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Medical Staff Bulletin

March 2011



Contents

A message from the Chief of Staff

Much of what we report in the Medical Staff Bulletin relates to the efforts of physicians and allied health professionals to increase the safety and effectiveness of our practice. This usually is in the context of hospital medicine and our reflections on what is necessary to improve our care quality. It must also be recognized that central and most critical to the entire hospital enterprise is the nursing provided at YNHH.

One overarching effort in the last decade has centered on improving the collaborative leadership of YNHH physicians and nurses. In the past, we often functioned as independent estates, honing the qualities of our separate practices but not building on what we have in common. As recognized this January by The Joint Commission, however, we have made tremendous strides in both advancing our individual practices and our collaborative leadership for the betterment of patient care.

We began the patient safety movement at YNHH a decade ago at a retreat where managers throughout the medical center contributed their recommendations for key initiatives. A Patient Safety Task Force, co-led by a physician and nurse, was formed and has met every week over the last ten years, driving this movement forward. Physicians and nurses have led our capital budget process to ensure availability of the technology and related resources needed in patient care. Nurse and physician practice councils now distinguish most major services, and our most transformational performance management initiatives have been jointly sponsored and executed by nurses and physicians. Together we advanced to nearly universal inpatient electronic medical record documentation in the last year and we are now jointly contributing to the design and implementation of Epic for both our inpatient and ambulatory settings.

Later this month, four reviewers from the American Nurses Credentialing Center will visit YNHH and judge whether YNHH deserves the designation "Magnet hospital." If the opportunity arises, our medical staff should readily acknowledge gratitude for YNHH nursing leadership as well as nursing's fundamental contributions to patient safety, quality outcomes and our Hospital's success.

New director of epilepsy program appointed

Lawrence J. Hirsch, MD, has been named director of the epilepsy program at Yale-New Haven Hospital. For the past eight years, Dr. Hirsch was the director of the continuous EEG monitoring program at New York-Presbyterian Hospital, where he also served as director of the epilepsy and general neurology clinic and as associate attending neurologist. Dr. Hirsch earned his undergraduate degree in computer medicine from the University of Pennsylvania and his medical degree from Yale School of Medicine. He completed his neurology residency at YNHH and medical fellowship in epilepsy/EEG at Columbia-Presbyterian Medical Center. Dr. Hirsch is founder and chairman of the American Clinical Neurology Society's Critical Care Monitoring Committee. He also serves as current chair of the Professional Advisory Board for Epilepsy Society of Southern New York.

Performance management update

In March, Medicare will release its long awaited Final Rule on Value Based Purchasing (VBP) that outlines how Medicare will now pay hospitals based on performance on core measures. 70% of this payment will be based on the measures to the left that are printed in bold, 30% will be based on each hospital's performance on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the national, standardized, publicly reported survey of patients' perspectives of hospital care.

We have been working very hard to improve our performance on all of our publicly reported quality measures, and we must now redouble our efforts for those core measures selected to be part of VBP. Additionally, while our HCAHPS patient satisfaction scores have been increasing over time, our rate of improvement is not fast enough. What are the questions on the HCAHPS survey? There are eight question domains: 1) communication with nurses; 2) communication with doctors; 3) responsiveness of the hospital staff; 4) pain management; 5) communication about medicines; 6) cleanliness and quietness of the hospital environment; 7) discharge information; and 8) overall rating of the hospital.

With regard to the communication with doctors, we are currently in the 14th percentile nationally. The communication questions that are asked are: How often did the doctors treat you with courtesy and respect? How often did doctors listen carefully to you? How often did doctors explain things in a way that you could understand? We are far below the national average for performance on this set of questions. We can and must do better. It is important that we listen to our patients, treat them with respect, and give them the information they need to continue their care after discharge. We all must continue to work very hard to ensure that our patients receive truly patient-centered care. Many thanks for your help with these initiatives and for your care of our patients. If you have questions or concerns, please do not hesitate to contact Tom Balcezak, MD, at 203-688-1343.

Surgical Director named for Center for Heart Failure,
Heart Transplantation and Mechanical Circulatory Support

Abeel A. Mangi, MD, has been appointed surgical director of the Center for Heart Failure, Heart Transplantation and Mechanical Circulatory Support. He specializes in complex and reoperative cardiac surgery, heart, heart-lung, and lung transplantation, ventricular assist devices, total artificial hearts, extracorporeal membrane oxygenation (ECMO), operations for heart failure, aortic and mitral valve repair and replacement, off-pump coronary bypass grafting, myectomy and the surgical treatment of left ventricular outflow tract obstruction, treatment of chronic pulmonary emboli, and ascending aortic and arch replacement.

Dr. Mangi earned his undergraduate and medical degrees from Brown University. After completing his residency in general surgery at the Massachusetts General Hospital & Harvard Medical School, he completed his residency in cardiac surgery at Columbia University. He was awarded a postdoctoral National Research Service Award fellowship, and won awards from the American Heart Association and the American College of Cardiology for groundbreaking stem cell research done at the Brigham & Women's Hospital and Harvard Medical School. He was then appointed as an Associate Staff Cardiac Surgeon at the Cleveland Clinic.

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