April 2004

Medical Staff Bulletin

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

Medical Staff President, Dr. Arthur Levy, has led discussions at two recent Medical Staff Cabinet meetings addressing institutional adaptation to the ACGME-mandated 80-hour resident work week. Attending and Nursing staffs participated and shared their perspectives.

One universal concern had to do with identification of responsible staff (e.g. residents, PAs, APRNs) providing cross-coverage on evenings, nights and weekends. Coverage schedules and protocols on many services are complex and it is not currently possible to electronically forward our pagers. As noted in the Bulletin item below, a new CCSS pathway has been developed to remedy this problem. It should greatly facilitate identification of responsible coverage with display of current House Staff beeper number on the Patient Information screen.

Several problems do not lend themselves to electronic solutions. A larger number of team members is participating in care and there is a sense that the transition from individual to team responsibility sign-out protocols need to be more comprehensive. A committee, chaired by Dr. William Crede, is addressing this issue. It is also now most critical that Attending physicians specify their plans and treatment objectives in the medical record. This will ensure consistency of approach in management of care issues ranging from analgesia to evaluation and treatment of comorbidities.

Resident training matters are also of concern. There is less resident participation in family discussions, problems attending post-call clinics, absences from noon-time conferences, and conflicts between perioperative and nursing unit opportunities and responsibilities. Department Chiefs and Program Directors will be addressing these issues, which vary greatly among departments. They will also be working to assure uniform quality of House Staff coverage across individual services.

New system for posting house staff beeper numbers

CCSS has modified the Patient Information screen to permit ready identification, on all shifts, of the beeper number of clinicians responsible for patient coverage. The correct and timely beeper number will appear on the upper left hand corner of the screen. Residents, PAs and APRNs serving as House Staff are asked to maintain current information at all times. If you experience problems or notice incorrect beeper numbers, please notify the Chief of Staff Office, providing time of day and patient identity. Thanks to Marcia Dobrowski, Nora Roche and Nancy Tepping for this CCSS enhancement.

EP 8-8 to become unit for acute care of patients over 65

In June, 8-8 in the East Pavilion will become an acute care inpatient unit for older hospitalized patients. Modeled after the ACE (Acute Care for Elders) Unit at University Hospital of Cleveland, the 12-bed unit will become Connecticut’s first unit expressly designed to provide enhanced care for the elderly, 65 years and older. It will serve as an educational model for residents, medical students, fellows, nurses and attending physicians. The specialty care focus should help prevent or decrease older adults’ risk of complications and improve their physical function and independence. A multidisciplinary team of nurses, physicians, rehabilitative services, social work and pharmacy will provide comprehensive services to ensure patients and families meet their goals. For more information, contact Leo Cooney, M.D., chief of Geriatrics, at 688-2204 or leo.cooney@ynhh.org

YNHH Hospitalist service thriving

The Yale-New Haven Hospitalist Service — a model partnership with YNHH, the Yale School of Medicine and community-based practitioners — provides coverage to YNHH’s medicine inpatients seven days a week, 24 hours a day. The Hospitalist Service, which serves as an extension of primary care practices from surrounding communities, includes 13 full-time attending physicians, 10 physician assistants, a medical director, operations manager and administrative coordinator. Patients are admitted to the service in one of two ways: through direct referrals from physicians in the community with whom we have an established relationship, or patients who have exceeded the resident team cap.

The Hospitalist Service formed in 1994 as the much smaller House Physician Team, in response to increasing patient demand on the resident teams. Since then, admissions to the internal medicine service have increased by 35%, most of which have been accommodated by the Hospitalist Service. Primary goals of the Hospitalist Service are optimal patient outcomes and patient satisfaction; secondary goals are efficient use of Hospital resources and staff satisfaction. In 2003, the Hospitalist Service cared for 3,133 patients. Patient satisfaction scores of the Hospitalist Service patients, as judged by response to the Press Ganey Patient Satisfaction survey, exceed those of YNHH in general. For more information, contact Victor Morris, M.D., at 688-4663 or victor.morris@ynhh.org.

New pediatric dental residency: New role for Dr. Kohn

The YNHH Department of Dentistry has supported a General Practice Dental Residency for many years. Dr. Donald W. Kohn and Mr. James Rawlings have announced plans to additionally develop a Residency Program in Pediatric Dentistry. It is projected that two Pediatric residents will be recruited this year and an additional two next year. When fully developed, there will be four residents in the Program. The Program is intended to meet local and national needs for Pediatric-trained dentists. Support for this program expansion will come from the Connecticut Health Foundation, the Connecticut Department of Public Health and YNHH. Dr. Kohn has announced his intention to relinquish his position as Chief of the Dental Department to devote all his energy to develop this Pediatric training program. After renovations, the new Pediatric Dental Program will be housed at 860 Howard Avenue. A national search for a new Chief of the Dental Department will begin this month.

Diagnostic Imaging implements digital system

Diagnostic Imaging has streamlined physicians’ access to diagnostic images and reports with the implementation of the new digital system or Picture Archiving and Communication System (PACS) — a filmless information system for acquiring, sorting, transporting, storing and electronically displaying medical images. YNHH Diagnostic Imaging generates reports on about 1,000 studies every day and with the new digital system, physicians can access images and radiologist reports anytime, anywhere through the hospital network via a secure Web-based interface. The new system creates a permanent, non-degradable archive that eliminates the risk of lost films.

Diagnostic Imaging began a phased implementation of the digital system termed Synapse last fall. Ultimately the new system will encompass all diagnostic images including x-ray, CT-scans, magnetic resonance imaging (MRI) , ultrasound, nuclear medicine, mammography and interventional radiology procedures. Physician offices can access both reports and images through MDLink. For more information, contact James Brink, M.D., interim chief of Diagnostic Radiology, at 785-5252.

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

Back issues of the Medical Staff Bulletin:

• March 2004
• February 2004
• January 2004
• January/February 2003
• October/November 2002
• August/September 2002
• April/May 2002
• February/March 2002
• January 2002
• November 2001
• July/August 2001

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Last revised: May 06, 2004 (cfs)

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All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.