From the Offices of Elliot Joseph and Jeffry Nestler, MD
February 6, 2011 Edition

Note: Some stories may link to content on the hospital's Intranet.
If a login screen appears, simply enter your Novell username/password.

“We are all faced with a series of great opportunities brilliantly disguised as impossible situations.” - Charles R. Swindoll

Thanks For Your Dedication and Patience During Recent Weather Emergencies

Sincere thanks go out to medical staff members who have braved the recent extreme weather conditions in order to care for patients and families at Hartford Hospital. We are in the grip of some of the worst winter weather on record, yet our staff has responded with exceptional skill and compassion to ensure that we are always there for those who need us. Whether you came in early or stayed late, remained at the hospital overnight to be available to your patients, or were inconvenienced by the traffic gridlock around our campus, know that we recognize and appreciate your professionalism and willingness to continue putting the safety and quality care of our patients first.

Preventing Ventilator-associated Pneumonias Placed on Balanced Scorecard

Hartford Hospital is demonstrating its commitment to end Ventilator-Associated Pneumonias (VAP) by placing VAP prevention on the 2011 Balanced Scorecard. VAPs are the leading cause of death among hospital-acquired infections with a mortality rate approaching 40 percent. VAPs account for 11-15 percent of all nosocomial infections. A multidisciplinary task force has met and outlined its goals for the year, and subgroups have been tasked with addressing sedation protocols; documentation issues; pre-ICU care and antibiotic selection. A fifth subgroup has been charged with conducting VAP huddles to discuss, in real time, cases in which a VAP has developed. Findings will be presented to the VAP Steering Committee for discussion and potential implementation.

CMS Postpones Claim Rejections

The Centers for Medicare & Medicaid Services (CMS) announced Jan. 12 that it has not yet decided when it will begin to reject claims if an ordering/referring provider does not have a PECOS record. CMS will give providers ample notice before claim rejections begin. Recent revisions to CR 6417 require MACs to delay rejecting claims until receiving further direction from CMS. Some language in this article was also revised to be more aligned with language in the Change Request. The following link provides additional detail:

American College of Surgeons Supports Value-Based Purchasing Proposed Rule

The American College of Surgeons has stated its support for CMS’ proposed rule on the Value-Based Purchasing program, calling it an “important step toward improving the quality of care and patient outcomes while reducing complications and the cost of care.” Read the ACS release on value-based purchasing at

Warning: Avoid Having Your Privileges Suspended: Act By Feb. 28

In order to avoid having prescriptive privileges suspended, you must renew your Connecticut Controlled Substance Registration (CSR) by Feb 28. There is no longer a 30-day grace period for renewal. Renew online by going to Click “login” in the upper right corner of the screen and enter the User ID and Password provided on your renewal notice.

Rapid Response Team Efforts Lead to Great Outcomes: New Audit Tool Now on Desktop Icon

The Rapid Response Team has been able to prevent patients from deteriorating to cardiac arrest outside intensive care units, and this has reduced in-hospital mortality in that group from 80 percent to 15 percent. The Rapid Response Action Group continues to learn from the experience and to refine the program. Recent improvement efforts have focused on improving the information available from the audits that occur following each RRT call. The changes being made are expected to enhance our ability to review the impact of our RRT program and to identify opportunities for improvement. Last Tuesday (Feb. 1), the audit form for Rapid Response calls was placed as an HH desktop icon under “RRT” (see icon in right hand column of your desktop). The bedside nurse completes the form with the assistance of the RRT critical care nurse. Paper audit forms will no longer be used.

Institutional Review Board Re-Structured into Two Panels

To better meet the needs of investigators, the requirements of accreditation and to fulfill a key initiative of the strategic plan for research within Hartford HealthCare, the IRB has been restructured into two review panels. Meetings now will occur on the second and fourth Wednesday of each month. Submission deadlines are approximately two weeks prior the scheduled meeting. The full schedule is available at:

Cancer Center Completes Pilot Portion of Study on Prostate Cancer Patients

The Helen & Harry Gray Cancer Center was recently awarded $238,634 from The Institute for Health Technology to analyze the effect of advanced medical technology and devices on the ability of early stage prostate cancer patients to work during or shortly after therapy. Under the direction of Dr. Andrew Salner, the team has recently completed the pilot portion of the study, testing the study questionnaire with a small sample of prostate cancer survivors. The study will involve three large cohorts of survivors and will include three areas of expertise for Hartford Hospital among the technologies to be studied: robotic prostatectomy, intensity modulated radiation therapy and brachytherapy.

Medical Staff, Physicians’ Groups Boost Black & Red to New Level

With strong support from the medical staff and physicians’ groups, Hartford Hospital celebrated its most successful Black & Red gala ever on January 29 at The Bushnell. Net proceeds of more than $600,000 will be used to enhance multidisciplinary care for our cancer patients at the Helen & Harry Gray Cancer Center. More than 900 guests representing Hartford’s civic leaders, business executives, medical professionals and generous patrons enjoyed the first-ever sold-out event. Among the more than 100 sponsors providing support were leadership sponsors Travelers and United Technologies Corporation. The medical staff at Hartford Hospital was among the presenting sponsors, and Dr. Andrew Salner served as chair of the medical staff advisory committee. Your support of the Black & Red sends a positive message to our community about the importance of this signature fund-raising event in helping us to deliver remarkable care, each and every day.

Welcome New Physicians

Required Risk Management Grand Rounds Scheduled

There are several Risk Management Grand Rounds sessions scheduled for Hartford Hospital-employed providers (MDs, DOs, APRNs and PAs), who must attend one session to fulfill the Risk Management Rounds requirement. It is recommended that you attend a session related to your specialty, but you will still receive credit by attending any session regardless of the specialty. These sessions are for Hartford Hospital-employed providers only:

  • Psychiatry: Feb. 17 from 11:30 a.m.–1:30 p.m. (Location TBD – IOL)
  • Clinical Leadership: Feb. 23 from 8–9:30 a.m. in JB 118
  • Medicine: March 2 from 5:30–7 p.m. in Gilman Auditorium
  • Surgery: March 9 from 7–8:30 a.m. in Gilman Auditorium
  • Surgery: March 10 from 5:30–7 p.m. in Gilman Auditorium
  • Women’s Health: March 31 from 7–8:30 a.m. in Special Dining Room
  • ED: April 6 from 12–1:30 p.m. (Location TBD)
  • ED: April 21 from 8:30–9:30 a.m. (Location TBD)

Balanced Scorecard Keeps HH on Its Game

Harford Hospital uses the Balanced Scorecard to set and achieve its most strategically-important goals. It has six main focus areas or “pillars.” These are: Service Excellence, Quality, People, Growth, Financial Strength and Academic Excellence. The Balanced Scorecard is used to: drive strategy execution; clarify strategy and make strategy operational; identify and align strategic initiatives; link budget with strategy; align the organization with strategy; and conduct periodic strategic performance reviews to learn about and improve strategy. To learn more about the initiatives set forth in the current Hartford Hospital Balanced Scorecard and view First Quarter FY 2011 (Oct. – Dec.) progress, click here.

Coming Events

February 9:
BEACON Seminar: Accelerating The Availability of The Artificial Pancreas

Biomedical Engineering Alliance & Consortium Seminar. Marc Anderson, manager of new technology development, Juvenile Diabetes Foundation Artificial Pancreas Project, NYC. 5:30 p.m., Room 118, Jefferson Building. Reservations: Terri Wilson at 860-547-1995 or

February 10:
IOL Grand Rounds: Cover, Content and Course: Career Convergence in Scientific Editing

Andres Martin, MD, MPH, professor of pediatric oncology psychosocial services, Child Study Center at Yale University School of Medicine, editor-in-chief of the Journal of the American Academy of Child and Adolescent Psychiatry. 12-1:15 p.m., Hartford Room, Commons Building.

February 17:
Department of Traumatology and Emergency Medicine Grand Rounds: VisualDX in Emergency Medicine: Look-alike Rashes That Might Kill Your Patients

Gil Shlamovitz, MD, assistant professor of emergency medicine, University of Connecticut School of Medicine, and attending physician in the Emergency Department at Windham Hospital. 12 noon, Gilman Auditorium. Hartford Hospital designates this educational activity for a maximum of 1 AMA PRA Category 1 credit (s)™. Click here for more information, or contact Michael Drescher, 860-545-4377.

February 17:
IOL Grand Rounds: Risk Management Rounds

Alfred Herzog, MD, medical director of IOL professional program, and Neil Danaher, JD, Medical Risk Management, LLC, Hartford. NOTE: Attendance is limited to active and consulting Department of Psychiatry medical staff, IOL (employed) clinical staff and trainees. 11:30 a.m.–1:15 p.m., Hartford Room, Commons Building.

February 23:
Cancer Program Grand Rounds: Social Determinants of Health, Implications for Oncology

Karen D’Angelo, MSW; Grace Damio, MS, CD/N; and Denise Rivera Coladonato. 7:30-8:30 a.m. Gilman Auditorium. Hartford Hospital designates this educational activity for a maximum of 1 AMA PR Category 1 credit(s)™ Contact Ginelle McPherson, 860-545-4594.

February 24:
IOL Grand Rounds: Emotional Schemas in Cognitive Behavioral Therapy

Robert L. Leahy, PhD, director of the American Institute for Cognitive Therapy in New York City and psychiatry professor at Weill-Cornell Medical School. 12-1:15 p.m., Hartford Room, Commons Building.

Save the Date, April 6:
Heart Rhythm Symposium

The Eighth Annual Heart Failure Symposium, entitled Bridging Electrophysiology and Heart Failure, will be held on April 6 from 7 a.m. to 4:30 p.m. at the Farmington Marriott. Sponsored by the Henry Low Heart Center at Hartford Hospital, the free symposium will feature speakers, case presentations, and device workshops. Speakers and topics are:
  • Dr. Detlef Wencker: Advanced Cardiac Care with Heart Failure
  • Dr. Jeffrey Kluger: Arrhythmogenesis of Heart Failure
  • Dr. Eric Crespo: Atrial Fibrillation in Heart Failure
  • Dr. Steven Zweibel: ICD/Beyond Sudden Death
  • Dr. Christopher Clyne: Resynchronization Therapy, New Indications
  • Dr. Joseph Radojevic: When Resynchronization Therapy Fails
  • Dr. Jonathan Hammond: Surgical Approaches to Heart Failure Including VAD

For more information or to register go to:

Save the Date, May 4:
Board of Directors and Medical Staff Spring Event

6-9 p.m., Heublein Hall, Education Resource Center

For Your Information: Hot Topics in Healthcare

The States’ Next Challenge —
Securing Primary Care for Expanded Medicaid Populations
NEJM | January 26, 2011

In the coming years, the United States must address both an expansion of Medicaid coverage and an expected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated Medicaid expansions are also the ones that have less primary care capacity, they could face surging demand from the newly insured without having sufficient primary care resources available. These gaps could affect access to care not only for newly eligible Medicaid beneficiaries but also for others who depend on a state’s existing supply of clinicians.

The Seymour Street Journal (SSJ) has been developed to communicate key messages pertinent to our hospital’s physicians. It will keep you informed and up-to-date on hospital, network, and health care news in a concise, convenient format. The SSJ will be sent to your preferred e-mail address every other Sunday. Back issues can be viewed here. For any questions or suggestions, please contact Dr. Jeffry Nestler, Medical Staff President, at (860) 836-7313.