January 2002

Medical Staff Bulletin

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

The New Year always symbolizes a fresh beginning, renewal, opportunity to set things right. The holiday distractions are over and we return to work resolved to make this a better year than last.

Winter, albeit belatedly, has arrived. Infectious diseases are having their way with our community. Pediatric units are close to overflowing, demand for the Children’s Hospital’s services by other hospitals is peaking and acuity is very high. The Internal Medicine service is always tight for beds. During the next two to three months, the Medical Intensive Care Unit (MICU) will be boarding patients in the CCU, the CTICU and occasionally in the SICU and NICU. Similarly, medical patients in non-acute beds will predictably be occupying 15-25 beds on designated surgical units. More medical beds will come available when the South Pavilion renovations are completed. For now, we must function with fewer beds.

Virtually all of our crowding in winter 2001 was attributable to an increase in length of stay (LOS) rather than admission volume. There was an increase of 0.53 days in Internal Medicine and 0.36 days in Surgery. Both services have shown considerable improvement during the first two months of FY 2002 ­ Surgery LOS has fallen by a remarkable 1.16 days and Medicine by 0.31 days. Pediatrics has actually increased by 0.63 days because of acuity in the Newborn Special Care Unit.

If we can sustain the trend demonstrated this fall ­ and several initiatives are in place to promote care efficiency ­ we can avoid winter congestion in our Emergency Service and back-ups in our post-anesthesia care unit and intensive care units. This will require focus on communication of care and discharge plans to patients, families and other team members; early and frequent interaction with Care Coordination staff; and deferral of non-critical testing to the ambulatory setting. Finally, there must be willingness to use the Temple Recovery Center and other sub-acute settings when inpatient Hospital resources are not required.

Hospitals in most areas of our country are facing similar challenges with rising inpatient census and falling reimbursement. Fortunately, as an institution, we have incredible resources with which to address these challenges. Our Medical Staff’s commitment is extraordinary ­ it is the soul of YNHH. Its guidance, investment and participation in all activities of this Hospital indemnify us against failing. Many thanks for so much in 2001. Happy New Year!

New clinical documentation program to begin at YNHH

In the second week of January, YNHH began a new program to improve clinical documentation on the medical and surgical services. Goals are to improve the accuracy and completeness of the medical record so that the severity of patient illnesses, co-morbid conditions and complications are charted, reported, coded and billed appropriately. Documentation specialists will be reviewing medical records for completeness concurrently with patients’ hospital stays, and will be interacting with physicians and other caregivers to improve chart documentation. Documentation specialists will in no way interfere with the care of patients, but they will seek clarifications from caregivers water damage to equipment when a water main broke and flooded our patient treatment area on December 19. The response by our staff to this mishap has been positive and swift. We are aggressively working to reinstate our normal operations as soon as possible.

Over the upcoming weeks, we will continue arrangements with the Hospital of St. Raphael (HSR) for our physicians and staff to treat our patients in their Radiation Therapy facility during the evening. We are most grateful to Dr. Joseph Cardinale and Dr. Charles Riordan who quickly facilitated arrangements to treat more than 30 patients at HSR. We are also utilizing our satellite facilities at Lawrence and Memorial Hospital in New London and the William Backus Hospital in Norwich. In addition, patients who reside to our southwest are being treated at Bridgeport and Norwalk Hospitals.

We expect to be able to begin treating patients at Yale-New Haven Hospital by January 21. Construction and new equipment installation and commissioning is continuing on an aggressive timetable. We hope to be fully operational with an actually improved radiation therapy facility within a matter of months. We apologize for any problems created for physicians and their patients. Please let us know if there is any way that we can assist you. You can call the Department at 688-4344.

HIPAA update: Faxing

While HIPAA regulations do not yet specifically address faxing, other organizations have articulated general guidelines that can be useful until there is HIPAA clarification. For confidentiality guidelines about faxed information, see Practice Brief: Facsimile Transmission of Health Information (Updated). For a copy of the article, Practice Brief: Facsimile Transmission of Health Information call Jean Ahn at 688-8605.

Residency training program update

The accreditation of YNHH’ s specialty and subspecialty residency training programs is an ongoing process. External site visits by the Accreditation Council of Graduate Medical Education (ACGME) are made to each of the 64 accredited programs every one to five years. In addition, the entire institution will undergo an accreditation visit in 2003. Preparation for these visits begins as soon as the previous site visit has concluded, and includes a mid-cycle internal review. This review is conducted by a program director from another residency, a resident, and an administrator from the Graduate Medical Education (GME) Office. Since the beginning of September, six training programs have undergone the rigorous process of preparing the Program Information Form, and having the program director, faculty, residents and subspecialty residents prepare to meet with the site visitor. Thanks to all program directors and their program coordinators for their work with our trainees, the accreditation process, and keeping the programs among the top residencies in the country.

Platelet transfusion clarification

A new YNHH policy on platelet transfusions was announced in the May/June 2001 issue of the Medical Staff Bulletin. In general, the “trigger” for prophylactic platelet transfusion, was reduced from 20,000/ul to 10,000/ul. It was stated: “Some diagnostic procedures like bone marrow aspiration, bone marrow biopsy and lumbar puncture, can be safely performed with platelet counts below 20,000/ul.” This should be corrected to indicate, “the platelet level for lumbar puncture should at least be in the range of 20,000/ul to 40,000/ul.” The remainder of the guidelines are unchanged.

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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