June 2006

Medical Staff Bulletin

Contents

Message from the Chief of Staff

As of January, 2006, it is a JCAHO requirement that hospital staff “reconcile” the medications of patients as they pass through the continuum of care. This is a most challenging process! At the time of admission, an accurate list of current medications must be compiled based on information from the patient, personal physician, family or pharmacy. At YNHH, this list is recorded in the paper medical record. As the patient transitions through different levels of care, this list serves as a point of reference to avoid lapses in critical medications. At the time of discharge, the patient is provided with a summary, in comprehensible language, of home medications to be continued or discontinued, as well as new medications prescribed as a consequence of hospitalization.

YNHH Clinical Chiefs and Associate Chiefs discussed assignment of responsibility for patient medication reconciliation and concluded this resided with physicians and other licensed, independent practitioners who have prescriptive authority. The discharge medication list will be entered in CCSS by resident physicians or mid-level practitioners and will be a required element of the discharge order. Attending physicians wishing to personally complete the discharge medication list should notify the residents or mid-level practitioners assigned to their patients. When dictating or validating the discharge summary, the Attending should either refer to or dictate from the list contained in CCSS and provided to the patient.

We are most grateful to Drs. Grace Jenq, William Crede and Lilly Wang, who spent many hours with Nancy Tepping, R.N., to computerize this phase of medication reconciliation.

Ambulatory Services Corporation moves to YNHH

After a six-month planning process, Ambulatory Services Corporation (Temple Surgery Center, Women’s Surgery Center, Temple Endoscopy, Temple Radiology, Gamma Knife) will become provider-based services of Yale-New Haven Hospital effective July 1, 2006. In addition, YNHH will manage the Temple Recovery Center and the Yale-New Haven Shoreline Surgery Center. Dr. Richard Stahl will lead the YNHH division as Vice President of the Ambulatory Services Division, and Linda Smelser will serve as administrator of the Ambulatory Services Division. In addition to the Temple sites, Ambulatory Services Corporation includes radiology satellites in East Haven, West Haven, Hamden, Branford, North Haven and the Shoreline Surgery Center. Evyleen McGucken, R.N., will continue to provide the nursing leadership for the division.

With Dr. Stahl’s promotion to Vice President, Ambulatory Division, Dr. Doug Vaughn and Ena Williams, R.N., will serve as interim directors of Perioperative Services while a national search for an executive director is conducted.

New brochure about YNHH Hospitalist service

In the March issue of the Medical Staff Bulletin, the Message from the Chief of Staff focused on the Hospitalist Service at YNHH and how the admission rate to this service has increased exponentially in the last five years. Enclosed with the June issue of the Medical Staff Bulletin is a new highly informative brochure about the service, listing its staff. If you have any questions about the service, please call Dr. Victor Morris at (203) 688-4740.

Performance management update

At left are YNHH’s February performance numbers for the set of measures we report to Medicare and JCAHO. While these data are available with some time delay on websites run by CMS, JCAHO and the Connecticut Hospital Association, we have begun exploring some strategies for broadly reporting data directly to our patients. We are still evaluating this option and would be interested in hearing from the Medical Staff how best to approach this matter.

The Surgical Infection Prophylaxis (SIP) measures will be publicly reported for the first time for January ’06 discharges; therefore, the SIP data will also be publicly reported. This expands our publicly reported data and is our first set of measures specific to surgery. Much work has already been done to improve the timely and accurate delivery of antibiotics to our surgical patients. We thank many within the departments of Surgery, Neurosurgery, Orthopedic Surgery, Anesthesia and Nursing. As noted last month, the National Surgery Quality Improvement Program (NSQIP) and the Perioperative Patient Safety Program will also provide opportunities to improve quality and safety in our surgical areas.

Many thanks to our staff devoted to improving the care and experience of our patients. If you have any questions, please call Dr. Tom Balcezak at 688-1343.

February 2006 Performance

AMI	#	YNHH%	Nat'l 90th%
ASA at arriv.	11/11	100	100
ASA at D/C	21/21	100	100
B-Block at arriv.	9/9	100	100
B-Block at D/C	25/25	100	100
ACEI at D/C	4/5	80	100
PCI <120 min	2/2	100	86
Smoking cess.	10/10	100	100

CHF	#	YNHH%	Nat'l 90th%
LVEF assess.	27/27	100	98
ACEI at D/C	8/9	89	100
Smoking cess.	2/2	100	100
D/C instr. given	11/20	55	86

Pneumonia	#	YNHH%	Nat'l 90th%
02 assess. at arriv.	18/18	100	100
Pneum. vac. given	11/11	100	86
Abx given <4 hrs	14/17	82	91
Smoking cess.	6/7	86	97
Blood cx before abx	15/15	100	93
Initial (non-ICU)     Selection Abx	7/8	88	89
Influenza vac.	12/12	100	n/a

Quality Conference recap

Almost 300 people attended the Joseph A. Zaccagnino 2006 Patient Safety and Clinical Quality Conference in Harkness Auditorium in May. Keynote speaker was James Bagian, M.D., whose 15-year tenure at NASA included two flights on the space shuttle and an appointment as chief flight surgeon/medical consultant to the Columbia Accident Investigation Board. Dr. Bagian discussed patient safety from the perspective of the aviation industry, which has improved safety with an attitude that avoids blame and emphasizes prevention in a confidential, non-punitive environment.

A highlight of this year’s Quality Conference was an awards ceremony recognizing 47 quality and safety initiatives in YNHHS hospitals. YNHH’s winning entry was “Improving Quality of Care for Diabetic Patients,” a project to redesign diabetes care in the Adult Primary Care Center. Dr. Cary Gross accepted the award on behalf of his team.

Expanded hours at Shoreline ED; Moscovitz named medical director

The Emergency Department at the Yale-New Haven Shoreline Medical Center will expand its hours to 16 hours a day, as of Thursday, July 6, to open at 7 a.m. and close at 11 p.m., seven days a week. In July, Dr. Harry Moscovitz will become the full-time director of the Shoreline satellite ED.

New medical director appointed to YNHH Adult ED

Dr. Rick Kulkarni will replace Dr. Harry Moscovitz as medical director of the YNHH adult ED in July. Dr. Kulkarni comes to YNHH from the David Geffen School of Medicine at UCLA and the Olive View-UCLA Medical Center where he was director of informatics. Prior to that, he was director of technology and graduate medical education at Beth Israel Deaconess Medical Center in Boston and project manager of online continuing medical education at Harvard Medical School. Dr. Kulkarni received his medical degree from the University of California, San Francisco. He went on to specialize in Emergency Medicine at Harvard Affiliated Emergency Medicine Residency, Brigham & Women’s Hospital/Massachusetts General Hospital. Dr. Kulkarni is recognized as an expert in the area of emergent airway management, systems and operation issues in emergency departments, medical informatics and animal venoms.

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:

• 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: June 22, 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.