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A message from the Chief of Staff

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 codified the basic privacy protection to which all patients are entitled. The American Recovery and Reinvestment Act of 2009 contained the Health Information and Technology for Economic and Clinical Health (HITECH) Act which considerably enhanced and expanded HIPAA's privacy and security rules. While these laws are now two to five years old, it is remarkable how frequently they are violated at considerable risk to healthcare providers. Civil penalties are as high as $50,000 for single violations and up to $1,500,000 for multiple violations. Professional penalties include termination of employment. Moreover, institutions are required to report suspected violations to the Centers for Medicare and Medicaid Services (security violations) or to the Office for Civil Rights (privacy violations).

Yale-New Haven Hospital is enhancing its efforts to assure that all staff members are fully informed to avoid violations and related sanctions. It is essential that members of the medical staff are aware of and fully compliant with our policies to protect our patients' privacy which prohibit:

  1. Access of electronic medical records by individuals not directly involved in a patient's care. Random audits will be conducted to identify illicit access. When sign-on is inadvertently left open and access taken by others, we are held accountable for that access.
  2. Revealing protected health information (PHI) to individuals not directly involved in the episode of care, including to family or friends of the patients, without the patient's written consent or documented verbal consent.
  3. Failure to secure all paper and electronic devices containing PHI.
  4. Use of unencrypted electronic devices for transmitting or storing PHI.
  5. Sharing of passwords for electronic health records.
  6. Failure to report known or suspected violations of the privacy or security policies.

It is natural to be concerned about hospitalized colleagues, friends and neighbors. It is easy to assume spouses, children and close friends are aware of a patient's health issues. Busy clinicians can understandably fail to sign off from clinical work stations. Cases can be dramatic and the desire to share details in elevators, stairwells, cafeterias or at home can be great. So opportunities to violate the law, as defined by HIPAA and HITECH, present many times each day. It is everyone's responsibility to protect the privacy of our patients and the integrity of the institution.

The YNHHS Privacy and Security policies, educational material and links to additional resources can be found on the Corporate Compliance and Privacy intranet site.

YNHH earns Magnet status

After a rigorous, multi-year application process and four-day site visit, Yale-New Haven Hospital has been granted Magnet recognition by the American Nurses Credentialing Center (ANCC). Only six percent of all American hospitals have been honored by the Magnet Recognition Program®. Magnet appraisers look closely at four areas of nursing excellence in every hospital that applies for it. They rigorously examine the hospital's nursing leaders and how they empower nursing staff, the hospital's culture of safety, the quality of nursing practice, and the best practices nurses discover and share to deliver safe patient care.

Performance management update: Avoiding wrong-side surgery

YNHH has made two significant changes to its policy on "Universal Protocol for Surgical/Invasive Procedures." These changes are to further ensure that wrong-side surgery is truly a "Never event."

The first change, called "New surgical site verification/pause," requires that surgical site verification must be accomplished and documented in the operative nursing record any time a change is made to the surgical field that requires a change in patient position and/or a change is made to the boundaries of the original areas that were prepared and draped for surgery. At a minimum, a circulating nurse, scrub technician, attending surgeon and anesthesia provider must participate in this verification and pause process.

The second change relates to marking the surgical site for pediatric patients or patients who refuse to have the skin marked or where marking is impractical. Previously, it was acceptable to mark the hand or an upper extremity on the side of the procedure. Now, an ID band with patient's name, MRN and site/side will be placed on the patient's wrist or ankle. The operating surgeon may alternatively elect to use an indelible marker to establish laterality by marking the upper extremity on the same side as the planned procedure. In either case, after anesthetic induction is completed, the actual surgical site must be marked as part of the "Time Out" procedure.

The revised policy applies to all procedures, not just in the operating rooms, but in procedure rooms and at the bedside. It can be found in the online Clinical Administrative Policy & Procedure Manual, # C-S-8. For more information, contact Doug Vaughn, MD, DDS, medical director, Perioperative Services, 203-200-1252 or douglas.vaughn@ynhh.org

Plans to help alleviate bed capacity issues

YNHH has taken several steps to help deal with a record high census over the past few months. Patients who do not appear to require hospital-level care but who require observation and shortterm treatment, currently receive care on a number of inpatient units. To increase efficiency of their care and related documentation, as well as to create inpatient beds for those of higher complexity, a 26-bed observation unit was established on EP 5-7. The new unit opened in May with eight temporary observation beds, increased to 14 beds in July and will expand to 26 beds in October.

The observation unit will have no impact on YNHH count of licensed beds and ultimately will care for 13 general medical and 13 cardiac patients. Medical oversight will be provided by a Hospitalist, with general medicine and cardiac PAs.

A 28-bed short-stay medicine unit on 4-7 is also helping to free up more beds in the Hospital. A Hospitalist team cares for the short-stay patients and is responsible for their efficient discharge. In addition, YNHH plans to submit a certificate of need application to the state Office of Health Care Access later this spring to request an additional 70 beds. We will keep you updated on the progress of this.

HHS recognizes YNHCH for efforts to eliminate HAIs

The U.S. Department of Health and Human Services recently recognized 37 hospital and healthcare facilities — including Yale-New Haven Children's Hospital — for their efforts to prevent and eliminate healthcare-associated infections (HAIs). The organizations are the first to be honored as part of a new national awards program to highlight successful, sustained efforts to prevent HAIs, specifically in critical care settings. Awards were conferred on two levels: the "Outstanding Leadership Award" went to organizations that sustained success in reaching their targets for 25 months or more, and the "Sustained Improvement Award" recognized teams that demonstrated consistent progress over an 18- to 24-month period. YNHCH's Newborn Special Care Unit received an Outstanding Leadership Award for its achievements in eliminating central line associated bloodstream infections.

New associate chief appointed; three others reappointed

Steven J. Fleischman, MD, of Obstetrics, Gynecology and Menopause, PC of New Haven and assistant clinical professor of Obstetrics & Gynecology (OB/GYN) at Yale School of Medicine, has been appointed associate chief of OB/GYN at YNHH. Dr. Fleischman received his undergraduate degree from Washington University in St. Louis and his MD from Albany Medical College. He trained in OB/GYN at YNHH. A member of the executive board of the American College of Obstetricians and Gynecologists, Dr. Fleischman is actively involved in organized medicine and one of his areas of interest is new technology in obstetrics and gynecology. He lectures extensively on alternatives to hysterectomy, including endometrial ablation procedures and the management and treatment of urinary incontinence.

Dr. Fleischman will take the place of Lawrence J. Wartel, MD, who has stepped down to devote himself entirely to his practice. Dr. Wartel was associate chief of OB/GYN at YNHH for almost 25 years and, since 1989, has been a clinical professor of OB/GYN. The physicians of Yale-New Haven Hospital, particularly those in the department of Obstetrics & Gynecology, owe a debt of gratitude to Dr. Wartel for his tireless and resolute support of the department. Fortunately, he will continue to be a major contributor.

There have also been three reappointments of associate section chiefs, including: Michael C. Bennick, MD, associate chief of Internal Medicine; Stephan Ariyan, MD, associate chief of Surgery; and Joseph H. Zelson, MD, associate chief of Pediatrics.

Attending Notes

  • Dr. Robert Sherwin, MD, C.N.H. Long Professor of Medicine and chief of the Endocrinology Section of the department of Medicine, has received the American Diabetes Association's (ADA) 2011 Albert Renold Award, presented, according to the ADA, "to an individual whose career is distinguished by outstanding achievements in the training of diabetes research scientists and the facilitation of diabetes research."
  • Donna Diers, RN, PhD, Annie W. Goodrich Professor Emeritus, Yale School of Nursing, was named a 2010 Living Legend by the Academy of Nursing. This is the American Nurses Association's highest recognition for distinguished leaders in nursing. Diers was honored for her leadership in the development of clinical nursing research, graduate entrance into advanced practice and the use of data to determine outcomes.

YNHCH pediatric inpatient units have been reconfigured

Yale-New Haven Children's Hospital has just completed a major change that reflects best practices in American pediatric medicine with the reconfiguration of its patient care units from age-designated to condition-specific units. YNHCH reconfiguration:

  • 7-2: Cardiac, Medicine and Surgery
  • 7-3: Hematology/Oncology
  • 7-4: Short-stay Unit and the Pediatric Sleep Center (still under renovation)
  • 7-W: Neurosciences/ Pediatric Respiratory Care Unit
  • 8-W: Children's Transplantation

Unchanged are the Pediatric Intensive Care Unit on the seventh floor, Newborn Special Care Unit on the fourth floor, and the Pediatric Emergency Department on the first floor. For more information, please contact Cliff Bogue, MD, clifford.bogue@yale.edu.

YNHCH seeks to integrate pediatric services with Bridgeport Hospital

YNHH is submitting a Certificate of Need (CON) to the Connecticut Office of Health Care Access, asking to integrate pediatric services at Bridgeport Hospital with those at Yale-New Haven Children's Hospital. The CON process is expected to take a few months. If approved, it will create two inpatient campuses for Yale-New Haven Children's Hospital.

The CON proposes that YNHCH increase its licensed beds from 201 to 243 to include the 42 pediatric and newborn intensive care unit beds and also to include the pediatric clinic currently located at Bridgeport Hospital. The newborn nursery will remain on the Bridgeport Hospital license. This integration is in keeping with the national shift in pediatric hospital care to larger integrated pediatric networks, and is expected to standardize best practices and create a coordinated and cost-effective delivery system.

Change to Medical Staff Rule #19: "Medical Record Completion"

On the recommendation of the Medical Board and Medical Staff, the Patient Safety & Clinical Quality Committee of the Board of Trustees recently approved a number of changes to the Medical Staff Bylaws and Rules & Regulations. Complete copies of these documents can be found here. Please note that relative to Rule #19 and failure to complete discharge summaries, the definition of "extenuating circumstances" still includes "illness and other unanticipated circumstances" but now explicitly excludes "planned absences such as vacations or attendance at conferences." Medical Staff should therefore be sensitive to medical record completion requirements.

Epic update: It's time to review the Epic service agreement

Progress continues on our multi-year process to implement Epic, a Yale New Haven Health System-wide clinical information technology system. In early October, Epic electronic medical records will begin to be installed in Hospital-affiliated community practices and ambulatory clinics.

The first community practices signed the Epic service agreement in May. YNHHS continues to offer a subsidized rate for Epic; the fee structure is based on practice size. For practices with one to four providers at a single site, the base fee is $5,000 per provider and $175 per provider per month. For practices with five to nine physicians at a single site, the fee is $4,000 per physician with a monthly fee of $175 per provider. Over 200 community physicians have seen demonstrations.

In order to qualify for the $44,000 payment in federal stimulus dollars in 2012, physicians must be using the EMR for at least 90 days in 2012. To meet this deadline, if you are considering the Epic EMR, please contact the Epic team by August 31. If you want to review the service agreement or see a product demonstration, please call Tracy D'Anna, manager of our community program at 203-200-EPIC. More information.

54 YNHH physicians named to New York magazine's "Best Doctors" list

New York magazine recently named 54 YNHH physicians among the best in the New York metropolitan area in its "Best Doctors" issue. The YNHH doctors were selected from more than 6,000 physicians spanning 63 specialties in the greater New York area. Castle Connolly Medical Ltd., a research and information company sends nomination forms to 12,000 physicians in New York and portions of New Jersey and Connecticut. The complete list is here.

Interpreter Services at YNHH

Please remember that both federal and state law and The Joint Commission require that physicians use interpreters to communicate with limited or non-English speaking patients or their family members/ caregivers (the latter should not be used to interpret). The Yale- New Haven Interpreter Services Department provides interpreters in 150 different languages and sign language 24/7. Contact 203-688-7523 for assistance.

U.S. News & World Report ranks YNHCH

Yale-New Haven Children's Hospital (YNHCH) has been ranked among the best in the nation for five of its pediatric subspecialties in the 2011 edition of America's Best Children's Hospitals, published online by U.S. News & World Report. The hospital's diabetes and endocrinology service ranked seventh in the nation; YNHCH also ranked among the very best in the nation in four additional medical specialties: gastroenterology, urology, neonatology and pulmonology. This is the third consecutive year YNHCH's diabetes and endocrinology service has been recognized by U.S. News.

YNHH 2010 annual report now available online

Yale-New Haven Hospital's 2010 annual report is available only online. To view it, go to the front page of the website and click on the annual report tab. The report includes all the components of past years: a year-end message, lists of leadership, medical staff and donors, financial and statistical information and patient and hospital stories. The entire Medical Staff is listed online but is also available as a PDF which can be printed.

Home health care and attending responsibility

The Patient Protection and Affordable Care Act has imposed new physician documentation requirements if patients are to receive home healthcare services. Simply stated, attending physicians must evaluate patients, face-to-face, determine if, indeed, patients will be homebound and require services, and then document this fact and order the services. Physicians may ask physician assistants, nurse practitioners, clinical nurse specialists or certified nurse midwives (but not physicians in training) to do the face-to-face evaluation, but nevertheless must verify the need and document this on the W-10.

Dr. Herbert has sent practical details for the W-10 to all members of the medical staff which, if misplaced, can be obtained by calling 203-688-2604.

New patient identification team formed

Under the sponsorship of Peter Herbert, MD, and Sue Fitzsimons, RN, PhD, a new patient identification team has been formed with the goal of reducing risks associated with patient misidentification throughout the hospital. As a first step, the committee is compiling existing patient identification-related policies, guidelines or algorithms from departments or work areas. Future issues of Medical Staff Bulletin will be update their work. For more information, contact Sally Roumanis at 203-688-8692 or sally.roumanis @ynhh.org.

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