From the Offices of Jeffrey A. Flaks and Jeffry Nestler, MD

In This Issue...

April 28, 2013 Edition

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1998-The first Chest Pain Unit in Hartford was established here to offer expedited management and more accurate diagnosis of heart-related symptoms.


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Top News

FinkelsteinDr. Jeff Finkelstein Named Chief of Emergency Medicine

Dr. Jeff A. Finkelstein has been named the new chief of Emergency Medicine at Hartford Hospital.

Dr. Finkelstein comes to us from The Hospital of Central Connecticut, where he served as chief of Emergency Medicine and chief medical information officer, overseeing the care of more than 110,000 Emergency Department patients annually at the New Britain and Bradley Memorial campuses.

He is a seasoned, well-regarded leader in this field with an excellent record of transforming Emergency Department services. He is well versed in the use of technology, transparency and clinical process improvement to both enhance the patient experience and to make Emergency Department services more efficient and competitive.

He received his M.D. from Albert Einstein College of Medicine and completed a residency in Emergency Medicine at the Joint Military Medical Centers in San Antonio, Texas. He completed a teaching fellowship at the Emergency Medicine Foundation and the University of Texas in Dallas. He gained experience in ACS Level 1 trauma centers in Texas before coming to Connecticut. He is a Fellow of the American College of Emergency Medicine and has published and presented widely on the topic of emergency care.

The arrival of Dr. Finkelstein will allow Dr. Lenworth Jacobs to turn his full attention to his new role as Hartford Hospital’s chief academic officer. We are deeply in debt to Dr. Jacobs, who has served as our director of Emergency and Trauma Services for three decades. Internationally recognized for contributions to emergency medicine and traumatology, he is responsible for the growth and success of the Hartford Hospital program.

Dr. Finkelstein will be working with other key leaders in the Emergency Department who will continue to contribute to this vital program. These include: Dr. A.J. Smally, medical director for Emergency Medicine; Dr. Fred Tilden, associate director of operations; and Dr. Ken Robinson, associate director with oversight of the Life Star.

One of the great advantages of coming together as a system is the potential to take advantage of talent across Hartford HealthCare. It means a lot that Dr. Finkelstein comes to us from a member hospital, bringing experience, best practices and a track record of success. This is an example of our system at its best.

 

Hartford Hospital's First Mini-Maze Procedure Performed Last Tuesday

A surgical team at Hartford Hospital led by Dr. Robert Hagberg, chief of cardiac surgery, performed the first minimally invasive maze procedure (mini-maze) at the institution on April 23.

The mini-maze is a cardiac surgery procedure intended to treat atrial fibrillation. It is derived from the original maze procedure developed by Dr. James Cox in the 1980s.

The procedure uses minimally invasive surgical techniques to electrically isolate the pulmonary veins from the left atrium, and remove the left atrial appendage (where clots are most likely to form in patients with atrial fibrillation). The ablated tissue effectively blocks the migration of the abnormal electrical impulses, thus stopping atrial fibrillation from reaching the main part of the atrium.

This is done through a bilateral mini-thoracotomy approach and is video-assisted by the use of a small fiber optic camera. The procedure also involves an electrophysiologist to assist the surgeon in assuring that there is complete electrical isolation of the pulmonary veins. Autonomic ganglia thought to contribute to atrial fibrillation are identified and ablated as well.

Published reports show good short term results with success rates greater than 90%, and few complications.

 

Hull Hundreds Pay Tribute To Dr. David Hull

Scores of colleagues, friends and family members attended a celebration in memory of Dr. David Hull, emeritus director of the Transplant Program,on Friday, April 26, at the Education Resource Center’s Heublein Hall.

Dr. Hull, the face, voice and hands of the Hartford Hospital Transplant Program for more than two decades, died Feb. 11 after a courageous battle against lymphoma. He was 59.

The Hull family expressed gratitude to all of his medical colleagues at the tribute.

David Hull was truly family to all of us at Hartford Hospital and he is sorely missed.

 

Hartford Hospital's CESI Featured in American Hospital Association News as a Center of Innovation

Hartford Hospital was featured as a center of innovation in the April 24 issue of the American Hospital Association's newsletter, News Now. Here is the item as it appeared on the front page of the AHA newsletter as the "Message of the Day:"

America's Hospitals: Caring for Patients, Strengthening Communities

CENTERS OF INNOVATION

Hartford Hospital was home to Connecticut's first simulation center, which has grown into The Center for Education, Simulation and Innovation. CESI is one of the only facilities to offer a fully comprehensive range of robotic and high-tech training capabilities, including robotic and endovascular simulators, task trainers, ultrasound technology and five simulated clinical environments (labor and delivery, resuscitation, ICU, trauma/ED and operating room) each with its own control room. The departments of anesthesia, critical care, emergency medicine, Ob-Gyn and surgery all use the facility to orient first year residents and fellows to clinical practices. The residents are able to experience hands-on training without the added pressure of performing tasks on real people. It builds their confidence and allows them to learn, practice and repeat procedures in a controlled, non-rushed environment. To learn more, go to: http://www.aha.org/advocacy-issues/initiatives/hosp-story-index.shtml.

 

Length of Stay Journey Continues

By Dr. Stuart Markowitz,VP and Chief Medical Officer; and Cheryl Ficara, VP of Patient Care Services

After nearly eight months of redesign and development of a program to decrease excess length of stay, we are beginning to show signs of success.

The LOS Clinical Operations Project began with 10 patient care units and beginning this month is now rolling out to the remaining units across the hospital. The cooperation, engagement and excitement from so many disciplines caring for our patients is coming together with March showing reduction of nearly 0.5 days in overall length of stay.

At the heart of the process change is Clinical Progression Rounds. These occur every day on every patient unit and are attended by representatives from Nursing, Case Coordination, Discharge Planning, Physician and/or Advance Practitioner providers and where indicated Physical Therapy, Pharmacy and other disciplines.

Our focus is on removing barriers to appropriate and timely discharge and engaging the patient and their families in discharge anticipation and planning. We have created a robust dashboard to track our progress and guide us towards action steps for continued improvement.

We thank you for all the hard work that has taken us to this point in time but there is still a great deal of work ahead. We thank you for your continued commitment.

 

Hartford Hospital Scores Higher Than National Average in Safety

In its May 2013 issue, Consumer Reports calculated safety scores for 258 teaching hospitals nationwide with the average score being 49. Nine Connecticut hospitals scored higher than the national average, including Hartford Hospital, St. Francis Hospital and Medical Center, and Manchester Memorial Hospital.

Yale-New Haven Hospital and Hospital of St. Raphael (which have merged) scored 44 each. Middlesex Hospital in Middletown received the highest score, 69, in the state. The highest-scoring teaching hospital in the nation was the Mayo Clinic Hospital in Phoenix, Ariz., with a score of 69. Dempsey Hospital scored 17 out of 100.

 

HullRibbon Cutting Celebration For New Garage, Fitness Center and Skybridge

Dozens of staff members turned out on April 23 for a ribbon cutting ceremony celebrating the official opening of the new Hudson Street Garage, Barney Employee Fitness Center and Skybridge.

As a result of the new parking garage, there will be ample parking for all everyone who comes to Hartford Hospital. We will see a 16% increase in parking spaces for staff, and a 35% increase in parking spaces for patients and visitors. We will also have ample space for cars that come on campus for special functions. We expect to have 500 to 1,000 open spaces at any given time.

The Barney Fitness Center is 5,000 square foot facility located on the ground floor of the employee garage. Membership is free to Hartford Hospital employees. It is open 24 hours a day, 7 days a week to employees with badge access.

The Skybridge connects the Hudson Garage with the Ingalls Building on Jefferson Street, allowing employees to walk from the parking garage to the main campus in a safe, climate controlled passage without having to cross the street.

 

Dr. Sharon Diamen Named New Chair of the Medical Staff Annual Campaign

Dr. Sharon Diamen, general internal medicine, has been named chair of the Medical Staff Annual Campaign. As such, she'll help Fund Development to ensure successful support of the hospital's annual campaign by our physicians.

She is taking over the role held for the past five years by Dr. Robert Siegel, medical director of Cancer Clinical Research. Dr. Siegel was named Hartford Hospital Medical Staff's Philanthropist of the Year in 2012.

 

Conn. Panel Passes Tax Bill, But Plan Could Change

San Francisco Chronicle, April 19

The legislature's tax-writing committee has approved a revenue package that delays the governor's proposal to slash car taxes, extends a surcharge on Connecticut's corporation tax and creates a tax amnesty program.

But lawmakers stressed that the final decision on taxes won't be made until legislative leaders reach a final budget agreement with Gov. Dannel P. Malloy.

Friday's 31-17 vote by the Finance Revenue and Bonding Committee on the tax bill, coupled with the expected approval of a spending bill by the Appropriations Committee, sets the stage for the full-fledged budget negotiations. Some groups are pushing for lawmakers to raise taxes on the wealthy as a way to avoid affecting hospitals caring for the needy.

 

Hartford Hospital Officials Put on Alert for Incoming Patients From Boston Marathon Bombing

Hartford Courant, April 15

Following the bombings at the Boston Marathon on April15, Boston MedFlight, the critical care flight service, issued a warning that Boston hospitals were on "divert" and that Hartford Hospital officials should be on alert for incoming patients, according to Rebecca Stewart, spokeswoman for Hartford Hospital.

Soon after the explosions, Connecticut officials started sharing information in Hartford through the Connecticut Intelligence Center, which is also known as the fusion center. Connecticut's operation is among 72 centers nationwide that were upgraded after the Sept. 11, 2001, terrorist attacks.

 

Hartford Hospital Commits To 10 Youth Internships As Possible Payment in Lieu of Taxes (PILOT)

Hartford Hospital has committed to a minimum of 10 internships as part of Hartford Mayor Pedro Segarra’s 2013 Summer Youth Employment Program. The program is open to qualified high-school students in the local community.

HH's participation resulted from discussions with Mayor Segarra regarding the issue of possible payment in lieu of taxes (PILOT). We are working to develop a model for the program at our hospital so that students have meaningful experiences and units see real value in sponsoring the interns.

Data suggest that participants in the summer program have higher graduation rates compared with similar students who have not had the same opportunity. Hartford Hospital’s commitment to education and economic well-being recently was demonstrated in our announcement of a $1 million donation, over five years, to the Hartford PROMISE Scholarship Program, which supports Hartford Public School students by providing financial assistance for college. We strongly believe in education as a determining factor in the health, wellness and economic well-being of communities.

 

Dr. Henry Lee Visits HH; Seeks Collaboration Between CESI, Genomas, and Institute of Forensic Science

World-renowned forensic scientist Dr. Henry Lee and his son visited Hartford Hospital April 5. Dr. Lee is chief emeritus for Scientific Services for the State of Connecticut and founder of the Henry C. Lee Institute of Forensic Science at the University of New Haven.

Dr. Lee’s visit focused on identifying potential opportunities for collaboration between the Institute of Forensic Science and Hartford Hospital’s Center for Education Simulation and Innovation (CESI) and Genomas.

 

The New World Of Health Care - The Clinical Integration Newsletter

The second of Integrated Care Partners' ongoing Connected Care newsletter is attached.

In it, Dr. James Cardon, executive vice president and clinical integration officer for Integrated Care Partners, writes:

"Care coordination, standards of care and seamless patient transitions are among the improvements that need to happen in order to improve quality, reduce costs and meet the new expectations of the organizations that pay us to provide care. The health care industry recognizes this, and organizations across the nation are implementing new information technology systems to better coordinate care and measure quality.

Integrated Care Partners is changing the way we provide care in our marketplace. Together, as a group of dedicated physicians, we are building a successful future as we improve our practices and give patients the care and experience they deserve."

 

President Flaks Facilitates Discussion at State of the Hartford Schools Symposium

President/CEO Jeffrey Flaks facilitated a discussion at the State of the Schools Symposium on April 24 about the role government, philanthropic and corporate leaders play on the sustainability of Hartford Public Schools reform.

The symposium was called Leading With Promise: Creating Change Through Partnerships. Held at the Bushnell, it was directed by Dr. Christina Kishimoto, superintendent of Hartford Public Schools.

Excellence

Hartford Hospital’s Partnership for Breast Care Receives National Accreditation as a Breast Center

The Partnership for Breast Care, Hartford Hospital’s comprehensive breast care program, has been awarded a second cycle of full three-year accreditation by the National Accreditation Program for Breast Centers (NAPBC). Receiving a perfect compliance score on 27 categories of breast care and program organization, this accreditation recognizes our commitment to providing the highest level of quality breast care.

Dr. Patricia A. DeFusco, a medical oncologist is the newly appointed medical director for the Partnership for Breast Care; Dr. Andrew Ricci, a pathologist, was the medical director for the previous four years.

Administered by the American College of Surgeons, the NAPBC is a consortium of professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. Our program was first accredited in 2010 not long after the NAPBC first began its accreditation program, which includes a detailed application and full-day onsite visit.

Hartford Hospital’s breast care program was established in 2001. It provides a single comprehensive resource for individuals with breast health issues, including: referrals and patient navigation, patient and community education, development of clinical best practices, a weekly Cancer Case Conference outreach through “Take the Time” Digital Mobile Mammography Program, and a variety of other activities.

The breast program addresses all phases of breast care and breast cancer care throughout the continuum through risk assessment, screening, diagnosis, treatment, survivorship and end-of-life care. It is led by a multidisciplinary disease management team comprised of physicians representing radiology, surgery, medical and radiation oncology, pathology and women’s health along with cancer center staff. The group meets monthly to oversee program development.

 

Center For Global Health Being Developed at HH

By Dr. Joseph J. Klimek, vice president of Physician Relations

With rising interest in and attention to international health experiences among domestic medical students, trainees, and attending faculty, the field of global health is rapidly gaining recognition as an indivisible component of global public health and health systems strengthening in resource-poor areas worldwide. Accordingly, a growing number of academic institutions in the United States are formalizing their participation in global health efforts.

We are beginning to create a new Center for Global Health at Hartford Hospital.

Many caregivers at Hartford Hospital are currently engaged in some form of global health work, but these activities are not coordinated in any formal way. Integration and coordination of these Hartford Hospital-based global health initiatives will help promote collaboration across disciplines and will improve their cost-effectiveness and ultimate sustainability, both domestically and abroad.

As a first step, we sent a survey to all physicians, nurses, dentists, PAs, APRNs, and CRNAs at Hartford Hospital in February 2013. We received 224 replies, with 55 (25%) saying that they had provided medical or dental care internationally. Countries where HH caregivers have visited include: Cape Verde, Costa Rica, Dominican Republic, Ecuador, Ethiopia, Guadalupe, Guyana, Haiti, Honduras, India, Indonesia, Israel, Jamaica, Kenya, Mexico, Nepal, Nicaragua, Nigeria, Paraguay, Peru, Philippines, South Africa, Switzerland, Uganda, United States, Uzbekistan, and Zambia.

Three-quarters of the survey respondents said they would be interested in visiting these countries in a to-be-developed program. A number of respondents said they were interested in joining a planning group for developing a program in Global Health.

The survey was only the very first step. An advisory group was formed (Drs. Alan Babigian, co-director of hand surgery; Jeff Cohen, colon and rectal surgery; Christopher Hughes, resident; Joseph Klimek, vice president of physician relations; Srinivas Mandavilli, director of surgical pathology fellowships; Jamie Roche, vice president of Patient Safety and Quality; and Andrew Wakefield, associate director of Neurosurgery) and met in early April to begin discussions of where, what, how, and why a Center for Global Health might proceed. We will begin to involve many of the survey respondents in our future discussions. We will keep you all informed on our progress.

Innovative and Complex Care

Dr. Steve Zweibel and the Division of Electrophysiology Introducing Initiative To Reduce Length of Stay for Pacemaker/ICD Patients

Dr. Steve Zweibel and the Electrophysiology Section of Cardiology, under the direction of Dr. Paul Thompson, is initiating a program to reduce length of stay for selected low risk patients undergoing pacemaker or ICD implantation.

Currently, patients undergoing pacemaker or ICD placement are kept in the hospital overnight even though they are classified as "outpatients" under observation.Our experience suggests that select groups of these patients can be discharged even earlier and safely without any higher incidence of complications. The process would open beds needed by other patients awaiting procedures or admission. The initiative is set to begin in May.

 

Shared Medical Appointments To Be Piloted at HHMG OFfices

In the time it once took to see two or three patients, a physician may be able to attend to 12 during a shared medical appointment: a 90-minute visit conducted in a group of about eight to 12 patients who have similar medical conditions or needs. Across the United States, the concept has grown in popularity since it was introduced in the early 1990s and studies have shown good results for patients with chronic conditions such as diabetes, hypertension, arthritis, asthma and obesity.

Four physicians at three Hartford HealthCare Medical Group offices will offer shared medical appointments to test the model starting this spring.

They are: Dr. Elizabeth Fasy, an endocrinologist from the South Main Street office in West Hartford; Dr. Janice Oliveri, an internist in Wethersfield; and Enfield physicians, Dr. Nancy Lindberg, a family physician, and Dr. Vasanth Kainkaryam, an internist and pediatrician.

Kainkaryam, who was introduced to shared medical appointments during his residency at Baystate Medical Center, said he initially plans to use group visits with his older patients who come in for annual wellness visits covered by Medicare. In the future, he can imagine seeing groups for other common visits including routine well-child care and perhaps sports physicals for an entire team.

Research and Academics

Dr. Rocco Orlando On Expert Panel Discussing Surgical Quality Progress

Hartford Business Journal, April 23

Dr. Rocco Orlando, senior vice president and chief medical officer for Hartford HealthCare, was one of the state's top doctors who met Friday at the State Capitol to talk about the state of health care in Connecticut.

The "American College of Surgeons forum on Surgical Health Care Quality," included a panel of experts who discussed how surgeons and other clinicians, hospitals, health plans, and government can work together to achieve better patient outcomes and increase the value of health care.

The forum highlighted the success of the Connecticut Surgical Quality Collaborative and its goal to expand partnerships with additional hospitals and health care organizations throughout the state.

 

HH Becomes a NCI Gynecologic Oncology Group Phase 1 Institution; First Patient Enrolled

Hartford Hospital is now a Gynecologic Oncology Group (GOG), National Cancer Institute (NCI) Phase I institution with our first patent enrolled. We are now part of an elite group of institutions doing cutting edge cancer research with NCI funding.

Our Phase I group is jointly headed by Drs. Amy Brown and Stacy Nerenstone.

In less than six months we have successfully applied for the designation, received approval, got HH IRB approval, and enrolled our first patient.

Kudos to Dr. Henry Jacobs and his research team, Dr. Andy Salner and Donna Handley from the Cancer Center, the IRB, the pharmacy, and the nursing staff.

 

Dr. Bruce Browner and Department of Orthopaedic Surgery Hosts International Trauma Conference Via Internet

Dr. Bruce Browner, Chair Emeritus of the Department of Orthopaedic Surgery, organized an international multidisciplinary trauma internet conference on March 14. The topic was Open Fractures Management, and speakers were Dr. Browner, Dr. Mark Sebastian,director of the Trauma Service at Hartford Hospital; and Dr. Rajiv Chandawarkar,associate professor of Surgery and chief, Division of Plastic Surgery, University of Connecticut.

Following the presentations, there was an online interaction with doctors in Africa led by Dr. Robert Mhina, orthopedic surgeon in Dar es Salaam, the largest city in Tanzania.

Fifty people participated from Gilman Auditorium at Hartford Hospital, and 20 joined from the World Bank Conference Center in Dar es Salaam.

They have planned another live international internet conference on Spine Injury Management with Dar es Salaam, Tanzania and possibly Kampala, Uganda and Nairobi, Kenya for June 20 from 6:30-8 a.m. in the Gilman Auditorium. Speakers will include Dr. Inam Kureshi, Dr. Jay Krompinger and a spine surgeon from the Muhimbili Orthopedic Institute (MOI) in Dar es Salaam.

Dr. Browner has been working as a consultant with a group in Dar es Salaam to help them establish a trauma system for that city and the coastal region. The initiative is based on the model utilized by the American College of Surgeons, Committee on Trauma, Trauma Systems Consultation Group. The plan is to extend the system to the rest of Tanzania and then to have it serve as a model to similar system development in other East African countries.

The College of Surgeons of East Central and South Africa (COSECSA) that includes representation from 10 countries is engaged in the process. These conferences are seen by COSECSA leadership as being an important part of their effort to deal with the immense challenge of caring for victims of road traffic injuries, war, agricultural and industrial accidents.

 

Dr. Barry Stein Presents at Society of Interventional Radiology Annual Meeting in New Orleans

Dr. Barry Stein, section director of cardiovascular MRI and CT, participated as faculty and presented at the annual meeting of the Society of Interventional Radiology (SIR) in New Orleans this month.

The Society of Interventional Radiology is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions.

 

Dr. David Tolin Serves As Expert in Medi-Resource Article on Compulsive Hoarding

Dr. David Tolin, director of the Anxiety Disorders Center at Hartford Hospital's Institute of Living,was interviewed for an article in Medi-Resource C-Health News on compulsive hoarding.

Dr. Tolin has done extensive investigations into the mysteries of hoarding. He headed a study to compare the way hoarders and non-hoarders process information and found hoarders to be more impulsive but slower to react. He also recently was interviewed on CNN concerning this topic.

 

Dr. Gualberto Ruano To Appear in Panel Discussion of Genetics, Bioethics and the Future

Dr. Gualberto Ruano, Hartford Hospital's director of genetics research, participated in a live, onstage panel discussion hosted by local radio personality and writer Colin McEnroe at the Watkinson School in Hartford on April 24. In a presentation called "The Future's So Bright, You Gotta Wear Shades," the discussion focused on the effects of genetics research and bioscience on the future and quality of life. 

Also on the panel were James J. Hughes, futurist, sociologist and bioethicist on the faculty of Trinity College; and UConn Philosophy Professor Michael Lynch, whose upcoming book is Prisoners of Babel: Knowledge in the Datasphere.

The event, which was aired by WNPR CT public radio on the Colin McEnroe show, was part of the school’s “Freshly Squeezed with Colin McEnroe” series of unscripted discussions.

 

Dr. Ronald Rosenberg Inducted Into ACNM

Dr. Ronald Rosenberg, Radiology Nuclear Medicine, has been inducted into the American College of Nuclear Medicine.

 

Dr. Michael Hallisey Inducted Into ACR

Dr. Michael Hallisey, Interventional Radiology, has been inducted into the American College of Radiology.

 

Radiology Resident Dr. Monica Froicu Receives Research Excellence Award

Radiology resident Monica Froicu, MD PhD, has won the Introduction to Academic Radiology Award and Stipend co-sponsored by the Radiology Society of North America (RSNA), the Association of University Radiologists (AUR) and the American Roentgen Ray Society (ARRS). This award is present to residents who have demonstrated research excellence during their training and who have been identified as having high potential for future academic pursuits.

Chief's Corner

Welcome To SSJ's New Feature Entitled "Chief's Corner"

As an outcome of our recent Hamilton Retreat and discussions amongst representatives of our Medical Staff and Hospital Leadership, we recognize the need for sharing information about activities throughout the hospital more widely with our Medical Staff.

Here debuts our new column to bring to you highlights of activities of interest, which will be authored by our Department Chiefs under my direction. Should you have any comments or suggestions along the way, please share them with us.

- Dr. Stuart Markowitz, Vice President, Chief Medical Officer

 

KumarKumarDr. William Pastuszak and Dr. Laila Mnayer:
Molecular Pathology Laboratory's New High Density SNP Array

The Molecular Pathology Laboratory at Hartford Hospital/Clinical Laboratory Partners is pleased to introduce high density single nucleotide polymorphism (SNP) array.

The high-density Affymetrix (SNP) genotyping Cytoscan HD microarray interrogates the whole genome using more than 2.89 million probes for copy-number analysis and approximately 750,000 SNPs. This platform offers excellent performance and exceeds current guidelines for specificity, sensitivity, and resolution across the genome.

The array is designed to identify hundreds of common microdeletion/microduplication syndromes, subtelomeric deletions or duplications, and loss of heterozygosity (LOH ) at thousands of loci throughout the nuclear genome. The array allows detection of gene-level abnormalities, LOH, uniparental disomy (UPD), and tracks of homozygosity by-descent, which may indicate increased risk of a recessive condition.

This technique is being validated as a laboratory diagnostic tool for the diagnosis of developmental delay/intellectual disability, congenital anomalies, and dysmorphic features. Using this technique, a patient’s genome can be examined for gains or losses of genetic material too small to be detected by standard G-banded chromosome studies.

At the same time, the array is being validated for the evaluation of patients with suspected myelodysplastic syndrome (MDS), a form of bone marrow failure. The SNP array has proven to be a valuable tool in effectively identifying clonal abnormalities in patients whose conventional morphologic and cytogenetic evaluation is non-diagnostic.

A recent report has shown abnormalities detected by the SNP array in 27.6% of such patients, permitting earlier diagnosis. This test will then be validated to include patients with other hematologic neoplasms, including: acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myeloproliferative neoplasms (MPN). Early detection of clonal abnormalities and identification of submicroscopic lesions have the potential to impact patient management, and are steps toward personalized medicine.

Dr. Pastuszak is director of the Department of Pathology and Laboratory Medicine, and Dr. Mnayer is director of Molecular Pathology and Cytogenetics.

Please contact Dr. Mnayer with any questions at 860-545-3589.

Enhancing The Patient Experience

Fichandler The CXO Report: Patients Rate the Perceptions of Their Doctors

By "Chief Experience Officer" David Fichandler, Director of Patient Experience

As part of the Press Ganey tool, there are several questions that patients are asked about their experience with providers when in the hospital. They are:
During this hospital stay, how often did doctors treat you with courtesy and respect?
During this hospital stay, how often did doctors listen carefully to you?
During this hospital stay, how often did doctors explain things in a way you could understand?
How satisfied were you with the Time physician spent with you?
How satisfied were you with your physician's concern for your questions and worries?
How satisfied were you with how well physician kept you informed?
How satisfied were you with the friendliness/courtesy of physician?
How satisfied were you with the skill of physician?

So how are we doing? Our overall score top box for MD communication is currently at 83.2%, placing us in the 71st percentile nationally.

Our greatest opportunity is in the patient perception of how much time providers are spending with them, which currently ranks at 45.9% satisfaction or 1st percentile nationally.

We have amassed significant data on provider communication and even have reports for many providers in the Press Ganey system.

If you have any questions or would like additional information, please reach out to David Fichandler, Director, Patient Experience @ dfichandler@harthosp.org.

 

‘Incredible’ Caregiving by Clinical Teams Leads to Generous Pledge

Thankful for the exceptional and compassionate care that gave him 10 more years with his wife, Bob Krowka recently committed to a generous pledge to support the Tallwood Urology and Kidney Institute.

His hope is that more patients will benefit from similar care that was provided by Dr. Steven Shichman, chair of the Department of Urology; Dr. Robert Siegel, medical director of Cancer Clinical Research, and “the incredible” nurses and patient care assistants at the Helen & Harry Gray Cancer Center.

Bob’s wife, Cheryl, passed away in 2011, and he made generous gifts in her memory in 2011 and 2012. He made his pledge this year when he learned that Dr. Shichman was named medical director of the Tallwood Institute, reflecting the enormous respect he has for Dr. Shichman and for the entire team of clinicians who cared for Cheryl while she was a patient at the Cancer Center for 11 years.

“You are doing something awfully right,” said Bob, who is impressed with how the hospital can deliver “this kind of service” so consistently from everyone throughout the organization.

 

FOCUS ON SAFETY: Please Report All Events and Near Misses in Quantros

All safety events and near misses should be documented in Quantros, the event reporting software we use to document and track quality and safety performance.

Every week a team with representation from Nursing, Physicians, Pharmacy, Risk Management, and Quality Management meets to review all events reported through Quantros. We are also beginning to do Root Cause Investigations of Serious Safety Events in order to identify the systems issues that may adversely affect and/or contribute to patient harm.

Reporting of events and near miss events supports our continuing efforts to provide excellent care to our patients built around a culture of safety and reliability.

Operational Update

Reach Out To Your Representatives:
These Two Bills Will Strip Away The Few Remaining Protections for CT Physicians

Two bills that have recently moved out of the Judiciary Committee to be considered by the General Assembly could have a significant impact on the practice of medicine.

If passed, they will strip away the few remaining protections for Connecticut physicians, worsening an already difficult liability environment. These bills are expected to come to a vote in mid-May.

The bills are HB 6687 Certificate of Merit, and SB 1154 Accidental Failure of Suit. * Download information about HB 6687 and SB 1154.

Here’s a quick recap of the bills:

(1) Certificate of Merit (COM) effectively protects physicians against frivolous lawsuits. Under current law, a physician’s care must be reviewed by a similar physician to determine whether standards of care have been met. If the reviewer does not issue a COM, the plaintiff cannot proceed with a lawsuit. HB 6687 would allow COM determinations to be made by a “qualified” physician, who could be trained in any specialty, rather than by a similar physician. How are a patient's best interests served when a cardiologist's care is reviewed by an ophthalmologist, rather than another cardiologist?

(2) The current Accidental Failure of Suit (AFS) statute allows plaintiffs to re-file a claim dismissal if the dismissal was due to inadvertent or excusable neglect on the part of the plaintiff’s attorney. SB 1154 would significantly expand the current AFS statute, allowing any dismissed medical claim an opportunity to refile – even if the cause for dismissal was a denial of Certificate of Merit. This bill would allow a “do-over” for potentially meritless claims, clogging the court for cases of merit and driving up costs. For physicians, this could mean another 12-18 months in legal limbo, waiting for a case to be determined for a second time. Essentially, this is another bite at the apple for the plaintiff.

Add Your Voice: A strong, coordinated physician response is critical to defeating this legislation.

Reaching out to your state representatives and senators is a key way to educate them about your concerns related to these bills and the impact they may have on patient care in the future. Here's what you can do:

Contact your state representative and senator.
Urge them to vote NO on HB 6687 and SB 1154. Tell them about the negative impact these bills will have on your practice and on your patients.

* If you haven’t contacted legislators yet, now is the time. Click here for Four Tips to Effective Calls
* If you’ve done this already, help keep up the pressure and contact them again.
* Urge your colleagues to call and email legislators.

Donate to the Physicians' Liability Campaign. The trial bar has deep pockets to fund their spin. We need to offer a strong response, and share the truth with legislators and the public.

Use social media.
Are you on Facebook or Twitter? Use these platforms to share your message with friends and colleagues. You can also re-post and re-Tweet CSMS messages.

Send a letter to the editor. Whether online or print, these are well-read by subscribers. Check your local paper to find the letter guidelines. Some will accept email attachments or actual letters; other papers provide an online form. Most papers will have a word limit – be sure to follow it.

 

Physician License Renewal CME is Available on Jubilant Learning Portal

State mandated CME for physician license renewal is available on the Hartford Hospital Jubilant Learning Platform. You will need your Novell sign on information to access the portal.

To access Jubilant from the web, go to the Hartford hospital page and click on the gold tab “Medical Professionals” . Click on “Learning Portal” from the drop down menu, and then click on the green tab “Learning Portal Login” .

From the intranet (inside H.H.), click on the Academic Affairs page, then Medical Education or Medical Staff Office page. Click on the Learning Portal for Medical Education and Training link .

Use your Novell sign in, and the CME is under Physician License renewal CME.

Once you have passed the post-test, you will be awarded a printable CME certificate. Your CME will also be maintained and easily self-service accessed on the Learning Portal site, should you need a copy in the future.

Please note that your Risk Management required activities through MRM will provide your Risk Management CME.

Questions? Contact Maryanne Pappas at mpappas@harthosp.org

 

Medical Staff Annual Spring Event and Awards Meeting Scheduled for May 22

The Board of Directors and Medical Staff Spring Event and Awards is scheduled for Wednesday, May 22 from 6-8 p.m. in Heublein Hall.

Congratulations to the seven physicians who will receive awards there:

Young Practitioner Award: Dr. Colin Swales, gastroenterology, transplant hepatology director

Physician in Philanthropy Award: Dr. Andy Salner, director, Helen & Harry Gray Cancer Center

John K. Springer Humanitarian Award: Dr. Peru Venkatesh, associate director, Department of Medicine

Distinguished Service Awards: Drs. John Welch
and Joe Klimek, vice president of physician relations

Quality and Safety Awards: Drs. Eric Shore,
director of the Medical Intensive Care Unit, and Jack Ross, infectious diseases, director of HIV Program

Please plan to attend the Medical Staff Annual Spring Event and Awards Ceremony on May 22 and congratulate these award- winning physicians.

 

Second Annual �Chef to Farm� Dinner Set for July 12th

Please save the date for the 2nd Annual Hartford Hospital Medical Staff �Chef to Farm� Dinner from 6-9 p.m. on Friday, July 12 at Rosedale Farms in Simsbury. More details will follow.

You will be able to join the officers of the Hartford Hospital Medical Staff in celebrating the beauty and abundant bounty of our local farms � as a unique opportunity to socialize and enjoy the company of your colleagues. You�ll be treated to the freshest foods and produce in the sublime beauty of Our Farms, the true treasures of the state.

 

Hayes Named Director of Nursing for Musculoskeletal Institute

Kim Hayes, RN, BSN, CNOR, has been appointed director of Nursing for Hartford Hospital’s new musculoskeletal institute, effective immediately. She will have responsibility for all aspects of direct patient care and will report directly to Dr. Courtland Lewis, physician in Chief of the HH Musculoskeletal Institute and chief of the Department of Orthopedics.

The musculoskeletal institute will be the third patient-centered, disease-specific institute created at Hartford Hospital following the Cancer Institute and the Tallwood Urology and Kidney Institute. The institute will include all subspecialties of orthopedics, spine surgery, rheumatology, rehabilitation, pain management and metabolic bone disease and will train the next generation of musculoskeletal care givers.

Hayes began her career at St. Francis Hospital in med-surgical nursing. She came to Hartford Hospital in 1982 as a staff nurse in perioperative services and has since held roles of increasing responsibility. She worked in many perioperative service specialties before becoming nurse manager of neurosurgery and later, orthopedics. She currently is the perioperative nurse manager of neurosurgery, spine, total joint and orthopedic services.

HH In the News

Deadly Blast Rocks Boston

The Wall Street Journal, April 16

Dr. Paul Thompson is quoted in this Wall Street Journal article.

Two deadly explosions ripped through a crowd at the Boston Marathon on Monday, killing at least three people and injuring about 140, once again raising the specter of terrorism on American soil.

Dr. Paul Thompson, a spectator who is a sports cardiologist, has researched and published extensively about the health implications of running the Boston Marathon. Driving away from the bloody scene near the finish line Monday, Dr. Thompson couldn't speak without crying.

"For what? For what?" said the 65-year-old. "These people are totally innocent. They're not engaged in combat."

A 29-time finisher of the race who first witnessed it as a child at his father's knee, Dr. Thompson said he couldn't imagine the race ever being the same. "Unequivocally, it will change these events. It will become less fun. Less of a party. I just can't tell you how terrible I think this is."

 

Hospitals in Connecticut Prepare for Disasters With Frequent Drills

Eyewitness News 3, April 16

Following the explosions at the finish line at the Boston Marathon, more than 170 people were injured and had to be rushed to area hospitals. The situation in Boston has heightened the awareness at many hospitals in Connecticut, and officials assured us they would be ready.

"Every hospital hopes they're prepared," said Dr. Joseph Portereiko, of Hartford Hospital. "But what we've learned from yesterday, we will incorporate from our disaster planning again to modify that and really fine tune it. So we can take advantage of what they did in Boston and what they did right and the few things they did wrong."

Doctors at Hartford Hospital told Eyewitness News they're always learning from disasters that happen locally, nationally and overseas and taking that information to help improve our health system at home. In the event of a traumatic scene such as what happened at the finish line of the Boston Marathon, the Hartford Hospital staff has a plan in place.

"We will bring triage out from inside the hospital to in front of the hospital, this way we can really get a sense of what's going on and the critically injured can be brought into where life saving equipment is," Portereiko said.

Officials at Hartford Hospital said it takes part in drills at least twice a year. "For any level one trauma center, 22 people injured, 150 people injured, those are huge numbers, so it would require a lot of mutual assistance between hospitals, police, fire and other medical services in the area," said Sandra Brown of the Center for Emergency Preparedness at Hartford Hospital.

Boston officials called Yale-New Haven Hospital to ask about their burn bed capacity. Officials at Hartford Hospital said its facility was on standby to receive patients, but did not get any.

 

CT Prepared for Next Medical Emergency

Public News Service, April 16

Hospitals across New England were on alert Monday for victims of the Boston Marathon bombing, and local trauma officials say emergency preparedness now is part of the drill for all major events in the region.

Sandra Carter Brown manages the Center for Emergency Medical Preparedness at Hartford Hospital. Had there been more victims with life-threatening injuries, she said, they would have ended up in her unit. Brown wants locals to know they prepare for all major events.

"We're not behind the eight-ball when it comes to emergency preparedness," she declared. "We've been planning and planning and exercising the regional agencies, as well as the state agencies in the hospital community - police, fire and EMS."

Brown said everything from rock concerts to this fall's Hartford Marathon all require extra attention to emergency preparedness. She said the last round of national political conventions helped solidify the bonds among emergency responders in the region.

"Both affected the City of Hartford in terms of us having to have planning and strategy sessions with the states of Massachusetts and New York, in the event that something happened that we would need to put our emergency plans into effect," she said.

Brown noted that emergency preparedness relies heavily on federal funding, so that those responding to the Newtown shootings and now the Boston Marathon bombings are being forced to do more with less.

 

Cardiac Wars

Hartford Business Journal, April 15

The cardiac wars among Connecticut hospitals are back.

Nearly a decade after the state's larger hospitals competed fiercely to block smaller competitors from offering emergency angioplasty, there is a new wrinkle in the fight over the procedure.

In the past 14 months, four community hospitals have asked regulators for permission to begin offering elective angioplasty, which was once thought to be too risky to perform at smaller hospitals. But new research that suggests those safety concerns were exaggerated — and technological advances that have made the procedure much simpler — have small Connecticut hospitals racing to get in on the elective angioplasty business.

And in some cases they are drawing fierce opposition from nearby competitors looking to protect their market share. John Dempsey Hospital is raising red flags over The Hospital of Central Connecticut's proposal to get in on the business.

"The studies show doing elective angioplasty without surgical backup can be done safely with no different outcomes," said Dr. Justin Lundbye,the chief of cardiology at HOCC. "That stance has opened up a lot of opportunities for hospitals that want to offer it."

Lundbye said HOCC is already providing 100 angioplasties a year to patients in emergency situations, so it makes sense for the hospital to be allowed to extend the service on an elective basis, now that the science says it is safe to do so.

Currently elective angioplasty patients at HOCC are sent to either Hartford Hospital or John Dempsey Hospital for treatment, Lundbye said. Hartford Hospital, which is affiliated with The Hospital of Central Connecticut, is supporting the service expansion.

There are financial benefits as well. If they get regulatory approval, HOCC will likely double or triple its angioplasty patient base over the next few years, adding $2 million to $3 million in new revenue. Since the hospital already has the staff and equipment in place, there would be little to no capital costs as well, Lundbye said.

"If we are not allowed to offer this, we are doing a disservice to patients," Lundbye said.

 

Providers Say Mental Health Services To Suffer If State Cuts Enacted

The Connecticut Day, April 13

Mental health experts who spoke before the governor's Sandy Hook Advisory Commission on Friday said they oppose the governor's $63 million cut to mental health services in 2014 and 2015.

"I understand the pressures Gov. (Dannel P.) Malloy is under to establish a budget. At the same time, these kinds of cuts have already translated into the elimination of core grants that keep the mental health system going," said Dr. Harold Schwartz, a commission member and vice president of behavior health at The Institute of Living at Hartford Hospital.

Malloy's two-year budget calls for reducing state subsidies for underinsured and uninsured individuals by $63 million. The reasoning was that by Jan. 1, 2014, more people would be insured under the Affordable Care Act. Therefore, clinics providing mental health services would receive Medicaid or private insurance payments for their services instead of needing state subsidies. Schwartz said without the $63 million in grants, which support outpatient clinics at a variety of facilities, those parts of the care system for individuals with mental illness are not sustainable.

"Clinics around the state are at risk for closing access to inpatient beds and other levels of care are at risk for going away," Schwartz said. "And all of these patients … would be accessing it through overcrowded emergency rooms that will back up in unsustainable ways, leading many to not seek care."

 

Greater Hartford Hospital Margins Improve in FY'12

Hartford Business Journal, April 12

Greater Hartford hospitals are seeing improvements in their financial condition as better operating performance and higher investment returns are helping to pad their bottom lines.

Hartford Hospital, Bristol, Manchester, Middlesex, and Rockville hospitals, along with the Hospital of Central Connecticut all reported higher margins in fiscal 2012, while St. Francis Hospital and Medical Center and Farmington's John Dempsey Hospital narrowed their losses.

 

Most Hospital Profit Margins Up

Journal Inquirer, April 11

A new state report suggests that Connecticut hospitals on average improved their financial performance over the last fiscal year. But it also reveals that four of 28 hospitals covered by the report recorded negative total margins, which means they didn’t receive sufficient revenue to pay expenses and had to use other sources of funds to cover costs.

“Total margin” also might be called “profit.” Topping the positive margin list was St. Vincent’s Medical Center in Bridgeport, at 18.91 percent; William W. Backus Hospital in Norwich, at 12.98 percent; Midstate Medical Center in Meriden, at 10.56 percent; Hartford Hospital, at 9.42 percent; and Danbury Hospital, at 9.39 percent.

 

Hartford Steam Company Agrees to Purchase Fuel Cell Power Plant; Will Sell Ultra-clean Electricity to Hartford Hospital

The Wall Street Journal, April 17

Energenic's subsidiary, Hartford Steam Company, has reached an agreement to install a 1.4 megawatt fuel cell at Hartford Hospital.

Hartford Steam will sell the ultra-clean electricity and steam generated by the $8 million power plant to Hartford Hospital under a long-term energy purchase agreement that will result in savings to the hospital. Excess heat not used by the hospital will be used by the district heating system owned and operated by Hartford Steam. The plant is expected to be operational in December 2013.

Over one year of power production, the fuel cell power plant is expected to prevent the emission of more than 57,000 pounds of nitrogen oxide, a pollutant that causes smog, as well as preventing the emission of more than 128,000 pounds of sulfur dioxide and more than 3,000 pounds of particulate matter compared to conventional combustion-based power generation. The high efficiency of the fuel cell power generation process significantly reduces COemissions compared to combustion-based power generation and the combined heat and power configuration further drives efficiency. The power plant is expected to prevent the emission of more than 6,700 tons of CO over the course of one year when compared to conventional combustion-based power generation, which is equivalent to removing more than 1,200 cars from the road.

Story also in NASDAQ GlobeNewswire

Story also in Hartford Courant

 

$500,000 Land Deal Questioned By Hartford Residents

NBC Connecticut, April 26

A recent land deal between SAMA, the City of Hartford and Hartford Hospital has some residents asking questions.

That property is located at 95 Park Street. It's SAMA's main office building. About a year and a half ago, SAMA bought it and the and land it sits on for $1. According to documents, SAMA turned around the same day and sold a piece of the land to Hartford Hospital for $500,000. Hartford Hospital needed that land in order to build a parking garage.

The quit-claim deed , signed by the Mayor, shows the city was well aware of the land's value and Hartford Hospital's desire to buy it from the city. Instead of selling the property for the $500,000 though, city leaders sold it for $1, allowing SAMA to collect the hefty sum.

In the HHC System

Healthy Living: Patient portals make accessing your health information easy

The Bristol Press, April 15

By Jeff Finkelstein, M.D., who was chief of Emergency Medicine and Chief Medical Information Officer at The Hospital of Central Connecticut, and is now chief of Emergency Medicine at Hartford Hospital.

What if you could get your medical records without leaving home, or message your doctor’s office to request an appointment or ask a question about a health condition?

A patient portal may allow you to do these and more. Patient portals give you online access to your medical information; and many allow you to interact with your health care providers. Patient portals work much like online banking: You go to a secure website with a login screen, and after entering your user name and password, you’re connected to your information stored on the hospital or doctor’s office electronic medical record system.

Not all hospitals and physician offices offer patient portals, but they will likely become more common as more health care providers adopt electronic medical records. The federal government is encouraging the adoption of electronic records and other technologies by offering financial incentives to health care providers that implement and demonstrate “meaningful use” of these technologies.

If your hospital or physician offices offer a patient portal, take advantage of it. Most portals are free to register for and use, and provide an easy, convenient way for you to play a greater role in your care and take charge of your health.

To learn more about the hospital’s patient portal, MyHOCC, visit www.thocc.org/patients.

 

Health Advice, Exercise on Tap at Walk With a Doc at Norton Park

New Britain Herald, April 11

Hartford HealthCare’s next Walk with a Doc will be held at 9 a.m. April 20 at Norton Park, Plainville. It will include a 30-minute walk and health tips from Timothy Parsons, M.D., neurologist, who will discuss “Stroke Symptoms and Treatment.”

Sign-in is at 8:30 a.m. New participants will receive a hat and pedometer; each walker will receive a water bottle. Event host is The Hospital of Central Connecticut. Walks will continue on a monthly basis through September.

Hartford HealthCare’s Walk with a Doc program is part of Just Walk!, a Walk with a Doc program that hosts free community walks at area parks that are led by doctors and stress the benefits of exercise while providing health tips. Hartford HealthCare’s Walk with a Doc program includes MidState Medical Center and HOCC. Sponsor is HPC Foodservice.

Walk with a Doc was started in 2005 by a cardiologist in Ohio. There are about 100 active Walk with a Doc sites in the United States as well as in several other countries.

 

Public Invited To Rushford For Open House May 9

Hartford Courant, April 22

Rushford at Glastonbury, 110 National Drive, Glastonbury, invites the community to learn more about the substance use prevention and recovery services it provides to both adolescents and adults by attending an open house on Thursday, May 9 from 3 to 7 p.m.

"This is an opportunity to meet our clinicians and staff, tour the facility and answer questions about Rushford's substance use recovery programs based in Glastonbury," said Rushford President and CEO Jeff Walter. "Whether you are a provider or a concerned family member, if someone you know is seeking a substance use recovery program with flexible hours, and clinicians who provide support, privacy, and encouragement, we invite you to learn more about Rushford at Glastonbury by attending our open house."

 

Rushford Program Receives Accreditation

Middletown Press, April 25

Rushford Center’s post-graduate addiction medicine residency and fellowship program has been accredited by the American Board of Addiction Medicine, members said Thursday.

Rushford and Hartford Hospital, partners in the Hartford HealthCare system, said the town’s location is among eight of the nation’s leading medical organizations to receive fellowship accreditation from the ABAM. They join an elite group of the foundation’s accredited programs across the country and in Canada.

“An important goal of the fellowship is to prepare candidates for independent practice and certification in addiction medicine, also offered by ABAM,” said Dr. Samuel M. Silverman, Rushford’s ABAM Fellowship Program Director, in a statement. “By doing this, we ensure that high-quality, interdisciplinary, evidence-based addiction treatment programs can be provided to those most in need of this clinical service.”

The fellowship offers physicians a one-year training opportunity in the evaluation and treatment of patients with substance use disorders. They will train across a broad array of clinical settings at Rushford’s five state campuses, including Middletown. Candidates will also have the opportunity to work within Hartford HealthCare’s Behavioral Health Network partners, including The Institute of Living/Hartford Hospital and MidState Medical Center.

Health Care News In the Region

Budget Plan Means Layoffs, End of Services, Say Hospital Advocates

Hartford Courant, April 11

The governor's proposed state budget plan will "devastate" Connecticut hospitals and cause layoffs and elimination of services, hospital advocates and legislators told a crowd of hundreds at the state Capitol on Thursday.

"There is no way around it — cuts of this magnitude will impact patient care," said Jennifer Jackson, president and CEO of the Connecticut Hospitals Association. "It will close programs and services. It will put people out of work in hospitals and around the communities. It will lay an added health care cost on businesses and premiums for workers. We cannot let this happen."

The crowd — mostly hospital workers and administrators –- packed a room in the Legislative Office Building and spilled out into the hall, prompting security officials to clear the way several times. The rally featured speakers from Connecticut hospitals, lawmakers and workers concerned about the proposed state budget. Patrick Charmel, CEO of Griffin Hospital in Derby, also said that the state had imposed a tax of $350 million on hospitals in 2012. It was welcomed by hospital officials at the time because, by exploiting a federal loophole, the state would then "recycle" the money back to the hospitals. In the proposed budget, though, the state will be keeping most of that money.

Over the next two years, according to the Connecticut Hospital Association, $403 million from this tax will not be returned to hospitals. Additionally, hospitals will lose $45.4 million due to Medicaid rate cuts and $100.7 million because of the elimination of Disproportionate Share Hospital subsidies — federal money provided to help make up some of the costs of care for the uninsured and shortfalls in Medicaid payments.

 

Boston Bombing a Lesson in Prep For Hospitals

MedPage Today, April 16

The Boston Marathon bombing serves as yet another tragic reminder that American healthcare must be prepared to deal with terrorist attacks that result in the injuries typical of the wide-ranging damage caused by explosive devices, experts said Tuesday.

"The complexity of these injuries is not something that the usual emergency physician sees," said Richard Hunt, MD, senior medical adviser for the federal government's Hospital Preparedness Program in Washington. "We have a lot of collective learning to do."

Injuries like those incurred in Boston are similar to those inflicted in bombings around the world, Hunt said: Primary damage comes from the force of the blast. But projectiles intentionally built into the device, like nails, or from surrounding material -- like flying glass, concrete, and metal -- gain force in the explosion. Internal injuries result from compression. Blood loss is extreme. And mental health issues -- the result of terror -- can linger and debilitate if not addressed along with other injuries.

David Marcozzi, MD, director of the Hospital Preparedness Program, also a lieutenant colonel in the U.S. Army who has served two tours in Iraq, said American doctors will need to learn from military doctors how to handle bomb injuries at home. In addition to treating myriad wounds, healthcare systems will need to be as organized for bomb events as military systems in the battlefield.

 

Westerly Hospital Sale Process Enters Final Stages

The Connecticut Day, April 19

Finally, after a year and a half of uncertainty about the future of The Westerly Hospital, the end is in sight.

The decision this week by the Rhode Island Department of Health and Rhode Island Attorney General Peter Kilmartin to approve the sale of the financially troubled hospital to Lawrence + Memorial Hospital in New London is being met with a collective sigh of relief throughout the community.

Steven Hartford, Westerly town manager and head of the Westerly Hospital Area Residents Committee, said that knowing the closing will take place by June 1 gives the community assurance that the institution that came close to shutting down will instead stay open with new ownership and a fresh infusion of cash.

Some L+M managers and other staff may be assigned temporarily or long-term to work at Westerly Hospital, O'Farrell said. The two hospitals will maintain distinct medical staffs, O'Farrell said, with one significant change. EMP, the physicians group that staffs the main L+M Emergency Department and Pequot Health Center, will also staff the Westerly Hospital Emergency Department.

While there will be a lot of behind-the-scenes activity going on to bring about the closing, O'Farrell said, patients and the rest of the public should notice little if any immediate outward signs of change.

Hot Topics in Health Care

The Impossible Workload for Doctors in Training

The New York Times, April 18

Over the past decade, in response to public concerns about medical errors arising from fatigue, the Accreditation Council for Graduate Medical Education, the organization responsible for accrediting American medical residency programs, has been progressively limiting the number of hours that trainees can work. The latest mandate, which took effect in 2011, is the most stringent and deals most specifically with interns. These youngest doctors are allowed to work no longer than 16 hours in a day; and residency programs that violate the restriction risk losing their accreditation.

In response to the 16-hour mandate and faced with a Rubik’s-cube conundrum of covering all the work with the same number of interns working fewer hours, training programs across the country came up with several innovative scheduling configurations. Some created complicated and overlapping shifts where outgoing doctors “signed out” their patients, passing off their responsibilities to the incoming shift. Others adopted a “night float” system that meant a resident just a year out of internship had to carry the work of as many as 12 interns at night, looking after more than 100 patients and fielding questions about those patients at best every 20 minutes and at worst every 11 minutes throughout the night.

Now, two years after the 16-hour mandate was established, studies on the outcomes are being published, and the results reveal one thing: Maybe we should have thought a little harder about the arithmetic.

Contrary to expectations, these studies have shown that interns have not been getting significantly more sleep. Moreover, they are not happier, nor are they studying more. In one national survey, nearly half of all doctors in training disapproved of the regulations altogether. Another study revealed that interns were spending less time in educational activities because the additional time required for such conferences and lectures would push them over the 16-hour limit.

 

Hospitals Profit From Surgical Errors, Study Finds

The New York Times, April 16

Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds.

Changing the payment system, to stop rewarding poor care, may help to bring down surgical complications rates, the researchers say. If the system does not change, hospitals have little incentive to improve: in fact, some will wind up losing money if they take better care of patients.

 

Emergency Doctors Promote Patient Handoff Checklist

American Medical News, April 17

A group of emergency physicians recently launched a website offering free tools designed to standardize the patient handoff process to reduce the risk of harmful communication miscues.

About half of so-called sentinel events — mistakes that result in death or serious patient injuries — involve errors that occur during handoffs in care, according to the Joint Commission. The problem is pronounced in the fast-moving arena of emergency care, where noisy environments, frequent interruptions and high-acuity patient loads combine to make handoffs a hazardous endeavor, said Drew C. Fuller, MD, MPH, an emergency physician who gave a presentation April 5 about the new handoff procedure at the Maryland Patient Safety Foundation’s 9th Annual Patient Safety Conference in Baltimore.

“Handoffs are considered one of the riskiest procedures in the emergency department or any high-risk area in the hospital,” Dr. Fuller said. “We wanted a system that invoked high reliability.”

Dr. Fuller works for Emergency Medicine Associates, a Germantown, Md.-based provider of emergency medical services in the mid-Atlantic region. He and his colleagues at EMA developed the new handoff protocol, dubbed Safer Sign Out, which was finalized after surveying more than 100 of the company’s doctors. It already has been implemented at 12 hospitals serviced by EMA in Maryland, Virginia, Washington, D.C., and West Virginia.

The key to the handoff protocol is the Safer Sign Out Form, a quality assurance tool separate from the medical record that serves as a checklist for the physician whose shift is ending to complete along with the physician taking over. The doctors note patient diagnoses, key issues, potential safety concerns and pending items. The physician signing out asks the doctor coming on shift the open-ended query, “What questions do you have?” to promote discussion.

 

A Health Provider Strives To Keep Hospital Beds Empty

The New York Times, April 23

Advocate Health Care, based in Oak Brook, Ill., is a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services.

Advocate, a faith-based nonprofit, has an advantage over other health systems just jumping into what is more broadly known as “value-based care.” In the late 1990s, well before it forged its contract with Blue Cross Blue Shield, Advocate began taking steps to control costs and improve quality. A decade ago it adopted a “clinical integration” program, requiring doctors to work together on patients in common. It was also a pioneer in the use of electronic health records.

Under Advocate’s deal with Blue Cross Blue Shield, certain patients are assigned to the accountable care framework — about 380,000 — and their health costs are projected. If Advocate achieves savings below that amount while meeting explicit quality targets, it splits the money with the insurer. If not, its revenue is at risk.

Most health economists agree that accountable care organizations are one of the most promising recent developments in the giant industry. Kaufman Hall, a consulting firm that studied Advocate’s results, said its research showed that the older and the bigger a value-based care system, the more capable it proved at controlling costs — and the more it was able to influence the larger community of health care providers.

Coming Events

April 30 (Tuesday)

ECHN First Annual Diabetes Symposium: The Ins and Outs of Diabetes Management for the Health Care Professional

Manchester Country Club, 8 a.m.-4:30 p.m.

Eastern Connecticut Health Network (ECHN) first annual Diabetes Seminar. Increase awareness and knowledge of issues related to management and treatment of diabetes from an inpatient and outpatient perspective at this seminar. Attendees can earn up to 6.5 hours of CME while reviewing inpatient, outpatient and surgical topics.

Intended audience is physicians, hospitalists, nurse practitioners, physician assistants and nurses. There will be speakers from Hartford Hospital, St. Francis Hospital and Manchester Hospital.

Fee is $75. Breakfast, lunch and snack are included. There will be participant quizzes and great prizes! Advance registration is required. Register online only. For more information, contact Sharmila Swerathan at 860-647-6824, or 860-646-1222 ext. 2149.

 

May 5 (Sunday)

Sharon's Ride.Run.Walk for Epilepsy

West Haven, 7:30 a.m.

The 9th Annual Sharon's Ride.Run.Walk for Epilepsy is Sunday, May 5, starting at 7:30 a.m. at Old Grove at Savin Rock, in West Haven.

Last year we doubled the number of participants and doubled the amount of money raised from 2010. We want to continue to grow the number of people attending this event and show our support and solidarity for those living with epilepsy. Start a team, get your family, friends, coworkers together and have them register and collect donations.

We have some great sponsors: Hartford Hospital, On the Border from Orange, who will be there with a taco bar; entertainment by Juicebox, and FUN activities for your kids.

For more information, contact Allison Gamber at the Epilepsy Foundation at 860-346-1924 or allison@epilepsyct.com.

 

May 9 (Thursday)

Sixth Annual Neil Grey MD Memorial Lecture in Diabetes (Medicine Grand Rounds)

Gilman Auditorium, 8 a.m.

The Sixth Annual Neil Grey MD Memorial Lecture in Diabetes will be held Thursday, May 9 from 8-9 a.m. in Gilman Auditorium. Speaker is Dr. Guillermo Umpierrez, head of endocrinology and diabetes at Grady Health System at Emory University. Topic is Inpatient Management of Medical and Surgical Patients With Type 2 Diabetes.

 

May 9 (Thursday)

State of the Art Dialysis Surgery Made Simple

Glastonbury GI Center, 7 p.m.

Hartford Hospital experts Dr. Matthew Brown and Dr. Caroline Rochon will provide education about the most common dialysis access surgeries at a free educational seminar on Thursday, May 9 from 7-8 p.m. at the HH Glastonbury GI Center, 300 Western Boulevard. Registration is required through the Health Referral Service; call 860-545-1888.

 

May 9 (Thursday)

Psychiatric Grand Rounds

IOL Commons Building, Hartford Room, 12 p.m.

Topic: Neurotransmitter Regulation & Eating Behavior

Presenter: Barbara E. Wolfe, PhD, RN, FAAN, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA

 

May 16 (Thursday)

Department of Medicine Meeting

Gilman Auditorium, 8 a.m.

 

May 15 (Wednesday)

24th Annual Mary Mulready Sullivan Oncology Symposium:
Advances in Melanoma: Strategies for Screening, Local and Systemic Management

ERC, 7:30 a.m.-2 p.m.

Hartford Hospital Faculty includes: Dr. Lisa Kugelman, division chief, Dermatology, Hartford Hospital; Dr. Zendee Elaba,director of Dermatopathology at Hartford Hospital; Dr. Robert Piorkowski, division chief, Surgical Oncology at Hartford Hospital.

Visiting Faculty includes: Dr. Ryan Sullivan, medical oncologist, Melanoma Program, Massachusetts General Hospital Cancer Center, Boston; Dr. Michael Davies, director, Department of Melanoma, Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston; Dr. Frank Stephen Hodi, co-director of Dana-Farber/Harvard Cancer Center Melanoma Program, Boston; Virginia Seery, nurse practitioner, Biologics and Cutaneous Oncology Programs, Beth Israel Deaconess Medical Center, Boston.

Program objectives include: strategy for screening and treatment; coordinate care with multidisciplinary team; utilize information about new targeted therapies and articulate the staging system for melanoma and how it is utilized to guide patient care.

Fee is $50 for physicians and $20 for non-physicians; Students and residents - no charge. Registration deadline is May 6. For more information or to register by phone with credit card, contact Sandi Beggs at 860-545-2390 or sbeggs@harthosp.org.

 

May 16 (Thursday)

Emergency Medicine Grand Rounds

Gilman Auditorium, 12 p.m.

Topic: Mass Casualty Incident: Tabletop Exercise

Presenter: Dr. Stanley Chartoff, UConn School of Medicine, chair of the Emergency Department Disaster Preparedness Committee

 

May 17 (Friday)

12th Annual Henry Low Heart Center Cardiovascular Nursing Symposium

ERC, 8 a.m.-3 p.m.

This symposium is designed to educate Hartford Hospital nurses on a variety of cardiovascular topics. Speakers will be Dr. Eileen Herman, Dr. Jeffrey Klugar, Dr. John Granquist, April Mann, Jami Tyska, and Angel Rentas.

 

May 18 (Saturday)

NAMI Walk (National Alliance on Mental Illness)

Bushnell Park, 10 a.m.

Come join the IOL team and support the 10th annual NAMI (National Alliance on Mental Illness) Walk on Saturday, May 18 at 10 a.m. at Bushnell Park. the largest and most successful mental illness awareness event in America. Support NAMI's mission of education, support, and advocacy for those with mental illness.

To join the team and/or donate please go to http://namiwalks.nami.org/IOL2013. For more information, call the IOL Family Resource Center at ext. 5-7665.

 

May 22 (Wednesday)

Medical Staff Annual Spring Event and Awards Meeting

Heublein Hall, ERC, 6-8 p.m.

Medical Staff Annual Spring Event and Awards Meeting, May 22.

 

May 23 (Thursday)

Med-Path CPC (12)

Gilman Auditorium, 8 a.m.

Dr. Demytra Mitsis

 

May 30 (Thursday)

Medicine Grand Rounds

Gilman Auditorium, 8 a.m.

Topic: Transplant - Current Issues

Presenter: TBD

 

June 1 (Saturday)

Susan G. Komen CT Race for the Cure

Bushnell Park, 7 a.m.

This annual event to raise funds for breast cancer awareness will be held Saturday, June 1, at 7 a.m. in Bushnell Park.

Participants can register online or on the day of the event. Fees are: Youth - $10 ($15 day of race); Regular - $30 ($35 day of race); In The Pink - $75.

Please join the Hartford Hospital Team Hartford HealthCare! Register online at www.komenct.org (click on "Join Existing Team - Hartford HealthCare").

For more information, contact Linda Skiff at 860-545-5387 or lskiff@harthosp.org.

 

June 7 (Friday)

Safe Opioid Prescribing Academy

Gilman Auditorium, 8 a.m.-4 p.m.

Presented by The American College of Medical Toxicology (ACMT). Recent changes in the world of prescription opioids. Come interact with experts in medical toxicology, emergency medicine, addiction medicine, and pain medicine as we address issues requiring your attention in this changing area of medical practice. This day-long symposium will combine didactic presentations with break-out sessions and panel discussions to provide an informative, interactive experience.

 

June 13 (Thursday)

Semi-Annual Medical Staff Meeting

Gilman Auditorium, 6:45-8 a.m.

 

 

July 12 (Friday)

2nd Annual Medical Staff Chef to Farm Dinner

Rosedale Farms, Simsbury, 6-9 p.m.

Please save the date for the 2nd Annual Hartford Hospital Medical Staff “Chef to Farm” Dinner from 6-9 p.m. on Friday, July 12, 2013 at Rosedale Farms in Simsbury. More details will follow.

 

July 13 (Saturday)

ERRACE

Helen & Harry Gray Cancer Center, Avon

Save The Date And Start Training! The ERRACE (Everyone Ride/Run Against Cancer Everyday) organizational team is asking for your help in our fight against cancer. Our goal is not only to raise funds to support cancer care and research, but also to inspire good health, fitness, self awareness and to challenge you to try something new.

Like last year, our event will be held at the Helen & Harry Gray Cancer Center in Avon and will include a supported 25, 50, or 100-mile road bike ride, a 20-mile technical mountain bike ride and a 5 km run/walk. In addition, we plan to have a return of the exotic car corral/parade, wellness tent, raffle, giveaways, and fabulous food.

We are deeply saddened by the loss of our co-executive director, Allyson Caputo, who passed away after a long and courageous battle with cancer. She was the driving force in the founding and running of ERRACE, an inspiration to all who knew her. Her life was not defined by its length, but by its glory. We continue on in her example of perseverance and challenge all of you to do the same.

We are excited to inform you that ERRACE was the LIVESTRONG Foundation’s top grassroots fundraiser for 2012. We raised over $185,000, thanks in part to our top fundraising team "miles4mary" and all the cyclists and runners who participated in 2012 to ERRACE cancer. This award has lead to our partnership with the LIVESTRONG foundation, and we are now a partnered event. Funds from ERRACE will still be split between the LIVESTRONG foundation and the Helen & Harry Gray Cancer Center.

To find out more please go to www.errace.org. Please save the date and start training. We will inform you when registration is open.

 

 

For more coming events, click here.

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. If you would like to be added to the Seymour Street Journal email list, or to receive it at a different email address, please opt-in at www.harthosp.org/SSJ. This ensures that you will receive the newsletter at your preferred email address. Back issues can be viewed here. For any questions or suggestions, please contact Dr. Jeffry Nestler, Medical Staff President, at (860) 836-7313.