June 2005

Medical Staff Bulletin

Message from Joseph A. Zaccagnino, President and CEO

As you know, I recently announced my decision to retire at the end of this fiscal year. As I work with the Board of Trustees and members of the executive management team on the transition, I wanted to take a moment to offer my personal appreciation for the exceptional support the members of the medical staff have provided me throughout my tenure at Yale-New Haven Hospital.

Over the course of over 35 years, I have had the great privilege of working with some of the most talented physicians in the nation. I have been consistently impressed by your individual and collective dedication, unsurpassed focus on quality and safety and your staunch advocacy for the patients in our care. You have shaped our great hospital and I am confident that you will continue to positively impact our patients, their families and our trainees.

Working together over the last three-and-a-half decades, we have achieved many milestones, always with a focus on improving patient care. In each decade, we have opened remarkable new facilities such as the South Pavilion in 1982, the Yale-New Haven Children's Hospital in 1993 and the Shoreline Medical Center in 2004. We have acquired Temple surgical and diagnostic facilities and opened the Yale-New Haven Psychiatric Hospital. And within the next few years, we will open a new clinical Cancer Center/North Pavilion that will rival any facility of its kind in the nation. We have also improved patient care quality and safety and conducted outstanding training programs.

Working together, we have forged a remarkably strong health system that has brought together the greatest capabilities of Yale-New Haven, Bridgeport and Greenwich hospitals and today our system hospitals collectively care for nearly one out of every five hospitalized patients in Connecticut. There is much to be proud of and there is ample reason for great optimism about the future, led by a high caliber Yale-New Haven senior management and clinical leadership team that is solid and focused.

From a personal perspective, my decision to retire was not an easy one but it was made with the recognition that opportunities for new professional experiences as well as the flexibility to spend more time with family cannot be indefinitely deferred. I know that I will continue to benefit from the rich experience provided to me by Yale-New Haven and I hope to apply this experience by teaching at the graduate level and through corporate board service and consulting.

Your steadfast determination and clarity of purpose have been inspiring to me and I look forward to the continued success of Yale-New Haven Hospital and Yale New Haven Health System well into the future. Thank you for the opportunity to have served alongside you in working to better serve our patients.

Re-location of Department of Physician Services

The Department of Physician Services has moved from the Grace Building to Hunter 4. The phone number remains the same: (203) 688-2615.

Performance management update

In the first week of April, the Connecticut Hospital Association and CMS both published updated information on hospitals' publicly reported performance measures. CMS published data for the period January - June of 2004, and The Connecticut Hospital Association published the data for July - September 2004. Yale-New Haven Hospital continues to perform very well with respect to the state, and the state compares favorably to the rest of the nation. Our most recently collected data, for December 2004, is below.

December 2004 Performance

In keeping with our 2005 goal to exceed the national 90th percentile for every performance measure that we report to JCAHO and CMS (see most recent data in the December 2004 Medical Staff Bulletin), the CCSS discharge order entry screens for physicians and other practitioners have been changed to improve our documentation of important information.

When entering a discharge order for a patient with acute MI, HF, CABG, stroke/TIA, or community acquired pneumonia, you will be prompted to select the diagnosis and then to validate the patient's receipt of prescriptions for indicated discharge medications/treatments or your rationale for not prescribing these (e.g. ASA, beta blocker, ACEI, statin, smoking cessation, lipid and EF assessment). Data that you enter will print on a performance report for the permanent medical record. The screens have been streamlined to expedite documentation and will serve as a reminder regarding these reported performance measures.

Many thanks to Janet Parkosewich, RN, Karin Nystrom RN, and Leslie Hutchins, RN, for designing these pathways. If you have questions, please call Dr. Tom Balcezak at (203) 688-1343.

Yale-New Haven Hospital has received the 2005 Connecticut's Hospital Community Service Award for its Pediatric Dentistry Center (PDC) program. The award, sponsored jointly each year by CHA and the Department of Public Health (DPH), recognizes a Connecticut hospital that has made an outstanding contribution to the health of its community.

The Yale-New Haven Hospital PDC, part of the Department of Community Health, was established in 2004 to eliminate oral health disparities in the New Haven area. The program serves a predominantly minority patient population, 90% of whom are covered by the Medicaid program. Only about 10% of the general dentists in New Haven are participating providers in the managed care organizations that provide coverage to the majority of the pediatric Medicaid population, creating a hardship for families that rely on HUSKY A for dental coverage.

Yale-New Haven Hospital has expanded its pediatric dentistry staffing and scope, created a new facility and developed a new pediatric dental residency. The PDC has treated approximately 1,500 patients since opening last year.

Yale-New Haven Hospital has invested more than $1.3 million in capital and incremental operating expense in the PDC, including 8.8 FTE staff, two pediatric dental residents and solicited direct and indirect support for the program from the community. The latter includes donation of professional services totaling more than $300,000 by 42 dentists throughout the state.

Message from the Chief of Staff

The Yale New Haven Health System 2005 Quality Conference was held in Harkness Auditorium on May 10. The highlight of the event was not the formal invited presentations by notable speakers but the project posters summarizing major institutional process improvement efforts conducted during the last year. I want to call some of these to your attention.

Workers in laboratory medicine addressed the issue of inaccuracies that may occur when test samples have to be recorded by hand rather than by computer entry. Error rates in this process were reduced by 75%, greatly reducing the necessity to redraw blood samples. Failure Modes and Effects Analysis was used to approach problems in dosing and therapeutic duplication when non-formulary home medications are converted to formulary agents. A computer pathway was developed using therapeutic substitution for statin medications as a model. Hospital epidemiology and infection control showcased approaches used over the last three years to drive our hand hygiene compliance. Teams from perioperative services targeted operating room turnover and reduced delays (greater than 20 minutes) by 50%. They also dramatically improved instrument accuracy in OR trays. Moreover, there were several additional highly successful projects.

Garnering the first place award for Yale-New Haven Hospital were Nilesh Amin, Michelle Benish and Jeff Topal, who sought to increase pneumococcal vaccine immunization rates for patients with community acquired pneumonia. Using collaborative drug therapy management, this team achieved vaccination rates above the target goal of 85%. As noted below, this honor presaged another. Most impressive, in all projects, was the sophistication of analysis and approach and demonstrated capacity to achieve predetermined goals.

Yale-New Haven Hospital wins CHA's 2005 John D. Thompson Award

Connecticut Healthcare Research and Education Foundation (CHREF) has again selected Yale-New Haven Hospital for its prestigious quality improvement award - the John D. Thompson Award for the fourth year in a row. Yale-New Haven Hospital won the award for its initiative to increase pneumococcal vaccination rates for inpatients with community-acquired pneumonia (CAP).

Vaccination of CAP patients is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) quality measure, and is also reported on the Centers for Medicare & Medicaid Services (CMS) Hospital Compare performance reporting website. Yale-New Haven Hospital received the Thompson award in recognition of its efforts to implement a collaborative practice agreement, between physicians and pharmacists, to improve the hospital's rate of vaccination for eligible CAP patients in the inpatient setting.

Recognizing that patients hospitalized with CAP are at increased risk for future hospitalizations from invasive pneumococcal disease, the hospital reviewed data from previous efforts to improve its vaccination rates. A multidisciplinary team consisting of leadership from pharmacy, nursing, and quality improvement met in the summer of 2003 to identify barriers to success and offer potential solutions. The data revealed that there were improvements in assessment of patients for vaccination, but the hospital had not reached its goals for vaccination administration.

After a comprehensive analysis of current processes, the group recommended a non-traditional approach: an alternative member of the healthcare team, the pharmacist, would have primary responsibility for pneumococcal vaccination for eligible CAP patients. By implementing this new, pharmacy-based vaccination program, the hospital was able to centralize its process to an individual or small team to ensure that vaccination was performed and documented. As a result, the hospital improved its average pneumococcal vaccination rate for eligible CAP patients to 81% for 2004, and since July of last year, the hospital has either met or exceeded its goal of an 85% pneumococcal vaccination rate, which exceeds the 90th percentile nationwide for the quality measure.

Changes to Event Reporting Policy

Yale-New Haven's event reporting policy has been updated to reflect changes in regulatory requirements and in hospital practice. The newly revised policy - clinical policy I-3 - may be found online in the hospital's administrative manual.

Among the changes to the policy are updates in the definitions of sentinel events (as designated by JCAHO) and adverse events (as defined by the CT Department of Public Health), as well as changes to the reporting timeframe to the DPH. Under the old law, hospitals only had 24 hours to report adverse events to DPH. Hospitals now have 7 days, providing us with additional time to determine whether an event meets the reporting criteria.

Despite this extended timeframe for reporting to the state, Yale-New Haven Hospital Legal Affairs office - which coordinates sentinel and adverse event reporting with Dr. Bill Crede - should still be notified immediately about any events which may have caused a death or possible serious disability in a patient. The sooner the event is analyzed, the fresher the facts are in the minds of the staff. This is critical to the root cause analysis that is performed in each case to identify systemic issues that may require improvement to prevent recurrence.

The new policy also articulates that the Employee Assistance Program is available to help staff having difficulty after involvement in an adverse or sentinel event. Access to counseling and assistance is covered by a new JCAHO standard.

Finally, the policy describes the new process for online reporting of virtually all events. This "event reporting" system is now available to all clinical staff for anonymous reporting via the clinical workstations. This system should be used for medication use variance reports, falls, device-related events and other events that may have harmed patients or visitors. Staff are also encouraged to use the system for near-misses, as sometimes it is important to evaluate them as well to prevent future injuries. The system is very user friendly and simpler than the previous system which consisted of several different forms.

Note: Employee injuries or transfusion-related incidents are still reported, respectively, to Occupational Health and the Blood Bank. For information, contact the Legal Office at (203) 688-2291.

Physician Referral Service Reminder

The annual physician profile updates for doctors participating in the physician referral service were mailed out this spring. Please fax your update to the Yale New Haven Health Call Center at 688-5444. If you need another copy or have questions about your profile, the update or how to participate in the referral service, please call Ann Marie Bonvini, Call Center Manager at (203) 688-8403.

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:

• 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: June 30, 2005 (mv)

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