June 2004

Medical Staff Bulletin

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

There has been considerable, recent press coverage of the Connecticut Substitute Senate Bill 566 (SB 566 — An Act Concerning the Quality of Healthcare), which was passed last month by a vote of 145-2. The Bill redesigns the State’s adverse event reporting system and moves it closer to a process promoting system remedies for error prevention rather than an instrument for punishment.

SB566 clarifies what should be reported to the Department of Public Health (DPH). The recent, rapid, state-wide decline in reported events reflected continuing confusion over what indeed was the intention of previous legislation. The National Quality Forum (NQF) list of 27 serious reportable events will now be employed in addition to specific events designated by the Commissioner of Public Health. The NQF list includes surgery on the wrong patient, the wrong body part, the wrong procedure; retention of foreign objects and perioperative deaths in ASA Class I patients. Also included on the list are problems in adequate patient protection, care management events due to blood and drugs, environmental events, including fatal falls, and criminal events.

Since the advent of adverse event reporting to DPH in October 2002, reports had to be made within 24 hours, often when event analysis was incomplete. This led Yale-New Haven Hospital and other hospitals to incorrectly report untoward events that were due to the underlying disease rather than the care management. SB 566 permits up to seven days to complete root cause analysis and to submit a corrective action plan.

Importantly, SB 566 restricts public disclosure or subpoena of adverse event information to those events investigated by DPH. This, hopefully, will promote more comprehensive reporting by all institutions and data analysis leading to effective error prevention measures. Finally, SB 566 obviates the need for individual physician orders to administer influenza and pneumococcal vaccines. An approved hospital policy can substitute for a physician order. Overall, SB 566 is a very commendable piece of legislation.

Physician reception to be held at new Shoreline Medical Center

Members of the Medical Staff are invited to a special physician tour and reception at the new Yale-New Haven Shoreline Medical Center on Tuesday, June 29, from 4-7 p.m. This exciting new facility at 111 Goose Lane in Guilford (exit 59 on I-95) is on schedule to open in July. The three-story, 80,000 square-foot building will serve physicians and consumers in the shoreline. This new healthcare resource for the local shoreline community and community physicians will provide an accessible point of care, featuring new, state-of-the-art facilities. Shoreline services include: The Shoreline Surgery Center, Childbirth Education, Diagnostic Radiology, a part-time Emergency Services Satellite, Hospital Pre-Admission, Laboratory Medicine/Blood Work, Nuclear Medicine, Nutrition Center, Pathology Services and Radiation Oncology.

If you have questions about the reception, please call Marketing & Communications at 688-2488. If you have questions about the new Shoreline Medical Center, please call Steve Bencivengo 688-8842 or e-mail him at steve.bencivengo@ynhh.org

Mandatory Electronic Signature Authorization (ESA) implemented

The Medical Board recently approved mandatory electronic signature authentication for completion of all medical records. Currently only electronically signed documents are available on-line as they are uploaded into CCSS, Logician, MD Link, and soon Sunrise Clinical Manager. Thus, the new requirement that all discharge summaries and operative reports be signed electronically through the ESA system (available to all Medical Staff on clinical work stations and through MD Link), will assure that all of these documents are readily available when they are needed.

Currently 75 percent of the Medical Staff is already trained to review, edit and sign these documents electronically through ESA. The remaining staff will be offered ESA training through a web-based program and one-on-one training by appointment. Mandatory signing of discharge summaries and operative reports will begin October 1. Physicians from Pediatrics will be temporarily excluded from this new initiative until we shift from the current CCSS-based discharge summary procedure to one which includes the use of dictated summaries that can be signed electronically through ESA. The Medical Staff will soon receive a detailed letter with training options and time line.

Public reporting of hospital care has begun

This spring, the Center for Medicare Services (CMS), the Connecticut Department of Public Health and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) all posted hospital-specific care metrics for three common medical conditions (pneumonia, acute myocardial infarction and congestive heart failure) on their web sites. Acute care hospitals across the nation were asked to voluntarily report; all Connecticut hospitals were required to report.

How does Yale-New Haven appear to perform in these metrics? Overall, we perform quite well, but there is room for improvement. Of the 10 metrics within the three clinical conditions, one area stands out as most needing improvement: use of ACE-I in patients with CHF or MI. Our own internal audit demonstrated that we frequently fail to document why another treatment is selected over an ACE-I. We have begun a program to remind clinicians of patients with CHF or MI to give, or to document why an ACE-I was not given, to a patient on discharge. Please help improve documentation and performance. For information, contact YNHH’s Performance Management Initiative (PMI) director, Thomas Balcezak at 688-1343.

New digital imaging system debuts

Diagnostic Imaging and Yale Diagnostic Radiology will offer enhanced imaging services through Synapse, a Digital Image and Report Distribution system. Beginning July, all imaging exams (except mammography and fluoroscopy) will be available via Web access on workstations throughout the Medical Center, the Yale Physicians Building and private physician offices.

We are able to bring this technology to your offices and clinics and will provide training and assistance for your practice to transition successfully. We will hold a series of open houses to introduce Synapse, the image distribution system, in the main reading room of diagnostic imaging on the second floor of the South Pavilion during the week of July 5. Staff will be available to demonstrate Synapse and provide individual training and passwords. The specific dates and times will be confirmed in a letter to each member of the Medical Staff. Web-based training on Synapse is also available via Internet Explorer at www.ynhhslearning.com/synapse/

As of July 15, Stentor will no longer be available and all images must be accessed through Synapse. The image library staff has been fully trained and can assist you with Synapse as well as provide you with digitized images on CDs upon request. There is a dedicated customer service beeper for the image library 128-3009.

Criteria set for stenting privileges

The Medical Board and Medical Committee of the Board of Trustees recently approved criteria for members of the Medical Staff to be granted privileges in the areas of peripheral vascular angioplasty/stenting and carotid arterial angioplasty/stenting. Members of the Medical Staff who are interested in applying for privileges in any of these areas should contact the department of Physician Services at 688-2615 for copies of the criteria and privilege delineations.

Adult invasive chronic pain therapy privileges established

In April, the Medical Board and Medical Committee of the Board of Trustees approved a new interdisciplinary privilege delineation for adult invasive chronic pain therapy. Members of the departments of anesthesiology, neurosurgery, neurology and orthopedics, including physical medicine, who are interested in applying for privileges in this area should contact the department of Physician Services at 688-2615 to obtain a copy of the delineation. Privileges will be approved by a multidisciplinary committee on chronic pain.

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:

• 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: June 17, 2004 (cfs)

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.