May 2004

Medical Staff Bulletin

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

In this space I have, on several occasions in the last year, celebrated our success in improving compliance with hand hygiene. Contact precautions have received less attention. The efficacy of these performance improvements were earlier reflected in reductions or stabilization in serious infections with vancomycin-resistant enterococci (VRE) on the adult services. Physician compliance generally has exceeded that of other major groups of caregivers and of this we are justifiably proud.

For the first time in two years, Yale-New Haven Hospital has shown a decline in hand hygiene compliance in the period January to March, 2004. Physicians and other caregivers similarly shared in this negative trend. While YNHH still has what is probably national benchmark performance in this area, we cannot be satisfied. It occurred to me that the patient safety advantage of the majority who are in compliance can be completely undone by a tiny minority who might carry dangerous pathogens from room to room.

We cannot accept less than universal compliance with standards designed to limit nosocomial infections. We are asking all categories of caregivers to monitor each others actions. We ask that they immediately remind any personnel who are noncompliant on entering or leaving patients rooms that the standard(s) in question must be observed. Physicians and others should not resent such friendly reminders and should not pass up opportunities to remind others.

Personal order sets will be eliminated as of July 1

The hospital will soon begin the implementation of its new computerized physician order entry (CPOE) system, Sunrise Clinical Manager. Currently, physicians place orders via CCSS through a variety of channels. One of these is departmental order sets, which are created and maintained by each department or section. Another is personal order sets. While departmental order sets are managed at the department level, personal order sets are managed at the individual physician level.

An unlimited number of personal order sets can be created and maintained by each physician. Currently, we have over 3,500 personal order sets. It is impossible to keep personal order sets compliant with rules of regulatory agencies, such as JCAHO. While departmental order sets may be kept up-to-date through departmental or sectional review, such a review process would be exceedingly difficult for personal order sets.

In an attempt to facilitate institution-wide dissemination of information and evidence-based care, personal order sets will be eliminated as of July 1. Personal order sets that physicians feel contain critical information will be incorporated into departmental order sets, which can then be maintained and changed at the discretion of the individual departments and sections. If you have questions or want more information, call Dr. Benny Soffer, at 688-1103.

ICD-9-CM code required when diagnostic test is ordered

As of last October, the Centers for Medicare and Medicaid Services (CMS) has required that all paper and electronic claims must contain a valid diagnosis code from the ordering/referring physician at the time the test or service is requested. If the physician does not provide a code, the laboratory may do so, based on a narrative diagnostic statement from the practitioner. Please read the accompanying letter from Drs. Jatlow and Herbert about this requirement.

Children’s Hospital renovations complete; high-acuity cluster created

YNHH recently completed major renovations of the Yale-New Haven Children’s Hospital to increase access for patients and create greater opportunities for delivering family-centered care. The most recent work, which followed renovation of the infant/toddler and school-age inpatient units, focused on the development of a 32-bed high acuity cluster on the West Pavilion’s 7^th floor. This includes a 19-bed Pediatric Intensive Care Unit with single and double rooms that can accommodate parents who wish to room-in with their critically ill child. It also includes a 6-bed Pediatric Respiratory Care Unit for the care and rehabilitation of children with chronic respiratory diseases. A generous gift from Kohls Department Stores has enhanced parent and family space by adding consult rooms and a new family lounge. A beautiful new playroom has also been constructed on 7-WP following a generous gift from the Auxiliary’s Toy Closets program.

The renovations created an opportunity to redefine the distribution of patients across the Children’s Hospital. General Pediatric patients are cared for in age-appropriate units. Infants and toddlers up to age 3 will generally be cared for on 7-3; school-age children and adolescents will generally be on 7-2. Oncology patients will be cared for in the high acuity cluster on 7-WP and on 7-4. Patients admitted to the hospital as part of research studies will continue to be cared for on 7-4. We trust that these renovations will contribute to an environment which facilitates compassionate care for patients and their families and reduces barriers between providers and recipients of pediatric care.

YHHH Shoreline Medical Center to open in July

The Yale-New Haven Hospital Shoreline Medical Center at 111 Goose Lane in Guilford is on schedule for a July opening. The Center will contain a linear accelerator, CT simulator, diagnostic CT scanner and nuclear medicine gamma camera. It will also have an emergency department with eight exam rooms, open 4 p.m. to midnight Monday through Friday, and noon to midnight on Saturdays, Sundays and holidays.

Groundbreaking was less than a year ago for the three-floor, 80,000 square-foot building, which will serve 12 shoreline communities and house three operating rooms, two endoscopy rooms and a post-anesthesia recovery area. In addition, patients will have access to radiation therapy, comprehensive diagnostic imaging services, including MRI and CT scanning, and same-day laboratory services. The owner of the building, Goose Lane Medical, LLC, will be leasing physician offices in the Shoreline Medical Center.

For information about the project, contact Stephen Bencivengo, Director of Yale-New Haven Hospital Shoreline Medical Center Services at 688-8842.

Dr. Balcezak to direct PMI

Thomas Balcezak has been appointed director of the Yale New Haven Hospital’s new Performance Management Initiative (PMI). This is a new position that will have extensive responsibility for process improvement efforts in both clinical and operational domains. PMI will bring a more formalized approach to enhancing performance in Bridgeport, Greenwich and Yale-New Haven hospitals.

PMI will also include an Institute of Excellence, a centralized training center for non-clinical education related to performance improvement and general management skills. PMI will support the development of an automated performance management information technology data system. Future issues of the Medical Staff Bulletin will provide more information as the effort gets underway.

Dr. Balcezak will continue to be Associate Chief of Staff and have primary responsibility for the Medical Staff Office. In addition, the department of Quality Improvement Support Service will report to him.

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:

• 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 07, 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.