July 2004

Medical Staff Bulletin

Message from the Chief of Staff

We had opportunity in the last two weeks to welcome several hundred new residents to Yale-New Haven Hospital. A formal review of our success in the residency match, undertaken by Dr. Rosemarie Fisher, demonstrated exceptional recruiting by virtually every Graduate Medical Education (GME) program. We also bid farewell to a comparable number of trainees who now serve as attending physicians at institutions across the United States.

In the last two years, we have reflected a good deal on where we are succeeding in GME and where we could do better. We do a commendable job at information transmission, as reflected by in-service examination scores and specialty/subspecialty board pass rates. Our graduates have good procedural skills and learn to work very efficiently. They are also adept at exploiting computers for continuing education and day-to-day patient care. Conversely, we must also acknowledge that short inpatient stays, the restrictions of the resident 80-hour work week, and the often chaotic schedules of attending physicians have considerably reduced attending-resident contact. Actual attending presence in the inpatient setting has also decreased remarkably in some specialties. Thus, residents have less opportunity to directly observe the patient care activities of seasoned clinicians. They rarely observe attendings eliciting histories, performing physical examinations, processing testing data, or counseling patients about diagnosis, prognosis, discharge instructions or end of life decisions.

These missed opportunities can have several consequences. If trainees do not see effective patient communication modeled, they will not place a high premium on communication. If trainees fail to grasp the essence of an acute hospitalization, they will be ill prepared to serve as attending physicians. If trainees do not learn how to establish effective therapeutic relationships, they will ultimately fail the patients they have trained so long to serve.

Resident physicians contribute in innumerable tangible and intangible ways to the care of our patients at Yale-New Haven Hospital. We commit to their comprehensive training. We must establish systems and opportunities to ensure that we train them in the art as well as in the science of medicine.

Patient identification guidelines established

YNHH, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and good medical practice require physicians and nurses to use two key patient identifiers before administering medication or doing any test or procedure. Care providers must identify patients using name and medical record number or name and date of birth. This information is on the patient ID band for all inpatients and many outpatients. We are asking that all care providers use the ID band, not the name over the bed or outside the door, to verify identification. Each outpatient area has a system in place and caregivers should determine the area protocol. Please tell patients why their ID is verified so frequently. They should be reassured by this important safety protocol and understand that it is done to reduce the risk of misidentification and not because of our lack of short-term memory.

YNHH wins CHA’s John Thompson award again

For the third consecutive year, Yale-New Haven Hospital has won the Connecticut Hospital Association’s John D. Thompson Award for Excellence in the Delivery of Healthcare Through the Use of Data. YNHH was chosen for its initiative to reduce the rate of nosocomial catheter-associated urinary tract infections (CAUTI) on its medical-surgical units. Once the quality improvement project was implemented, subsequent data collection demonstrated a 42% reduction in catheter days, a 51% reduction in the incidence of patients with a urinary catheter placement, and a 47% reduction in the occurrence of nosocomial CAUTI. Congratulations to all involved, especially team members Sandra Conklin, R.N., Karen Camp, R.N., Tom Balcezak, M.D., Victor Morris, M.D. and Jeffrey Topal, M.D.

2004 Gala to be held on October 30

The Hospital’s 2004 Gala will be held on October 30 at Oakdale Theater. This year’s Gala will benefit the Newborn Special Care Unit and Maternal Special Care. Invitations are expected to be mailed after Labor Day. For more information, contact Catherine Giaccone in Development at 688-8728.

Zaccagnino named new board chairman of VHA Inc.

VHA Inc., the national health care alliance based in Irving, Texas, has named Joseph A. Zaccagnino as its new board chairman. As chair, Zaccagnino leads the board of trustees of the non-profit organization, a nationwide network of 2,200 leading community-owned health care organizations and their affiliated physicians. VHA has 18 local offices across the U.S., and encompasses nearly 26 percent of the nation’s community hospitals. VHA helps members identify, integrate and implement best practices that will improve clinical and operational performance.

Zaccagnino has served as a member of the senior management team of both Yale-New Haven Hospital and the Yale New Haven Health System since 1970, and in 1991, he was appointed president and CEO of both organizations. Just before he assumed leadership of the VHA board, he completed his term as chair of the National Committee for Quality Health Care.

Training and implementation to begin for Sunrise Clinical Manager

The hospital has recently begun implementation of its new computerized physician order entry (CPOE) and results retrieval information system, Sunrise Clinical Manager (SCM). On Sep. 8, SCM’s result retrieval and patient list functions will be implemented throughout YNHH. SCM is currently being piloted in pre admission testing and EAS.

Available on the system for both inpatients and outpatients will be laboratory, diagnostic imaging and surgical pathology results as well as discharge summaries and operative notes, all dating back to January 2000. Interpreted ECG results will also be available but only as far back as May 2004.

Training for physicians will be optional and web based. The hospital has created a training module to help physicians gain familiarity with the new system. The training module, which can be accessed after July 1 from any web browser at any time, is at www.ynhhslearning.com where there will be a link to SCM training.

Sign on codes will be distributed to physicians during the month of August. A booth staffed by SCM representatives will be in the hospital atrium Monday through Friday between 6:30 a.m. and 4:30 p.m. August 9-27. They will also be available 6-10 a.m. and 3-7 p.m. Saturday, August 7 and 21. We hope you find the training process both helpful and convenient.

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:

• June 2004
• May 2004
• April 2004
• 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: July 27, 2004 (jj)

Home page URL: http://www.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.