November/December 2007

Medical Staff Bulletin

Contents

Message from the Chief of Staff

I have just begun my ninth year at YNHH and this, without question, has been the most eventful year. While it is unwise to make too much of the honor roll of America’s Best Hospitals, this recognition in 2007 underscores our gains in staffing, programs, outcomes, and national status of our clinical programs. Identification as a Thomson/Solucient Top 100 Hospital further validates this recognition.

The resolution of the stalemate surrounding construction of the Smilow Cancer Hospital and the naming gift to drive the capital campaign alone would have made 2007 a fabulous year. Despite a relatively quiet first quarter in 2007, demand for our services increased dramatically in the last three quarters, and we recorded another record number of Hospital discharges at 51,479, more than 1,100 over the last fiscal year total. Our expense per patient discharge was controlled, largely due to excellent expense management by the patient services division, and our patient satisfaction initiatives led us to well-exceed our target score. In general, outcomes relative to our performance goals were outstanding and our hospital-wide Performance Incentive Plan produced an historic payout of up to three percent of salary.

Once again, we express great gratitude to all of our Medical Staff for tremendous support and leadership of patient care at YNHH. We wish you a wonderful holiday season and a spectacular and healthy 2008.

YNHHS/YCC affiliate with Bristol Hospital for cancer services

In October, Yale New Haven Health System (YNHHS) and Bristol Hospital signed a new clinical affiliation agreement that will enhance Bristol Hospital’s cancer services to patients in the community. The relationship will allow Bristol Hospital access to clinical resources, clinical research and other support service from YNHH, Yale School of Medicine and Yale Cancer Center (YCC). In November Bristol Hospital opened a new $1.4-million Cancer Care Center, where they will be treating about 1,200 patients. The new affiliation will allow Bristol area residents to receive treatment close to home, but at the same time have access to clinical trials and experts, participation in quality and safety initiatives, and the latest clinical breakthroughs from Yale Cancer Center, the only National Cancer Institute-designated cancer center in the state. Bristol Hospital joins Bridgeport and Greenwich Hospitals as part of the Yale-New Haven Cancer Network, and similar outreach networking in southern New England may follow. Bristol Hospital is actively recruiting a new medical director for its Cancer Care Center.

Dr. Kushlan receives 2007 Yale Medal

Dr. Samuel D. Kushlan, Clinical Professor of Internal Medicine, Digestive Diseases, was selected by the Association of Yale Alumni (AYA) to receive the Yale Medal this year. The Yale medal is the highest honor presented by AYA. Dr. Kushlan, a graduate of Yale College in 1932 and Yale School of Medicine (YSM) in 1935, has been the consummate volunteer and alumni leader for YSM since graduation. He has taught medical students, residents and physicians for over 50 years. At age 95, he continues to attend the YNHH Internal Medicine “morning report,” where one of the services bears his name. He has also established a merit award for medical house staff and digestive disease fellows. In addition, he has devoted his time and resources to create an outstanding Capital Visiting Professorship in gastroenterology.

Performance Management Update

Below, please note our June 2007 publicly reported performance measures. Of special note is the improvement in discontinuation of prophylactic antibiotics after surgery. This is very important to prevent the development and spread of antibiotic resistant bacteria, a subject that is much in the news of late. Congratulations to the surgical and orthopedic staffs!

Also in the news, but with a much lower profile, has been Connecticut Public Act 06-142, an Act Concerning Hospital-Acquired Infections. This act established the Committee on Healthcare Associated Infections (HAI) and charged it with advising the Department of Public Health (DPH) with respect to development, implementation, operation and monitoring of a mandatory reporting system for HAIs in Connecticut. This committee has been meeting since August, 2006 with Dr. Louise Dembry as Yale-New Haven Hospital’s representative.

The Committee has recommended that all Connecticut hospitals report central line-associated bloodstream infections (CLABSIs) for patients in intensive care units. In order to do so, all hospitals must join the National Health Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC). In its deliberation, the committee chose CLABSIs because they have been demonstrated to add $40,000 additional cost per case and are among the most preventable of all HAIs. This committee also recommended that DPH consider future reporting initiatives on urinary tract infections (the most common HAI), surgical site infections (the most costly HAIs), and ventilator-associated pneumonias (the HAI with the highest mortality). This committee will continue to meet through the coming years and has recommended that three new FTEs be hired by DPH in order to administer this program.

How will this impact Yale-New Haven Hospital? For many years, YNHH has participated with NHSN and has reported our CLABSI rates for at least two of our ICUs. By next year, these rates, together with the rates of other ICUs in the states, will become publicly reported. This increase in the transparency of our performance measures follows a well-worn path and has been preceded by heart attack cases, heart failure cases, pneumonia cases and surgical infection prevention performance, with many other measures certainly to follow. In this space, we will continue to provide updates and information regarding the latest direction these initiatives are taking. Please call Dr. Thomas Balcezak at 688-1343 with any questions.

November 2007 Performance

AMI	#	YNHH%	Nat'l 90th%
ASA at arriv.	15/15	100	100
ASA at D/C	24/24	100	100
B-Block at arriv.	9/9	100	100
B-Block at D/C	16/17	94	100
ACEI at D/C	3/3	100	100
PCI <90 min	4/4	100
Smoking cess.	14/14	100	100

CHF	#	YNHH%	Nat'l 90th%
LVEF assess.	26/26	100	99
ACEI at D/C	8/9	89	100
Smoking cess.	5/5	100	100
D/C instr. given	16/26	62	93

Pneumonia	#	YNHH%	Nat'l 90th%
02 assess. at arriv.	15/15	100	100
Pneum. vac. given	10/10	100	94
Abx given <4 hrs	10/11	91	93
Smoking cess.	4/4	100	100
Blood cx before abx	12/12	100	93
Initial (non-ICU)     Selection Abx	5/5	100	93

SIP	#	YNHH%	Nat'l 90th%
SIP-1 (Proph Abx 1 hr)	38/39	97	94
SIP-3 (Proph Abx D/C)	36/39	92	95

New YNHH tissue banking program to bring changes

YNHH has implemented a new tissue banking program to ensure that all tissue is procured, utilized and evaluated according to FDA and Joint Commission regulations and the highest standards of current good manufacturing practices. The tissue bank at YNHH is now an FDA registered facility – currently the only such hospital facility in CT – and follows FDA regulations and YNHH standard operating procedures.

The tissue program will validate all tissue suppliers, track tissue use, and follow patients for adverse reactions following tissue implantation. The program plans to follow patients after discharge – for evaluation of long-term adverse events and to assist in any FDA tissue recalls. All patient follow-up activities will be done in conjunction with the patient’s surgeon to ensure that they are aware of any patient-related regulatory issues.

The tissue bank working group has cataloged all tissues at YNHH; discarded outdated or unlabelled tissues; inventoried and verified dates and appropriate storage of all remaining tissues; and consolidated storage facilities which are now continuously monitored under each of the four types of tissue storage conditions – namely, room temperature (20° -24° C), refrigerated (1° – 6° C), frozen (-40° to -80° C), and cryopreserved tissues stored in liquid nitrogen (-170° to-196° C).

Because tissue can not be freely transferred back and forth between FDA and non-FDA registered institutions (i.e., other Connecticut hospitals), YNHH is working to ensure that all needed tissues will be available and the transition to more stringent tissue procurement will be seamless for the operating surgeon. Although routine movement of tissue to or from an unregistered hospital or provider is no longer allowed, provisions can be made for variances, such as when a patient’s life or limb would be at risk unless a needed piece of tissue was obtained from an FDA-unregistered facility.

As the new tissue banking program moves forward, physicians will be contacted individually by Dr. Snyder or other members of the team, as specific concerns arise. If members of the Medical Staff have questions, please call Dr. Edward Snyder in the Blood Bank at 688-2441, pager (203) 412-7772 or email edward.snyder@yale.edu. Dr. Douglas Vaughn is also available to answer questions.

New location for Yale Eye Center

In October, the Yale Eye Center moved from 330 Cedar Street to a newly renovated location on the third floor of 40 Temple Street. Patients may use valet parking or one of two garages connected to the building – the Temple Street Garage or the Temple Medical Garage. A small consult service, with an attending physician, residents and an ophthalmic technician, will remain on site (currently in Boardman but moving to Dana) to care for emergency department and inpatients requiring ophthalmology consultations.

Interim section chiefs named for Hematology and Cardiology

Thomas P. Duffy, MD, has been named interim chief of Hematology. Dr. Duffy, who received his MD from Johns Hopkins, completed his residency and hematology fellowships at Johns Hopkins, where he was also associate director of continuing education. He came to Yale-New Haven in 1976 and became professor of Medicine at Yale in 1981. He was a founding member of the YNHH Ethics Committee in 1982. He has also directed the Program for Humanities in Medicine since 1999. He has a major interest in the study and management of systemic mast cell disorders.

Forrester (Woody) A. Lee, MD, professor of Medicine, has been named interim chief of Cardiology, pending Board of Trustees’ approval. Dr. Lee, a graduate of Dartmouth College, received his MD from Yale School of Medicine and was a resident, chief resident and cardiovascular fellow at YNHH. From 1988 to 1995, Dr. Lee served as fellowship program director for the cardiovascular medicine division and medical director of the Yale Cardiac Transplantation and Heart Failure Program. He was named the first assistant dean to head the Office of Multicultural Affairs at Yale School of Medicine in 1995. He has been the principal investigator on major grants from the National Institutes of Health, the Robert Wood Johnson Foundation and the Howard Hughes Medical Institute.

Manager rounding now in place at YNHH

As part of its Service Excellence initiative, over the past year, YNHH senior leaders and managers have been trained to round with staff on a regular basis to engage staff, learn about what is going well, see what could be improved, determine if staff have the appropriate resources to do their jobs, identify any obstacles or barriers that need to be removed to achieve better outcomes, and reward and recognize staff who are doing a great job. In addition to fostering productive staff/manager dialogue, manager rounding provides real-time feedback about patient experiences. The result should be improved employee satisfaction, which can translate to improved patient satisfaction. Another highly successful outcome of manager rounding has been the Clean and Safe rounds on which a number of physician leaders participate.

Clinical chiefs to begin rounding with senior leadership, nursing directors

Within the next couple of months, the clinical chiefs, associate chiefs and section chiefs will begin rounding with senior leadership, clinical service coordinators and nursing directors on a quarterly basis. Together they will round on PSMs and managers, unit staff, medical directors, attending and resident physicians and patients. The rounding will rotate among different units. The goals of the effort include relationship-building; an opportunity for managers, staff and physicians to share information about their services; insight into performance of medical directors; and a patient perspective. For more information about senior leadership/chief rounding, contact Grace Jenq, MD (grace.jenq@yale.edu or 688-7026) or Lara Hauslaib (lara.hauslaib@ynhh.org or 688-8167), who are coordinating the effort.

New associate firm chiefs committed to patient satisfaction and safety

Three new physicians have been recruited to work collaboratively with Patient Service Managers on a variety of issues, including communication, patient satisfaction and care efficiency. John Moriarty, MD, on the generalist firm (10-7), Frank Lobo, MD, on the Peters and Fitkins teams (9-7), and Krystn Wagner, MD, Ph.D., on the Atkins and Donaldson firm (9-5), have been working with house staff on each unit, focusing on general quality indicators to improve overall patient care, patient safety, and patient satisfaction. Under the direction of Dr. Grace Jenq, the associate firm chiefs are reviewing and improving processes such as hand hygiene, communication to patients about their daily plans of care, the quality and timeliness of discharge summaries, and the structure of the discharge process.

Effort underway to increase number of 11 a.m. discharges

With patient volume at an all-time high this year, YNHH has undertaken an effort to increase the percentage of 11 a.m. discharges so that beds will be available earlier in the day for patients from the emergency department, operating rooms and ICUs. YNHH COO Rick D’Aquila formed a steering group in February 2007 to develop ways to facilitate 11 a.m. discharges for those patients who are ready for discharge.

Six different patient care units piloted various approaches – all relying on a “triad” team – the physician, nurse and care coordinator. All the units implemented some form of “day-before planning” to identify patients who might be ready for discharge the following day and see what needed to happen before discharge – such as discharge instructions, nursing home placement or transportation. And all six units developed some method of communication – a whiteboard, daily “huddles” or a notebook with anticipated date of discharge that could be shared from shift to shift. Not surprisingly, all six units increased the percentage of 11 a.m. discharges.

According to Sandy Bacon, involved through operations support, the effort is geared only to patients who are ready for discharge but failed to get discharged until later in the day for reasons related more to hospital inefficiencies or lack of communication or preparation. This is not an effort to rush a discharge – the goal is a safe, timely discharge for all patients. The initiative will be rolled out through the operation councils in each of the hospital’s services – medicine, surgery, pediatrics, etc.

Yale-New Haven Children’s Hospital appoints new head of pediatric orthopedics

Brian G. Smith, MD, has been appointed chief of pediatric orthopedics at Yale-New Haven Children’s Hospital. Dr. Smith, associate professor of orthopaedics at Yale School of Medicine, most recently served as assistant director of orthopedics at Connecticut Children’s Medical Center in Hartford. After graduating with a bachelor’s degree in biology from Williams College in Williamstown, MA, Smith received his medical degree from Georgetown University Medical School in Washington, D.C., and completed his residency at Georgetown University Medical Center. Dr. Smith served in the United States Air Force as an orthopaedic surgeon at Wright-Patterson Air Force Base in Dayton, Ohio, and then completed a fellowship in pediatric orthopaedics at Children’s Hospital in Boston, MA.

Dr. Smith has been honored for his accomplishments by the American Orthopaedic Association and being named as one of the “Best Doctors” in greater Harford by Hartford Magazine He has also held leadership positions in several professional societies including the Pediatric Orthopaedic Society, the Scoliosis Research Society, and the Connecticut Orthopaedic Society.

Peter DeLuca, MD, has shouldered a major portion of pediatric orthopedic care at YNHH for many years and with Dr. Smith will ensure this very critical service continues to be available to our Children’s Hospital patients.

Welcome, new Medical Staff:

Chief of Staff
Peter N. Herbert, MD

Associate Chief of Staff
Thomas J. Balcezak, MD

Assistant Chief of Staff
Victor A. Morris, MD

Medical Board Officers
President
Brett J. Gerstenhaber, MD
President-Elect
Leo M. Cooney, MD
Secretary
Gordon V. Reid, MD
Past President
Robert M. Weiss, MD

Medical Board Members
Stephan Ariyan, MD
Michael C. Bennick, MD
James A. Brink, MD
Richard D’Aquila
Richard L. Edelson, MD
Jack A. Elias, MD
John A. Federico, MD
Patricia Sue Fitzsimons, RN, PhD
Gary E. Friedlaender, MD
Peter M. Glazer, MD
Peter N. Herbert, MD
David G. Hesse, MD
Roberta L. Hines, MD
Margaret K. Hostetter, MD
Lee Jung, MD
Suzanne P. LaGarde, MD
Charles J. Lockwood, MD
Marc E. Mann, MD
Jon S. Morrow, MD, PhD
Michael J. Murphy, MD
Michael K. O’Brien, MD, PhD
Joel S. Silidker, MD
Brian K. Singletary, D.MD
William H. Sledge, MD
Brian R. Smith, MD
Dennis D. Spencer, MD
Thomas F. Sweeney, MD
Harold H. Tara, MD
James C. Tsai, MD
Robert Udelsman, MD
Fred R. Volkmar, MD
Gary R. Wanerka, MD
Lawrence J. Wartel, MD
Stephen G. Waxman, MD, PhD
Norman S. Werdiger, MD
Joseph H. Zelson, MD

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:

• October 2007
• August 2007
• June/July 2007
• May 2007
• 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: Oct. 15, 2007 (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.