October 2004

Medical Staff Bulletin

Message from the Chief of Staff

On September 20, 2004, Yale-New Haven Hospital (YNHH) "went live" with our new clinical information system, Sunrise Clinical Manager (SCM). A note elsewhere in this Bulletin strongly encourages all members of the Medical and Affiliated Staffs to obtain sign-on codes for the new system.

SCM is to be used for results-retrieval, while CCSS will continue to be supported for order entry until the order entry pathways can be converted to SCM. Results available in SCM include all contained in CCSS, with several invaluable additions. The latter include direct access to all transcribed operative and discharge summaries. This will obviate the need to separately enter "ChartView" for this information. Electronic access to transcribed reports in the past has been inconsistent because documents, signed by hand rather than electronically, were only found in the paper record. Since all transcribed documents must now be signed electronically (ESA), all will be accessible through SCM.

SCM will also provide pathology reports which previously were electronically available only through Logician. ECG reports will be found on SCM and, in addition to radiology reports, we will be working to provide direct connection to radiology images. We have back loaded several months of DI results at this time and shortly will have results dating back to 2000.

YNHH's goal is to have an entirely electronic, paperless medical record (EMR) within the next three years. This monumental undertaking will be justified by gains in data access and improved communication and patient safety. Since this EMR will be developed around SCM, it is imperative that all YNHH clinicians make the investment to become facile with SCM and in the extraction of the clinical information contained therein. Admittedly, many will delay learning SCM until there is no other recourse. Within a couple of months, therefore, direct access to CCSS will disappear and CCSS access will only be through SCM. Take advantage of this time to become deft in SCM.

SCM sign-on codes

These will differ from those assigned for CCSS. All clinicians must obtain a sign-on code in the next month. Follow signs to the appropriate desk in the CCSS area behind the East Pavilion cafeteria. Take web-based training in SCM (about half hour) at www.ynhhslearning.com Call Marcia Dobrowski (203) 688-7579 with problems.

New protocol procedure for CT exams

Diagnostic Radiology is implementing changes to streamline and improve CT ordering and acquisition. As of October 5, the Department will only require pre-approval for CT scans performed in the Emergency Department, for pediatric examinations and for all STAT CT examinations - defined as those needing to be done within 3 hours. All other adult CT scans will be directly scheduled after the request is received in CCSS for inpatients, or from a physician's office for outpatients. Inpatient CT studies will be performed on the same day for all requests received by 3 p.m.

To help clinicians select the most appropriate CT protocol, the CCSS ordering screens have been updated to reflect the most up-to-date CT protocols and indications. A new "Help" screen, with additional information about appropriate utilization and indication, will be added in the near future for online consultation. As always, there will continue to be a radiologist available for consultation 24 hours a day, 7 days a week.

Dr. Irena Tocino, Professor of Diagnostic Radiology and Chief of Clinical Quality Improvement in Diagnostic Radiology, will be leading this initiative. Please forward comments and suggestions to her at: irena.tocino@yale.edu

Performance Management Update

Our publicly reported quality metrics, as reported below, continue to improve. The greatest improvement is seen in the area of ACEI for CHF, where we have improved from the mid 60 percent range to 94 percent, an excellent result! How? A combination of chart sticker reminders, CCSS prompts and the hard work of a great many.

There are still areas that are in need of improvement. Despite intense work by Dr. Jeff Topal and others, we still failed to vaccinate 5 out of 17 eligible patients who had community-acquired pneumonia in July. We are already near the top 10 percent of hospitals across the nation that report this data; our goal is to be within the top 5 percent. We will continue to use chart reminders and personal contact to improve our compliance with these metrics. Additionally, we are now working on, and you will soon see, a new discharge pathway to increase our capture of important information at the time of discharge. If you have any questions, please call Dr. Tom Balcezak at (203) 688-1343.

July Performance

Bone Marrow Drive to be held on November 11

YNHH, in partnership with WFSB Eyewitness News Channel 3 in Hartford and the New Engand Bone Marrow Donor Program, will host a two-city bone marrow drive on Thursday, November 11, to encourage people to sign up on the registry. Drives will take place simultaneously in Hartford and New Haven from 11 a.m.-6 p.m. The New Haven drive will take place in YNHH's Grace Building lounge. The New England Bone Marrow Donor Program continues to stress that minority donors are in great demand. For more information, contact Dr. Dennis Cooper at (203) 737-5251.

New “Natural and Artificial Nails Policy” implemented for patient safety

YNHH implemented a new “Natural and Artificial Nails Policy” on October 1. Artificial nails and long natural nails harbor large numbers of bacteria and yeast under and around the nail and have been linked to the transmission of infections to patients in healthcare settings. Most Connecticut hospitals have implemented policies prohibiting artificial nails.

The YNHH policy applies to everyone - including medical staff and affiliated medical staff in the inpatient and outpatient setting (regardless of whether or not they are employed by YNHH) - who has any contact with patients, patient care equipment, supplies and medications, or are involved in preparation of medication and food. People with artificial nails have until December 31, 2004 to comply with the policy, allowing time to grow natural nails. Thank you for your cooperation in this patient safety issue.

The policy specifies:

• Fingernails should be ¼ inch or less in length, clean and well manicured.
• Nail polish, if worn, must be of a single color and free of cracks and chips.
• Food service workers involved in food production and service are not permitted to wear nail. polish as per public health regulations.
• Rhinestones, sparkles, designs or foreign bodies/nail jewelry are not permitted.
• Artificial nails and nail tips are prohibited.
• Specific departmental policies may be more stringent due to practice or regulatory standards.

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:

• 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

Return to medical professionals page

Last revised: October 18, 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.