August/September 2002

Medical Staff Bulletin

Message from Dr. Peter N. Herbert,
YNHH Chief of Staff

The Yale-New Haven Hospital triennial survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will take place on October 7-11, 2002. These surveys are taken seriously by every hospital since JCAHO accreditation is necessary to receive Medicare reimbursement. Loss of accreditation is not a viable option but neither is it our major concern. Rather, preparation for our JCAHO survey is focused on the comprehensiveness of our compliance with JCAHO standards. The majority of the standards are meaningfully related to the quality of our patient care.

One of the accepted National Patient Safety goals is to dramatically improve communication among caregivers. This underlies YNHH’s recent and significant investment in new clinical information technology; and this was a major topic of discussion at a meeting of the clinical leadership group this spring. Communication is also central to the JCAHO standard requiring that all brief operative notes and detailed operative dictated reports must be done on the day of surgery and this includes ambulatory surgery. The division of labor and the culture of academic medical centers has traditionally frustrated this goal. However, there is little disagreement that the goal is laudable and it is one we shall aggressively pursue. Our own review indicates we are currently only 80 percent compliant.

Appropriate application of physical and pharmacologic restraints in health care settings has been a concern of patient rights’ advocates and patient safety experts alike. Use of restraints may be seen as an expedient way to deal with agitated patients, but all other options must be exhausted and communicated before restraints are applied. Any patient who is ultimately restrained for medical or behavioral reasons must have an order from a physician, physician assistant, or advance practical nurse (licensed independent practitioners or LIPs). Patients in behavioral restraint must have a documented in-person assessment by an LIP within one hour of restraint application. Note, however, that trained staff members, such as registered nurses, may initiate the use of restraints in an emergency before an order is written.

A third area pertinent to patient safety and JCAHO concerns is that of conscious sedation, or what is now termed “moderate sedation.” The risks associated with this procedure are well known and individuals with this privilege must demonstrate both knowledge of sedation principles and medications as well as current airway management skills. Residents, in their fourth or later years, are eligible but must be specifically credentialed to administer conscious sedation.

Finally, I would note that we still occasionally encounter incomplete “do not resuscitate”/DNR orders. Not only must Attendings sign these, but there must be a note in the medical record detailing discussions with the patient or family.

When considered from the perspective of “legislated” documentation or communication, the JCAHO standards referenced above might seem bureaucratic. When viewed in the light of our goals for patient safety and communication, they are eminently reasonable.

Dr. Hostetter named Chief/Chair of Pediatrics

On September 1, Margaret K. Hostetter, M.D., was appointed Chief and Chair of Pediatrics. Dr. Hostetter received her M.D. from Baylor College of Medicine in Houston and did her post-graduate training at Children's Hospital in Boston. She joined the Yale faculty in 1998 as Professor of Pediatrics and Chief of the section of Immunology and Director of the Yale Child Health Research Center. In 2000, she received a joint appointment as Professor in Microbial Pathogenesis. Since coming to Yale-New Haven, Dr. Hostetter has established the Yale International Adoption Clinic and has doubled the size of the Pediatric Scientist Development Program. She succeeds Norman J. Siegel, M.D. who has served most admirably as the interim Chief and Chair of Pediatrics.

Dr. Glazer named Chief/Chair of Radiation Therapy

Peter M. Glazer, M.D., Ph.D., is the new Chief and Chair of Therapeutic Radiology, succeeding James J. Fisher who has served with distinction as the Chief/Chair of the department for 30 years. Dr. Glazer received his M.D. and a Ph.D. in Genetics from Yale University in 1987 and joined the Yale faculty after a residency in Therapeutic Radiology at YNHH. In 1995, he received a joint appointment in the Department of Genetics. Dr. Glazer's research in the area of DNA repair and mutagenesis in mammalian cells has earned him national recognition in the field of radiation oncology. He has also been an active clinician, serving as medical director of the YNHH-satellite facility, the Phelps Radiation Therapy Clinic at Uncas-on-Thames Hospital in Norwich, from 1994-1998. In 1998 he guided the establishment of a new radiation therapy treatment center at William W. Backus Hospital and served as its medical director until his recent appointment as Chief of the YNHH service.

HIPAA update

The Department of Health and Human Services released its final modifications to the HIPAA privacy regulations on August 14th, chief among the changes is the proposed restructuring of the HIPAA consent requirement. HHS secretary Thompson said: "The prior regulation, while well-intentioned, would have forced sick or injured patients to run all around town getting signatures before they could get care or medicine." A summary of the proposed changes is at http://www.hhs.gov/ocr/hipaa. Extension requests for compliance with the Transactions and Code Sets (TCS) standards must be filed by the October 15, 2002 deadline. A model template of the compliance plan can be accessed at www.cms.gov/hipaa. Please note that it is unnecessary to file separate compliance plans for each physician in a group practice if the practice files all third-party claims on the physicians' behalf. However, if claims are submitted for payment outside of the group's claims processing system, a separate compliance plan will need to be filed for each physician.

Medical Staff Lunch Room

The Max Taffel Room (Sides C&D) will not be available to Medical Staff members from 11:30 a.m.-1 p.m. on: Sept. 6, Oct. 7 and 28, and Nov. 25. We apologize for any inconvenience and encourage Medical Staff members to utilize the Atrium Cafe or main cafeteria during these times.

Refer items for the next issue of Medical Staff Bulletin via phone, fax, E-mail or mail to:
Peter N. Herbert, MD
1063 Clinic Building
P: (203) 688-2604, F: (203) 688-7152
herbertpn@ynhh.org
or
Katie Krauss
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
krauss@ynhh.org

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Last revised: April 13, 2004 (cfs)

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