In this issue:
A message from Thomas Balcezak, MD, Chief Medical Officer
July is a time for renewal at Yale New Haven Hospital, as it is the beginning of the academic year at Yale, when the new house staff and many new members of the medical staff join our team. These new physicians drive our clinical, research, and education programs forward, and the trainees work hard to become the next generation of master clinicians, scientific pioneers, educators and leaders in American health care.
As a former YNHH resident and chief resident in Internal Medicine, I know well the transformative experience of learning from our teaching faculty and from the great socioeconomic, ethnocultural, and clinical diversity of the patients we are privileged to serve. Our mission to train future leaders in health care through our 90+ residency and fellowship programs is central to our success as an institution and health system – it instills a deep sense of learning that is essential to sustaining a highly professional, patient-centered institutional culture.
In addition to contributing to a culture of learning and excellence, our more than 1,500 trainees, along with our advanced practice providers, provide the bulk of front line care to our patients. In many cases, one of our residents or fellows is the first physician a patient meets at our hospital, and the last one a patient encounters before being discharged. Our trainees are integral to the provision of front line care, but the transient nature of training programs, and primary focus on learning the nuts and bolts of their clinical specialties, has historically prevented our residents from participating in performance improvement work, operational committees, and other activities that shape our institutional culture, standards, and patient-centered strategy. Those same barriers have also made it difficult to provide the same level of support, professional development, and internal recruitment enjoyed by our employees and attending medical staff.
Beginning with Dr. Rosemarie Fisher, our first designated institutional officer and associate dean for Graduate Medical Education, and for the last two years with Dr. Stephen Huot, we have made significant investments in building structures to eliminate those barriers as well as better engage and include our trainees in our institutional community. Our Graduate Medical Education Senate, which includes representatives from all the training programs, has recently organized councils to target the five priorities that are key to better integrating our trainees into the larger institution.
The five priorities we have identified are Diversity and Inclusion, Trainee Wellness, Quality and Safety, Advocacy and Education. Each of these councils either has or will soon have GME directors to facilitate their activities and ensure full coordination and integration into the hospital’s larger strategies.
Our trainees come here from across the country and the world, and have a great diversity of ethnicity, culture, socioeconomics, gender and sexual orientation. We are a better institution when we welcome and accept that diversity, such that all our trainees are able to learn and integrate into the institution to the greatest extent possible. The GME Diversity and Inclusion Council, advised by Dr. Ingenia Genao, GME director for Diversity, Equity and Inclusion, is working to advance that mission through the organization of events that address these extremely important issues, and is coordinating its work with the hospital’s chief diversity officer and office of Human Resources.
The issue of caregiver wellness is of great concern within our walls and nationally. The GME Wellness Council, advised by Dr. Rosemarie Fisher, GME director of Resident/Fellow Well-being, is coordinating with the work of our Medical Staff Wellness Committee, and focuses on issues that contribute to trainee burnout, such as navigating work-hour requirements, reducing the negative impact of handoffs, fragmented provision of care, and barriers to efficient workflow. We have also significantly expanded access and support for to mental health services for our trainees, as mental health issues remain far under-reported and under-supported within the medical community, and particularly for trainees.
The GME Quality and Safety Council, with a faculty advisor and GME director to be named soon, is working to better include trainees in existing quality and safety initiatives throughout the hospital and health system. High Reliability precepts teach us that sensitivity to front line concerns is essential to creating a resilient and patient centered culture – integrating our trainees into Clinical Redesign and our innumerable other quality and safety improvement initiatives will significantly enhance the quality of their output and outcomes.
The GME Advocacy Council, advised by Dr. Kiki Kennedy, is focusing on understanding and creating avenues for our trainees to express themselves as caregivers in the national conversation on the direction of health care. The GME Education Council, advised by Dr. Dana Dunne, GME director for Educational Development and Dr. Janet Haffler, associate dean for Educational Scholarship and director of the Teaching and Learning Center, focuses on developing innovative, efficient and reliably effective approaches to clinical training.
Lastly, we are supporting and developing programs that facilitate leadership development for our residents and fellows. We are supporting the participation of more than 30 trainees in the Connecticut Medical Society’s Young Physician Leadership curriculum, and are developing a standardized program for leadership development for chief residents for all our training programs.
I am convinced that these activities for our trainees is essential – our residents and fellows must be fully aligned and integrated into the fabric of our institution if we are to continue the transformative work of providing reliably high value patient care and instill those values into the future leaders of American health care.
As always, I welcome your questions and feedback, and can be reached via email at [email protected].
| 12-Month Period | 5/16-4/17 | 6/16-5/17 | 7/16-6/17 | 8/16-7/17 | 9/16-8/17 | 10/16-9/17 | 11/16-10/17 | 12/16-11/17 | 1/17-12/17 | 2/17-1/18 | 3/17-2/18 | 4/17-3/18 |
| C. diff |
150 |
150 | 160 |
154 |
149 |
153 |
160 | 162 |
164 | 167 |
167 |
159 |
| CAUTI |
72 |
78 |
82 |
89 |
83 |
81 |
83 | 84 |
84 | 80 |
77 |
73 |
| CLABSI | 100 |
95 |
87 |
84 |
83 |
83 |
81 | 82 |
82 | 79 |
80 |
78 |
| SSE | 41 |
37 |
34 |
29 |
27 |
24 |
24 | 25 |
22 | 19 |
18 |
17 |
| 12-Month Period |
3/16-2/17 | 4/16-3/17 | 5/16-4/17 | 6/16-5/17 | 7/16-6/17 | 8/16-7/17 | 9/16-8/17 | 10/16-9/17 | 11/16-10/17 | 12/16-11/17 |
1/17-12/17 |
2/17-1/18 |
| Colon SSI |
48 |
52 |
56 |
52 |
49 |
52 |
50 | 52 |
49 | 47 |
46 |
44 |
| Hysterectomy SSI |
9 |
8 |
8 | 6 |
6 |
4 |
4 |
6 |
5 | 7 |
8 |
10 |
| PE/DVT | 112 |
105 |
97 |
102 |
81 |
81 |
85 |
85 |
81 | 78 |
67 |
71 |
| Iatrogenic Pneumothorax |
15 |
15 | 13 |
12 |
11 |
10 |
10 | 10 |
11 | 8 |
6 |
7 |
The Patient Safety and Quality metrics are reported on a 12-month rolling timeframe. The most recent timeframes differ based upon the various databases reporting the metrics. 12-month rolling total updated with AHRQ v6.0 definition starting January 2017.
Patient Safety and Quality Metric Definitions
Colon and Hysterectomy SSI: A surgical site infection within 30 days of the operative procedure, classified as superficial, deep, or organ/space infections based on CDC/NHSN surveillance definitions.
C. diff (Clostridium difficile): A patient who develops diarrhea greater than 48 hours after admission to an inpatient unit and for whom the C. diff testing (either rapid toxin, cytotoxin or PCR) is positive.
CAUTI (Catheter Associated Urinary Tract Infection): A patient who has an indwelling urinary catheter in place for over two days, with at least one of the following signs or symptoms: fever > 38 degrees C, suprapubic tenderness (with no other recognized cause), costovertebral angle pain/tenderness (with no other recognized cause), urinary urgency (not while catheter in place), urinary frequency (not while catheter in place), or dysuria (not while catheter in place).
CLABSI (Central Line Associated Blood Stream Infection): A primary bloodstream infection (not related to an infection at another site) that develops in a patient with a central line in place over two days before onset of infection. Culturing the catheter tip is not a criterion for a CLABSI.
Iatrogenic Pneumothorax: A pneumothorax caused by medical care, with certain exclusions for trauma, cardiac and thoracic surgery patients.
PE/DVT (Pulmonary Embolism/Deep Vein Thrombosis): Any PE/DVT that occurs postoperatively.
Serious Safety Event: A deviation from generally expected care that results in moderate to severe patient harm.
The Medical Staff elected new officers for the term beginning September 1, 2018. Joni Hansson, MD, (Medicine/Nephrology) will complete her term as past president of the Medical Staff and, as current president, Lynn Tanoue, MD, (Medicine/Pulmonary/Critical Care) will assume the role of past president. Eugenia Vining, MD, (Surgery/ENT) will become president and chair of the Medical Executive Committee. Michael Caty, MD, (Pediatric Surgery) has been elected president elect. These terms will continue through August 31, 2020. Michele Johnson, MD, (Radiology) will complete her term as secretary/credentials chair and Michael O’Brien, MD, (General Surgery) will begin his two-year term in this role.
Requesting a consult at Yale New Haven Hospital has historically relied on a highly variable process, with providers relying on their own personal directory of contact numbers to call when needed. “This process resulted in delays in patient care, and consult fellows were often paged inappropriately,” said Scott Sussman, MD, senior medical director, Clinical Operations. “Through a clinical redesign team, we changed the consult order process through the creation of the Consult Connect Center and orders in Epic so that providers can have the fastest, easiest way to request routine inpatient consults.”
Providers, in Epic, type the specialty needed to see a list of consult groups. Once selected, the request goes to the Consult Connect Center, which is staffed by paramedics, and ensures that the appropriate consultant is notified of the consult request in a timely manner. The patient is also added to an Epic patient list, as a secondary way to notify consultants of the new consult request.
Consultants are notified via Mobile Heartbeat (or answering service for community providers) and receive a MH message with patient name, medical record number consult question and best call back number. Consultants confirm receipt of the consult by sending “OK” back to the Consult Connect Center. Staff writes a note in Epic to indicate that the consultant has been notified, and the consultant then calls back the requestor to discuss the case.
“The workflow helps the primary team and consultants connect more easily as well as share a unified message with the patient,” Dr. Sussman said.
He noted, however, that processes for STAT consults, RRT, Code Blue, Stroke Code and Cath Lab activation remain the same. “Individuals should continue to call the page operator or check the on-call schedule for the appropriate provider in these instances,” he said.
The workflow process improvement started last fall, with a presentation to Yale Medicine clinical chiefs. Over the following months, the successful project received the endorsement of medical staff leadership groups, including MAP/JLC, GMEC, department of Medicine, Surgical Executive Committee, pediatric section chiefs, Urology, residency and fellowship directors and the fellows, residents and advanced practice providers at YNHH.
As of July 2018, 12 services are using the Consult Connect Center, which has facilitated 4,895 consults since December 2017. The services include: dermatology, GI, infectious disease, medicine, nephrology, hematology, oncology, palliative care, pediatric hospitalist, psychiatry, rheumatology and pediatric pulmonology.
In collaboration with the resident senate, a new series, "Meet the Consultant," will launch in September and will provide an opportunity for primary teams and consultants to connect and better understand each others' services, with the goal of improving patient care.
For more information, contact Dr. Sussman.
Peter Schulam, MD, PhD, has been named chief innovation and transformation officer, Yale New Haven Health System. In this new role, he will help develop and coordinate clinical relationships with YNHHS delivery networks and selected affiliate hospitals. These relationships may take different forms, such as telemedicine programs and Yale Medicine specialists and services throughout the region. In addition to his new role, Dr. Schulam will continue as chief of Urology, Yale New Haven Hospital; chair of Urology, Yale Medicine; and faculty director, Tsai Center for Innovative Thinking, Yale University. Before joining Yale New Haven in 2012, he held a number of leadership positions at UCLA, including chief of Minimally Invasive Surgery, Department of Urology, surgical director of the Living Kidney Donor Program and vice chair of Urology. Dr. Schulam earned his medical degree and PhD in immunology from Baylor College of Medicine in Houston and completed residency and fellowship training in surgery and urology at Johns Hopkins Hospital.
Physicians, advanced practice providers (APP) and nurses across Yale New Haven Health and Yale Medicine are urged to sign up for the course offered through YNHHS Patient Experience entitled, “Enhancing Relationship-Centered Communication.”
Through this one-day, peer-led, 12-person workshop, participants will discover how communication can improve health outcomes, patient satisfaction and professional engagement. The session includes didactic presentations, live demonstrations and practice activities with guided feedback to enhance relationship-centered communication skills. The goal of this course is to improve interactions between healthcare professionals and patients as well as conversations with colleagues and staff. The workshop also teaches clinicians to be more mindful in their approach with patients and families.
Sessions are available through April 2019. Upon completion, participants will receive 7 AMA PRA Category 1 credits.
Register at www.ynhh.org/events. Search for “communication” for a listing of upcoming dates. Sessions are from 8 am – 4 pm at the YNHHS SYN:APSE Center for Learning, Transformation and Innovation, 730 Howard Avenue, New Haven.
In June, Yale Medicine introduced e-consults for cardiology to several primary care/internal medicine practices, including the YNHH Primary Care Centers, Yale Internal Medicine Associates, Fair Haven and Yale Health. Primary Care physicians in these practices can now consult a Yale Medicine cardiologist with a simple, quick, electronic workflow leveraging the Epic InBasket.
Routine mammograms are a key part of preventative care for many patients, especially women over 40. Yale Medicine and Yale New Haven Health have made this important screening even more convenient with the addition of an online “Schedule My Mammogram” feature, just a click away from patient-facing websites and MyChart. A friendly interface sends these appointment requests to specially-built scheduling reports for mammography sites. Easy scheduling plus proactive communication mean more patients staying up-to-date on screening, more chances for early intervention if needed, and patient convenience.
Looking at an ongoing research study with trainees and clinicians, The Diversity Attitudes in Medicine study is designed to investigate ideas and attitudes related to diverse individuals among physicians, residents and graduating medical students. All medical students graduating in 2018 (MD or DO), interns, residents, fellows, and physicians are eligible to participate in this study. This study has been deemed exempt by the Yale University IRB.
Participation in this study will involve completing an anonymous online survey, which includes implicit association tasks and measures of explicit belief. The survey takes approximately 15 minutes.
Participants will be eligible to enter a raffle for one of ten $50 Amazon gift cards following completion of the survey.
Take the survey at: https://yalesurvey.ca1.qualtrics.com/jfe/form/SV_3Db2iMaaOsH0h6Z .
Please note that you must take this survey on a computer, as it does not function properly on mobile devices. If you have any questions about this study, please e-mail Nix Sitkin Zelin and Michael Bloch.
For the fifth consecutive time, the Yale Claude D. Pepper Older Americans Independence Center (OAIC) has been renewed for funding from the National Institute on Aging (NIA). The Center is one of only two such programs nationwide to receive continuous NIA support since it was first funded in 1992, marking more than 25 years of excellence in geriatrics and aging research under the leadership of Geriatrics Section Chief Dr. Mary Tinetti, Dr. Thomas Gill, and Dr. Terri Fried.
The latest renewal, totaling approximately $5.7 million over five years, supports the innovative work of this multidisciplinary center. The focus of the center has long been the investigation of complex geriatric conditions that have multiple causes, or that affect multiple outcomes. From this perspective, the center’s objectives are to increase scientific knowledge, advance the science of clinical decision- making, and educate new investigators dedicated to aging research.
Specifically, the funding renewal will be directed to a wide range of activities, including: career development of leaders in aging research; training; study design and development; strategies for recruitment of older persons into studies; investigations of causes and treatments for complex geriatric conditions; interdisciplinary research; and strengthening collaborations.
High Reliability Organization (HRO) training is required for newly credentialed practitioners. Medical Staff members can attend training on any of the dates listed below. To register for any of the sessions below, please contact [email protected] or [email protected].
Janet Marseglia, RN, MSN, has been named director of Supplemental Staffing, Yale New Haven Health. She will lead a new, centralized health system nursing agency that will deploy supplemental staff, with the goals of using resources more effectively and reducing traveler costs. Marseglia has over 25 years of healthcare management experience, including six years as director of Nursing Patient Services for Yale New Haven Hospital’s Nursing Resource Operations Center. Before that, she held various leadership positions at Saint Raphael’s. She earned her BSN at the University of Connecticut and her MSN at Sacred Heart University.
Yale New Haven Health has announced Art Lemay's promotion to vice president, Network Development for Smilow Cancer Hospital. Art will be responsible for the next phase of regional network development of Smilow Cancer Hospital, including the continued expansion of Smilow's ambulatory presence across the state and region. He will also coordinate our efforts to establish a statewide partnership to build the first Proton Beam Treatment Center in Connecticut.
The most visited section of the Yale New Haven Health hospital websites are physician profile pages. To ensure your online information is current and accurate so potential patients can find you, please take a few minutes to review your profile. If changes are needed, email the YNHH Physician and Services Referral Center at [email protected].
