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Medical Staff Bulletin

March 2014

Contents

Message from the Chief of Staff

We are almost through the heart of a dark, cold and messy winter and within a month of more sun and the optimism of spring. The resident match lists are in. In short order we will be welcoming a new cohort of recent medical school graduates and bidding farewell to a newly minted group of boardeligible physicians.

The next three months are a perfect time to review the status of our electronic medical record and establish standards to introduce to new trainees. The Epic implementation team, after a spectacular tour-de-force in 2013, is now devoting considerable resources to the optimization of the system. We are establishing a team of clinicians to both identify and prioritize the changes that will most advantage our clinical operations and the functionality of Epic.

Simultaneously we are calling on each department to review their documentation in Epic. There is general consensus we can make dramatic improvements. There exists considerable variability in the quality of admission notes in recording critical history and events leading up to hospitalization. Physical exams can be sketchy. Assessments are often comprehensive but lacking specificity and focus. Progress notes are typically littered with lists of medications, laboratory data, radiology reports, etc., that are easily accessed without ever opening a note and rarely receive comment within notes. The use of copy and paste without appropriate editing has rendered many notes confusing or irrelevant.

Rehabilitation facilities and primary care physicians relate that discharge summaries too frequently are sketchy and do not clearly articulate what happened during the hospitalization and what is expected in follow-up.

Each department is asked to convene a task force — including program director, residents and active attending physicians — to define elements to be addressed in documentation, identify who is responsible and accountable, establish standards and create a review mechanism to monitor documentation quality. An electronic medical record can be a powerful communication tool, but it will fall far short of its potential if documentation is not disciplined. Just as we all spend time honing our diagnostic skills, building our knowledge bases and differentials, work and attention to improve our use of the electronic medical record will be effort well spent.

Performance Management Update

December 2012 - November 2013
CMS/TJC Core Measures Performance


AMI
#
YNHH%
Nat’l 90th%
ASA at arriv.
295/296
99
100
ASA at D/C
272/276
98
100
B-Block at D/C
258/262
98
100
Statin D/C
262/269
97
100
PCI <90
32/33
97
100
       
CHF
#
YNHH%
Nat’l 90th%
LVEF assess.
337/337
100
100
ACEI at D/C
68/76
90
100
D/C instr. given
224/236
95
100
       
Pneumonia
#
YNHH%
Nat’l 90th%
Blood Cx before Abx
179/190
94
100
Initial (ICU and non-ICU)
Selection Abx
69/71
97
100
       
SIP
#
YNHH%
Nat’l 90th%
Proph Abx 1 hr
386/397
97
100
Abx selection 389/394
99
100
Proph Abx D/C
370/374
99
100
DVT proph ordered
399/400
99
100
DVT proph given
394/395
99
99
6 am glucose
107/116
92
100
BB Periop period
240/240
100
100
Foley removal POD2
385/397
97
100

YNHH has sustained high performance on the CMS/TJC core measures. The performance has remained consistent over the past fiscal year and, in many cases, has improved, contributing to our success with Value-Based Purchasing (VBP).

One outcome measurement that has been added this year is hospital-acquired central line-associated blood stream infections (CLABSIs) in intensive care units. In calendar year 2013, there were 30 CLABSIs in the ICUs across both campuses — a 25 percent decrease from 2012 when there were 40 CLABSIs.

An interdisciplinary team, led by physician leaders John Boyce, MD, and Jonathan Siner, MD, and nurse leaders Lenore Reilly, RN, and Laurie Devin, RN, has been working on changes to ICU processes to decrease CLABSIs. These include technology and product standardization/ upgrades, standard processes for insertion, maintenance, device awareness and removal and a robust improvement effort to standardize how and when blood cultures are drawn. As a result of these efforts, the current ICU performance is 1.09 per 1,000 catheter-days, which is not different than expected as compared to other medical centers. In the non-ICU setting, YNHH had 107 CLABSIs in 2012 and 76 in 2013.

We will continue to highlight Value Based Purchasing outcome measures like CLABSI, as your awareness and continued support will enable us to measure, change and improve care across all settings at YNHH. Please direct any questions to Tom Balcezak, MD, (203) 688-1343.

National Doctors' Day breakfast to be held on March 27

Please join your colleagues in the Medical Staff Lounge (Main 1) at the Saint Raphael Campus to celebrate National Doctors' Day on Thursday, March 27. YNHH will alternate campuses for this event each year but all Medical Staff are invited to attend. A special breakfast will be served from 7 - 8 am. No RSVP is required.

YNHHS and NEMG sign agreement with PriMed

Yale New Haven Health System and Northeast Medical Group (NEMG) signed an asset purchase agreement with PriMed, a physician practice based primarily in Fairfield County, on February 14. NEMG will acquire PriMed's assets and operate the practices under NEMG's organizational structure. More than 100 PriMed providers and 500 staff members will join NEMG. Over the next 90 days, we will work to transition PriMed staff and operations to NEMG. Due diligence is in process and will be completed prior to the expected go-live June 1, 2014.

Update on YNHHS / Tenet relationship

Yale New Haven Health System has reached a partnership agreement with Tenet Healthcare that will support the Yale New Haven Health System's goal of providing accessible, patientcentered care in association with local community hospitals throughout the region. The agreement will preserve and ultimately expand access to care for patients, without fundamentally changing YNHHS or its role as a regional not-for-profit health system.

Tenet will bring the capital necessary to financially stabilize certain community hospitals that have been seeking a corporate parent, address their existing liabilities and invest in their programs and infrastructure in a way that the Yale New Haven Health System cannot. YNHHS will be involved in supporting access to and the delivery of certain clinical services that have been a hallmark of our organization in key communities in the region.

In addition, YNHHS will work with Tenet and other hospitals and providers to manage the various types of insurance products that are being developed where providers share risk for the care provided. Tenet has significant expertise in this area that will benefit YNHHS as we become a more active participant in a changing healthcare insurance marketplace.

Moving forward, we will work with the Governor's Office and the legislature to support Tenet's acquisition of regional hospitals. As a result, over the course of the next several weeks, we will be working with Tenet leadership and senior leadership at hospitals in Waterbury, Bristol, Manchester and Rockville to advocate for a smooth acquisition process.

New section chief named for Vascular Surgery

Timur Sarac, MD, has been named new chief of the section of Vascular Surgery and co-director of the YNHH Heart and Vascular Center. Dr. Sarac has been vice chairman of Vascular Surgery at the Cleveland Clinic since 2011, and was professor at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Prior to joining Cleveland Clinic in 1999, Dr. Sarac was a vascular surgeon at Walter Reed Army Medical Center. Dr. Sarac obtained his undergraduate degrees from Canisius College and the University of Rochester, his medical degree from SUNY at Buffalo School of Medicine. He completed his general surgery training at the University of Rochester, his vascular surgery training at the University of Florida and endovascular surgery training at Texas Tech University.

Our thanks to Bauer Sumpio, MD, PhD, for his leadership and dedication to the Vascular Surgery section. He will remain active in the section, in addition to his roles as program director of both the vascular surgery fellowship and residency training programs, and as associate director of Graduate Medical Education.

Preparation for transition to ICD-10 continues; training to begin soon Yale-New Haven Hospital is in the midst of System-wide preparations to make the transition from the old ICD-9 coding system to the new, federally-mandated ICD-10 codes for patient diagnoses, procedures and surgeries. Hospitals and other healthcare organizations that do not implement the new ICD-10 codes by Oct. 1, 2014 will not receive reimbursement for the care they provide from the government, insurance companies and other private payers. The new ICD-10 codes are more specific and more numerous — the number of codes for diagnoses will increase from around 14,500 to almost 69,000, and the number of codes for procedures will increase from 4,000 to almost 72,000.

Improved documentation, updated software applications, and organization-wide educational efforts are underway. Twelve YNHHS subcommittees are supporting this multidisciplinary, system-wide effort, led by Cindy Zak, executive director of HIM and Coding. Ian Schwartz, MD, YNHH executive director of Care Management, is leading the provider education subcommittee that will be communicating and training members of the medical staffs at YNHH, Bridgeport and Greenwich hospitals and Northeast Medical Group.

Provider training will begin in April with a System Go-Live scheduled for May 17. This education will consist of online training modules through Healthstream, short tutorials at staff meetings and a variety of specialty-specific webinars. Detailed training information will be communicated within the next few weeks. If you have questions about ICD-10 or upcoming training, contact Dr. Schwartz at ian.schwartz@ynhh.org.

Find scanned documents in Epic media tab

Scanned documents, including consent forms and documents from other hospitals, are in Chart Review in Epic, in the Media tab. Follow these steps to locate documents:

  • To view the document in the patient's chart, log in to Epic Hyperspace.
  • Search for your patient in the Patient Lookup dialog box.
  • Select the Chart Review tab.
  • Go to the Media tab in Chart Review
  • To change the view from thumbnail to detail view click the "Details View" button on the toolbar.
  • Click the "Thumbnail View" button to change back to the detail view.

If you have questions about navigating the Epic Media tab, or would like to schedule one-onone training, contact Susan French, Susan.French@bpthosp.org.

Call for abstracts: Zaccagnino Patient Safety and Clinical Quality Conference

The deadline for abstract submissions for the 2014 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference is Friday, March 21. A submission form and guidelines are on the YNHHS Performance Management website. From the intranet, click "departments" in the top navigation bar, then "Performance Management" on the list. The conference will be Thursday, May 15, 9 am - 3 pm at the Omni Hotel, New Haven. For information, contact Ella McGhee, Performance Management, 688-4641 or ella.mcghee@ynhh.org.

Heart walk to be held in West Haven on May 3

Chris O'Connor, YNHHS executive vice president and COO, is chairing the American Heart Association's (AHA) annual Greater New Haven Heart Walk at Savin Rock Park in West Haven on Saturday, May 3 at 10 am. He invites members of the Medical Staff and their families to support this year's walk. To register online, visit newhavenheartwalk.org./p>

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