August 2007

Medical Staff Bulletin

Contents

Message from the Chief of Staff
I have written often in this space about attending physician relations with our patients, our trainees and hospital staff. Additionally, our By-Laws, Rules and Regulations establish many standards of patient care and deportment. All of the latter are incorporated in nearly 100 pages of text and are not succinctly summarized. For this reason, the clinical leadership has developed the following.

YNHH Medical Staff Professional Commitment:

1. Recognizing the complex needs of patients presenting for hospital care, I commit to timely, efficient and compassionate management of all patients referred to me.
2. The hospital is an environment where most work under time pressures, physical demands and /emotional stress. I commit to respectful and courteous interactions with all who work with me to better create a healing environment for patients.
3. I commit to strictly maintain the confidentiality of all patients.
4. Because communication among caregivers is an essential component of successful patient outcomes and satisfaction, I commit to consistently and fully communicate, in writing and orally, with all members of the patient care team.
5. I will assist in maintaining a care environment that is clean and safe, where compliance with infection control standards is universal, and where safeguards against medical injury to patients and staff are strictly maintained throughout the hospital.
6. Medical staff membership is a privilege that requires I take ownership of all aspects of YNHH within my control. I shall personally take direct and immediate action when I can right a potential wrong to patient care or the environment of care.
7. I acknowledge the compact between resident physicians and their teachers as well as my status as a role model, and I pledge full commitment to the professional and personal development of YNHH trainees.

This will be sent to you at the time of recredentialing every two years. We hope you will sign it to affirm your recognition of this commitment to safe, high quality patient care. A similar commitment will be made by all hospital employees.

Electronic patient documentation
Last month the Medical Staff Bulletin described that “Single Sign-On” (SSO) is now featured on all clinical work stations. Use of the SSO permits access to Sunrise Clinical Manager, SoftMed, Centricity (Logician), Synapse, MDLink, and Novell. Clinicians, once signed on through this mechanism, can enter and leave all systems without repeating the sign-on process. It should be noted that the password selected works only in the SSO route and does not provide individual access to these systems if SSO is not employed. Therefore, the SSO password is unique to SSO and when access is taken directly into one of the clinical systems (and not in SSO), a different, unique password is required.

Currently, SoftMed contains patient discharge summaries and operative reports dating back more than a decade. Moreover, SCM contains all transcribed and electronically signed documents from the last six years. With the availability of these historical sources, the Medical Record Department will no longer deliver paper charts to nursing units for every admitted patient. If paper records are desired, however, simply ask the unit business associate and these will promptly be brought for your review.

YNHH makes U.S.News & World Report’s Honor Roll for America’s Best Hospitals
For the first time, U.S.News & World Report has named Yale-New Haven Hospital (YNHH) to its Honor Roll as one of the nation’s premier hospitals. YNHH ranked #15 in the United States according to the publication’s annual “America’s Best Hospitals” rankings in the July 23 issue. Yale-New Haven Hospital was the only Connecticut hospital selected for the Honor Roll, and one of only three hospitals in New England to be so honored.

In addition to being included on the list of the 18 best U.S. hospitals, Yale-New Haven Hospital was ranked among the very best in the nation in 10 of the 16 medical specialties evaluated: cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics, gynecology; heart and heart surgery; kidney disease; psychiatry; and respiratory disorders.

Of those, YNHH’s geriatrics ranking made the nation’s top ten for the seventh time and psychiatry for the thirteenth time, while cancer, digestive disorders, endocrinology, gynecology, kidney disease, and respiratory disorders were all ranked in the nation’s top 25.

Only 173 of the 5,462 hospitals evaluated were ranked in one or more clinical specialties. In New England, YNHH joined Massachusetts General Hospital and Brigham and Women’s Hospital, both of Boston, on the 2007 Honor Roll.

Chief medical information officers named
Allen Hsiao, M.D., and Nidhi Shah, M.D., have been named chief medical information officers (CMIOs) at YNHH. In their new roles, Drs. Hsiao and Shah will help ensure that information technology (I.T.) enhances patient safety, clinical quality and customer service. Chief medical information officers help design and support the clinical information systems that clinicians use in the delivery of patient care. They represent the needs and requirements of the physician community and advocate for the use of efficient and effective information technology in the hospital. Drs. Hsiao and Shah are heavily involved in the Sunrise Clinical Manager (SCM) project.

Dr. Hsiao, a pediatric emergency medicine attending, received his B.A. from Brown University and his M.D. from Brown University School of Medicine. After training in Pediatrics and Emergency Medicine at YNHH, Dr. Hsiao completed a fellowship at the Yale Center for Medical Informatics. Dr. Shah, a YNHH hospitalist attending, received her B.S. from Massachusetts Institute of Technology, her M.D. from New York University School of Medicine and her M.P.H. from Harvard School of Public Health. She completed a fellowship in general internal medicine at Brigham and Women’s Hospital, where her research focused on how clinical information systems can improve patient safety and facilitate physician work flow.

Surgical consent form and policy changes
YNHH has recently adopted a new surgical consent form to comply with new federal guidelines. A copy of the new form is included. The changes include:

• Written informed consent is required for any procedure coded as “surgical,” including certain bedside procedures such as central line placement, lumbar puncture, thoracentesis, etc.
• Documentation of informed consent must always be recorded on a form rather than a note in the chart.
• The date and time of the patient’s signature must be on the consent form.
• The process must include a discussion of procedure-specific risks, benefits and alternatives, with all material risks being documented on the consent form.
• The form now mentions that YNHH is a teaching hospital and that trainees will be involved in portions of the procedure.
• The form also includes a statement that if someone other than the medical team will be present in the OR (such as a vendor or an observer) that the doctor has discussed this with them (separate written permission should be obtained).
• The new form also includes a permission for photographs to be taken for medical, research or educational purposes.

Physicians or patients may cross out provisions that they believe do not apply. As in the past, in the event of an emergency, no informed consent form is necessary (though when possible, obtain consent from the patient, a legal representative or next of kin, even via telephone). A new Section C has been added to the form to allow for documentation of emergency circumstances.

Taking precautions with prescription practices
All members of the Medical Staff are reminded to take precautions with regard to their prescription writing practices. Carelessness in this area increases the potential for diversion of narcotics by employees or patients. Inappropriate prescriptions ending up in the wrong hands can lead to potential criminal prosecution or licensure actions against the physician.

Some useful tips:

• Don’t leave prescription pads on your desk or in examination rooms when you are not there.
• Never pre-sign your prescriptions and hand them to staff who lack prescriptive authority to fill out.
• Use care in indicating the number of pills you are prescribing – do not leave space for an extra zero to be added at the end of the number.
• Write out and spell out the quantity of the drug to be dispensed.

YNHH selected as a 2007 most wired and most wireless award winner
 For the eighth consecutive year, Yale-New Haven Hospital has been selected as one of the top 100 Most Wired hospitals in the nation by Hospitals and Health Networks, a trade magazine published by the American Hospital Association. YNHH was one of only 12 New England hospitals to be selected as Most Wired. YNHH was also selected for the fourth year as a Most Wireless award winner. This recognition is based on technology advancements made by the organizations to enhance patient safety, clinical quality and customer service in healthcare centers.

According to Hospitals and Health Networks magazine, the nation's 100 Most Wired hospitals have demonstrated better outcomes in four key areas - mortality rates, patient safety, length of stay and the federal government's "Hospital Compare" core measures. The 100 Most Wired hospitals excel in the use of I.T. in several key areas: improving patient flow and workflow; implementing and capturing results of quality improvement techniques; medication management, operating room and anesthesia documentation; disaster planning; and access to digital images.

Nurse/PCA rounding begins at YNHH
This summer, YNHH began nurse hourly rounding on inpatients in the pediatric and medical units. The effort is part of Service Excellence and spearheaded by Marcelle (Williams) Applewhaite and Francine LoRusso. In late June, representatives from the Studer Group - an outcomes-based healthcare consulting firm – provided an indepth presentation on principles of hourly rounding including definition, necessary behaviors of staff and tactics to assist us in planning our implementation process. This was presented to staff nurses, patient care associates, business associates and unit leadership. Studies have shown that nurse hourly rounding reduces call light requests, falls and skin breakdown and improves patient and nurse satisfaction.
  At YNHH, nurses and PCAs have begun to round each hour on every patient in their unit, asking about the “four Ps” - pain, positioning, placement and personal needs. They also check the room for obvious safety or cleanliness problems, make sure the caregivers’ names are written on the white board and see if the patient has everything he or she needs (call light, drinks, etc) within reach. Pediatrics and medicine will be fully implemented by the beginning of October, with other patient care divisions to follow.

E-scripts now accepted at MedicalCenter Pharmacy
Medical Center Pharmacy (MCP) now accepts electronic prescription refills directly from physicians’ office PCs or PDAs. MCP computers are connected to SureScripts – the nation’s largest electronic prescribing network. Through this secure connection, MCP can send requests for new prescriptions and prescription refills directly to physicians’ computers and receive their responses securely and accurately on its computers.
  E-prescribing is a timesaving alternative to phone calls and faxes that can burden the prescribing process. Pharmacists can now send prescription refill requests directly to a physician’s practice computer – saving time, reducing the potential for dispensing errors and decreasing the number of phone calls to physician offices for clarification.
  For more information about electronic prescribing and how physician practices can connect, please contact SureScripts Electronic Prescribing Resource Center at 1-866-RxReady (866-797-3239), or visit their Web site at www.surescripts.com.

Cancer operations patient flow project
Yale-New Haven Hospital has engaged Helicon Consulting to evaluate the operational requirements of the Cancer Hospital. Helicon Consulting will be validating the current operations design model to verify that patient- and family-centered care is as accessible and convenient as possible. We have asked the consultants to specifically evaluate patient stops and patient wait-times as well as provide recommendations for carrying out our multidisciplinary team approach.
  The first phase of this planning effort will utilize computer simulations that will be based on patient flows, patient volumes and treatment times. The model will identify potential bottlenecks in the system, such as cumbersome processes and points of care that are at risk for long delays. A series of five meetings are expected to take place over the course of three months.

Welcome, new Medical Staff:

July

Olukemi T. Akande, M.D., Associate, Internal Medicine
Robert Solomon Bercovitch, M.D., Associate, Internal Medicine
Veerle Ilse Bossuyt, M.D., Attending, Pathology
Rebecca J. Brandenburg, P.A.., Affiliated, Internal Medicine
Leonard Lois Calo, M.D., Associate, Internal Medicine
Brian C. Cambi, M.D., Attending, Internal Medicine
Michael F. Canarie, M.D., Attending, Pediatrics
Catalin M. Cantemir, M.D., Associate, Anesthesiology
Kristin A. Carmody, M.D., Associate, Surgery
Hanna Huey-Jiun Chao, M.D., Ph.D., Attending, Internal     Medicine
Christine Wong Chen, M.D., Attending, Internal Medicine
Gary Chen, M.D., Associate, Diagnostic Radiology
Lara G. Chepenik, M.D., Ph.D., Associate, Psychiatry
Kevin Y. Ching, M.D., Attending, Pediatrics
Jennifer Nam Choi, M.D., Associate, Dermatology
Brett V. Citarella, M.D., Attending, Pediatrics
Dana M. Correale, M.D., Associate, Dermatology

Roy Harold Decker, M.D., Ph.D., Associate, Therapeutic     Radiology
Anjela Galan, M.D., Associate, Dermatology
Rina Lyset Garcia, M.D., Associate, Internal Medicine
Arnar Geirsson, M.D., Associate, Surgery
Sahar Ghassemi, M.D., Attending, Internal Medicine
Darius R. Gilvydis, M.D., Associate, Diagnostic Radiology
Ingrid Gonzalez, M.D., Associate, Internal Medicine
Julie Elizabeth Goodwin, M.D., Attending, Pediatrics
Jonas O. Hannestad, M.D., Associate, Psychiatry
Joseph Michael Harburger, M.D., Associate, Internal Medicine
David J. Hass, M.D., Attending, Internal Medicine
Keith Anthony Hernandez, M.D., Associate, Anesthesiology
Scott Kirkland Heysell, M.D., Associate, Internal Medicine
Kelly Lynn Hodges, M.D., Associate, Pediatrics
Eric John Hodgson, M.D., Associate, Obstetrics & Gynecology
Shyoko Honiden, M.D., Attending, Internal Medicine
Avlin Barlow Imaeda, M.D., Ph.D., Attending, Internal     Medicine
Mark Girish Jablonski, M.D., Associate, Diagnostic Radiology
Stephanie Colleen Jost, M.D., Associate, Internal Medicine
Sandhya Vasudev Kanade, M.D., Attending, Internal Medicine
Steven Joseph Karidas, M.D., Associate, Diagnostic Radiology
James Eric Kempton, M.D., Associate, Ophthalmology
Paul D. S. Kirwin, M.D., Attending, Psychiatry

James M. Lai, M.D., Attending, Internal Medicine
Melissa L. Langhan, M.D., Attending, Pediatrics
Elizabeth Larned, P.A., Affiliated, Surgery
Caroline Seton Loeser, M.D., Attending, Internal Medicine
Karen Ann Mangold, M.D., Associate, Pediatrics
William C. Manson, M.D., Associate, Surgery
Michelle Catherine Marcy, M.D., Associate, Pediatrics
Patricia Marriott, P.A., Affiliated, Orthopedics
Michael K. Matthew, M.D., Associate, Surgery
Bart E. Muhs, M.D., Attending, Surgery
Rupa Mukherjee, M.D., Associate, Internal Medicine
Jennifer E. Myer, M.D., Attending, Psychiatry
Samuel Nakat, M.D., Associate, Diagnostic Radiology
Jesse Charles Nussbaum, M.D., Associate, Internal Medicine
Himati Kirit Patel, M.D., Associate, Internal Medicine
Christine Laro Patterson, M.D., Associate, Pediatrics
Natalie Penelopy Pauli, M.D., Associate, Internal Medicine
Lawrence S. Rosenthal, M.D., Attending, Internal Medicine

Daniel J. Salchow, M.D., Associate, Ophthalmology
Steven R. Sawyers, M.D., Associate, Diagnostic Radiology
Rebecca M. Scandrett, M.D., Attending, Internal Medicine
Jared Michael Scott, M.D., Associate, Dermatology
Catherine M. Smith, M.D., Associate, Diagnostic Radiology
Mukta Chandra Srivastava, M.D., Associate, Internal Medicine
Karena L. Swan, M.D., Attending, Pediatrics
Tamar H. Taddei, M.D., Attending, Internal Medicine
Ece Tek, M.D., Attending, Psychiatry
Adam Zydor Voorhees, M.D., Associate, Diagnostic Radiology
Mark J. Wehrum, D.O., Attending, Obstetrics & Gynecology
Anna M. Weissmann, M.D., Associate, Diagnostic Radiology
Emad Yacoub, M.D., Associate, Diagnostic Radiology
Jay S. Zimmerman, M.D., Attending, Internal Medicine

Chief of Staff
Peter N. Herbert, M.D.

Assistant Chiefs of Staff
Thomas J. Balcezak, M.D.
Victor A. Morris, M.D.

Elected Medical Staff Officers

President
Brett J. Gerstenhaber, M.D.
President-Elect
Leo M. Cooney Jr., M.D.
Immediate Past President/Treasurer
Robert M. Weiss, M.D.
Secretary
Gordon Reid, M.D.

Medical Board Officers

Chairperson
Brett J. Gerstenhaber, M.D.
Vice Chairperson
Leo M. Cooney Jr., M.D.

Medical Board Members

Stephen Ariyan, M.D.
Michael C. Bennick, M.D.
James A. Brink, M.D.
Benjamin S. Bunney, M.D.
Christopher R. Canny, M.D.
Richard D’Aquila
Richard L. Edelson, M.D.
Jack A. Elias, M.D.
Fredric O. Finkelstein, M.D.
Patricia Sue Fitzsimons, R.N., Ph.D.
Gary E. Friedlaender, M.D.
Peter M. Glazer, M.D.
Peter N. Herbert, M.D.
David G. Hesse, M.D.
Roberta L. Hines, M.D.
Margaret K. Hostetter, M.D.
Karen A. Johnson, M.D.
Suzanne P. LaGarde, M.D.
Charles J. Lockwood, M.D.
Marc E. Mann, M.D.
Jon S. Morrow, M.D., Ph.D.
Michael O’Brien, M.D., Ph.D.
Joel S. Silidker, M.D.
Brian K. Singletary, D.M.D.
Brian R. Smith, M.D.
Dennis D. Spencer, M.D.
Thomas F. Sweeney, M.D
.James C. Tsai, M.D.
Robert Udelsman, M.D.
Fred R. Volkmar, M.D.
Gary R. Wanerka, M.D.
Lawrence J. Wartel, M.D.
Stephen G. Waxman, M.D., Ph.D.
Norman S. Werdiger, M.D.
Joseph H. Zelson, M.D.

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:

• June/July 2007
• May 2007
• March/April 2007
• February 2007
• January 2007
• November 2006
• September 2006
• July 2006
• June 2006
• May 2006
• March 2006
• January 2006
• December 2005
• November 2005
• September 2005
• August 2005
• June 2005
• March 2005
• January 2005
• December 2004
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• October 2004
• September 2004
• July 2004
• June 2004
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• 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: Aug. 27, 2007 (dh)

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.