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Medical Staff Bulletin

January/February 2011



Contents

Performance management update

At left are our Joint Commission and CMS measures for the most recent three-month period. Also at left is our performance in preventing central line-associated bloodstream infections (CLABSI), reported as days since last infection for each of our eight ICUs. It's rewarding to see these numbers grow larger as the initiatives spearheaded by Francine LoRusso, RN, and Jonathan Siner, MD, take root across the organization. To date there has been a standardization of the "insertion bundle" as well as the "line maintenance bundle." These efforts are clearly making headway. But, we can do better.

With regard to CORE measures, our challenges continue to be in the areas of PCI within 90 minutes, pneumococcal vaccination in patients with pneumonia, and home management plans for patients with pediatric asthma (although there has been dramatic improvement here). There are active improvement projects around all of these and we should be seeing progress over the next couple months.

Last month we discussed the recent Center for Medicare and Medicaid services (CMS) survey. I'm happy to note that this survey has been completed and we have been found to be in full compliance with all of the conditions of participation. Still, we cannot rest on our laurels. As noted earlier, continuous readiness for regulatory visits from CMS and the Joint Commission are key elements of our efforts around clinical quality and patient safety. We will report next month on our Joint Commission Requirements for Improvements and efforts to achieve full compliance. Many thanks for your care of our patients. If you have any questions of concerns, please do not hesitate to contact Tom Balcezak, MD, at 203 688-1343.

YNHH to receive Nursing Magnet site visit

In response to the application for Magnet status to the American Nurses Credentialing Center (ANCC) submitted by YNHH in August, the hospital has been granted a site visit, March 29 - April 1. Only 6 percent of all American hospitals are designated Magnet hospitals by the ANCC. Of the hundreds of hospitals that apply each year for the three-year certification, only 60 percent are chosen for a site visit; 80 percent of those who have a site visit actually attain Magnet. To prepare for the visit of four appraisers who will canvas the entire hospital, Shoreline Medical Center and Temple Medical Center for four days, Patient Services is training nurse leaders and Magnet champions who in turn will inform staff about what the appraisers will be asking when they interview physicians and employees during the survey. While appraisers will focus more intensively on nurses, they will meet with physicians and all employee groups who contribute to patient care.

Roy Herbst appointed chief of medical oncology

Effective this March, Roy Herbst, MD, PhD, will become chief of medical oncology and associate director for translational research at Yale Cancer Center. Dr. Herbst comes to Yale-New Haven from the University of Texas MD Anderson Cancer Center. He received his undergraduate and master's degrees from Yale, his medical degree from Cornell University Medical College and PhD in molecular cell biology from the Rockefeller University. Dr. Herbst completed his medical oncology fellowship at Dana Farber Cancer Institute and a medical hematology fellowship at Brigham and Women's Hospital in Boston, where he additionally received a master's degree from Harvard University in their clinical investigator training program.

Over the last several years, Herbst has initiated novel, first-in-man clinical studies using agents now approved for cancer patients. He currently serves as co-principal investigator of the Biomarker-based Approaches of Targeted Therapy for Lung Cancer Elimination Program (BATTLE) Trial, which explores utilization of highly personalized therapy for non-small cell lung cancer.

Attending Notes

• Executive Leadership and Academic Medicine: Lynn T. Tanoue, MD, vice chair for Clinical Affairs in the Department of Medicine, has been named a 2010-2011 fellow of the Executive Leadership and Academic Medicine (ELAM) program, the only national program dedicated to preparing senior women faculty for leadership at academic health centers.

• Institute of Medicine: Three physicians from Yale-New Haven have been elected to the Institute of Medicine (IOM), one of the most prestigious awards in the healthcare field. They are Jack A Elias, MD, chief of Internal Medicine and Waldemar Von Zedtwitz Professor of Medicine; John H. Krystal, MD, chief of Psychiatry and Robert L. McNeil Professor of Translational Research; and Charles J. Lockwood, MD, chief of the Department of Obstetrics, Gynecology and Reproductive Sciences and Anita O'Keeffe Young Professor of Obstetrics, Gynecology and Reproductive Sciences.

• Association of Program Directors of Internal Medicine (APDIM): Rosemarie L. Fisher, MD, professor of medicine and associate dean for graduate medical education, has received the APDIM' s Dema Daley Founders Award, the highest honor bestowed on internal medicine educators. Dr. Fisher has spent 35 years on the Yale faculty, including seven as director of graduate medical education at Yale-New Haven Hospital.

• National Alliance of Children's Trust and Prevention Fund and the American Academy of Pediatrics: announced the recipient of the 2010 Ray E. Helfer, MD Award is John M. Leventhal, MD, professor of Pediatrics and medical director of the YNHCH Child Abuse and Child Abuse Prevention Programs.

• VNA Health Systems: announced Grace Jenq, MD, medical director of inpatient medicine, has been elected to board of directors for VNA of South Central Connecticut (VNA/SCC).

Epic electronic medical record update

Many attending physicians have recently received a letter providing an update on the Epic project. So far, Epic has held two of the five scheduled collaborative design sessions in which Epic team members and subject matter experts from all organizations - the three System hospitals, Yale Medical Group, Northeast Medical Group and community physicians - have reviewed and provided input on the Epic model to help determine content and best practices for workflow, documentation, and patient care. These first two sessions have covered about 600 individual decision points, with a 95 percent agreement rate among the participants.

In addition, Dr. Steven Schlossberg, chief medical information officer for YNHH and Yale School of Medicine has convened a Physician Advisory Group. Representatives from the university- and community-based Medical Staff meet weekly to give more detailed input. Members of the YNHH Medical Staff who have questions or are interested in participating in the Epic development can contact Dr. Schlossberg at 203-688-6225 or steven.schlossberg@ynhh.org or Daniel Barchi at 203-688-2100 or daniel.barchi@YNHH.org

Atrium renovation creates new physician/staff entrance at 20 York Street

Although the renovations to the Atrium are not quite complete, one noticeable change is the creation of a staff entrance just to the left of the hospital's 20 York Street entrance. This new staff entrance - called the South Pavilion entrance - was designed to help alleviate the congestion and confusion in the main entrance and lobby, provide better access for staff, patients and visitors and improve the overall security at the hospital. Having two separate entrances will allow security officers to better monitor the public entrance.

Members of the Medical, hospital and School of Medicine staffs, as well as all other I.D. badge holders (volunteers, contactors and vendors) should begin to use the South Pavilion entrance. When construction is completed, the staff entrance will be equipped with an optical turnstile which will automatically recognize staff I.D. badges with a proximity reader, improving the flow of traffic and security at both entrances. If a physician or employee is accompanied by someone who does have not an I.D. badge, both can enter the South Pavilion entrance.

Until the renovation and transition has been completed, Protective Services staff will courteously remind and communicate to staff and physicians about the importance of using the new entrance when they enter and exit the hospital.

Medical Staff members participate in YNHH's $2 bill program

In 2007, YNHH introduced a $2 bill program to recognize employees "caught in the act of Service Excellence." In January 2007, employees redeemed 225 of the new $2 bill. The program has become so successful that in November 2010, more than 5,500 were redeemed. Last year, the Rewards and Recognition Committee added a new blue $2 bill for physicians to use when they see an employee providing extraordinary service for a patient, family member or another employee. Each month, all redeemed $2 bills are entered into a drawing for a $100 American Express gift card. If members of the Medical Staff would like a packet of $2 bills to use for staff recognition, stop by the Chief of Staff's Office, 1063 CB.

Marna Borgstrom named to board of AAMC

YNHH President and CEO Marna P. Borgstrom has been named to the Association of American Medical Colleges (AAMC) 2010-2011 Board of Directors. She will serve a two-year term on the 17-member AAMC governing board, which represents all 133 U.S. and 17 Canadian accredited medical schools; nearly 400 major teaching hospitals and health systems, including 62 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. The AAMC represents 128,000 faculty members, 75,000 medical students, and 110,000 resident physicians.

Borgstrom, who began her career at YNHH more than 30 years ago, became president and CEO of both Yale-New Haven Hospital and Yale New Haven Health System in 2005, after having served as executive vice president and COO for the previous 11 years. Borgstrom holds a Master of Public Health degree in Hospital Administration from the Yale School of Medicine and a Bachelor's degree in human biology from Stanford University. She is a lecturer in Yale's Department of Epidemiology & Public Health, Health Policy & Administration Division.

Free flu shots available for Medical Staff

Free flu shots continue to be available for members of the Medial Staff at Occupational Health Services on the first floor of the East Pavilion, Monday through Friday between 7:30 a.m. and 4:15 p.m. For more information, contact Occupational Health Services at 688-2462.

Transforming patient care

YNHH has launched an initiative analyzing the amount of time nurses spend at the bedside and the impediments to more direct patient interaction. Sue Fitzsimons, RN, PhD, senior vice president, Patient Services, and Richard D'Aquila, executive vice president and COO, are leading a Transforming Patient Care team. The team observed YNHH nurses for more than 1,300 hours and coded how nurses and Patient Care Associates spend their time in three ways: at the bedside, administrative duties related to patient care; and activities as a result of broken systems and processes. Similar observations were conducted in pharmacy, clinical and plant engineering, environmental services, laboratory medicine, materials and food and nutrition.

The pilots demonstrated that 63 minutes of registered nurse time and 46 minutes of patient care associate time could be returned to the bedside each 12-hour shift. This additional time at the bedside is expected to positively impact nurse-sensitive outcome measures (decrease falls and pressure ulcers), reduce medication errors and improve patient satisfaction. A team of dedicated resources work directly with the staff and leadership on patient care units to implement the method changes. Key nursing method changes include an uninterrupted nursing report and bedside hand-off with the patient, streamlined paperless real time documentation at the bedside with workstations on wheels (WOWs), medication administration at the bedside with the WOW, and a medication safety zone around Pyxis machines to deter interruptions during medication administration. The team has implemented eight patient care units to date with the full implementation to be completed by May 2011. All of the method changes focus first and foremost on patient safety with the added benefit of patient satisfaction and operational efficiencies.

Patient- and Family-Centered Care at YNHH

YNHH's Patient-and Family Centered Care (PFCC) program is a continuing effort to be responsive to the needs and choices of patients and families by involving them in all aspects of the planning, delivery and evaluation of healthcare services. The core concepts of patient- and family-centered care are dignity and respect, information sharing, collaboration, and participation.

Over the last two years, YNHH has made an effort to engage patients and families as advisors. Patients and families are highly receptive - some sit on hospital committees, others share the story of their YNHH experience during staff education while others are members of advisory councils. There are several PFCC advisory councils - adult, pediatric, newborn special care and Smilow - comprised of patients, family members, physicians and staff. Recently a Family Resource Center opened in room 701 of the Children's Hospital, and a second resource room in Smilow is now being planned.

If you have questions about patient- and family-centered care or the advisor program contact PFCC manager Susan Kamm at 688-3299 email PTFAMCARE@ynhh.org.

In memoriam: Dr. Samuel D. Kushlan

Samuel D. Kushlan, MD, a member of the YNHH honorary medical staff, died on October 16, 2010. Dr. Kushlan was one of the most distinguished graduates of the Yale School of Medicine and a patriarch at YNHH. He was the only Yale graduate to receive all three of the university's most prestigious awards - the Campbell Medal, the Peter Parker Medal and the Yale Medal. A graduate of Yale University and School of Medicine, he trained at YNHH and joined the YNHH Medical Staff in 1938 and, that year, became the first physician in Connecticut to perform gastric endoscopy. In 1959 Dr. Kushlan was selected by his peers as the first president and associate Physician-in Chief of the newly combined Medical Staff at YNHH. This recognized his diplomatic skills in uniting the staff of private physicians with the full-time faculty of the medical school. His most valued role was as mentor and role model for generations of residents over the course of 75 years. Memorial contributions may be made to the Samuel D. Kushlan, MD Lectureship Fund of Yale Medical School, c/o YNHH Department of Medicine, 20 York Street, New Haven, CT 06510-3202.

YNHH anonymous donor supports nurses with $500,000 gift

An anonymous donor has given a $500,000 gift to YNHH to provide financial assistance to nurses who wish to expand their education and expertise. The gift will establish two scholarship funds: the Marna P. Borgstrom and Peter N. Herbert, MD Yale-New Haven Hospital Nursing Advanced Education Scholarship. Beginning in January 2011, the scholarships will provide tuition assistance of up to $10,000 to qualified registered nurses engaged in advanced education as nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, clinical nurse midwives or doctors of nursing practice. Potential applicants should contact YNHH Human Resources.

YNHCH and Connecticut Children's partner for pediatric cardiac surgery

Yale-New Haven Children's Hospital (YNHCH), Yale School of Medicine (YSM), and Connecticut Children's Medical Center have created a joint medical foundation that will enable the two hospitals to share pediatric cardiac physicians. By forming a single program to serve the State of Connecticut and the region, the new partnership provides appropriate patient access as well as volume for each surgeon to maintain the highest level of quality. Together, the hospitals will begin recruiting pediatric cardiac surgeons. The surgeons will spend part of their time at each hospital and have admitting privileges at both hospitals, as well as be eligible for faculty appointments at both Yale School of Medicine and the University of Connecticut School of Medicine. The foundation will also coordinate policies and procedures to ensure quality and support academic pursuits. For information about pediatric cardiac surgery or the new partnership, contact Yale Pediatric Cardiac Surgery at 203-785-2702.

Safe Patient Flow initiative helping bed management and 11 a.m. discharges

With the YNHH census consistently at record-breaking levels, the Safe Patient Flow Steering Committee recently reviewed progress over the past year. Much of its work surrounding 11 a.m. discharges for clinically ready patients has been successful, allowing the hospital to safely treat increasing numbers of patients. Last year, 19 percent of patients were discharged by 11 a.m. This year, the goal is 21 percent and the hospital is focusing on ensuring that first cases in the operating rooms begin on time to avoid the cascading effect that results from a schedule gone awry. We are also working intensively with medical and surgical units to make sure they can accept clinically ready patients from the PACUs and the Adult Emergency Department. This allows patients to move to the appropriate patient care unit in a timely manner.

2011 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference May 19

The 2011 Yale New Haven Health System Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held on Thursday, May 19 at the Trumbull Marriott Hotel. The deadline for submitting project abstract is February 25. For abstract submission guidelines and registration details, contact Darriell Rolka, YNHHS Performance Management Department, at 203-688-8692 or darriell.rolka@ynhh.org.

Suites at Yale-New Haven

The Suites at Yale New Haven is now open to provide short- and long-term lodging to patients, their families, friends and caregivers. The hotel is located in the hospital's new 2 Howe Street building - two blocks from YNHH - offering 20 two-room suites and four single-room studios on three floors. Rooms offer full kitchens, complete with cooking and dining essentials. A laundry is on site and a coffee shop, dry cleaners and hair salon are right around the corner. The rooms are comfortably furnished and can be reserved by calling 203-654-7500.

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