January/February 2008

Medical Staff Bulletin

Contents

Message from the Chief of Staff
The YNHH hand hygiene initiative is entering its seventh year. We are very well positioned to achieve our goal of 95% hand disinfection both before and after patient contact. Alcohol-based hand rub dispensers are widely available throughout patient care and public areas. Knowledge about surfaces likely to harbor microbes has increased. We have specifically addressed logistical barriers to compliance during many healthcare tasks. Active, unit-based interventions have been remarkably successful. However, we are still experiencing some variability because hand hygiene has not become habit for all involved in patient care.

During the next year, we will ask everyone participating in patient care and service to monitor all co-workers and remind those who are forgetful or preoccupied. A small handful of us, moreover, will begin working month by month, on all shifts, with specific patient care units to reduce the inter-unit variation to a minimum. We will create the imperative for success and provide the tools to overcome common barriers and, in rare cases, resistance. We will continue to use internal surveyors from Quality Improvement Support Services to conduct “concealed” observations of all those entering and leaving patient rooms. This data collection technique has great validity and is a rarity in hospital infection control.

Over the last three months, at YNHH, we observed 79% hand hygiene compliance before patient contact and 90% afterwards. Physicians were compliant 81% before contact and 88% after, closely reflecting our overall compliance. Our 95% goal is very achievable but it will take commitment and a very concerted effort to reach that goal.

Dictated consultations
As YNHH moves toward a comprehensive electronic medical record, we will increase the availability of critical documents on Sunrise Clinical Manager (SCM). As of February 4, formal specialty and subspecialty consultations may be dictated, with an expected turn-around time of 8-12 hours. Only “official” notes, that are to be validated by attendings, may be dictated. These will be available in SCM, transmitted there from SoftMed after transcription, and available both before and after electronic signature by attending physicians. As with other documents, trainees may dictate notes in preparation for attending editing. The dictation work type to be entered is “work type 15.”

Specialty and subspecialty services are also encouraged to create consultation templates in SCM, which can be customized to the needs of individual services. These can be used for direct attending or resident typing of consult notes, permitting creation of the document in real time.

If interested, please contact Dr. Nidhi Shah

Patient safety and quality of care concerns
It is a requirement of the Joint Commission and a policy of YNHH that any concerns about patient safety or quality of care should be reported to the clinical leadership at YNHH. Moreover – and this should never be the case – if an issue is not resolved, staff should feel free to forward their concerns to the Joint Commission without worry about retaliation from any source. Staff who feel patient care concerns are not addressed in the usual chain of command should contact Dr. Peter Herbert 688.2604 or Dr. P. Sue Fitzsimons, 688.2131.

Performance Management Update
Below are our publicly reported performance measures for September 2007. Improving heart failure discharge instructions continues to challenge us, while discontinuation of prophylactic antibiotics in surgical cases has markedly improved. Reported for the first time is our performance in the prevention of deep venous thrombosis (DVT), a subset of the surgical infection prophylaxis (SIP) measures which report on our ability to prevent DVT among surgical patients.

In March 2008, we anticipate that the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) will publicly report our patient satisfaction results. Additionally, Medicare will begin reporting our performance on surgical cases and patients treated for pneumonia and congestive heart failure as outpatients.

All Connecticut acute care hospitals are now required to report data on catheter-associated blood stream infections (CABSIs) in adult medical/surgical ICUs and in pediatric ICUs. We can continue to lower our CABSI rate in our ICUs and throughout our institution with our continued attention to meticulous hand hygiene and complete adherence to contact precautions among all patients. In patients where a central venous catheter is to be inserted, it is vitally important to: use chlorhexidine as a site prep; use a large, sterile drape when prepping the field; ensure that any and all operators wear a cap, full gown, sterile gloves and mask; perform catheter site maintenance in a sterile and meticulous fashion; and reduce line changes over a guide wire to the absolute minimum. Every time a line is inserted, these recommendations must be followed completely. This has been validated to reduce infections in all settings, both ICU and floor. We owe it to our patients to reduce the risk of nosocomial infections. Please call Dr. Tom Balcezak with questions at 688.1343.

September 2007 Performance

AMI	#	YNHH%	Nat'l 90th%
ASA at arriv.	11/11	100	100
ASA at D/C	22/22	100	100
B-Block at arriv.	8/8	100	100
B-Block at D/C	17/17	94	100
ACEI at D/C	2/2	100	100
PCI <90 min	1/1	100	86
Smoking cess.	4/4	100	100

CHF	#	YNHH%	Nat'l 90th%
LVEF assess.	29/29	100	99
ACEI at D/C	9/11	82	100
Smoking cess.	3/3	100	100
D/C instr. given	10/21	48	93

Pneumonia	#	YNHH%	Nat'l 90th%
02 assess. at arriv.	18/18	100	100
Pneum. vac. given	13/14	93	94
Abx given <4 hrs	13/16	81	93
Smoking cess.	7/7	100	100
Blood cx before abx	16/16	100	93
Initial (non-ICU)     Selection Abx	7/7	100	93

SIP	#	YNHH%	Nat'l 90th%
Proph Abx 1 hr	35/36	97	94
Abx selection	30/36	83	N/A
Proph Abx D/C	32/34	94	95
DVT proph ordered	21/23	91	N/A
DVT proph given	20/23	87	n/1

Share your success at the safety and quality conference May 15
The 2008 Joseph A. Zaccagnino patient safety and clinical quality conference will be held May 15 in Harkness auditorium and lounge. The keynote speaker will be David Munch, MD, chief clinical and quality officer for Exempla Luthern Medical Center who has been leading their work to improve both clinical and nonclinical processes using “Lean” (the tools that Toyota popularized and healthcare systems have used to trim waste and inefficiencies in their processes). The conference allows individuals throughout YNHHS to meet and discuss their patient safety and performance management projects. Please submit your quality improvement abstracts by February 14. This year the winners will receive a trip to the December Institute for Healthcare Improvement Forum. For registration and details about abstract submission, visit: http://intranet.ynhh.org/ynhhs/applications/QA_Registration/

SCM’s order entry/clinical documentation functions preparing for roll-out
Sunrise Clinical Manager’s order entry/clinical documentation function will be going live early this year, starting with psychiatry in February, followed by the rest of the hospital. Implementation will be completed in June – at which point CCSS will no longer be used. Chief medical information officers Allen Hsiao, MD, and Nidhi Shah, MD, have worked closely with IS&T’s clinical analysts on developing the various components of SCM. Mandatory training began in January for more than 4,000 users, including the medical staff. Users will not receive security access for order entry until after they have completed the two-part training – online sessions and classroom practice scenarios. Dates of training sessions will be communicated shortly. For information, contact Marcia Dobrowski, RN, at marcia.dobrowski@ynhh.org or 688.7579.

Welcome, new Medical Staff:

Chief of Staff
Peter N. Herbert, MD

Associate Chief of Staff
Thomas J. Balcezak, MD

Assistant Chief of Staff
Victor A. Morris, MD

Medical Board Officers
President
Brett J. Gerstenhaber, MD
President-Elect
Leo M. Cooney, MD
Secretary
Gordon V. Reid, MD
Past President
Robert M. Weiss, MD

Medical Board Members
Stephan Ariyan, MD
Michael C. Bennick, MD
James A. Brink, MD
Richard D’Aquila
Richard L. Edelson, MD
Jack A. Elias, MD
John A. Federico, MD
Patricia Sue Fitzsimons, RN, PhD
Gary E. Friedlaender, MD
Peter M. Glazer, MD
Peter N. Herbert, MD
David G. Hesse, MD
Roberta L. Hines, MD
Margaret K. Hostetter, MD
Lee Jung, MD
Suzanne P. LaGarde, MD
Charles J. Lockwood, MD
Marc E. Mann, MD
Jon S. Morrow, MD, PhD
Michael J. Murphy, MD
Michael K. O’Brien, MD, PhD
Joel S. Silidker, MD
Brian K. Singletary, D.MD
William H. Sledge, MD
Brian R. Smith, MD
Dennis D. Spencer, MD
Thomas F. Sweeney, MD
Harold H. Tara, MD
James C. Tsai, MD
Robert Udelsman, MD
Fred R. Volkmar, MD
Gary R. Wanerka, MD
Lawrence J. Wartel, MD
Stephen G. Waxman, MD, PhD
Norman S. Werdiger, MD
Joseph H. Zelson, MD

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/December 2007
• October 2007
• August 2007
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Last revised: Oct. 15, 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.