Medical Staff Bulletin - Yale-New Haven Hospital

Recall the predictions of the savants, 10 years ago, that there would be major shifts in acute care from the inpatient to outpatient settings. This shift, together with shortening of hospital stays, would lead to widespread hospital closures and a contraction of inpatient beds in those hospitals that survived. These predictions seemed valid in the late 1990s and, from 1998 through 2000, there was no growth in discharges at Yale-New Haven Hospital or in Connecticut. In the last three years, however, annual discharges from Yale-New Haven Hospital have increased by more than 5,000 or 12.5 percent, while bed capacity has changed very little. The increase in admissions has been managed by improving the efficiency of care, and dedicating physician and nursing staff to bed management. As a consequence, patients now rarely spend nights in the ED and elective surgeries are very rarely cancelled.

During the first quarter of the current fiscal year, admissions have continued to grow, up 5.8 percent over last year. It is clear we need to make further patient flow adjustments to avoid unacceptable back-ups in the ED, ORs and PACU. These will include implementation of a new bed management computer system, dedication of an additional inpatient nursing unit to the Department of Medicine, and a major effort to change average discharge time from mid-afternoon to mid-morning.

Your help in achieving mid-morning discharges is very much needed. Notice to family and to other caregivers together with prior-day completion of W-10s, discharge summaries, follow-up instructions and prescriptions will aid immensely. If only 30-40 percent of patients leave in the morning, rather than the afternoon, we can avoid the congestion in the ED and perioperative services which daily produces gridlock.

Physicians who would like copies of the YNHH Policy on Medical Staff Health, adopted by the Medical Committee of the Board of Trustees in July, 2002, may call the Department of Physician Services at 688-2615.

Solicitation to Medical Staff for volunteers in emergency/disaster situations

Yale-New Haven Hospital is among 21 hospitals in Connecticut that have recently contracted to participate in the Statewide Emergency Credentialing Program. The program's objective is to prospectively identify medical practitioners who would be willing to volunteer in the event of an emergency or disaster situation in Connecticut. All 21 hospitals are in the process of soliciting volunteer physicians and mid-level providers for the program. The YNHH Department of Physician Services will maintain a statewide database of contact information on behalf of the participating institutions. It is anticipated that the remaining 10 hospitals in Connecticut will also be included in the coming months. A letter describing the program and sign-up sheet was sent to the active and affiliated Medical Staff on January 5. If you have questions concerning this matter, please contact Theresa Zinck-Lederer, director, Physician Services at 688-2615.

The Connecticut Department of Public Health has revised the Certificate of Death (VS-4) to comply with changes suggested by the National Center of Health Statistics. Two fields were dropped: the dates the patient was attended and surgery relevant to the cause of death. Two questions were added about pregnancy status and tobacco relating to cause of death. Instructions about completing the death certificate have been updated and some fields (such as date and time of death) have been moved. As always the certifying physicians is responsible for completing all pink shaded areas. The new death certificate will have a revision date of 1/04. Please shred any death certificates with a revision date prior to 1/04. The old death certificate forms will not be accepted after Feb. 29, 2004.

JCAHO has identified five sets of abbreviations (1-5 below, nine in toto), deemed "unsafe" to use in the medical record due to potential for confusion and error. In addition, YNHH was mandated to select at least three additional abbreviations for our unsafe list. The Medical Record/Clinical Information Committee chose items 10-12 below for the unsafe list. As of February 1, 2004, these abbreviations should no longer be used in written medical orders, in other medical record locations, or in bedside documentation, such as day sheets, or protocol flowsheets.

List of "unsafe" abbreviations which should be excluded from all YNHH medical record documentation

Set	Item	Abbreviation	Potential Problem	Preferred Term
1.	1.	U (for unit)	Mistaken as zero, four or cc.	Write "unit"
2.	2.	IU (for international unit)	Mistaken as IV (intravenous) or 10 (ten).	Write "international unit"
3.	3. 4.	Q.D., Q.O.D. (Latin abbreviation for once daily and every other day)	Mistaken for each other. The period after the Q can be mistaken for an "I."	Write "daily" and "every other day"
4.	5. 6.	Trailing zero (X.0 mg), Lack of leading zero (.X mg)	Decimal point is missed.	Never write a zero by itself after a decimal point (X mg), and always use a zero before a decimal point (0.X mg)
5.	7. 8. 9.	MS MSO₄ MgSO₄	Confused for one another. Can mean morphine sulfate or magnesium sulfate.	Write "morphine sulfate" or "magnesium sulfate"
	10.	µ g(for microgram)	Mistaken for mg (milligrams), resulting in 1,000-fold overdose.	Write "mcg"
	11.	T.I.W. (for three times a week)	Mistaken for three times a day or twice weekly, resulting in an overdose.	Write "3 times weekly" or "three times weekly"
	12.	A.S., A.D., A.U.(Latin abbreviation for left, right, or both ears)	Mistaken for OS, OD, and OU, etc.).	Write: "left ear," "right ear" or "both ears;" "left eye," "right eye," or "both eyes"

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

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.