December 2005

Medical Staff Bulletin

Message from the Chief of Staff

There has been considerable national press concerning the Institute for Health Care Improvement (IHI) campaign to save lives of 100,000 hospitalized patients between January 2005 and July 2006. Participation of at least 2,000 hospitals was sought and all three hospitals in the Yale-New Haven Health System have agreed to participate. The anticipated outcome is a reduction in overall hospital mortality.

Progress in three of the six IHI initiatives was well underway at Yale-New Haven Hospital before January 2005. We already had dramatically reduced both central line infections and ventilator-associated pneumonia. We had also implemented protocols to reduce surgical site infections through use of prophylactic antibiotics, proper hair removal and control of perioperative blood glucose levels.

The other IHI initiatives deserve mention because they are still works-in-progress. One of these concerns medication reconciliation. This process is required at each transition in the continuum of care and requires verification of drugs prescribed and clarification of any reason for discontinuation or change in dose, time or route of administration. A second initiative requires implementation of Rapid Response Teams (RRT). We have documented, from our own internal data, that patients admitted directly from the Emergency Department to the ICUs fare better than those first admitted to general nursing units and later transferred for intensive care. We know the changes in vital signs that presage the need for such transfer and, soon, any clinician will be able to call in the RRT for an expedited evaluation followed by stabilization or ICU transfer. The department of Pediatrics has already established such a team and adult medical and surgical services will be launching a similar initiative.

The last IHI recommendation calls for programs to enhance teamwork and collaboration among all clinicians. Similar programs in the aviation industry have been credited with dramatic reductions in airline fatalities. The department of Obstetrics and Gynecology is piloting such a program which can greatly enhance our safety culture.

Service Response Center to boost cleanliness efforts

Yale-New Haven Hospital has a new centralized service for dealing with any facilities and cleanliness issues within the hospital, including spills, bathroom cleanliness, trash, etc. All members of the Yale-New Haven Hospital Medical Staff, in addition to all Yale-New Haven Hospital employees, can simply call the Service Response Center at 688-9000 if they see a problem that needs to be remedied. The environment of care is important to patients, staff and visitors alike, so please do your part in keeping the hospital neat and clean, and reporting any environmental needs.

Cancer center TV ads appeal for public involvement

Concerned with the city of New Haven's delay in granting Yale-New Haven Hospital approval to demolish the Grace Building and begin construction of the new cancer center, the hospital has begun a TV ad campaign. This encourages concerned citizens to contact their elected officials to hopefully break the logjam created by Service Employees International Union influence on local officials.

Flu vaccines still available to Medical Staff

If members of the Medical Staff have not yet received influenza vaccine, they may do so free of charge at Yale-New Haven Hospital Occupational Health Services, located on the first floor of the East Pavilion (past the Max Taffel Conference Room) any time between 7:30 a.m. and 4:15 p.m., Monday through Friday.

SCM update

Sunrise Clinical Manager (SCM) is now implemented in all clinical areas. Clinicians are using the system to design and maintain patient lists and retrieve all patient results. Currently, clinical analysts are working to design ordering and documentation pathways for SCM. MIS is seeking physicians, APRNs, PAs and nurses to provide assistance with order entry and workflow redesign for the new system. Interested clinicians should contact Marcia Dobrowski at (203) 688-7579. MIS hopes to implement order entry/documentation by the end of 2006. All physicians should gain familiarity with the lab result system (DLA or clinical labs) for the rare times SCM has a scheduled or unexpected downtime. It is the expectation this be part of the physician skill set.

JCAHO final report

During the last announced JCAHO triennial visit, Yale-New Haven Hospital received three "Recommendations for Improvement" (RFIs), including documentation of pain assessment, pediatric anesthesia documentation of anesthesia risk score and needs to do an overall hazard assessment of operations at the Guilford facility. This was excellent performance compared to our peer hospitals, and all RFIs were resolved by early November. The Medical Staff should know that illegible physician handwriting was noted on several patient care units, but we did not receive a high level citation.

Liver transplantation resumes at Yale-New Haven Hospital

Four liver transplants have been performed at Yale-New Haven Hospital since July 1, 2005, as Yale-New Haven Hospital opened a new liver transplantation center, under the leadership of David C. Cronin, II, MD, PhD, program director. Dr. Cronin performed over 600 liver transplants at the University of Chicago. He has been joined by Mario Strazzabosco, MD, PhD, medical director of transplant hepatology. Dr. Strazzabosco was a hepatology fellow at Yale in the late 1980s and returned to his native Italy, where he established and directed the country's third largest liver transplant program in Bergamo. To contact either physician or make a referral, call the liver transplantation center at (203) 785-7643.

New section and chief of thoracic surgery

At the September meeting of the Board of Trustees, the Medical Board approved the creation of a new section of Thoracic Surgery, which historically has been part of the former section of Cardiothoracic Surgery (which will now be known as Cardiac Surgery) in the department of Surgery. In the last decade it has become clear that most, though not all, lung surgery is performed by thoracic, rather than cardiothoracic, surgeons.

Frank C. Detterbeck, MD, is the new section chief of Thoracic Surgery. Dr. Detterbeck, who previously headed the section of cardiothoracic surgery at the University of North Carolina (UNC), received his undergraduate degree from the University of Michigan and his MD from Northwestern University. He served residencies at UNC and Virginia Mason Clinic in Seattle and a fellowship in Thoracic Transplantation at UNC.

Pediatric adolescent and endocrinology section chiefs named

Sheryl A. Ryan, MD, was appointed as chief of Adolescent Medicine in the department of Pediatrics. Dr. Ryan, associate professor of Pediatrics at Yale School of Medicine, graduated from Boston College, received her MD from Yale and served her internship and residency at Children's Hospital of Philadelphia. Robert Sherwin, MD, has been appointed interim chief of the section of Endocrinology. Dr. Sherwin is the CNH Long Professor of Internal Medicine, program director of the Yale-New Haven Hospital Clinical Research Center, and an internationally known authority on type 2 diabetes.

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:

• November 2005
• September 2005
• August 2005
• June 2005
• March 2005
• January 2005
• December 2004
• November 2004
• 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: December 8, 2005 (mv)

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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.