January/February 2003

Medical Staff Bulletin

Message from the Chief of Staff
Happy New Year to all members of the YNHH Medical Staff!
We have closed the books on 2002, which was a very eventful year for our Hospital. Four new chiefs were appointed: Dr. Charles Lockwood in Obstetrics and Gynecology, Dr. Alan Kazdin in Child Psychiatry, Dr. Peter Glazer in Therapeutic Radiology and Dr. Margaret Hostetter in Pediatrics. We did exceptionally well in a reaccredidation visit by the JCAHO. The General Surgery residency had a successful RRC review after a major Program overhaul. We further improved care efficiency, reducing overall length of stay in Medicine and Surgery by 0.3 days and Psychiatry by 1.6 days. This permitted us to care for more than 1,100 patients in Med/Surg and 400 in Psychiatry without increasing congestion in our Emergency Service or refusing transfers from other hospitals. YNHH finished the year on very solid fiscal footing.

I call special attention to the accomplishments of our Patient Safety and Performance Improvement efforts of the past year. There was tremendous focus on hand hygiene and definable outcome result. From the first through the fourth quarter of 2002, physicians improved compliance rates after patient contact from 54 to 77 percent! While causality is very difficult to establish, blood stream infections by vancomycin resistant enterococci (VRE) fell from 31 to 8 between FY 2001 and FY 2002, the first reduction in infection rate in recent memory. We achieved or exceeded our goals in projects addressing acute reperfusion in myocardial infarction, application of patient identification and allergy wrist bands, blood transfusion documentation, laboratory specimen labeling and pneumococcal and influenza immunization. We sustained excellent performance in management of congestive heart failure, community-acquired pneumonia and coronary artery disease. Ambulatory projects in care of febrile children, diabetes and HIV disease went very well and our multifaceted program addressing medication safety had another great year. Acquisition of Six Sigma tools by managers was accelerated. All members of the Senior Operations Group spent two full days in Six Sigma training and staff from nursing, physicians, administration and technical support services activity pursued major projects.

2003 will not provide opportunity to rest on our laurels. The agenda for process improvement is doubly ambitious. External economic and regulatory forces will truly test our collective creativity. The residency training programs will be sorely challenged to comply with the new ACGME work-hour regulations without compromise of educational and patient care objectives. Recruitment and retention of nurses, pharmacists and technical staff will continue to tax us. We thank our Medical Staff for unstinting support in 2002 and trust you will keep us on course in 2003.

Brain death determination guidelines formalized

Effective Jan.1, 2003, YNHH adopted a policy that establishes guidelines for the determination of brain death in Hospital patients. The policy had extensive input from the Neurosurgery service (thanks to Drs. Duncan and Chiang) and review by many other individuals and services. The policy provides information on relevant patient evaluation and testing and requires that the declaration of brain death be made by two separate Board-eligible or -certified physicians. One of these physicians must have neurologic qualifications. The policy can be found in the Hospital's Administrative Manual, which is on line and available through the clinical workstations.

NCPDF process updated

The New Clinical Program Development Fund (NCPDF) began in 1999 as a multimillion dollar initiative of the Yale New Haven Health System, Yale-New Haven Hospital and the Yale School of Medicine to enhance the clinical enterprise of the Medical Center. The NCPDF has funded 13 programs over two funding cycles including three programs in 2002. The NCPDF has provided seed funds for new patient care programs in five designated areas: brain disease, cancer, cardiovascular disease, developmental disorders and organ transplantation.

In the interest of improving the NCPDF's effectiveness at identifying and implementing new initiatives, a review of the processes that govern access to NCPDF funding has recently been completed. As one measure to improve the NCPDF's operation, YNHHS appointed Dr. Michael Apkon as the fund's medical director in 2002. Dr. Apkon will serve as a liaison to the Clinical Faculty, helping cultivate concepts and plans for new program development.

Another notable change is that the annual call for applications has been eliminated. Rather, individual applications may be submitted for review on a continual basis. Concepts for the development of potential programs for NCPDF funding will originate with the Medical Center leadership as well as with members of the Medical Staff. All programs must meet the definition of a "new clinical program" and must be able to demonstrate financial sustainability. The original five designated priority areas will remain in effect for an additional three years.

It is hoped that these changes will allow the NCPDF to be more responsive to opportunities for program development as they arise and more efficient in working with the medical staff to explore those opportunities. Dr. Apkon is available to meet with physicians, business managers, hospital management and departments who want to learn more about the initiative. Contact him by email, michael.apkon@yale.edu or phone, (203) 785-4651.

Appointment and reappointment documents

Current DEA (Drug Enforcement Agency) and State of Connecticut Narcotics certifications are required in order to prescribe controlled substances for your patients while they are hospitalized, as well as at the time of discharge from YNHH. Medical Staff members must provide current copies of these documents at the time of appointment and reappointment to the Medical Staff. Please be aware that if you do not supply copies or qualify for an exception, you will not be permitted to prescribe controlled substances until such documentation is provided.

The State of Connecticut provides a "grace" period for license renewal and considers your license to be "active" for 90 days after the expiration date printed on the license. YNHH bylaws, however, do not permit hospital practice without a "current" license and do not recognize the 90-day "grace" period. Please renew your license in time to ensure that you have an updated version before the printed expiration date.

The Department of Physician Services has begun requesting copies of certificates of completed CME courses at the time of re-appointment. Please keep these documents on hand so that you are prepared to provide the copies at the time of your re-appointment.

Direct admits

To facilitate direct admits from physicians' offices and to bypass the Emergency Department, YNHH has developed a streamlined process requiring only one phone call from a physician's office. Once a patient requiring admission is identified, call the YNHH Admitting Office at 688-BEDS. Appropriate information such as diagnosis, insurance, etc., will be requested. Admitting will then locate a bed, contact the appropriate admitting resident and call your office to confirm the admission. Patients proceed directly from your office to the Admitting Office on the first floor of the East Pavilion. The resident will then call you to discuss the care of your patient. Patients requiring an extensive preadmission evaluation, such as pulmonary embolism or possible ICU level of care, should be sent through the Emergency Department. For more information, call Dr. Victor Morris at 203-688-4663.

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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