November 2004

Medical Staff Bulletin

Message from the Chief of Staff

Yale-New Haven Hospital (YNHH) expects and plans for dramatic pressures on inpatient census in the first three months of the calendar year. Seasonal illnesses in the early and mid-winter occasion hospitalization of a number of vulnerable populations, particularly children with respiratory illness and the elderly. We have seen a surprising and unexplained increase in admissions this fall, and this has understandably raised concerns over what the next few months portend. Contributing to anxiety is the national shortage of influenza vaccine following Chiron Corporation's announcement on October 5 that none of its influenza vaccine would be available. The Centers for Disease Control and Prevention (CDC) has defined priority groups for influenza vaccination:

• All children aged 6 to 23 months
• Adults aged 65 years and older
• Persons aged 2 to 64 years with underlying chronic medical conditions
• Women who will be pregnant during the flu season
• Residents of nursing homes and long-term care facilities
• Children aged 6 months to 18 years on chronic aspirin therapy
• Healthcare workers involved in direct patient care
• Out-of-home caregivers and household contacts of children aged < 6 months

Yale-New Haven Hospital has set up a system to provide influenza vaccination, as long as supplies last, to high-risk YNHH inpatients as well as currently registered high-risk outpatients in YNHH clinics who meet the above CDC criteria (except for the last group as vaccine supplies will not currently permit us to extend vaccination to these individuals).

We find ourselves for the first time in memory discouraging, rather than encouraging, healthy people from receiving influenza vaccination. In addition, we have an ethical responsibility to cooperate with efforts to redistribute influenza vaccine to those institutions with vulnerable populations and acute needs. At least half of the CT hospitals depended on Chiron Corporation for 50 percent or more of their vaccine supply and nine of these for 100 percent. Fortunately, in New Haven, both the Hospital of St. Raphael and Yale-New Haven Hospital ordered and received 80 to 100 percent of the anticipated supply needs from Aventis-Pasteur.

Some physician practices have excess vaccine supplies and, in view of the new guidelines, are encouraged to participate in the vaccine redistribution effort. One prominent pediatric practice has done this to the benefit of several local clinics, and this citizenship is highly laudable. YNHH has cancelled routine vaccination drives and likewise is reserving available vaccine supplies for the priority populations. Both the Hospital of St. Raphael and Yale-New Haven Hospital are immunizing physicians and mid-level practitioners who are unable to be otherwise vaccinated.

Several facts are worth remembering in the next few months. Vaccine “protection” is always variable because of our inability to predict the effects of antigenic drift and “pick the correct strains of influenza A.” Clinical efficacy of vaccine is generally modest, and roughly 100 individuals must be immunized to prevent one death. Finally, there are good antiviral drugs for treating influenza when it is recognized early (within 40 hours of symptom onset), and at least one of these is active against avian influenza. Scrupulous attention to hand hygiene, using a tissue when coughing/sneezing (and then washing hands), as well as staying away from others when one has symptoms of a viral respiratory infection also contribute to controlling the transmission of influenza and other respiratory viruses. The hysteria surrounding the current vaccine shortage is not warranted.

Language Assistance Program improvements

As part of the Hospital's ongoing legal obligation to provide all its patients with effective communication, YNHH continues to enhance language services provided to patients who do not speak English well enough to understand their care. The Hospital currently has six full-time Spanish interpreters, plus 24-hour access to outside, over-the-phone or in-person interpretation services. Last year, the hospital had 18,407 requests for interpretation in 50 languages.

The Hospital will soon be notifying patients entering the building, on signs written in 15 languages, that: “Yale-New Haven Hospital provides language assistance, free of charge, upon request. Please point to your language for help.”

All medical staff need to be aware of the importance of ensuring that their patients can truly understand the health information and choices that are being communicated and staff must understand patient questions and responses. Call (203) 688-7523 for YNHH interpreter assistance.

Blood drawing hours expanded at Yale-New Haven Shoreline Medical Center

To increase convenience for patients, Laboratory Medicine at the Yale-New Haven Shoreline Medical Center in Guilford (exit 59 off I-95) has expanded its hours for blood drawing. The blood drawing station is now open weekdays from 8 a.m. to 6:30 p.m. and Saturdays 8 a.m. to 12 noon.

YNHH has been chosen by Working Mother magazine as one of the nation's “ 100 Best Companies” for working mothers. Yale-New Haven Hospital was the only healthcare organization to be selected in Connecticut and one of only four Connecticut companies to be honored. In addition, YNHH was the only hospital in New England to be honored, and among only 12 healthcare organizations nationwide to be selected. Working Mother magazine based its selection on five criteria: child care, leave for new parents, flexible work arrangements, work/life benefits such as elder care and adoption assistance, and opportunities for women to advance. Yale-New Haven was selected for the creative and proactive ways it helps its employees meet the challenges of balancing work and family. YNHH also received this designation in 2000.

YNHH now offers PET/CT scanning

YNHH Diagnostic Imaging now offers positron emission tomography combined with computed tomography (PET/CT) scanning for patients, providing earlier detection of many abnormalities that may go undetected using conventional nuclear medicine, X-ray, CT or magnetic resonance imaging (MRI). PET/CT is being offered in support of a wide range of diseases including Alzheimer's disease and many cancers. PET/CT scans are available Monday through Friday from 7:30 a.m. to 5 p.m. To schedule an appointment, please call (203) 688-5610. For more information, contact Dr. James Brink, interim chief of Diagnostic Imaging, at (203) 785-5252.

New adult medical/surgical flowsheet introduced in September

A new standardized nursing flowsheet for all adult medical/surgical units was introduced last month. A team of nurses created this flowsheet to provide complete and consistent nursing documentation, to decrease the number and variety of flowsheets being used in the hospital, and to meet regulatory standards. The new flowsheet was piloted in July and is currently under evaluation for functionality and quality of documentation.

The appearance of the flowsheet has changed to include a trifold format similar to the flowsheet used in the ICUs. The front of the flowsheet allows for pain assessments, vital signs, intake and output as well as detail areas for labs and comments. The back of the flowsheet contains a detailed description of the patient status. If you have any questions or concerns please contact team leaders Marie Devlin, RN, at (203) 688-2338 or Lori Kilraine, RN, at (203) 688-2328.

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 Murphy
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
Katie.Murphy@ynhh.org

Back issues of the Medical Staff Bulletin:

• October 2004
• September 2004
• July 2004
• 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: November 10, 2004 (mv)

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.