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Medical Staff Bulletin

Contents — March - April 2012

A message from the Chief of Staff

Activity relating to the proposed acquisition of the Hospital of Saint Raphael assets by Yale-New Haven Hospital has increased considerably over the last month. On February 9, we jointly filed a certificate of need application with the Connecticut Office of Healthcare Access (OCHA) and we currently are addressing their questions about the application. We are similarly preparing responses and supplying enormous amounts of data to the Federal Trade Commission (FTC). In April, several of us will visit the FTC in Washington, DC, to be deposed and provide oral testimony. Meanwhile, we are awaiting approval of the alienation petition to the Catholic Church.

In addition to the regulatory processes, much planning is ongoing to seamlessly transition to a single institution by the first week of July, 2012. Staffs from both hospitals have been identifying the tasks necessary to accomplish this, meeting all compliance and articulated clinical standards, creating a single work force, and credentialing all caregivers not already common to YNHH and HSR. Moreover, we are making intermediate and long-term plans to capitalize on the strengths of our institutions to provide better care and care at less expense, whenever possible.

Changes to our Medical Staff Bylaws, Rules and Regulations have been recommended by our Medical Board to accommodate all HSR Medical Staff and insure participatory governance. These will require approval by our Board of Trustees. Meanwhile, both hospitals have very successfully completed their resident matches for academic year 2012-13 and we seek the best approaches to integrating our GME efforts and enhancing the quality of our training programs.

We are grateful to the scores of physicians who have participated in planning and supported this effort. It is good to see the goal line three months away.

Zaccagnino Patient Safety and Clinical Quality Conference on May 17

The 2012 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held on May 17 at the Omni Hotel New Haven. Last year's conference highlighted over 90 projects from across the health system. Michael Leonard, MD, is the keynote speaker. Dr. Leonard is nationally known in the areas of human factors, team communication, patient safety and medical errors. He has been physician leader for patient safety at Kaiser Permanente and a senior faculty member at the Institute for Healthcare Improvement (IHI). Most recently, he was named adjunct professor of Medicine at Duke University School of Medicine. Please contact Darriell Rolka at 203.688.8692 with any questions. Darriell.Rolka@ynhh.org

Performance Management Update

At left are our familiar Core measures for the most recent three-month period. As of March 31, we have ended the performance period for Value Based Purchasing (VBP) for fiscal year 2013. How we performed on the CORE measures from July of 2011 to March 2012 will determine how much of our at-risk 1% payment is returned to us from the federal government. Based on our historical performance, we could lose approximately 60% of our at-risk payment. The fiscal year 2014 performance period will run from July 2012 to March 2013 — so we have great incentive to continue to improve both our Core measures and our HCAHPS performance.

In addition to public reporting of Core measures and HCAHPS, the state is now reporting hospital-specific rates of both adverse events and central line associated blood stream infections (CLABSI). YNHH has been reporting its CLABSI rates in ICUs to the Center for Disease Control's (CDC) National Health Safety Network almost since this program's inception. In the state, MICU and PICU rates have been publicly reported since 2008. YNHH began submitting CLABSI rates for all of its ICUs in January 2012 and these are reported by DPH in the form of a standardized infection ratio (SIR). Use of a SIR is necessary because certain ICUs have higher risks of CLABSI than others, e.g., burn units trend higher than cardiac care units. Where do we stand? For all of our ICUs, we are either at or below national averages for CLABSI.

Quite independent of public reporting, since January 1, 2010, hospital Epidemiology and Infection Control has been collecting CLABSI information on all YNHH inpatient services. Between calendar years 2010 and 2011, we saw an overall reduction of more than 9% in CLABSI, and this takes into account neither the increase in use of central lines nor the increase in our census and acuity. Some ICUs led the way, with the NICU reducing their overall CLABSI rate by 71% and MICU 9 by 45%.

YNHH Medical Director Leadership Council formed

For many years, YNHH physicians have served as directors provided oversight of clinical care in many areas of the hospital. Currently, about 150 physicians are aligned with specific inpatient nursing units, ambulatory clinics, clinical laboratories or service lines. Some directors are geographically based, such as in the Emergency Department, while others oversee care on many units, as in inpatient medicine.

Under the leadership of Thomas Balcezak, MD, associate chief of staff and chief patient safety and quality officer, YNHH is working to clarify and standardize the roles and responsibilities of the medical directors to better align them with the goals of YNHH. Those goals include strengthening clinical operations, improving quality outcomes and enhancing patient safety. Directors are expected to diminish variation in physician practice through implementation of evidence-based clinical practice and unified standards for bedside rounds, patient hand-offs, consultation, clinical documentation and adherence to Medical Board policy. Another goal will be to develop physician leaders — in hospital structure and function, management, performance improvement, healthcare finance and policy, and healthcare reengineering.

Carol L. Barsky, MD, MBA, the new medical director of Clinical Performance and associate chief of Patient Safety and Quality, is overseeing this effort. Dr. Barsky has formed a new Medical Directors Leadership Council (MDLC), made up of about 40 senior medical directors who represent the larger group.

All the medical and residency directors meet quarterly with Richard D'Aquila, YNHH president and COO. The MDLC itself recently held an all-day retreat where Rajneesh Behal, MD, associate chief medical officer and senior quality and patient safety officer at Rush University Medical Center, spoke about engaging and leading physicians in clinical transformation.

Smilow Patient and Family Resource Center opens

At the new Patient and Family Resource Center at Smilow on NP 1-300, patients and families can obtain information on health topics and hospital and community services. The Resource Center has computer workstations with internet access for research purposes or personal business, as well as a lending library offering current information on cancer- related topics and a selection of relaxation/meditation CDs. The Resource Center will be the site of regularly scheduled events, including educational programs, drop-in discussions with hospital staff and creative activities workshops. The Resource Center (NP 1-300) phone number is 203.200.INFO (4636).

YNHH hosts April 23 organ donation registration event to be part of GUINNESS WORLD RECORDS®

YNHH is sponsoring an organ donation registration event on Monday, April 23 from 8 a.m.-4 p.m., with the goal of setting a new record for registering the highest number of organ donors in a single day. People can register in the hospital Atrium or Hunter Courtyard. Organ donors must register in person and be over 18 years old, residents of Connecticut who are not already registered, or residents of other states or countries. The goal is to register more than 765 new organ donors. YNHH employees and members of the Medical Staff are encouraged to attend and help spread the word. Attendees can visit the photo booth and post their picture to Facebook, asking others to come and sign up that day.

YNHHS helps lead new Northeast Purchasing Coalition

In 2011, Yale New Haven Health System led an effort — along with 28 other New England health systems, including Beth Israel-Deaconess Medical Center and Mary Hitchcock Memorial Hospital — to form the Northeast Purchasing Coalition (NPC). In collaboration with VHA, the coalition's goals are to utilize evidence-based information and clinical input to standardize purchasing choices that will result in significant cost savings while maximizing quality outcomes.

The Northeast Purchasing Coalition's physician engagement effort is led by Maxwell S. Laurans, MD, MBA, who is a YNHH attending neurosurgeon. In its first year, the NPC has saved Yale New Haven Health System $14 million in annual purchasing costs. These savings have come from a range of products from prefilled syringes to exam gloves, contrast media, trocars, blood pressure cuffs and office supplies.

The NPC works closely with physician advisors and subject matter experts at each hospital to research product and vendor options, identify and involve product users, conduct product trials and reach agreement based on available evidence and physician input before making recommendations. Individual physicians will still have some choice of products or devices within an identified range of options.

YNHHS has recently formed a Physician Advisory Council to represent the Health System and obtain physician input on the selection process and the appropriateness of decision-making. The council includes physician advisors from all three YNHHS hospitals and the Northeast Medical Group. Among the members are Drs. Kimberly Davis, Henry Cabin, Richard Stahl, and Maxwell Laurans from YNHH; Drs. Nabil Atweh and Stuart Zarich from Bridgeport Hospital; Drs.Brian Doran and Paul Waters from Greenwich Hospital; and Dr. Robert Nordgren from NEMG.

Currently, the group is focusing on bone cement and surgeon gloves. Over the next several months, members of the Medical Staff will hear more about medical devices and clinical preferences under consideration — such as drug-eluting stents, sutures and endomechanicals. Members of the Medical Staff who have questions or would like to be involved in the process should contact Dr. Laurans at maxwell.laurans@yale.edu or Pam Scagliarini, vice president, YNHHS Supply Chain Management at pam.scagliarini@ynhh.org

YNHH to move ahead with ambulatory health center plans in North Haven

YNHH will purchase and remodel the120,000-square-foot, four-story former AT&T building at 6 Devine Street in North Haven to develop a comprehensive ambulatory care program this is expected to open in January 2013. Plans for the new building include a walk-in/primary care center to provide comprehensive medical services from injury care to management of chronic conditions. The center will be open seven days a week.

The building will also include a Smilow Cancer Hospital Care Center for outpatient medical and hematological care and an inflammatory disease center for patients with multiple sclerosis, rheumatoid arthritis and related disorders. The facility will offer onsite MRI and digital X-ray imaging, as well as laboratory and blood-draw services. YNHHS will consolidate some of its information technology offices from multiple sites in New Haven to the North Haven facility.

Attention Medical Staff and Affiliated Medical Staff members
If you have changed your office address, phone or fax number, home address or phone number, mobile phone number or pager number, please contact the Department of Physician Services at 203.688.2615 or email the information to: physiciansvcs@ynhh.org

 

Epic update: Physicians giving input and going live

A Physician and Provider Advisory Group (PAG) meets twice a month to participate in facets of the Epic implementation efforts. The PAG has provided guidance on ambulatory and inpatient builds, workflow and order sets that will be standard across the Health System. PAG members have been able to test, validate and make recommendations related to the new EMR, confirming streamlined workflows, easy functionality and quick answers. Securing this additional input before a hospital go-live ensures that the new EMR meets the needs of physicians and other clinicians across the system.

The first Yale Medical Group practice went live on Epic last October; the first Northeast Medical Group practice in November and the first community practice in January 2012. There are now more than 30 practices in 29 locations on Epic — from Fairfield to Guilford to Middletown — with more than 160 physicians using the Epic EMR system. More than 650 patients have already enrolled in the patient portal, MyChart.

The first System Hospital to go live on Epic for all of its clinical, revenue cycle and access functions will be Greenwich Hospital on April 20. Training for physicians and staff has been under way for the past two months. Physicians earn CME credits for every hour of Epic class time; depending upon the physician's specialty, classroom sessions can take up 16 hours. YNHH is scheduled to go live in February 2013 and Bridgeport Hospital in June 2013.

To learn more about the PAG or Epic implementation, please contact Allen Hsaio, MD, or Steve Schlossberg, MD, or send an email to ProjectEpic@ynhh.org.

Dr. Rutherford named interim section chief of Urogynecology

Thomas J. Rutherford, MD, section chief, Gynecologic Oncology and professor of Obstetrics, Gynecology and Reproductive Sciences, has been appointed interim chief of Urogynecology. Dr. Rutherford joined Yale in 1993 for a gynecology/oncology fellowship, after serving a residency at Albert Einstein Medical Center and at Cooper Hospital/University Medical Center. He was also a Galloway fellow at Memorial-Sloan Kettering Hospital. Dr. Rutherford received his PhD and MD from the Medical College of Ohio. Dr. Richard Bercik, former section chief of Urogynecology, has decided to return to full-time clinical practice.

Michael Caty, MD, named chief of Pediatric Surgery

Michael G. Caty, MD, is the new pediatric surgeon-in-chief at Yale-New Haven Children's Hospital. Dr. Caty joins YNHCH from Women and Children's Hospital of Buffalo, where he was surgeon-in-chief, director of pediatric surgical services, and professor of Surgery and Pediatrics at the Buffalo University School of Medicine and Biomedical Sciences.

Dr. Caty's clinical interests include neonatal surgery, intestinal motility disorders, pediatric renal transplantation, pediatric surgical oncology, pediatric laparoscopy and minimally invasive thoracic surgery. His research interests are concentrated on the pathophysicology of intestinal ischemia and reperfusion. Dr. Caty received his medical degree from the University of Massachusetts and trained in general surgery at the University of Michigan where he also did a research fellowship investigating intestinal injury during ischemia and reperfusion. His did his pediatric residency at Children's Hospital of Boston and Harvard Medical School. Dr. Caty has recently been named president of the Surgeons-in-Chief Group of the Children's Hospital Association (formerly known as NACHRI).

Richard D'Aquila named YNHH president and COO

Richard D'Aquila, who has served as the executive vice president and chief operating officer at YNHH for the past six years, has been appointed president of YNHH. He will continue in his role as the Hospital's chief operating officer. Marna Borgstrom, YNHH president and CEO since 2005, will remain YNHH's chief executive officer (CEO), as well as president and CEO of Yale New Haven Health System.

The change in the two senior leadership positions will allow both Borgstrom and D'Aquila to focus on areas vital to the success of both the Hospital and the Health System. D'Aquila will continue to drive YNHH's vision to be a regional and national referral center with multiple patient care specialties ranked among the best in the country. Borgstrom will focus more heavily on broad strategies to strengthen the System and enhance value, as well as develop and implement an approach to federal healthcare reform.

D'Aquila received his graduate degree in hospital administration from Yale School of Medicine and his bachelor's degree in economics from Central Connecticut State University. Before joining Yale-New Haven Hospital in 2006, he was senior vice president and chief operating officer of New York-Presbyterian Hospital/Weill Cornell Medical Center. Previously, D'Aquila was executive vice president and chief operating officer at St. Vincent's Medical Center in Bridgeport.

Second annual Closer to Free bike ride kicks-off

Registration is now open for the second annual Closer to Free (CTF) Bike Ride on Saturday, Sept. 8, beginning and ending at the Yale Bowl Complex. Cancer survivors, patients, families, friends, physicians, staff and riders of all skill levels and abilities are encouraged to ride. Riders can choose a 25-mile, 65-mile or 100-mile route, passing through New Haven and along the Connecticut shoreline. Last year, 250 riders participated in the ride and helped raise more than $400,000 to support patient programs and research at Smilow. Event organizers are also looking for corporate sponsors and volunteers. Anyone interested in taking part in the ride should contact Yale-New Haven Hospital's Office of Development at 203.688.8727 or email rideclosertofree@ynhh.org. Visit www.rideclosertofree.org for more information.

Patient and Family Advisor Program seek volunteers

YNHH's Patient and Family Advisor Program involves YNHH patients, former patients or family members who are willing to volunteer and help the hospital become more patient-and family- centered. Advisors can serve on one of five patient and family advisory councils (adult, pediatric, Smilow, behavioral health and newborn special care) or participate in other ways by sharing their unique personal experience in a positive, productive manner. If you know of a patient or family member who might be a good candidate to become an advisor at Yale-New Haven, please contact Sue Kamm, manager, YNHH Patient and Family Centered Services, at 203.688.3299 or susan.kamm@ynhh.org.

In memoriam: James J. Fischer, MD, PhD

James J. Fischer, MD, PhD, who served as chair of the YNHH Department of Therapeutic Radiology from its founding in 1972 until 2002, died on Feb. 22, 2012. Dr. Fischer was a leader in the radiation oncology community and an exemplary physician and scientist. Dr. Fischer joined the Yale faculty in 1968, and was fully engaged as a professor and attending physician until his death. Dr. Fischer is survived by his wife, Dr. Anne Curtis, his children and grandchildren.

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