July 2006

Medical Staff Bulletin

Contents

Message from the Chief of Staff

We are privileged this month to welcome 175 new first-year residents to Yale-New Haven Hospital, together with about 50 new clinical fellows who are beginning their subspecialty training. I had opportunity to meet with the majority of PGY-1s during their orientation process and shared with them the excitement of these times at YNHH, as well as our delight that they chose our medical center for graduate medical education.

My first reflection with the new House Staff concerned the enormous contributions they make to our culture and to our care of patients. Secondly, I stressed our commitment to honor their roles as trainees, abide by work-hour standards, and provide them with the best possible educational milieu and experience.

Lastly, I stressed, as always, the chain of command and responsibility in our patient care. Just as Attendings are required to practice within the scope of their training and experience, we expect residents to seek guidance and support when they are not absolutely certain of the correct diagnostic or therapeutic path. The great advantage to patient care afforded by the academic medical center is the ready availability of advanced trainees, specialists and subspecialists to participate in and contribute to critical decision-making. Trainees must always feel completely comfortable in their patient care roles and freely avail themselves of the established support systems. Elsewhere in this Bulletin is news of the progressive development of rapid response teams, one more element of the patient safety structure at YNHH. Please reach out, introduce yourself, and welcome our new residents. They will be fellow Attendings in very short order; and, in the interim, our most valuable assets.

U.S. News & World Report ranks YNHH among America's best

U.S .News & World Report again included YNHH among the nation's top hospitals, according to its annual "America's Best Hospitals" listing in the July 10 issue. YNHH ranked among the best in 10 of the 16 medical specialties evaluated: cancer; digestive disorders; ear, nose and throat; endocrinology; gynecology; heart and heart surgery; kidney disease; psychiatry; respiratory diseases; and urology. Of those, gynecology and psychiatry services are ranked among the nation's top 10, while digestive disorders, endocrinology, kidney diseases and urology all ranked among the nation's top 25. Gynecology and psychiatry have been recognized for 15 consecutive years.

Heart and heart surgery, gynecology and urology were ranked higher than last year.

Only 176 of the nation's 3,000+ hospitals were on the "Best Hospitals" list, and YNHH was the only Connecticut hospital included. In New England, Massachusetts General Hospital in Boston was the only hospital to be ranked in more specialties (12) than YNHH.

East Pavilion computer project completed

The EP Computer project, which was begun in February to improve computer access for clinicians, was completed in June. A total of 25 new clinical workstations were added to the following general medicine areas: EP 5-5/6; a new charting room on EP 5-7/8; Sach's Library on EP 5; Residents Room on EP 9; and a new charting room on EP 9-5/6. If you have questions or feedback about the project, contact Dr. Grace Jenq at 688-7026.

Making YNHH a quieter place

At the recommendation of the Patient Satisfaction steering committee, an Environmental Noise Reduction group formed a few months ago to address the level of noise on the patient care units. The group, led by Paula Crombie, Director of Social Work, has been working on a noise reduction plan and will work with the patient care units to heighten awareness, establish guidelines for behavioral change, set environmental noise standards for equipment and explore other ways noise level in the hospital can be improved. Because the intercoms on the units are viewed as a major dissatisfier by patients, YNHH will provide the unit nurses with SpectraLink® wireless phones.

YNHH develops rapid response team

As part of its participation in the Institute of Healthcare Improvement's (IHI) campaign to prevent 100,000 in-hospital deaths, YNHH created a rapid response team (RRT) in January to provide urgent and emergent care to YNHH medical patients medical units. The RRT team - which includes a hospitalist, critical care-trained R.N. and respiratory therapist - is essentially an "ICU at the bedside." The team is called as soon as any floor staff notes a "trigger sign" such as a drop in blood pressure, or simply a hunch that a patient is deteriorating. In less than five minutes, the RRT is working to stabilize the patient, often preventing transfer to the ICU and potentially save a life.

The rapid response team was piloted on adult patients in seven medical units in the East Pavilion between 7 p.m. and 7 a.m. The goal is to make a team available hospital-wide 24/7 by the end of the summer. Rapid response expects to get 10-15 calls a week once staff is educated and the hospital is fully covered. For more information, contact Dr. Victor Morris at 688-4748.

Schindler named clinical director of stroke program

Joseph L. Schindler, M.D., has been appointed clinical director of the YNHH stroke program. Dr. Schindler, a graduate of Tufts University and the Tufts University School of Medicine, served his residency at YNHH, and as chief resident, earned the Lewis L. Levy Scholar award, the American Academy of Neurology Resident Fellow award, and the YNHH Hugh Dwyer award. He served a two-year fellowship as a Howard Hughes fellow at the New York Hospital-Cornell Medical College. Over this past year, Dr. Schindler, an instructor in Neurology at Yale, worked closely with the late Lawrence M. Brass, M.D., and Karin Nyström, A.P.R.N., supervising two outpatient neurovascular clinics. To contact the Stroke program, call 203-737-1057.

Perioperative scheduling system earns POINTS

Perioperative Services has implemented a new automated scheduling system to streamline work flow and improve efficiency. Using a universal surgical procedure code, the Perioperative Information System (POINTS) schedules cases, registers patients and identifies the resources necessary for surgery including operating room, instruments and supplies.

The automated scheduling system helps reduce the amount of data entry time for scheduling and charting, by generating physician preference cards, managing surgical inventory and capturing all charges related to the surgical procedure. The POINTS provides one point of entry and integrates the services of Perioperative, Admitting, MIS and Financial Services.

Changes to PA Legislation effective 10/1/06

Subdivision 7 of Section 10-12a of the Connecticut General Statutes which outlines the requirements for the supervision of physician assistants will change effective October 1, 2006. The revisions state that in addition to the "supervising" physician of record, an additional/alternate physician who might provide supervision for a PA must also be registered as a supervising physician with the State of Connecticut. Additionally, the requirements in terms of the supervising physicians' oversight of the PA's practice have been tightened to require a face to face meeting with the PA at least weekly at the practice location where the PA or physician provides care. For the full text on these changes please go to www.cga.ct.gov and search for Bill #5477.

Welcome new members of the Medical Staff

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 2006
• May 2006
• March 2006
• January 2006
• December 2005
• November 2005
• September 2005
• August 2005
• June 2005
• 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: July 24, 2006 (dh)

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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.