May 2019

In this issue:

Creativity, connectivity and change

A message from Thomas Balcezak, MD, Chief Medical Officer

Those of you who have kept up with news in Connecticut know that our local healthcare environment continues to be dynamic. As the pre-eminent academic health system in the region, it is essential that we take steps to build on our strengths and think creatively about partnering with like-minded organizations to reduce the barriers to accessing our exceptional services. Additionally, we continue to experience high numbers of patients in many of the health system’s hospitals, adding stress for our physicians and clinical operations in general. We have been working for more than a year to address both issues and in the last few weeks have made material progress.

First, as you may have seen, we completed an agreement to form a clinical affiliation with Trinity Health of New England, which owns and operates several hospitals in northern Connecticut and southern Massachusetts. The agreement will enable us to provide exceptional specialty care far beyond our existing locations. The Trinity relationship will enable us to develop programs with Yale Medicine and community partners through our existing and future service lines, including Smilow Cancer Hospital, our Heart and Vascular Center, our telestroke and neurovascular network, and other clinical offerings currently in the pipeline. We envision that the specialists will be fully integrated into the local physician communities, but will have academic and clinical connectivity to the School and hospital service lines. This model enables us to enhance value for patients by reducing constraints to access and providing unique, exceptional care over a broader geography.

Meanwhile, in New Haven, our increased patient acuity, surge in daily census and increased stress on our front-line caregivers requires us to think creatively and broadly to ease those burdens. We also must understand how to accommodate our service line plans that leverage the excellence at the school and hospital. To those ends, we unveiled plans last month to significantly modify and expand the capabilities and services at the Saint Raphael Campus (SRC). Ever since the integration of Yale New Haven and Saint Raphael’s hospitals, we envisioned that unique services should be consolidated on one or the other campus to reduce duplication and expense. We knew that expansion on the York Street Campus would be very difficult, if not impossible because of the already concentrated use of the property we own. At SRC, however, we had far more options to expand both general medicine beds and specialty inpatient and ambulatory facilities.

As such, over the next three years, we will be building two clinical towers on SRC. These facilities will serve two purposes. First, they will house general medicine beds that are more patient centered than the double and triple-bedded rooms in the East Pavilion. That will allow us to use the East Pavilion more effectively for lower acuity care of fewer patients. Second, the towers will form the nucleus of a unique neurosciences service line focused on implementing cutting edge therapies for Parkinson’s disease, among others. The care model we envision will sit at the nexus bench, translational and clinical research and the highest value clinical care.

A third large development is the impending entry of Milford Hospital into the health system as a campus of Bridgeport Hospital. The acquisition will close in June, and we will use the Milford campus to increase our capacity to provide patient-centered inpatient general medicine care, and as a jointly operated site for specialized programs, including geriatrics, heart and vascular and others. The campus will allow us to provide the highest value care for our patients while navigating the significant changes to our facilities at both campuses of our hospital in New Haven. I am enormously excited about these developments since they represent a recalibration to enhance the value of the exceptional specialty services we have, and will continue to build. These two projects will do much to reduce the capacity constraints that are causing pain for our patients and clinicians, and help address the need for easy access to care for both patients and clinicians in the community. I thank you for your engagement, and welcome your input and questions on these and any other topic. As ever, I can be reached via email at thomas.balcezak@ynhh.org.

 

Patient Safety and Quality Metrics

12-Month Period

4/17-3/18

5/17-4/18

6/17-5/18

 7/17-6/18

 8/17-7/18

 9/17-8/18

10/17-9/18

 11/17-10/18

12/17-11/18

1/18-12/18

2/18-1/19

 3/18-2/19

C. diff

159

169

174

 171

 173

 176

 179

 177

179

178

176

 177

CAUTI

73

73

66

 59

 55

 56

 59

 54

56

59

60

 61

CLABSI

78

75

76

 79

 73

 72

 75

 74

69

71

72

 74

SSE

17

16

18

 16

 15

 12

 11

 13

17

21

23

 22









 

 

 

 

12-Month Period

2/17-1/18

3/17-2/18

4/17-3/18

 5/17-4/18

 6/17-5/18

 7/17-6/18

 8/17-7/18

9/17-8/18

10/17-9/18

11/17-10/18

12/17-11/18

 

Colon SSI

44

46

41

 41

 43

 45

 44

 50

46

51

51

 50

Hysterectomy SSI

10

9

12

 12

 13

 14

 16

 17

17

18

17

 16

PE/DVT

71

70

68

 70

 66

 69

 67

 63

66

67

69

 72

Iatrogenic Pneumothorax

7

6

6

 5

 6

 7

 6

 6

6

7

7

 7

 

The Patient Safety and Quality metrics are reported on a 12-month rolling timeframe. The most recent timeframes differ based upon the various databases reporting the metrics. 12-month rolling total updated with AHRQ v6.0 definition starting January 2017.

Patient Safety and Quality Metric Definitions

Colon and Hysterectomy SSI: A surgical site infection within 30 days of the operative procedure, classified as superficial, deep, or organ/space infections based on CDC/NHSN surveillance definitions.

C. diff (Clostridium difficile): A patient who develops diarrhea greater than 48 hours after admission to an inpatient unit and for whom the C. diff testing (either rapid toxin, cytotoxin or PCR) is positive.

CAUTI (Catheter Associated Urinary Tract Infection): A patient who has an indwelling urinary catheter in place for over two days, with at least one of the following signs or symptoms: fever > 38○ C, suprapubic tenderness (with no other recognized cause), costovertebral angle pain/tenderness (with no other recognized cause), urinary urgency (not while catheter in place), urinary frequency (not while catheter in place), or dysuria (not while catheter in place).

CLABSI (Central Line Associated Blood Stream Infection): A primary bloodstream infection (not related to an infection at another site) that develops in a patient with a central line in place over two days before onset of the infection. Culturing the catheter tip is not a criterion for a CLABSI.

Iatrogenic Pneumothorax: A pneumothorax caused by medical care, with certain exclusions for trauma, cardiac and thoracic surgery patients.

PE/DVT (Pulmonary Embolism/Deep Vein Thrombosis): Any PE/DVT that occurs postoperatively.

Serious Safety Event: A deviation from generally expected care that results in moderate to severe patient harm.

 

Medical Staff Survey underway

The leadership teams of Yale New Haven Health (YNHHS) and Yale School of Medicine (YSM) invite members of the medical staff and faculty to participate in the joint 2019 Engagement Pulse Survey, currently underway through June 3. Administered by Press Ganey Associates, Inc., the confidential survey consists of a limited number of questions to help gauge engagement across the health system and School of Medicine.

To access the survey, follow the link included in an email sent directly from Press Ganey on May 13. All members of the YNHHS medical staff and YSM faculty are included in the survey, as are all clinicians, educators and researchers at YNHHS and YSM. New hires after April 8, 2019, are not included.

Note that medical staff members employed by NEMG and advanced practice providers employed by one of the hospitals or NEMG will be asked to take both the Medical Staff/Faculty Engagement Pulse Survey and the YNHHS Employee Engagement Pulse Survey.

Survey results will be disseminated to leadership by late summer. Anyone with questions or problems with the survey should contact Alison Tighe at 203-384-4790.

 

YNHHS expands upon HRO safety efforts with “Just Culture”

Yale New Haven Health embarked on its journey to become a high reliability organization more than five years ago. While HRO efforts have significantly reduced events of unintended harm, there is opportunity to reduce events further. YNHHS’ ultimate goal is zero serious safety events for patients and staff, eliminating all events of harm. Achieving this important goal requires an environment in which employees can receive coaching and support when reporting errors, or even near misses, without fear of retribution. The next step on this journey is creation of a fair and just culture.

As a result, YNHHS is formally embracing the Just Culture model, which has a successful track record in other high-consequence, high-risk industries such as aviation and nuclear power. This model provides an environment where employees feel safe, and it is the first step toward reducing workplace stress. When stress is reduced, resilience increases.

The Just Culture model is consistent with YNHHS’s vision, mission and values because it emphasizes patient-centered care in collaboration with staff who share our values. It underscores our commitment to shared accountability. The Just Culture model does more than ensure fairness in the workplace. It focuses on aligning employee and organizational values and expectations; learning from error; helping staff make better behavioral choices; and continually auditing and improving our systems through human factors engineering – all with the ultimate goal of producing better outcomes.

The model is a powerful driver to encourage high reliability behaviors and a catalyst to a robust, open, reporting and learning culture. It holds all staff accountable in a fair manner, but in an environment that promotes resilience and learning over punishment. Watch for more information about YNHHS’ efforts to create a Just Culture, including training that will be provided to leaders from across the system over the next few months.

 

Facility and security emergency codes change to "plain language"

On May 1, Yale New Haven Health hospitals converted facility and security emergency announcements from color codes to plain language. The change provides clear and consistent messages during emergency events throughout the health system.

The plain-language changes do not apply to each hospital’s medical codes. These codes remain the same, but they’re now announced as medical codes, i.e., “Medical alert: Code Blue, East Tower 9.”

The security and facility code plain-language changes are based on national best practice and a Connecticut Hospital Association recommendation. Plain-language codes have been shown to reduce confusion and provide more accurate information that staff, patients and visitors can act on.

Examples of facility and security code changes include:

  • Previous fire alarm activation: Code red. New code example: “Facility alert: Fire alarm activation, Verdi 3 South.”
  • Previous disaster alert: Code D. New code: “Facility alert: Yale New Haven Hospital’s Emergency Operations Plan has been activated due to flooding.”

Other plain-language facility emergency codes cover decontamination, evacuation/relocation, hazardous material release, mass casualty, utility/technology interruption and weather. Security plain-language codes cover active shooter/assailant, bomb threat, combative patient and suspicious package.

Flyers with the new codes can also be downloaded from the YNHHS Marketing and Communications intranet site. In addition, a brochure listing new codes is available for free on the Yale New Haven Print Center.

 

Creating a culture of mobility

By Jim Shea, Manager, Rehabilitation Services, Bridgeport Hospital, and Sandy Fillion, Performance Improvement Coordinator, Yale New Haven Hospital Co-chairs, System Falls and Mobility Performance Improvement Committee

How many times in the past 10 years have you spent three consecutive entire days in bed when you were capable of getting up? In bed for the entire day means not even out of bed to use the bathroom, walk to the refrigerator or to stand to look out the window. This is the state that too many of our inpatients experience.

Numerous published studies validate the rapid decline in functioning that occurs with each day of bedrest. Across the health system, there is growing concern that we have created a culture of unnecessary and prolonged bedrest that is working against our ultimate goal: to move patients towards an improved state of health.

With the work being coordinated through the newly established System Falls and Mobility Committee, strategies will be rolled out in the coming months to create a culture of mobility, where patients will be consistently assisted in mobilizing throughout the day, within their individual capabilities. As we begin this journey, there are a three important things that the medical staff can do to help:

  • Enter accurate activity orders and use bedrest orders only when indicated
  • Set the expectation for patients that getting out of bed is important
  • Each time you meet with the patient, follow up by asking about how much time they are spending out of bed

The process to create this culture of mobility will require the efforts of everyone. The foundation of these efforts is in the medical staff establishing the expectation that mobility is important for all patients who are capable of getting out of bed.

 

Program helps young adults navigate cancer, life

Cancer is the leading disease-related cause of death for this age group. Young adults are more likely than younger children or older adults to be diagnosed with certain cancers, such as Hodgkin lymphoma, testicular cancer and sarcomas. When detected, cancer in adolescents and young adults (AYAs) tends to more advanced than in other age groups. In the past, AYAs were cared for by adult or pediatric physicians, depending on cancer type and patient and family preference. Yale New Haven Children’s Hospital’s Adolescent and Young Adult Oncology program provides treatment, support and research for a patient population that has historically been underserved nationwide.

“Medically, we had the training and skills to treat the disease, but we needed additional resources to meet these patients’ unique needs,” said Asher Marks, MD, director, Pediatric Neuro-Oncology and AYA Oncology program medical director.

The program launched nearly six years ago, combining resources from the children’s hospital and Smilow Cancer Hospital to care for patients ages 13 to 30. In addition to oncologists, the program includes advanced practice providers, nurses, social workers, psychologists and psychiatrists, child-life specialists and other team members with expertise in working with adolescents and young adults.

The AYA Oncology program is also expanding research for patients under age 18, who haven’t traditionally been offered the opportunity to participate in clinical trials.

“What we’re finding as we delve into certain cancers is that they might initially look the same as they do in younger children and older adults, but they can be unique in the AYA population,” Dr. Marks said. “More research is needed to find out why, and how we can target treatments for adolescents and young adults.”

One of the most challenging aspects of treating AYAs is finding a balance between respecting their independence and providing support when they need it. They don’t want to be treated like children, but they don’t always want you to be so formal. Dr. Asher has a card from a former patient that illustrates this point. The patient expressed appreciation for the medical care he provided and added, at the end, “’Thank you for not being so serious all the time.’”

smilow

Caption: The Yale New Haven Children’s Hospital Lauren Telesz/Smilow Teen Center is a space where patients with the Adolescent and Young Adult Oncology program can socialize, watch movies, play video games or just hang out. Officially opening the center last year were (l-r): Gary Kupfer, MD, chief of Pediatric Hematology/Oncology; Cynthia Sparer, senior vice president, Operations, and executive director, YNHCH; Telesz, a cancer survivor and Yale University student; Asher Marks, MD, AYA Oncology program medical director; Clifford Bogue, MD, chief medical officer, YNHCH; Amanda Garbatini, adolescent and young adult coordinator, YNHCH; Connie Nicolosi, LCSW, Social Work manager, YNHCH; and Ellen Good, manager, Child Life Program, YNHCH.

 

CME made easy and accessible

In collaboration with the Yale School of Medicine, free Category 1 CME credits are available for member of the medical staff. There are a large number of CME offerings covering much of clinical care, including Connecticut mandated required CMEs.

All members of the medical staff have FREE access to:

  • Category 1 CME credit for ALL Yale CME online courses, including CT Mandates modules to help you fulfill the state-mandated requirements
  • On demand access to your CME transcript – a list of all credits awarded to you by Yale CME
  • Access to the courses continually being added to enhance Yale CME’s on-line, with Grand Rounds such as Internal Medicine, Surgery, Cardiology, and a number of other offerings
  • Yale CME will work with you to develop CME programs and courses that are specifically aimed at meeting your educational needs
  • Free access to targeted live courses – please call the Yale Office of CME when you have an interest in attending and they will assist with the registration process

If you have not already done so, please create your Yale CME Profile by going to CloudCME. If you have any questions regarding the registration process, please contact Yale CME via email or 203-785-4578.

 

Newsmaker: Brian Wang, PhD

 Brian Wang, PhD, has been named director of Radiation Oncology Physics, Smilow Cancer Hospital. In this position, he will lead the physics and dosimetry team. Before joining Smilow, he was chief of Physics and Medical Physics Residency director at the University of Louisville, and before that, medical physicist and assistant professor at the University of Utah. Dr. Wang earned his BS and MS in engineering physics from Tsinghua University in Beijing and his PhD in nuclear engineering from Rensselaer Polytechnic Institute, Troy, NY.

brian wang md

Upcoming Events

Housestaff hosts QI Night, May 30: The medical staff is invited to celebrate quality improvement and patient safety initiatives with all housestaff and faculty for QI Night, May 30, 4:30 – 7 pm at The Anylan Center (corner of Congress and Cedar streets). Sponsored by Yale New Haven Health, Yale Resident Fellow Senate and Yale School of Medicine, the program showcases the stellar quality and safety work conducted during the year. The dinner event includes poster presentations, a panel discussion on housestaff safety reporting and the awards presentation. Featured keynote is Steven Choi, MD, chief quality officer, Yale New Haven Health and Yale Medicine.

Palliative care research retreat, June 4: Join colleagues for “Moving Forward: Building an Inter-professional Palliative Care Research Center at Yale,” June 4, 8 am – 1:30 pm, Yale West Campus Conference Center, 100 West Campus Drive, West Haven. Keynote speaker is R. Sean Morrison, MD, director, National Palliative Care Research Center, Ellen and Howard C. Katz Professor and chair, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai. Register by May 31. For further information, please contact Lorena Fonte.

2019 Safety, Quality and Experience Conference, June 5: The 2019 Safety, Quality and Experience Conference, sponsored by Yale New Haven Health and Yale Medicine, is June 5 at the Oakdale Theatre, Wallingford. The doors open at 7:30 am and the conference concludes at 3:30 pm. Register online. Guest speakers are:

  • Lucy Kalanithi, MD, the widow of the late Paul Kalanithi, MD, author of the New York Times bestselling memoir, When Breath Becomes Air. An internal medicine physician and faculty member at Stanford School of Medicine, she completed her medical degree at Yale. Dr. Kalanithi has special interests in healthcare value, meaning in medicine, patient-centered care and end-of-life care.
  • Michael Englesbe, MD, the Cyrenus G. Darling Sr., MD, and Cyrenus G. Darling Jr., MD, Professor of the Surgery at the University of Michigan in the Section of Transplantation Surgery. He practices liver transplantation in children and adults. He is the director of the BCBSM supported Michigan Surgical Quality Collaborative and co-directs the Michigan Opioid Prescribing and Engagement Network.
  • Matthew Dicks an award-winning elementary school teacher and the internationally bestselling author of Storyworthy: Engage Teach, Persuade, and Change Your Life through the Power of Storytelling. He is the founder and artistic director of SpeakUp, a Hartford-based storytelling organization. He is a 39-time Moth StorySLAM and six-time Moth GrandSLAM champion. In addition to performing, he teaches storytelling and communication around the world. He also is the humor columnist for Seasons magazine and an advice columnist with Slate.

 

YNHHS Grants Resource Office helps ideas GRO

Yale New Haven Health has long had an experienced team available to assist its hospitals and other corporate members with identifying and submitting state and federal grants. These grants support new ideas to further health system initiatives related to improving the delivery of care, advancing process change, reducing costs and addressing population health. The Grants Resource Office (GRO) team has now expanded capacity for even greater full-service supports that integrate expertise in comprehensive internal and external compliance monitoring, risk analysis, and policy development.

Through a recently approved YNHHS policy, the GRO now provides oversight of all Yale New Haven Health System and its affiliate organizations' grants, including sub-awards where YNHHS provides services as part of another organization's grant submission. The office is organized into two teams: GRO Pre-Award and GRO Post-Award.

GRO Pre-Award provides identification of grant and funding opportunities, writing and research, and the preparation and assembly of proposals (including narratives, forms, letters, budget, and other requirements or components). GRO Pre-Award also submits the final grant, then supplies clients with complete finished proposal including startup checklist, and communicates any notifications from the funder. GRO Post-Award oversees contracting, fiscal monitoring, performance and financial reporting, and compliance for grant awards and sub-awards.

GRO Post-Award serves as the YNHHS point of contact with the Sponsor regarding award terms and conditions. For more information, visit the Grants Resource Office department site on the intranet (under the departments tab) or send an email to grantsGMB@ynhh.org.

 

Schedule established for intercampus shuttles

To help staff plan their trips between the Saint Raphael and York Street campuses, the intercampus shuttle is now running on a schedule, versus a continuous loop.

During business hours on weekdays, a shuttle bus will be at each stop every 10 minutes. On nights, weekends and holidays, a bus will be at each stop every 15 minutes. Staff can use the YNHH Ride Systems mobile app to view the bus schedule at any time.

Staff can access Ride Systems at www.ynhhbus.org or from any smart phone at www.ynhhbus.org/m. They can also download the free iPhone app from the iTunes store or Android app from Google Play by searching for “Ride Systems.” Once downloaded, select “YNHH” from locations and “Intercampus” from the route options. To sign up for alerts, select the icon in the upper right corner of the main YNHH Ride Systems screen and choose “alerts.”