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Medical Staff Bulletin

Contents — May- June 2012

A message from the Chief of Staff

Attention Medical Staff
and Affiliated Medical Staff

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

Yale-New Haven Hospital (YNHH) and the Hospital of Saint Raphael (HSR) are very close to consummating an agreement that will make HSR a new campus of YNHH. The Catholic Church on May 3, 2012 granted the request of the Sisters of Charity of Saint Elizabeth to "alienate" the property of the Saint Raphael Healthcare System, thus permitting transfer of the property to YNHH. This past week, the Attorney General of the State of Connecticut and the Federal Trade Commission (FTC) concluded their investigations of the asset purchase agreement between YNHH and HSR, indicating that neither determined that this was contrary to the public interest. The single outstanding and necessary approval is that of the State of Connecticut Office of Health Care Access (OHCA). HSR and YNHH have completed OHCA's interrogatories, and OHCA should act on our certificate of need application after the public hearing held on June 5, 2012.

This has been an arduous and expense-laden journey for our two hospitals and the related regulatory reviews have been very intense. The FTC has scrutinized millions of internal documents and deposed a number of senior officers. No evidence was uncovered suggesting that medical care would not be improved and more cost effective as a result of this union of two great hospitals. This is in contrast to many other mergers or acquisitions which recently failed to receive regulatory approval.

If all continues to go well, as expected, we anticipate that we will finalize all details of our agreement in late July 2012. Then we move from planning to actualization of the promise to our community to create something much greater than the two hospitals brought together. The support of our medical staffs will be critical to the success of this effort. We will need openness and commitment to change for the greater good.

Performance Management update

Oct 2011-Jan. 2012 CMS/TJC
Core Measures Performance


AMI
#
YNHH%
Nat’l 90th%
ASA at arriv.
97/98
99
100
ASA at D/C
89/93
96
100
B-Block at D/C
83/84
99
100
ACEI at D/C
13/13
100
100
PCI
6/8
75
100
Smoking cess
21/22
95
100
 
CHF
#
YNHH%
Nat’l 90th%
LVEF assess.
93/93
100
100
ACEI at D/C
20/20
100
100
Smoking cess.
15/15
100
100
D/C instr. given
54/67
81
100
 
Pneumonia
#
YNHH
% Nat’l 90th%
Pneum. vac. given
17/22
77
100
Abx given
24/27
89
100
Smoking cess.
19/19
100
100
Blood cx before abx
40/43
93
100 Init. (non-ICU)
Selection Abx
17/20
85
99
Influenza vaccine
25/37
68
100
 
SIP
#
YNHH%
Nat’l 90th%
Proph Abx 1 hr
122/123
99
100
Abx selection
123/126
98
100
Proph Abx D/C
112/116
97
100
DVT proph ordered
119/121
98
100
DVT proph given
119/121
98
100
6 am glucose
36/39
92
99
BB Periop period
69/72
96
100
 
Pedi asthma
#
YNHH%
Nat’l 90th%
Inpatient relievers
86/86
100
100
Inpatient steroids
86/86
100
100
Home manag plan
70/86
81
90

Second Quarter PIP Results

Pt. Safety and Quality Threshld Target Max Actual
CLBSI
(per 10,000 discharges)
24 20 16 26.4
VBP Core Measures 93% 95% 97% 96%
Readmission Rate 18% 17% 16% 19.7%
EOC Mock Survey 96% 97% 98% 94%

Our CMS/Core measures updated through January 2012 are at right. The CORE measures that affect our Value Based Purchasing (VBP) score are in bold. Below are the hospital's Performance Improvement Program (PIP) scores together with the achievement goals. The PIP Program, now in its 14th year, is an incentive or pay-for-performance program that allows every hospital employee the opportunity to earn up to 3 percent of her or his annual salary. A substantial portion, 30 percent, of this fiscal year's PIP score is determined by the Hospital's performance on the quality and safety measures.

We regularly discuss our performance on most of these measures in this column. Central line associated blood stream infections (CLABSI), as measured per 10,000 patient discharges, is currently at 26.4 — below the threshold performance. We discussed our CLABSI performance in last month's column, and while we have improved over the last two years, we are not meeting our aggressive year-to-date institutional goal.

Our performance on the summed total of the VBP core measures is a somewhat better story. Since October 2011, we have made substantial progress in this subset of measures, and are currently above target. Hospital-wide readmissions have increased slightly and are below threshold performance at 19.7 percent. There has been substantial improvement in readmission rates, for high-risk patients, most notably Medicare patients with congestive heart failure. The Readmissions Committee, under the leadership of Drs. Grace Jenq and Leora Horwitz, are working to expand this work to other disease states.

The last patient safety and quality PIP measure, our environment of care (EOC) mock surveys, is also below threshold. These mock surveys, conducted twice per year in random fashion on every inpatient care unit, assess our institutional compliance with every element of The Joint Commission's environment of care standards. These measures, such as elements of fire safety, cleanliness, medication security, patient privacy, and others, are one of the foundations of safe, effective and high-quality clinical care, and are core to what we believe is necessary for YNHH to be an outstanding destination hospital. And, while we historically have seen this number approach 95 percent when we are expecting a survey, it is our expectation that we maintain a clean and safe environment every day and at all times.

The substantial weight that is assigned to the patient safety and clinical quality measures that drive the PIP payout for our almost 9,000 employees is a testament to our dedication to patient safety and clinical quality. It also affirms that it is the responsibility of all of us, medical staff, affiliated staff and all employees — from front-line nursing staff to those who work in corporate functions such as billing, finance, human resources — to always focus on our most important responsibility: the safe, effective, efficient, timely, equitable and patient centered care of our patients.

Please refer any questions about this performance management report to thomas.balcezak@ynhh.org

JAZ Quality Conference winners announced

The 2012 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference was held on May 17 at the Omni Hotel with more than 550 attendees, clinicians and managers from the three hospitals. Staff submitted a record 91 abstracts. Keynote speaker Michael Leonard, MD, discussed "Driving a Culture of Safety and Continuous Learning." At the conference, each hospital was recognized for a winning abstract and an additional five abstracts received honorable mention. The winning abstract from Yale-New Haven Hospital was: "Improving and Sustaining Safe Patient Flow through a Multidisciplinary Approach between the Medical Intensive Care Unit and the Emergency Department." Members of the YNHH team included: team leader Jennifer Ghidini, RN, Daniel Hartmann, RN, Hilary D'Atri, Pamela Zaniewski, Carol Barsky, MD, Judy Petersen, RN, Jeanette Bogdan, RN, and Claudia Oliveira.

Two Yale-New Haven Hospital abstracts earned honorable mentions. The first was "Improving Safe Patient Flow in the Pediatric ED," with team leader Peter Damore, Denine Baxter, RN, Karen Santucci, MD, Elizabeth Bartone, RN, Kristen Clark, RN, David Walker, MD, Crystal Clemons, MPH, DJ Harris, Maribeth Hayes, RN, and Jeanette Bogdan, RN. The other honorable mention was for "YNHH Heart Failure Readmission Reduction," with team lead Diane Collins, RN, Leora Horowitz, MD, Charisse Ward, MD, Osama Abdelghany, RPh, Kelly Howe, RN, Catherine Alvarez, RN, Cindy Johnson, RN, Maureen Robinson, Sophia Paul, RPh, Francine LoRusso, RN, Maureen Kennedy, RN, Julie D'Ambrosia, RPh, Will Cushing, PA, Cristine Santiago, RN, Jennifer Phung, RN, Maureen Roussel, RN, Sarah McManus RN, Allison Lucibello, RN, SueEllen Sullivan, Michael Ferry, Carrie Gordon, RN, Wei Teng, Gayle Schrillo, RN, Jeptha Curtis, MD, and Tom Balcezak, MD.

GNH CoSTARR program receives CMS award

A local coalition called the Greater New Haven Coalition for Safe Transitions and Readmission Reductions (GNH CoSTARR) is one of 30 community-based programs across the United States to date to receive an award from the Centers for Medicare & Medicaid Services (CMS) to improve the quality of care for Medicare patients and keep them from being readmitted to hospitals. Grace Jenq, MD, medical director of the YNHH East Pavilion, is applicant program director.

GNH CoSTARR is a partnership between Yale-New Haven Hospital (YNHH), the Hospital of Saint Raphael (HSR) and the Agency on Aging of South Central Connecticut (AASCC) that was formed in summer 2011. One of GNH CoSTARR's goals is to reduce the number of Medicare patients who are readmitted to the hospital within 30 days of a previous admission.

YNHCH specialties are recognized by U.S. News & World Report

Yale-New Haven Children's Hospital (YNHCH) has been ranked among the best in the nation for seven of its pediatric subspecialties in the 2012-13 Best Children's Hospitals rankings, published online by U.S. News & World Report. YNHCH ranked among the top 50 in diabetes and endocrinology (#3); gastroenterology (#22); neonatology (#47); nephrology (#40); orthopedics (#42); pulmonology (#19); and urology (#18).

This is the fifth consecutive year that Yale-New Haven Children's Hospital has been included in the U.S. News & World Report national rankings of pediatric services. Last year, YNHCH had five specialties ranked and two the previous year. Only 80 hospitals across the country ranked in one or more specialties.

Epic update: Greenwich Hospital goes live on Epic

Greenwich Hospital underwent a smooth implementation of the Epic electronic medical record (EMR) over the weekend of April 20. Greenwich was the first YNHHS hospital to go live with Epic. Critical to the success was the collaboration among GH leadership, physicians and staff.

With CME incentives and clear training expectations, physicians received training on using the software as well as how the system will change some aspects of how they see patients. To ease the transition to going live, over the course of three weeks physicians attended personalization sessions at Greenwich Hospital to practice common workflows and begin to set up their personal preference and favorites list — a process that continues after go-live.

As Greenwich Hospital went live on Epic, there were 200 "super users" out on hospital floors and departments to offer support, and identify and fix problems. This team will continue to work throughout the hospital over the next several weeks. In May, physicians who wanted more tips or missed earlier personalization sittings were able to attend additional post-go live support sessions. A physician web portal that is accessible from the ProjectEpic site is under construction for physicians, as well.

Yale-New Haven Hospital, scheduled to go live on February 1, 2013, will benefit from the Greenwich Epic implementation. Building the Epic software for YNHHS will improve with each go-live and the Epic teams gain valuable experience that improves the training for physicians. Still, YNHH physicians and caregivers will need to devote significant upfront time to understand how Epic will support processes of care and how the new EMR can improve many of the things done today.

Attending Notes

  • Seth Powsner, MD, professor of Psychiatry and of Emergency Medicine, is the new president of the American Association of Emergency Psychiatry. Since 2000, Dr. Powsner has served as director of Yale-New Haven Hospital's Crisis Intervention Unit in the Emergency Department.
  • Leo M. Cooney, Jr., MD, Humana Professor of Medicine, Geriatrics, received the American Geriatrics Society (AGS) 2012 Dennis W. Jahnigen Memorial Award on May 4 at the AGS Annual Scientific Meeting. The award is given annually to an AGS member who has provided outstanding leadership to train students in geriatrics and has contributed significantly to the progress of geriatrics education in health professions schools.
  • Tamar Taddei, MD, attending physician and assistant professor of Medicine, Digestive Diseases, has been appointed Chairman of the American Liver Foundation (ALF ) Connecticut Division's Medical Advisory Committee. She directs the liver cancer programs at Smilow Cancer Hospital at YNHH and at the VA Connecticut Healthcare System.
  • Anees B. Chagpar, MD, director of the Yale-New Haven Breast Center at Smilow, has been named to a two-year term as member of the American Cancer Society's New England Division Board of Directors. New recruits will be joining Smilow Cancer Hospital/Yale Cancer Center
  • Daniel Persky, MD, assistant professor of Medicine, Hematology, will be joining Smilow from the University of Arizona. He will focus primarily on the treatment of patients with lymphoma.
  • John Roberts, MD, associate professor of Medicine, Medical Oncology, will be the new director of the adult Sickle Cell Program. He will also care for patients in the prostate and urologic cancers program. Dr. Roberts comes from Virginia Commonwealth University, where he was interim chair of hematology, oncology and palliative care and co-director of the adult sickle cell program.
  • Sarah Goldberg, MD, assistant professor of Medicine, Medical Oncology, will care for patients in the Thoracic Oncology clinics on Smilow 4 and focus on expanding clinical research opportunities for patients with lung cancer. Dr. Goldberg was most recently at Massachusetts General Hospital, completing a research fellowship in thoracic oncology.
  • Terri Parker, MD, a third-year fellow in the Medical Oncology-Hematology Fellowship Program here, will join the faculty as an assistant professor of Medicine, Hematology. Dr. Parker received her medical degree from St. George's University School of Medicine, completed her residency at the University of Connecticut and a fellowship at Connecticut Hospice.

YNHCH to add Pediatric Specialty Center in Norwalk

YNHCH will open a Pediatric Specialty Center in Norwalk in early July. Occupying the first floor of a building at 747 Belden Avenue in Norwalk, the outpatient center will provide children with access to pediatric physicians trained in various medical and surgical specialties at this site. The specialties offered include adolescent medicine, cardiology, craniofacial, endocrinology, gastroenterology, general surgery, hematology, neurology, neurosurgery, ophthalmology, orthopedics and urology. Pediatric radiology services, such as X-ray, fluoroscopy, and ultrasound and pediatric phlebotomy will be available.

YNHH establishes Quiet Hours for patients

YNHH has an HCAHPS target of 63 percent for patients giving the highest score possible on the questions pertaining to the quietness of the environment. The hospital has intensified its continued efforts to create a quieter environment. One of the new elements is the implementation of structured "Quiet Hours" on inpatient units, when lights are dimmed, doors to patient rooms closed when appropriate, and clinical care clustered around other times when possible to help patients get uninterrupted rest. The times are:

  • Mornings: Each unit chooses a time
  • Afternoons: 2-4 p.m.
  • Evenings: All lights out no later than 9 p.m.

A task force led by Diane Vorio, RN, Jill Williams, RN, and Cathy Bursey, RN, is working to help heighten awareness of the need for quiet throughout the day and night, but in particular during the newly established Quiet Hours. Employees are being asked to respect posted Quiet Hours on each unit, speak in low voices, wear soft soled shoes and keep phones and beepers on vibrate while on the unit.

Fifty YNHH physicians named as New York magazine "Best Doctors"

New York magazine recently named 50 physicians at Yale-New Haven Hospital among the best in the New York metropolitan area in its 15th annual "Best Doctors" issue. The YNHH doctors were selected from more than 6,000 physicians in the greater New York area.

The list, which is compiled by a New York City research and information company, Castle Connolly Medical Ltd., includes more than 5,600 physicians deemed to be in the top 10 percent of the region's physicians. Physicians vote online for those doctors who, in their judgment, are the best in their field and related fields, taking into account not only professional qualifications such as education, residency, board certification and reputation, and patient care skills, such as listening and communication, empathy and instilling trust and confidence. To view the list of Yale-New Haven Hospital physicians from New York magazine's "Best Doctors" issue, go to the newsroom at www.ynhh.org

Wendell G. Yarbrough, MD, to lead otolaryngology at Yale-New Haven

Wendell (Dell) Yarbrough, MD, has been proposed for appointment as chief of otolaryngology at Yale-New Haven Hospital and Yale School of Medicine. He will also be director of the head and neck cancer program in Smilow Cancer Hospital and co-director of the molecular virology research program for Yale Cancer Center. He will begin his new appointment on August 1, 2012.

Dr. Yarbrough joins Yale-New Haven from Vanderbilt University, where he is professor of otolaryngology and of cancer biology. Dr. Yarbrough is the Ingram Professor of Cancer Research and co-leader of the thoracic and head and neck program at the Vanderbilt Ingram Cancer Center. He is also director of the Barry Baker Laboratory of Head and Neck Oncology at Vanderbilt University.

Dr. Yarbrough's research concentrates on the identification of tumor suppressors in head and neck cancers and the understanding of tumor growth. He also focuses on the association between viruses and the development of cancer, particularly the link between the human papillomavirus and head and neck cancers.

Dr. Yarbrough received his medical degree from the University of North Carolina School of Medicine. He completed his residency in otolaryngology head and neck surgery, and a fellowship in surgical oncology at the University of North Carolina at Chapel Hill.

Dr. Yarbrough is a member of the American Academy of Otolaryngology, American Association for the Advancement of Science and American Association for Cancer Research. He is also a fellow of the American College of Surgeons and a member of the American College of Surgeons Oncology Group. His research is supported by grants from the National Institutes of Health and the National Cancer Institute.

Jennifer Kapo, MD, is chief of Palliative Care Program

Jennifer Kapo, MD, joined Smilow Cancer Hospital and Yale Cancer Center in April as chief of the Palliative Care Program and associate professor of Medicine, Geriatrics. Dr. Kapo joins YNHH from the University of Pennsylvania where she was medical director of the palliative care services at the Philadelphia Veteran's Administration Medical Center. In her new role, she will expand YNHH's clinical palliative care services, develop a research program in palliative medicine and create an ACGME-certified fellowship in hospice and palliative care.

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