March 2004

Medical Staff Bulletin

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

Public reporting concerning the quality of hospital care has been greeted with some trepidation but, without question, it will not go away. There is also no question that it will drive change and that change is needed. Several states, Connecticut included, participated in the development of a patient satisfaction questionnaire called HCAHPS (Hospital Consumer Assessment of Health Plans), a product of the federal Agency for Healthcare Research and Quality (AHRQ).

The roughly 30-question survey will be sent to patients discharged from all Connecticut hospitals and four of the questions are centered on the doctor-patient relationship:

1. During this hospital stay, how often did doctors treat you with courtesy and respect?
2. During this hospital stay, how often did doctors listen carefully to you?
3. During this hospital stay, how often did doctors explain things in a way you could understand?
4. Using any number from 0 to 10, where 0 is the worst possible care and 10 is the best possible care, what number would you give the care you got from all the doctors who treated you?

Dissatisfaction with physician communication is a major cause of patient and family unhappiness with their hospital care. This has been particularly true in complicated cases involving multiple services, consults and caregivers. As physicians, we are often overwhelmed by time pressures, and attend to technical but not humane aspects of care. Most patients appreciate explanation of findings, treatment options and plans much more than they appreciate their well-documented medical records.

All of us have been patients or family members of patients. We have hung on every word of our primary care physicians and their consultants. We have communicated these snippets of information to tens of others, who have done likewise. While our inpatient rounds often fail to coincide with family visits, multiple phone numbers are usually available. This month, I challenged my Kushlan Firm team to communicate every day to one caring relative. Pretty low tech, pretty powerful therapeutic maneuver.

Surveillance team changing use of antibiotics at YNHH

YNHH is working to improve the efficacy and safety of antibiotic use through a major physician-led pharmacy initiative approved by the Medical Board. The mid-1990s saw a rapid rise in antibiotic resistance due to over-prescribed or chronic misuse of antibiotics. Two years ago, YNHH formed the Antibiotic Surveillance Team (AST) to change the way the drugs are prescribed at the hospital. Under the direction of Jeffrey Topal, M.D., and Nilesh H. Amin, Pharm. D., from Pharmacy Services, the team has helped YNHH reduce antibiotic usage by 14 percent. This reduction in antibiotic use occurred as hospital admissions rose almost four percent over the same period in 2001.

Every week, the AST reviews inpatients on targeted antibiotics. They review culture results, x-rays and patient charts, and, in some cases, consult with the caregivers. They examine up to 100 cases a week, and write recommendations on using antibiotics appropriately on up to 50 of these cases. The final decision on how to treat a patient is still up to the physician. But, whenever possible, the team tries to steer doctors away from over-using broad antibiotics and to use narrower spectrum agents.

Save the Date for the 2004 Gala

Mark your calendar! The Hospital's 2004 Gala will be held on October 30, 2004 at Oakdale Theatre. For more information, contact Catherine Giaccone in Development at 688-8728.

Pursuing greater predictability in the OR

Although operating rooms in acute care hospitals are, by nature, unpredictable places, perioperative services is working toward more predictability with the goal of improving satisfaction for patients, staff and physicians. This year, perioperative services has aligned seven of their performance improvement projects towards this goal. Three of these projects have been linked to YNHH's Performance Incentive Program (PIP).

The current projects' goals include: 1) Schedulers and physicians working together to more accurately predict case length; 2) A new Surgeon On Time Policy to encourage surgeons to arrive on time; 3) EAS staff starting more IVs before the patients arrive in the holding area (tied to PIP); 4) Improvement of floors' ability to accept timely PACU discharges, thus reducing PACU and OR delays; 5) Improvement of case readiness by reducing the number of kits waiting to be processed in CSS (tied to PIP); 6) A room readiness program to make sure rooms are properly stocked with supplies; and 7) Continually manage room turnover and room assignment as needed to stay on schedule (tied to PIP).

The goals are to have less cases starting late, to more accurately staff in advance for rooms that may need to run late, reduce unwanted overtime, reduce the disruption of cases being assigned to people and rooms that have not anticipated them, and achieve more overall predictability, consistency, efficiency - and most importantly - customer and staff satisfaction.

First Quarter hand hygiene and contact precautions

Compliance with hand hygiene showed tremendous improvement during FY03; before patient contact compliance averaged 52.4% and after patient contact compliance 80.6% for the year. Before patient contact compliance improved during every quarter and ended the fiscal year at 64.7% with physicians complying 73.5% of the time. After patient contact compliance also improved during every quarter of FY03 and ended at 84.7% with physicians performing hand hygiene 82.5% of the time (but nurses were better at 87.8%). The first quarter of FY04, however, showed a dip in compliance before patient contact to 61.8% compliance (physicians were at 62.5%) but the good news is that after patient contact hand hygiene compliance was at 89.2% with physicians having the highest compliance rates (91.1%). As we continue to strive towards improving hand hygiene compliance it is important to recognize where we started from (31.9% before patient contact and 56.6% after patient contact) and what we have yet to attain and sustain.

Improving compliance with contact precautions is also a Patient Safety initiative that has shown widely varying rates of compliance since FY02 (average of 61.6% in FY02 and 79.6% in FY03). Compliance for the first quarter FY04 was 71.1% (physicians were compliant 80% of the time). The goal for FY04 is to improve compliance to 85%. We should be setting a good example for all healthcare workers regarding hand hygiene and contact precautions; what we do does makes a difference.

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:

• 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: April 13, 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.