Medical Staff Bulletin - Yale-New Haven Hospital

Message from the Chief of Staff
Last month, I noted that one of the great accomplishments of 2006 was the approval of construction of the Yale-New Haven cancer hospital. This was made possible by Yale-New Haven entering into an Election Principles Agreement providing guidelines that governed an organizing campaign by the Service Employees International Union/1199. This agreement entailed provisions beyond the National Labor Relations Act (NLRA) and required the hospital and union not to disparage each other. It also called for the involvement of an independent arbitrator who would quickly investigate and define remedies if either party violated the agreement.

On December 13, 2006, the arbitrator found that the hospital had violated the agreement and supported the union's request to postpone the election scheduled for December 20 and 21. As the campaign continued, so did our internal review. We learned that background material provided to managers by outside consultants included language disparaging of unions and inconsistent with our values as an organization. This material was apparently used in other organizing campaigns by these consultants. The inclusion of this material was a mistake and we accept responsibility.

To correct these deficiencies, the hospital has already taken several definitive steps. It has ended its relationship with the outside consultants who provided guidance on the campaign to hospital managers. We have brought in new labor counsel under our newly-appointed general counsel, Bill Aseltyne, who will ensure compliance with the agreement. Additionally, the hospital plans to engage the services of a neutral party to serve as an "ombudsman" regarding all hospital labor matters.

We are hopeful that these changes will provide a better context for the campaign and ensure an environment where our employees will have the opportunity to finally cast a vote on this important matter.

Medical Oncology expands practice and chemotherapy services to Long Wharf
Yale-New Haven Hospital and Yale Cancer Center have jointly expanded clinical facilities to a second convenient location at One Long Wharf Drive in New Haven. This satellite, which opened on February 5, includes 12 exam and consultation rooms, an infusion center with 30 treatment bays, a laboratory satellite, and a pharmacy for compounding chemotherapy. Located on the sixth floor, the Long Wharf satellite will serve patients with solid tumors receiving cancer care. It will ease the overcrowding in the medical oncology clinic on the second floor of the Yale Physicians Building (YPB), 800 Howard Avenue, and allow for program growth until the new cancer hospital is built.

Patients with hematological malignancies will continue to receive their treatment at YPB-2. In the coming months, YPB2 will be renovated to accommodate bone marrow transplant day hospital patients. These patients currently receive their ambulatory care in inpatient rooms, which will soon become available for inpatients.

Yale Cancer Center also recently announced the appointment of Dr. Arthur Levy as medical director of Yale Medical Oncology. Dr. Levy has over 30 years of experience caring for cancer patients in the New Haven area and will have major program operations responsibility. His office will be located at One Long Wharf.

Performance Management update
Each January, Connecticut hospitals submit a clinical performance improvement plan to the Connecticut Department of Public Health (DPH). This plan is reviewed by senior hospital leadership, clinical chiefs and the Board of Trustees. In 2006, YNHH undertook a number of initiatives, including launching a consultative stroke service, a new inpatient diabetes care team, participation in the 100,000 Lives Campaign, and participation in both the National Surgery Quality Improvement Project and the Surgical Care Improvement Project. We continue work on publicly reported measures that we communicate each month to CMS/JCAHO. The most recent month's results are in the column at left.

What's new for 2007? It is anticipated that in June CMS/JCAHO will publish risk-adjusted mortality data for acute myocardial infarction, congestive heart failure and pneumonia (representing patients discharged in fiscal year 2005). Additionally, we anticipate reporting our performance in preventing venous thromboembolism in surgical patients, and our patient satisfaction results from the government-sponsored survey called HCHAPS (Hospital Consumer Assessment of Health Care Providers and Systems). We also expect the state of Connecticut to finalize its legislation on reporting hospital-acquired infections. New hospital initiatives for 2007 will include participation in the Institute for Healthcare Improvement's Five Million Lives Campaign, inpatient and outpatient diabetes care initiatives, standardization of caregiver hand-offs, and improvements in the overall quality of discharge instructions. In the coming months, you will hear more about those initiatives in this space. Please call Dr. Tom Balcezak with any questions at 688-1343.

Patient safety conference on May 17
The 2007 Joseph A. Zaccagnino Patient Safety and Clinical Quality Conference will be held Thursday, May 17, 8:30 a.m.-4 p.m, in Harkness Auditorium. The conference, open to all system employees and Medical Staff members, provides an opportunity to discuss projects and plans related to patient safety and performance management. The deadline for submitting abstracts on quality and safety projects is March 1. This year's speaker is best-selling author Ron McMillan who will discuss "Crucial Conversations in Healthcare." For information about submitting abstracts or registering for the conference, contact Andrea Benin, Performance Management, andrea.benin@ynhh.org, 688-8692, fax: 688-5571.

Bariatric program receives national accreditation
YNHH's bariatric surgery program has been designated by the American Society for Bariatric Surgery (ASBS) as a Center of Excellence. This designation recognizes the safety, efficiency and overall positive results of YNHH's bariatric surgical team. To earn this designation, YNHH underwent a series of site inspections during which the ASBS examined all aspects of the program's surgical processes and collected data on health outcomes. The YNHH bariatric surgery program offers the most advanced bariatric surgery procedures, including laparoscopic Roux-en Y gastric bypass, the Lap-Band®, and the laparoscopic sleeve gastrectomy - a new procedure for weight loss that is particularly suited to those patients at highest risk for surgery. For more information, contact Dr. Robert Bell at 764-9060 or robert.bell@yale.edu

November 2006 Performance

AMI	#	YNHH%	Nat'l 90th%

ASA at arriv.	12/12	100	100
ASA at D/C	26/26	100	100
B-Block at arriv.	9/9	100	100
B-Block at D/C	27/28	96	100
ACEI at D/C	6/6	100	100
PCI <90 min	0/0	9	86
Smoking cess.	12/12	100	100

CHF	#	YNHH%	Nat'l 90th%

LVEF assess.	27/27	100	98
ACEI at D/C	5/6	71	100
Smoking cess.	6/6	100	100
D/C instr. given	18/27	67	88

Pneumonia	#	YNHH%	Nat'l 90th%

0₂ assess. at arriv.	15/15	100	100
Pneum. vac. given	7/9	78	89
Abx given <4 hrs	4/4	100	92
Smoking cess.	12/12	100	100
Blood cx before abx	12/13	92	93
Initial (non-ICU) Selection Abx	7/7	100	91

SIP	#	YNHH%	Nat'l 90th%

SIP-1 (Proph Abx 1 hr)	35/37	95	94
SIP-3 (Proph Abx D/C)	22/35	63	95

Welcome, new Medical Staff:

January
Jill Francis Arthur, M.D., Attending, Anesthesiology
Andrienne Joy Burns, P.A., Affiliated, Internal Medicine
Michelle Cappiello, A.P.N., Affiliated, Internal Medicine
Alexandra Carter, M.D., Associate, Surgery
Alana Clements, A.P.N., Affiliated, Pediatrics
Katherine Devir, P.A., Affiliated, Pediatrics
Diane E. Fahey, A.P.N., Affiliated, Pediatrics
Surani Rita Fernando, M.D., Attending, Internal Medicine
Zoher Ghogawala, M.D., Visiting, Neurosurgery
Anna A. Hansen, M.D., Associate, Diagnostic Radiology
Brian Karsif, M.D., Associate, OB/GYN
Philip Martinez. A.P.N., Affiliated, Surgery
Erin McMahon, C.N.M., Affiliated, OB/GYN
Jeffrey Midgley, P.A., Affiliated, Surgery
Laura E. Niklason, M.D., Attending, Anesthesiology
Lisa R. Pavlovic, M.D., Attending, Pediatrics
Susan M. Peters, A.P.N., Affiliated, Pediatrics
Elahe Salehi, A.P.N., Affiliated, Internal Medicine
Toshiharu Shin'oka, M.D., Attending, Surgery
Andrew Patrick Swan, M.D., Associate, Ophthalmology
Eugene Scott Swenson, M.D. Attending, Internal Medicine
James Thomas, M.D., Attending, Diagnostic Radiology
Mary M. Tomayko, M.D., Ph.D., Attending, Dermatology

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.