May 2007

Medical Staff Bulletin

Contents

Message from the Chief of Staff
The Medical Staff regularly edits and updates its by-laws, often to maintain compliance with regulatory agencies. In April, the Medical Committee of the Board of Trustees approved several changes of which medical staff should be aware.

In the consideration of qualifications for both initial appointment and recredentialing, the six ACGME areas of general competency must now be considered. These include Patient Care, Medical/Clinical Knowledge, Practice-Based Learning & Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice. Clinical Chiefs and Associate Chiefs will need to comment on these qualities in each attending physician.

A new Institutional Practice Quality and Peer Review Committee has been created to oversee the gathering and analysis of data to improve the quality of YNHH healthcare services. This Committee will receive reports from departments, services and sections conducting peer review; complaints and concerns related to practitioner performance and behavior; and analyses of sentinel events and other significant unanticipated outcomes. Such functions shall be peer review activities as defined in Connecticut General Statutes and are kept in strict confidence. The President of the Medical Staff will chair this committee, which will also include a representative from my office, from Legal Services and Risk Management Department, two at-large Medical Board members, and two Department Chiefs.

Changes to the Rules and Regulations clarify the status of medical student notes in the patient hospital record. These will not be considered “authentic” unless validated by a qualified member of the attending or resident staffs. With respect to patient orders on transfer from one level of care to another, it is no longer required that all must be re-entered. Rather, the patients’ physicians are responsible and accountable to review all current orders, choosing which to continue or discontinue, and creating new orders as indicated. Finally, Rule No. 26 now specifies (bringing great joy to my heart) that “routine hand hygiene is to be performed before and after any patient contact.”

Copies of the Medical Staff bylaws, rules & regulations and policy changes are available
Complete copies of the revised Medical Staff Bylaws, Rules & Regulations and the Medical Staff Health Policy will be available at www.ynhh.org under the heading “Medical Professionals” after June 5. You may also contact the Department of Physician Services at 688-2615 forcopies.

Hospital seeks support on Medicaid rate increase
The Community and Government Relations Department urges members of the Medical Staff to contact their state legislators and the governor asking them to make hospital Medicaid funding a priority in the state budget. Governor M. Jodi Rell did not include any kind of Medicaid rate increase in her proposed budget and the hospital urges you to email your state representative, state senator and Governor Rell (governor.rell@po.state.ct.us) to tell them of your concern. The Appropriations Committee of the General Assembly has proposed a rate increase in each of the next two years, a start toward fixing the state’s chronic Medicaid underfunding. However, this increase will not compensate YNHH for the care it provides. In fact, last year, the hospital’s Medicaid shortfall was nearly $80 million.

Performance Management update
At left are our publicly reported care process measures for January 2007. We continue to do quite well except for CHF discharge instructions and antibiotic discontinuation. Work is ongoing in both of these areas; however, discharge instructions continue to be problematic due to a mismatch between medications listed in discharge instructions and those dictated into the discharge summary.

The Center for Medicare and Medicaid Services (CMS) continues to develop and promulgate new measures. In June, a hospital-specific, risk-adjusted, 30-day mortality rate for patients with AMI and CHF will be publicly reported at hospitalcompare.hhs.gov. While the measures at left provide information about processes of care, these new mortality measures are an effort to provide outcomes data. The methodology for these mortality measures was developed by Dr. Harlan Krumholz and colleagues at Yale and published in Circulation.

How does YNHH perform? The data to be published in June for Medicare beneficiaries treated and discharged between July 1, 2005 and June 30, 2006 demonstrate a national 30-day mortality rate for AMI of 16.4%, and a point estimate for YNHH of 14.4%. For CHF, the national rate was 11.1%, and the point estimate for YNHH was 10.4%. While the point estimates for both of these mortality rates were better than the national average, the 95% confidence interval for these measures included the national average; therefore, our mortality rates were not significantly different from those across the nation. Of the more than 4,000 hospitals with data reported, 17 performed better and seven performed worse than the national AMI mortality rate; 38 performed better and 35 performed worse than the national CHF mortality rate. In Connecticut, only two hospitals were better than the AMI national rates, none were worse, and none differed from the CHF national mortality rate. This is excellent performance for YNHH and CT. We can do better, and improving our performance in the care process measures is an important place to start

Associate Chief of Surgery announced
Stephan Ariyan, M.D., was named Associate Chief of Surgery at YNHH. Dr. Ariyan, clinical professor of surgery, plastic surgery and otolaryngology at Yale School of Medicine, is an internationally known reconstructive surgeon who specializes in the treatment of malignant melanoma. In addition to surgical treatment for malignant melanoma, Dr. Ariyan specializes in surgery of the head and neck, breast and hand. He has been recognized for the origination and development of several myocutaneous flaps for reconstructions of the head and neck – most notably the pectoralis major flap, the most commonly used flap for head and neck reconstruction worldwide. Dr. Ariyan received a B.S. from Long Island University and his medical degree from New York Medical College. He completed his residency in general surgery and plastic surgery and fellowship in surgery and hand surgery at Yale. He has an M.B.A. from the University of New Haven and served as professor and chief of plastic surgery here from 1979 to 1991.

New “Room Service Dining” started at YNHH
In May, YNHH began to introduce a new inpatient meal service program called At Your Request Room Service Dining [see accompanying brochure]. Initially kicking off in the maternity, pediatric and oncology units, the program should be rolled out to the remaining inpatient areas by the end of the year. Room service dining is similar to room service in a hotel – patients will be able to order the foods they like, when they like and receive them freshly prepared. However, patients will only be able to order a meal with a documented diet order, and the room service operators will have computerized access to physician diet orders for every patient.

Reminder to update your Call Center profile
Yale New Haven Health Physician Referral Service recently sent its participating physicians a copy of their most recent profile. Please fax any changes to the call center at 203-688-5444. If you currentlydo not participate but would like to receive more information, please contact Ann Marie Bonvini, Manager, at 203-688-8403. Information for each participating doctor may be found on the Yale-New Haven Hospital website at www.ynhh.org/findphys.html.

Welcome, new Medical Staff:

April
Andrea L. Benin, M.D. Attending, Pediatrics
Donald Murrill Botta, M.D. Attending, Surgery
Agnes Seryoung Kim, M.D. Attending, Internal Medicine
Diana Schumitz, P.A.. Affiliated, Internal Medicine
Sungmin Suh, D.D.S. Associate, Dentistry
Aseem Vashist, M.D. Attending, Internal Medicine

Chief of Staff
Peter N. Herbert, M.D.

Assistant Chiefs of Staff
Thomas J. Balcezak, M.D.
Victor A. Morris, M.D.

Elected Medical Staff Officers

President
Brett J. Gerstenhaber, M.D.
President-Elect
Leo M. Cooney, Jr., M.D.
Immediate Past President/Treasurer
Robert M. Weiss, M.D.
Secretary
Gordon Reid, M.D.

Medical Board Officers

Chairperson
Brett J. Gerstenhaber, M.D.
Vice Chairperson
Leo M. Cooney, Jr., M.D.

Medical Board Members

Stephen Ariyan, M.D.
Michael C. Bennick, M.D.
James A. Brink, M.D.
Benjamin S. Bunney, M.D.
Christopher R. Canny, M.D.
David A. Coleman, M.D.
Richard D’Aquila
Richard L. Edelson, M.D.
Fredric O. Finkelstein, M.D.
Patricia Sue Fitzsimons, R.N., Ph.D.
Gary E. Friedlaender, M.D.
Peter M. Glazer, M.D.
Peter N. Herbert, M.D.
David G. Hesse, M.D.
Roberta L. Hines, M.D.
Margaret K. Hostetter, M.D.
Karen A. Johnson, M.D.
Suzanne P. LaGarde, M.D.
Charles J. Lockwood, M.D.
Marc E. Mann, M.D.
Jon S. Morrow, M.D., Ph.D.
Michael O’Brien, M.D., Ph.D.
M. Bruce Shields, M.D.
Joel S. Silidker, M.D.
Brian K. Singletary, D.M.D.
Brian R. Smith, M.D.
Dennis D. Spencer, M.D.
Thomas F. Sweeney, M.D.
Robert Udelsman, M.D.
Fred R. Volkmar, M.D.
Gary R. Wanerka, M.D.
Lawrence J. Wartel, M.D.
Stephen G. Waxman, M.D., Ph.D.
Norman S. Werdiger, M.D.
Joseph H. Zelson, M.D.

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:

• March /April 2007
• February 2007
• January 2007
• November 2006
• 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: April 13, 2007 (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.