September 2006

Medical Staff Bulletin

Contents

Message from the Chief of Staff

Yale-New Haven Hospital is currently in the third month of an organizing campaign by Service Employees International Union (SEIU/1199), following a process negotiated as part of the Cancer Center settlement reached between YNHH and the City of New Haven. The 9-month campaign is targeting approximately 2,000 service workers in the hopes of getting enough employee signatures to request and succeed in a National Labor Relations Board-supervised secret ballot election.

As with most organizing campaigns, many of the issues revolve around wages and benefits. YNHH is committed to maintaining its competitive wage and benefit program, compared with other hospitals and health care organizations, and regularly makes improvements to assure its ongoing competitiveness. However, the SEIU/1199 has been comparing YNHH employees' wages and benefits to those at Yale University, where there is limited comparability in job content.

Probably as important to employees as wages and benefits is their work environment, particularly the mutual respect demonstrated to one another. The issue of respect was a major concern that recently surfaced in the YNHH Employee Opinion Survey conducted this spring. The survey revealed that doctors are not perceived as aware, sensitive or caring of others who work in the clinical environment. I chaired a focus group in June that explored reasons for physicians' perceived behavior. Participants pointed out that physicians, themselves, often do not feel respected, are frustrated by inefficiency, feel fatigued, and function under extreme time pressure. Simultaneously, physicians may not be cognizant of how their attitudes impact the roles of others and that at times they communicate less well with patients and staff. As a profession, we are often intolerant of "process," unaware of cultural diversity issues, lack adequate appreciation of our status as leaders and managers, and do not realize the importance of functioning within complex interdisciplinary teams.

YNHH continues to foster an environment of care that supports safe, high quality care and strives to support the work of physicians and all caregivers. And physicians must do their part to make YNHH a place where all employees feel valued, recognized and appreciated for all they contribute to patient care.

Clarification / State of CT CME requirements for licensure renewal

As of October 1, 2005, licensed physicians and surgeons are required to participate in CME activities in the total amount of 50 contact hours every two years. CME shall be in the area of the physician's practice. At least one of the total 50 contact hours (50 minutes) must be in each of the following four areas: 1) infectious disease, 2) risk management, 3) sexual assault, and 4) domestic violence. Initial communications from the State were somewhat confusing regarding the four required hours.

Helpful HIPAA tip

Access to computer medical records is acceptable only when caregivers or others have a defined or official reason. Every single access to a medical record is documented and retained permanently within the system.

Improving prostate care and evaluation

YNHH has added a new 3-Tesla magnetic resonance imaging (MRI) scanner, which has advanced imaging capacity for many conditions. The 3-Tesla quickly generates images with considerable detail and clarity, permitting more precise diagnoses and better pre-surgical staging and planning. In addition, YNHH recently acquired a daVinci robot minimally invasive surgery system. This enhances surgical capabilities by providing superior visualization, increased dexterity, greater precision and ergonomic comfort. Patients benefit from less pain, discomfort and blood loss and a quicker return to normal activities.

Physician Referral Service update

Physicians currently enrolled in the physician referral service at Yale-New Haven Hospital can review their profile data by going on line to www.ynhh.org and clicking on physician referral. Please review your demographics. If there are any edits you would like to make to your areas of interest, insurance participation or office locations and hours, please contact Ann Marie Bonvini, Physician Referral Service manager, at 203-688-8403 or email annmarie.bonvini@ynhh.org.

Performance management update

Below are NHH's May performance numbers for Medicare/JCAHO measures. While we continue to perform very well overall, there is some month-to-month variation. For example, this month we did not deliver beta-blockers on arrival to two patients with acute myocardial infarction. The Quality Improvement Department's review of these "failures" found that one patient was on beta-blockers, chronically, and likely took them pre-hospital; however, this was not documented. The other patient was admitted with atypical symptoms for a myocardial infarction and passed the window of opportunity for beta-blockers before the MI was recognized. These two cases highlight the difficulty in achieving 100% performance.

In the first week of August, the federal government expanded to 21 the number of publicly reported quality measures, beginning with July 2006 discharges. We have been providing these data since January 2006. At left, for the first time, you will see data for surgical infection prophylaxis. While we reliably deliver preoperative antibiotics, we have some work to do in improving our timely discontinuation of prophylactic antibiotics. These data will likely be released to the public on the CMS website in late fall.

In addition to expanding the measures, CMS also proposed reporting three additional surgical care improvement measures (glycemic control, DVT prophylaxis, postoperative normothermia) with January 2007 discharges, to require public reporting of patient satisfaction surveys by July 2007, and to publish Medicare-only mortality rates for AMI, heart failure and pneumonia. Although this is now only proposed, not final, it indicates CMS's current reporting direction. There is no doubt that all hospitals will face increasing scrutiny on structure, process and outcome quality measures.

Many thanks to our staff for these results and to those devoted to improving the care and experience of our patients. Please call Dr. Tom Balcezak at 688-1343 with any questions.

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May 2006 Performance

AMI	#	YNHH%	Nat'l 90th%
ASA at arriv.	8/8	100	100
ASA at D/C	4/4	100	100
B-Block at arriv.	6/8	75	100
B-Block at D/C	20/22	91	100
ACEI at D/C	3/3	100	100
PCI <120 min	5/6	83	88
Smoking cess.	9/9/	100	100

CHF	#	YNHH%	Nat'l 90th%
LVEF assess.	26/27	96	98
ACEI at D/C	6/6	100	100
Smoking cess.	3/3	100	100
D/C instr. given	9/20	45	88

Pneumonia	#	YNHH%	Nat'l 90th%
02 assess. at arriv.	20/20	100	100
Pneum. vac. given	15/16	94	89
Abx given <4 hrs	12/12	100	92
Smoking cess.	3/3	100	100
Blood cx before abx	14/14	100	93
Initial (non-ICU)     Selection Abx	4/4	100	9/1
Influenza vac.	n/a	n/a	n/a

 

Surg. Infection	Prevent#	YNHH%	Nat'l 90th%
Antibiotic start	20/23	87	n/a
Antibiotic D/C	3/18	17	na

Photo ID badges to be upgraded

Yale-New Haven Hospital is in the process of upgrading Photo ID badges to a new "state-of-the-art" high security badge. The new photo ID badge is slightly smaller with a variety of new technologies built into the badge itself which will allow for future access systems, including those designed for the North Pavilion. The badge replacement process for the Medical Staff and residents will take place in November. All old badges must be returned and destroyed. Members of the Medical Staff will be notified about the exact timing of badge replacements.

New pharmacy carousel system in place

YNHH is the first hospital in Connecticut to bring barcode-enabled carousel technology to the medication dispensing process in its pharmacy. The new system, Omnicell PharmacyCentral,® uses a vertical carousel system which produces a label with a barcode that uniquely identifies the medication by name and dose. The system uses bar code scanning to perform important verification checks throughout the medication dispensing process; links the automated receiving process to barcode-enabled storage and dispensing; and provides a detailed history database of all drug dispensing transactions. The system improves inventory control and organizes drugs by bar code so they can be found more quickly, eliminating common look-alike and sound-alike errors between drugs with similar names. The system also prioritizes orders and provides notification when patient care unit-based dispensing cabinet medication inventories reach low levels. It manages medication inventory in the central pharmacy while reducing medication errors, streamlining workflow and improving inventory control.

Changes to Connecticut advance directives law to take effect October 1

Connecticut law currently permits an adult to appoint another person as a "health care agent" to make health care decisions - but only about withdrawal and withholding of life support systems - in the event decision-making capacity is lost. In addition, a patient may appoint an "attorney-in-fact for health care decisions," who has authority to make most other health care decisions for the patient except those concerning withdrawal and withholding of life support systems.

In Public Act 06-195, effective October 1, 2006, the Connecticut Legislature made some significant changes to the laws governing advance directives. Among these are:

• The authority of the health care agent and the attorney-in-fact for health care decisions will be combined into a unified proxy called the "health care representative," so an adult patient will be able to appoint a single individual to make all health care decisions if the patient becomes incapacitated.
• Advance directives executed prior to October 1, 2006 will remain valid.
• The scope of a living will is expanded to include any aspect of a patient's health care, whether or not related to the withholding or withdrawal of life support.
• The revocation of an appointment of a health care representative must be in writing and signed by the patient and two witnesses.
• An advance directive validly executed outside of Connecticut will now be recognized in Connecticut, as long as the advance directive is not contrary to Connecticut public policy.

The Hospital's Legal Office will be conducting in-services about these changes. If you have questions about the act or wish to schedule an in-service please call Stuart Warner at 688-2291.

OEP offers pandemic personal preparedness wallet-cards

Yale New Haven Health System's Office of Emergency Preparedness (OEP) has been monitoring the pandemic influenza situation and working with all three System hospitals - Bridgeport, Greenwich and Yale-New Haven - for the past year, developing plans, policies and procedures to help prepare for a potential pandemic.

OEP, in collaboration with the delivery network hospitals, has identified six key areas to focus on: 1) risk communications; 2) education and training; 3) legal/ethical issues; 4) human resources/occupational medicine; 5) surge capacity; and 6) pandemic surveillance. YNHHS has been developing system-wide approaches for each of these areas.

Enclosed is a personal preparedness tool we have developed - "PSST," a pocket-sized information tool with helpful influenza information. This is also available to patients, visitors and the public. Please call the Call Center at 688-2000 if you would like additional copies for yourself or your patients.

OEP will continue to keep the Medical Staff informed on an ongoing basis about pandemic influenza preparedness efforts. For more information, call Christopher M. Cannon at 688-3224 or email christopher.cannon@ynhh.org

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:

• 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: Setp. 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.