November 2006

Medical Staff Bulletin

Contents

Message from the Chief of Staff

At its October meeting, the Medical Board approved a new policy concerning hand hygiene. A committee chaired by Dr. Michael Bennick developed this policy to drive YNHH toward virtually 100% hand hygiene compliance. In Fiscal Year 2006, we achieved our stretch goal before patient contact (68%) and our target after patient contact (83%). While these improvements place YNHH in a very admirable position relative to most American hospitals, they fall short of the standard we expect from our clinicians. Moreover, physicians are a little less compliant than nurses and others having patient contact. The new policy encourages caregivers to directly counsel those observed to be non-compliant – including physicians – and provides sanctions, up to suspension, for physicians who resist counseling. YNHH will develop comparable sanctions for other employed caregivers.

We also recently benefited from a surprise mock accreditation survey by a team of reviewers from Joint Commission Resources. They provided physicians with considerable encouragement to improve medication reconciliation, and we have committed to overhauling currently employed systems. They were generally disappointed with the knowledge reflected by all clinicians when questioned about our approach to National Patient Safety Goals. These goals – including improved accuracy of patient identification, improved caregiver communication, banned abbreviations, critical test result reporting, standardized hand-offs, reducing nosocomial infections, as well as hand hygiene and medication reconciliation – were known to caregivers but not recognized under the rubric “National Patient Safety Goals.” We need to be more aggressive educating clinicians on these points. Finally, they found a number of illegible progress notes, signatures and even beeper numbers. Calligraphy classes will be offered to selected members of the Medical Staff.

YSM receives major Clinical and Translational Science Award

The Yale School of Medicine has received a $57.3 million Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH). The grant includes $31 million to strengthen clinical research at Yale and $25.8 million to continue existing programs in education and the activities at the General Clinical Research Center at YNHH.

The CTSA initiative is part of the NIH Roadmap for Medical Research to enable more efficient development of new therapies. When fully implemented in 2012, the initiative is expected to provide $500 million annually to 60 academic health centers working in concert. Eleven other academic medical centers across the nation also received CTSAs.

Yale will use the grant to train a new generation of investigators in interdisciplinary clinical research, stimulate the extension of research from the laboratory to bedside, launch greater numbers of Phase 1 studies of drugs discovered by Yale scientists, and forge research relationships with the local community to improve public health.

In 2004, Yale established the Yale Center for Clinical Investigation (YCCI) as a focal point for translational research. Robert Sherwin, M.D., YCCI director, is principal investigator on the CTSA grant.

Performance management update

At left is YNHH’s June performance for Medicare/Joint Commission measures. We have recently increased the number of measures reported to Medicare/JCAHO and these will be available on all of the publicly reported websites in short order. One recent major addition to the publicly reported measures is our patient satisfaction numbers. Beginning with October 2006 discharges, Medicare/JCAHO will be surveying patients (over age 18 years and exclusive of psychiatric discharge) and reporting the results on the same public websites as our numbers at left. This satisfaction survey is called H-CAHPS.

H-CAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems, and was developed by the Agency for Healthcare Research and Quality (AHRQ). In January 2006, the federal government approved the use of the CAHPS hospital survey, and national implementation was launched in October 2006. YNHH surveys all patients, and our survey vendor randomly selects a small number each month to input the data to H-CAHPS. The H-CAHPS survey is a 27-question tool that asks patients questions in six different domains, including doctor communications, nurse communications, medication communications, staff responsiveness, hospital environment, pain management and discharge instructions.

How does this instrument assess doctors? There are three questions on doctor communications including how often did the doctors treat you with respect, how often did the doctors listen carefully to you, and how often did doctors explain things in a way you could understand. Additionally, there are questions that relate to physicians’ care in medication communications and discharge instructions.

It is important for our medical staff to know and understand these questions and how we are being assessed. We will report the results of these questionnaires in future articles. Please contact Dr. Tom Balcezak at 688-1343 with any questions or concerns.

New no-pass policy

The Medical Board approved a new no-pass policy at its October meeting. Because of the demand for YNHH beds, overnight passes for patients will not be allowed. Brief daytime passes should be rare, and will be allowed only for pressing family or legal emergencies. A social work consult will be required to see if the emergency can be handled from YNHH, and the pass will be allowed only with the approval of the social worker. This policy does not apply to the Psychiatry Service.

HIPAA tip of the month

Any documents or notes containing patient identifiers must be treated in a confidential manner and not left on countertops, in meeting rooms or carried outside of the institution.

Welcome, new Medical Staff, September 2006

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:

• September 2006
• July 2006
• 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: Nov. 21, 2006 (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.