Medical Staff Bulletin

October-November 2018

In this issue:

The transformative power of “true grit”

A message from Thomas Balcezak, MD, Chief Medical Officer

Over the past two decades, legislative, technologic and scientific disruption has fostered enormous change in how we care for our patients. Those changes will only continue, and we must have great ambition if we are to fulfill our promise of being one of the nation’s greatest healthcare institutions.

I have previously written about the ongoing growth in size and numbers of large health systems. These mergers are accompanied occasionally by clinical integration, which while slow and messy, presents enormous opportunities to provide reliably superlative, patient-centered and front-line sensitive care across a large integrated healthcare delivery system.

Dr. Tom Lee, chief medical officer at Press Ganey and former CEO at Partners’ Community Health Care in Boston, recently co-wrote an article in Harvard Business Review describing the virtue of “grit” – that is extraordinary stamina and steadfast commitment despite obstacles – in both individuals and organizations. In previous columns, I have been frank in how history has occasionally conspired to prevent the hospital, Yale School of Medicine and our essential community partners from achieving our enormous shared potential. Institutional grit will be essential to overcome our historical obstacles, clarify our vision, and together achieve a vision where research, education, and superlative patient care meld into a seamless, patient-centered healthcare delivery system.

When we began our high reliability journey six years ago, we knew we often provided exceptional, world-class patient care, but we also knew that the variability of our systems, conflicting cultures, and maladaptive behaviors led to patient and employee harm. We lacked a shared language to discuss safety events, a culture capable of learning from its mistakes in a non-punitive fashion, and an ability to reliably identify, mitigate, communicate, and prevent safety events. When we began the journey, we identified that we averaged at least 98 serious safety events, when gaps in care led to meaningful patient harm, on an annual basis.

How far we have come. Over the past six years, we have completed institution-wide trainings for us all to learn about how safety events happen, how to communicate about them, and how to fix them, all in context of the clear imperative – keeping our patients free from harm – that is fundamental to our sense of selves as healthcare professionals. We have developed an institution-wide system finely calibrated to detecting safety events – through our event reporting platform and an army of staff dedicated to responding and classifying events – that has allowed us to make thousands of iterative changes to our workflows, policies, electronic systems and management culture. Each fix has been small, but the additive impact has been nothing short of transformative. As of last month, our rolling 12-month total of serious safety events sat at 15 – reflecting a sustained achievement and surpassing of the 80 percent reduction we targeted as our goal at the beginning of our journey.

I highlight this achievement to recognize the enormous energies expended in its pursuit, and to illustrate that our “grit” in working on this over the last six years has transformed our organization. A shared commitment to our patients’ health and wellbeing can generate the gritty culture essential for us to harness the framework of high reliability to realize our other great ambitions.

We are not done. In addition to continuing our work to drive preventable harm to zero, many more issues must command our attention. They too will require “grit” as none are easy or quick to solve. We must transform our patient experience, create a new focus on clinician well-being, set a new expectation for relationships with the Yale School of Medicine and our community physicians, and create a single signature of care across our health system. We have much to do. I thank you for your collective participation and engagement in our achievements thus far, and hope you share my excitement for work and success to come.

As always, I welcome your questions and feedback, and can be reached via email at [email protected].

Patient Safety and Quality Metrics

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○ 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 the 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.

Yale New Haven Health names chief nursing executive

Yale New Haven Health System has named Beth P. Beckman, RN, DNSc, as its first chief nursing executive. In this new role, Beckman will develop and oversee plans for the system-wide integration of key nursing areas, including practice, staffing, education/development and communication. Under her leadership, YNHHS will establish a signature standard of nursing care focused on patient-centered clinical excellence. She has also been appointed as the associate dean for partnerships for Yale School of Nursing.

Beckman joins YNHHS from Baylor University Medical Center (BUMC), Dallas, TX, where she is vice president and chief nursing officer (CNO). Previously, she held positions at Baylor Scott & White Medical Center - Grapevine, including a dual role as CNO and chief operating officer. Beckman earned her doctor of nursing science degree from Johns Hopkins University School of Nursing, her MS in nursing - family nurse practitioner track from Arizona State University and a BS in nursing from the University of Arizona.

Flu vaccinations due by December 1

Flu vaccination at Yale New Haven Hospital and throughout YNHHS is again mandatory. All physicians and employees must receive a flu vaccination or have an approved medical or religious exemption by December 1, 2018. This includes members of the YNHH medical staff, as well as employed and community physicians affiliated through NEMG and Yale Medical Group.

Members of the medical staff can receive the flu vaccine at no cost, at flu clinics throughout the hospital campuses this fall. They may also get vaccinated elsewhere and should provide documentation of the vaccination. Refer to the list below for upcoming flu vaccination fairs available at YNHH’s York Street and Saint Raphael campuses.

York Street Campus, East Pavilion Cafeteria Special Events Area

Nov. 16: 7 pm - 3 am (the following day)

Nov. 18: 7 am - 7 pm

Nov. 27 and 28: 5 pm - midnight

Saint Raphael Campus, Fresh Inspirations Cafeteria

Nov. 19 and 20: 5 pm - 2 am (the following day)

Nov. 26, 27, 28, 29 and 30: 7 am - 7 pm

Program Update: YNHCH’s Pediatric and Adolescent Gynecology program

Yale New Haven Children’s Hospital’s Pediatric and Adolescent Gynecology program offers more than medical care to young girls, according to Alla Vash-Margita, MD, Julia Cron, MD, and Amanda Kallen, MD. “A girl is not simply a small woman,” said Dr. Vash-Margita, chief of Pediatric and Adolescent Gynecology, YNHCH. “Young girls have unique medical, gynecologic and psychosocial issues.”

The program, which started a year ago, treats girls from birth through adolescence and into early adulthood for a variety of concerns related to the menstrual cycle, congenital anomalies, hormone problems and other issues. In addition to the physicians, the program has a full-time, dedicated nurse coordinator.

Clinicians work closely with experts in other pediatric specialties, including adolescent medicine, endocrinology, general pediatrics, urology, surgery, psychology/psychiatry, nutrition and social work. Dr. Kallen is a board-certified reproductive endocrinologist whose focus is the Fertility Preservation program for young females.

Dr. Vash-Margita and Dr. Cron provide routine and preventive gynecologic care and address complex gynecologic concerns. A patient’s first routine visit to the Pediatric and Adolescent Gynecology clinic usually does not include a pelvic exam, but does include a regular physical exam and discussion about issues related to general and reproductive health and well-being.

Dr. Vash-Margita became interested in pediatric and adolescent gynecology while practicing general obstetrics and gynecology at YNHH. She is a member of the North American Society for Pediatric and Adolescent Gynecology and completed fellowship training in this sub-specialty at the University of Michigan.

Patients are seen at the Pediatric Specialty Centers at YNHCH and One Long Wharf in New Haven, at Greenwich Hospital and at Park Avenue Medical Center in Trumbull. For information, call 203-785-4081.

Advanced Oncology Pharmacy at Smilow introduces robotic staff member

The newly renovated Smilow Cancer Hospital pharmacy features a number of enhancements focused on safety and quality, including a robotic staff member named R.O.S.I.E. – an acronym for Robot Optimizes Safety, Improves Efficiency.

The robot precisely mixes patient-specific chemotherapy infusions for sterile compounding. Use of robotic technology enhances efficiency while reducing staff exposure to hazardous substances. R.O.S.I.E. can batch mix up to eight infusions simultaneously. The new facility also exceeds rigorous regulatory requirements for sterility and safety.

During the six-month renovation project, staff compounded more than 44,000 chemotherapy doses with no reported serious safety events despite working in temporary locations during construction.

HRO training schedule for newly credentialed practitioners

High Reliability Organization (HRO) training is required for newly credentialed practitioners across the health system. Medical Staff members can attend training on any of the dates or locations listed below. To register for an upcoming session, please contact [email protected] or [email protected].

• Wed., Nov. 21, 2018, 7-8:30 am at Westerly Hospital, Nardone Conf. Rm. (NCC A & B)
• Mon., Nov. 26, 2018*, 12:30-2 pm at 300 George St., New Haven, IFE 157, Auditorium
• Mon., Nov. 26, 2018*, 2-4 pm at Greenwich Hospital, Nobile 1
• Tues., Nov. 27, 2018*, 8 am-12 pm at Bridgeport Hospital, Hollander Auditorium
• Wed., Dec. 5, 2018, 5-6:30 pm at YSC, Clinic Building, New Haven, CB 1058 (Bishop Conf. Room)
• Mon., Dec. 10, 2018*, 12:30-2 pm at 300 George St., New Haven, IFE 157, Auditorium
• Mon., Dec. 10, 2018*, 2-4 pm at Greenwich Hospital, Nobile 1
• Mon., Dec. 10, 2018*, 12:30-2 pm at NEMG offices, 99 Hawley Lane, 1st Floor, Large Conf. Rm.
• Tues., Dec. 11, 2018*, 8 am-12 pm at Bridgeport Hospital, Hollander Auditorium
• Wed., Dec. 12, 2018, 7-8:30 am at L+M Hospital, Baker Auditorium
• Mon., Dec. 17, 2018*, 12:30-2 pm at 300 George St., New Haven, IFE 157, Auditorium
• Mon., Dec. 17, 2018*, 8 am-12 pm at Bridgeport Hospital, Hollander Auditorium
• Wed., Dec. 19, 2018, 7-8:30 am at Bridgeport Hospital, Dupont Conf. Rm.

*These sessions are modules of the general new employee orientation, but others are welcome to attend as space allows. Note: Bridgeport Hospital currently uses a more comprehensive, 3.5-hour training program. They are in the process of converting to the more streamlined training module used elsewhere.

Communications workshop available for clinical staff

Physicians, advanced practice providers (APPs) and nurses across Yale New Haven Health and Yale Medicine are urged to sign up for “Enhancing Relationship-Centered Communication,” a course offered through YNHHS Patient Experience.

This one-day, peer-led workshop will show 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 8 am - 4 pm at the YNHHS SYN:APSE Center for Learning, Transformation and Innovation, 730 Howard Ave., New Haven.

Newsmakers

Matthew Grossman, MD, Yale New Haven Children’s Hospital’s quality and safety officer, has won the 2018 Pediatric Hospital Medicine Award for Quality and Patient Safety from the Academic Pediatric Association. The award, presented at the organization’s national conference in Atlanta, celebrates significant achievements by a pediatric hospitalist in quality improvement and patient safety during the prior year. Dr. Grossman has led a number of quality and safety efforts at YNHCH, including his work to improve outcomes for children born opioid-dependent through infant-mother bonding.

Vicki K. Smetak, MD, has been named Yale New Haven Children’s Hospital medical director of Regional Strategy and Partnerships. In this role, she will lead efforts to expand YNHCH partnerships throughout the region and advance clinically integrated network efforts with pediatricians and family practitioners. Before joining YNHCH, Dr. Smetak was chief medical officer for Methodist Children’s Hospital and Women’s Services, San Antonio, TX. Prior to that, she held several positions at Norwalk Hospital, including chair of Pediatrics and medical director of Pediatric Hospitalist Medicine. Dr. Smetak earned her MD at New York University School of Medicine and completed a residency in pediatrics, followed by fellowship in pediatric critical care medicine at The Children’s Hospital at Montefiore/Albert Einstein College of Medicine. She had additional fellowship training in pediatric critical care medicine at Yale School of Medicine and YNHCH.

Eric Jose Velazquez, MD, has been appointed chief of the section of Cardiovascular Medicine in the department of Internal Medicine, chief of cardiovascular medicine at Yale New Haven Hospital, and physician-in-chief of the Heart and Vascular Center for Yale New Haven Health System. He was recently named the Robert W. Berliner Professor of Cardiology, Yale School of Medicine. Dr. Velazquez was previously professor of medicine in the division of Cardiology at Duke University, and held appointments at the Duke Clinical Research Institute and Duke Global Health Institute. He earned his MD from the Albert Einstein College of Medicine and completed his internal medicine and cardiology training at Duke University, including fellowships in clinical research and echocardiography.

YNHCH earns national recognition for innovation

Parents magazine has named Yale New Haven Children’s Hospital among the 20 most innovative children’s hospitals in the U.S., based on results of its comprehensive survey. The survey, sent to Children’s Hospital Association members, sought to identify hospitals with a proven track record of innovations that have led to advances in medicine, research, family support and technology. The survey also took into account a hospital’s adoption of the latest technologies and efforts to share its innovations with other pediatric centers. In addition to being the only tri-state hospital recognized, YNHCH was one of only three hospitals throughout the Northeast to be so honored.

YNHCH was selected specifically for its commitment to family-centered care by being the first children’s hospital to offer couplet care within its Neonatal Intensive Care Unit (NICU), where mothers and babies who need medical attention remain together. With couplet care and the state-of-the-art NICU that opened in February, YNHCH has established a new national model.

Upcoming Events

The YNHH Medical Staff is invited to mix and mingle at the New Physician Reception, Thursday, November 29, from 6 – 9 pm at the Peabody Museum of Natural History, 170 Whitney Avenue, New Haven. Members of the medical staff are welcome to bring a guest. For details or to RSVP, contact Marketing and Communications.

“Comeback kid” ad campaign features inspirational patient stories

This fall, Yale New Haven Health launched the “comeback kid” advertising campaign featuring patients who, with the help of YNHHS’ medical experts, have overcome some of the greatest challenges of their lives. Patients from each YNHHS hospital are featured in TV commercials, radio spots, billboards and print and digital ads. Visit ynhhs.org to view all of the stories.

Request for patient stories

Yale New Haven Health often features patient stories to highlight the work and dedication of our physicians, nurses and staff in its print publications, websites and advertising campaigns. If you have a patient that you think would make a great story -- and who is willing to share his or her experience -- please contact Cynthia Whitcomb at 203-688-9440, [email protected].