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Medical Staff Bulletin

January 2014

Contents

Message from the Chief of Staff

A sincere Happy New Year to the medical staff of Yale-New Haven Hospital. Our wish is that all will enjoy great health in 2014. More than most in society, we are acutely aware of the fragility of the human condition. Much that we confront appears without warning, and we are often defeated in our efforts to rectify injury and illness.

2013 surely was the most exciting and challenging year at YNHH in the last half century. We successfully implemented Epic on both campuses, a testimony to extraordinary planning and execution. An equally epic event was the assimilation of the Saint Raphael Campus which too required Herculean organization at all levels of the hospital. Several thousand new employees were on-boarded, largely without a hitch. An entirely new management structure was designed and executed with no interruption of service. We kept our commitment to invest in the Saint Raphael Campus and begin the consolidation of clinical services, when appropriate. Major trauma and pediatric services were largely moved to the York Street Campus. Pediatric psychiatry is now much better aligned. Great progress was made in planning for the musculoskeletal center on SRC … and all of this in virtually 12 months.

2014 promises no change in pace. Clinical integration across our two campuses will continue in a thoughtful and appropriate way. We will deal with monumental challenges in the financing of patient care and will do this primarily by delivering better care at less expense. Most importantly, we will move to make care at YNHH as safe and reliable as is possible.

I thank all members of our medical staff for their loyalty, commitment and patience in our joint efforts to make YNHH a truly great hospital.

Performance management update

In today's healthcare landscape, it is more important than ever to achieve value in care delivery. Maximizing the value of care, as defined as delivering the highest quality of care at the lowest possible cost, is the focus of academic and community hospitals around the country. Yale New Haven Health System is leading the field with its innovative, system-wide approach in clinical redesign, one of the four focus areas of the Cost and Value Positioning initiative. The initiative is rooted in the belief that improving care quality will reduce cost, and aims to sustainably reduce care delivery costs more than $60 million per year. YNHHS offers an innovative approach to improving the value of its care through 1) its model of leadership line-of-sight and centralized resources; 2) the scale of the redesign effort and its implementation of best practices; and 3) the advanced integration of decision support clinical registry, cost accounting and cost- and quality-benchmarking data.

Clinical redesign is driven by physician leaders from across the health system and benefits from highly engaged clinicians and dedicated analytics and project management support. The clinical redesign team is currently working with clinicians across the system to implement three system-wide initiatives focused balance of medicine and surgery units will prepare us for the move of two major anchor programs, musculoskeletal services and geriatrics, to the Saint Raphael Campus.

Medicine/Surgery: On the SRC, an average of 25-30 medicine patients a day have been boarding on surgical units. In February, Verdi 5 North (now a surgical unit) will be converted to a medicine unit. All SRC surgery services will be consolidated on Verdi 5 West and Sister Louise Anthony 2. The MICU is also part of the right-sizing and the SRC MICU will expand from 18 to 22 beds as the step-down unit goes from 26 to 19 beds. There are no plans to change the acuity level of medical and surgical patients on either campus. Both will continue to provide intensive care for acutely ill patients.

Musculoskeletal services: In early 2014, the recently renovated Verdi 4 North will open to complement our present orthopedic location on Verdi 3 South. This will be a "soft launch" meaning that initially just a couple of physicians from York Street will move their elective cases to SRC. By spring, elective joint replacements, neuro/spine and ortho/spine patients will begin to be admitted to Verdi 4 North. At this point we plan to have these surgeries performed at SRC.

Geriatrics: In spring 2014, Geriatrics, the Acute Care for the Elderly (ACE) unit, will move to Verdi 4 West. Multiple steps will take place before that can happen. In February, Verdi 4 West (general medicine) will close for renovation, and East Pavilion 4-6 on York Street will open as a general medicine unit to take the majority of those patients. This will allow us to accommodate the higher winter census of flu-related medical patients. In April, the renovated Verdi 4 West will reopen as the ACE unit, staffed by hospitalists and ACE nurses and staff. At this time, East Pavilion 6-5 will close and be supercleaned, reopening in May for non-elective orthopedic trauma and orthopedic oncology patients at York Street who are currently on 7-7, which will become a general medicine unit.

Hand hygiene initiative adds TJC's "Targeted Solutions Tools"

In the fall, Yale-New Haven Hospital kicked off its 2014 hand hygiene initiative with a new 2014 hand hygiene project charter that includes FY14 PIP goals (threshold goal of 91% compliance, target goal of 93% and stretch goal of 96%). Hand hygiene is also a YNHH corporate business plan objective to ensure that patients are kept safe and free from hospital-acquired infections.

This year's initiative will retain and build off the current Influencer Model that has been in place since 2011 to encourage hand hygiene compliance through three key behaviors: 1) Wash in/Wash out; 2) 200% accountability; and 3) Saying "thank you." The Influencer Model relies on hand hygiene champions, specially trained nursing and medical leadership at the unit level who work with staff to get to 100% compliance.

New for 2014 is the adoption of the Joint Commission's Targeted Solution Tools, which provide best practices across the country to expand awareness, promote engagement to improve hand hygiene compliance and reduce the frequency of HAIs. Targeting Solution Tools will add two more key roles — hand hygiene observers and Just in Time (JIT) coaches — in addition to continuing with the existing hand hygiene champions. Hand hygiene observers are specially trained staff who will anonymously collect hand hygiene data on all three shifts, seven days a week. JIT coaches will approach staff when they see non-compliance to find out the reason, and to provide positive reinforcement for good hand hygiene.

Additional champions have been trained, JIT coaches have been selected and observers are now being identified. These three roles — which are being expanded from weekday to 24/7 — will begin to be piloted on a unit on the Saint Raphael Campus in January, followed by a pilot unit on York Street. After that, the hand hygiene 2014 initiative will be rolled out across the hospital.

Also in store for 2014 are touch-free Purell dispensers. YNHH is committed to supporting staff and families by making it easier to wash hands, welcome feedback and say "thank you."

ACGME adds Clinical Learning Environment Review visit

The Accreditation Council for Graduate Medical Education (ACGME) has amended its policies and procedures related to its new accreditation model, Next Accreditation System, and developed a new institutional site visit, known as the Clinical Learning Environment Review (CLER). CLER visits, which will be conducted every 18 months, are designed to assess a sponsoring institution's compliance with six focus areas: patient safety, quality improvement, transitions in care, supervision, duty hours oversight and professionalism, and to make recommendations for areas for improvement. This visit is not for accreditation purposes. There will still be a full accreditation visit with a self-study every 10 years.

According to the ACGME, all sponsoring institutions across the country can expect to be notified of a CLER visit between now and March 2014, with little advance notice. The visit will include an initial meeting with leadership; walk-arounds with resident host/escort, opportunity for nursing staff and patient contact; resident/faculty/PD meetings; and an exit meeting with the CEO/president. This first round of visits will be used to collect baseline data and to promote learning.

The goal is to ensure the integration of residents into patient safety and quality improvement programs, reduce disparities in care delivery, and demonstrate the impact of oversight of supervision policies, transitions in care and duty hours standards.

YSN midwifery program relocates to Saint Raphael Campus

The midwifery practice of the Yale School of Nursing will be relocating to the Vidone Birth Center at the Saint Raphael Campus, in line with the YNHH vision for clinical services. The practice will begin attending births at the center on January 1, 2014 and will move its ambulatory practice to Main 6 in July. This move represents an exciting opportunity to enhance women's health care across YNHH and to continue to develop strong interprofessional collaboration and education. For questions about the practice, please contact the director, Richard Jennings, CNM, at 203-737-2479 (o); 718-809-9170 (cell).

Henry Cabin, MD, named interim chief of Cardiovascular Medicine

Henry S. Cabin, MD, clinical chief of Cardiovascular Medicine at Yale-New Haven Hospital since 2009, has been named interim chief of Cardiology, effective January 1 2014, when Dr. Michael Simons will step down as section chief for 18 months. Dr. Simons will continue as an active member of the faculty, as director of the Yale Cardiovascular Research Center, and co-director the Yale-UCL collaborative, working closely with Dr. John Martin. Dr. Cabin, professor of medicine and pathology at Yale School of Medicine, is also medical director of Yale-New Haven Hospital's Heart and Vascular Center.

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