, Dr. Stahl will work to standardize and optimize the performance of clinical services across the Health System and explore service integration opportunities, beginning with the transition of Occupational Medicine Services to the health system. Dr. Stahl joined YNHH in 1976 as a general surgery resident and subsequently completed a plastic surgery fellowship at Emory University. He returned to Yale-New Haven in 1983, where he has held a variety of key leadership positions, including most recently, vice president, Ambulatory Services Division. He has helped lead the growth of perioperative services at the York Street campus, the transition of Temple Medical to Yale-New Haven Hospital and the establishment of ambulatory facilities including the North Haven satellite, among others. Dr. Stahl continues to be a practicing plastic surgeon.

Cultural Integration Committee forms physician subcommittee

The physician subcommittee of the Cultural Integration Oversight Committee meets monthly to discuss the unity of the Medical Staff, processes, behaviors, similarities and differences on the two YNHH inpatient campuses. The group is co-chaired by Gary Kaml, MD, department of Surgery, and Michael Bennick, MD, associate chief of Internal Medicine. The subcommittee includes, from Chapel Street, Joseph Balsamo, MD, Internal Medicine; Thomas Donohue, MD, Cardiology; Thomas Martin, MD, Urology; James F Passarelli, MD, Surgery and Ruth Weissberger, MD, Internal Medicine. York Street members include: Steven Fleischman, MD, OB/GYN; Brett Gerstenhaber, MD, Pulmonary Medicine; Stephen Huot, MD, Internal Medicine; Walter Longo, MD, Surgery, Joe Quaranta, MD, Internal Medicine; Ian Schwartz, MD, Emergency Medicine; Stephanie Sudikoff, MD, Pediatrics. John McCreight is a guest member.

The mission of the Physician Cultural Integration Committee is to provide a venue in which physician representatives can voice their colleagues' viewpoints on cultural issues and challenges; facilitate dialogue and physician consensus on these issues; develop strategies and activities to enhance the integration and practice of medical staff; and promote the recognition and incorporation of physicians' core values into meaningful unifying processes implemented by YNHH.

If you have ideas or suggestions about the cultural integration of the two campuses, please contact Drs. Kaml or Bennick at gary.kaml@ynhh.org or michael.bennick@ynhh.org.

Simulation class available on brain death examination

The SYN:APSE Center (Simulation Program Simulation at Yale New Haven: Advancing Patient Safety and Education) will be offering a course to teach to practitioners how to conduct an accurate and thorough brain death examination, consistent with the new practice parameters from the American Academy of Neurology. The class is a partially didactic (~30 minutes) and partially simulation (~30 minutes) experience with direct supervision through a full brain death determination, including the clinical examination and apnea test. The class is appropriate for attendings and residents, in particular, intensivists, neurologists, neurosurgeons, anesthesiologists and trauma surgeons. It is offered in the East Pavilion or in the main SYN:APSE facility at 730 Howard Avenue in New Haven. For more information, please email David Greer, MD, david.greer@yale.edu.

Dr. Lilenbaum named chief medical officer of Smilow Cancer Hospital

Rogerio C. Lilenbaum, MD, is the new chief medical officer of Smilow Cancer Hospital. Dr. Lilenbaum, who was previously chairman of the Cancer Institute at the Cleveland Clinic in Florida, is a practicing medical oncologist and will care for patients through the Smilow Thoracic Oncology Program. He has done pioneering work in defining the best way to treat lung cancer — particularly in older patients. He was the former director of cancer research and thoracic oncology at Mount Sinai Medical Center in Miami Beach. Dr. Lilenbaum received his medical degree from the Federal University of Rio de Janeiro School of Medicine in Brazil and earned a master's degree in clinical epidemiology and clinical investigation from the Harvard School of Public Health. He completed his hematology/oncology fellowship at Washington University School of Medicine and a clinical and research fellowship at the University of California San Diego.

Epic update on York Street: Personalization and review sessions and access to live site

So far, 3,860 physicians and providers, including residents and medical students, have been trained on Epic — logging more than 7,000 classroom training hours. Because the Epic go-live period will involve a learning curve and users will be slower in performing routine tasks and documentation at first, personalization sessions have been developed to help you prepare and be more efficient for the York Street campus go-live date of February 1.

The one-hour sessions have been available almost every day between January 18-31, from 8 a.m. to 4 p.m. in different conference rooms in the South, East and West Pavilions. Epic trainers can meet with you to set up your personal preference and favorite lists. Register for a session via Skillport — ynhhs.spillport/com. After clicking the catalog link in Skillport, go to folder marked ambulatory & hospital staff. Near bottom of list is the Personalization folder. Click to open and go to Customization & Review. More dates will be added to the schedule.

Epic trainers suggest that before you attend a personalization session, create a Word document which lists your SmartPhrases — blocks of text created by typing a period followed by a phrase name that works like a keystroke shortcut. For instance, you could type ".st" instead of sore throat. You can either email the document to yourself or bring on a thumb drive to the session, where you will load your SmartPhrases into Epic prior to February 1 go-live. This advance preparation will give you personalized tools to help you practice efficiently on Epic starting Day One.

After all training courses have been completed, you will be able to again access to the live Epic site where you can personalize your settings either in one of the special one-hour sessions with a trainer, or by using the personalization tip sheet on the Physician Portal, http://md.ynhh.org/md/. You will receive hour-for-hour CME credits for each course completed. The Epic Training Team will handle the details to ensure you get proper CME credit.

FairWarning patient privacy breach detection reviews

YNHH is committed to protecting the privacy of patients and the confidentiality of health information and automatically monitors and audits patient records to determine which employees and caregivers access them and when. The Hospital has completed its first round of audits using the new FairWarning patient privacy breach detection tool and identified violations to Hospital policy. Most violations were employees or caregivers who accessed records of patients for whom they were not involved in care, and all have resulted in appropriate sanctions per Human Resources policies. These audits will continue access on an ongoing basis. If you have questions or concerns, please contact Nassar Nizami, 203.230.4364, or Faith McGrath, 203.230.3913, both in Information Security.

Making referrals to YNHH adult, pediatric and Shoreline emergency departments

When you refer a patients to one of our Emergency Department locations, please have the correct spelling and, if possible, date of birth of the patient, available when you call. After February 1, the Emergency Department staff will be entering the information you provide into Epic so that patients can be more appropriately tracked from the time of presentation. The availability of accurate identifying information from you will help the ED staff to provide better and more expeditious care to the patients you refer.

Chest Pain Center accredited

YNHH recently earned another full accreditation as a Chest Pain Center with Percutaneous Coronary Intervention by the Society of Cardiovascular Patient Care (SCPC), and also became the first hospital in Connecticut to receive the society's enhanced level Cycle IV accreditation. To achieve PCI designation, a hospital must have on-site 24/7 emergent catheter laboratory capabilities and must have successfully performed 36 primary PCIs during the 12 months prior to the site visit. Accredited chest pain centers assess, diagnose and treat patients who may be experiencing a heart attack; effectively reduce the time from the onset of symptoms to treatment that preserves heart muscle; and are committed to educating the public about heart health. According to the SCPC, an accredited Chest Pain Center is generally thought to provide better patient care, better prognosis, better quality of life, faster treatment and decreased length of stay in the hospital.

Religious Ministries and Pastoral Care become Spiritual Care department

On January 1, Religious Ministries on the York Street campus and Pastoral Care on the Saint Raphael campus changed their names to become the Department of Spiritual Care at YNHH. The department supports the spiritual and religious needs of patients, families and friends, and hospital staff with multi-faith chaplains who cover all inpatient units and many clinics.

YNHCH launches pediatric physician referral service

YNHCH has launched a 24/7 consultation resource for providers of pediatric patients to improve care by providing a consultation, assistance with an urgent issue or an emergency transfer to YNHCH. The Pediatric Consultation Service allows quick and easy access to YNHCH pediatric specialists with one call to the 24/7 Y Access Line — 888.964.4233.

Project abstracts due Feb. 15 for May 2 safety and quality conference

The 2013 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held on Thursday, May 2, 8:30 a.m.-3 p.m., at the Omni Hotel in New Haven. Employees of the three YNHHS hospitals and Northeast Medical Group are invited to present projects at the conference. The deadline for submitting an abstract is Friday, February 15. Guidelines for abstract submission are available on the YNHHS Performance Management website (open the YNHHS intranet, click on Departments tab, click on Performance Management link) or from Ella McGhee, administrative secretary, YNHHS Performance Management, 688.8692, or ella.mcghee@ynhh.org.

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 number or pager number, please contact the Department of Physician Services at 20.-688.2615 or email the information to: physiciansvcs@ynhh.org



















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