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

January 6, 2013 Edition

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HH Facts:

1988--The country's first aortic valve valvuloplasty, and the state's first mitral valve valvuloplasty, were performed by
Dr. Ray McKay.




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In This Issue...
Top News

Influenza Update #1

We are seeing an early and severe flu season this year. The predominant strain locally and nationally is H3N2, and as of Dec. 28, 2012, the vaccine is a good match to the strains that we are seeing. Flu vaccine effectiveness varies by age and underlying conditions, so infection control is still important.

The incubation period for influenza is one to four days, with an average of two days. From 10-25% of people with the flu are relatively asymptomatic, and 30% are infectious one day prior to symptoms.

The influenza virus is shed on average four to seven days (unless the patient is young or immunocompromised, when it can be 10 days or longer.) In the past it was thought that using Tamiflu for treatment shortened or decreased viral shedding. But more recent studies find that is has no impact on shedding of the virus. Tamiflu is effective for prophylaxis between 50-85% of the time.

ISOLATION: Tamiflu does not play into the decision to isolate a patient. Patients with the flu should be isolated for 24 hours after fever/symptoms resolve, or for seven days – whichever is longer. Patients should be placed on DROPLET ISOLATION using a surgical or procedure (yellow) mask. An N-95 mask is not required, but good hand hygiene is!

Patients with the following strains of influenza can be cohorted:
• H3N2 with H3N2
• H1N1 with H1N1
• Influenza B with Influenza B

DO NOT repeat the PCR to determine that the patient has been cured.

Health care workers can return to duties 24 hours after symptoms/fever resolve.


IOL Opens its Doors as Community Resource Following Sandy Hook Tragedy; Doctors Widely Quoted

Hartford Hospital’s Institute of Living opened its doors to the public, as well as to hospital staff, following the Sandy Hook tragedy, offering free counseling for those needing assistance to deal with the event.

A number of media, including international media outlets, quoted Dr. Hank Schwartz, Hartford Hospital psychiatrist in chief and director of the IOL, and other IOL staff concerning mental illness that might lead to such a tragedy. Dr. Schwartz was quoted in The Hartford Courant and the CT Mirror, among numerous outlets, and on WFSB – Channel 3 and WTIC – 1080 AM.

Dr. Laura Saunders, an IOL staff psychiatrist, was interviewed live on WFSB, Fox CT, NBC Connecticut, WDRC –102.5 FM, WRCH –100.5 FM and WTIC-AM.


Medical Staff, Medical Groups Bolster Successful 2013 Black & Red

Under the inspired leadership of Dr. Patricia Sheiner, Hartford Hospital’s Medical Staff and affiliated medical groups provided robust support for Saturday night’s very successful Black & Red at The Bushnell. As a result, our transplant patients and families will benefit significantly from nearly $1 million in net proceeds that will be used to refurbish our Outpatient Transplant Center.

Among the sponsors for the event were:
• Presenting sponsor ($35,000): Medical Staff
• Producer sponsors ($20,000): Jefferson Radiology, Hartford Anesthesiology Associates, Orthopedic Associates, Connecticut Multispecialty Group and Connecticut GI
• Director sponsors ($10,000): Connecticut Cardiology Consultants, Women's Health Connecticut, and Hartford Pathology Associates
• Spotlight sponsors ($5,000): Hartford Cardiac Lab and ProHealth Physicians

Our thanks to all our sponsors for their wonderful support.


Length of Stay Initiative: Important Update

One of the most critical components of reducing length of stay and providing the best possible care to our patients is to proactively plan for discharge starting on the day of admission.  As many of you know, daily discussion of an Anticipated Date of Discharge for every patient has been a focus point of the new Clinical Progression Rounds that are taking place on the ten targeted units involved in the Clinical Progression Rounds initiative.

 As part of this initiative, daily nursing documentation of Anticipated Dates of Discharge will begin January 8, 2013 on these targeted units. Staff nurses will be responsible for documenting Anticipated Dates of Discharge daily for each of their patients, with direction from the provider and the rest of the care team. 

The process for this documentation is outlined as follows:
 1. Staff Nurses will reference the Anticipated Discharge Date Order documented by the provider, if applicable, upon admission

2. The care team will discuss daily goals, plans for discharge, and Anticipated Dates of Discharge during daily Clinical Progression Rounds

3. Staff Nurses will update the date as the plan of care changes for the patient

 Nursing documentation of Anticipated Dates of Discharge will appear in the patient header in SCM so that it is visible to the entire care team.
 Documentation and communication of Anticipated Dates of Discharge will:
1. Promote safety and quality patient care
2. Enhance care team communication
3. Improve patient and family satisfaction
4. Reduce unnecessary handoffs and communication delays
5. Improve efficiency of care
6. Reduce delays caused by surprise discharges
In order to ensure this process is successful, providers should communicate directly to nurses and others on the care team about patient goals and plans for discharge.
Thank you for your continued support.


HHCMG – The Foundation - Now Officially Open

Hartford HealthCare Medical Group officially opened January 1. Last spring, we announced the formation of a medical foundation designed to provide a structure for physicians and advanced practitioners employed by Hartford HealthCare.

This group brings together physicians in more than 60 offices and our four Hartford HealthCare Hospitals and is made up of clinicians who have practiced with Hartford Specialists, Hartford Medical Group, MidState Medical Group, Doctors of Central Connecticut and Windham Family Medical Associates.

The name Hartford HealthCare Medical Group was chosen with the assistance of Landor, a nationally respected branding and marketing company that also created the successful Hartford HealthCare branding strategy two years ago.

Dr. Kent Stahl is president of the new organization as well as vice president of the Primary Care Division, and Dr. Jeffrey Cohen is vice president of the Specialty Care Division.


New Hudson Street Parking Garage To Open This Week

The new Hudson Street Employee Parking Garage will open its doors to the first phase of parkers next Wednesday. We are opening the garage in phases in order to work out any potential traffic flow issues. All phases will be complete by March 1, when all eligible staff will be parking in the new structure.

The new 440,000-square-foot garage adds 1,250 spaces and increases available campus parking by 20 percent. Safety was a key factor in construction of the garage, which has more than 80 safety features.

The new garage will allow us to open up B and J lots and two floors of the old employee garage for public parking. We will also have 150 unspecified spaces to accommodate public events, and much more signage and directions to parking.

We are very optimistic that parking at Hartford Hospital will be better and ample and that we will have 500 to 1,000 open spaces at any one time.

Built into the new parking garage facility is a staff Fitness Center. Scheduled to open at the end of February, the center will be open 24/7 with card access.



Clinical Ethics Rounds Focuses on Case From Bliss 11I

The Hartford Hospital Ethics Committee invites all health care professionals to Clinical Ethics Rounds on Tuesday, Jan. 29 from 11:30 a.m.-12:30 p.m. in Gilman Auditorium.

A new policy "Conscientious Practice in Medical Futility Disputes" case study from Bliss 11I will be presented. Lunch will be provided. CMEs and CEUs are available for MDs, RNs and social workers.


Innovative and Complex Care

New Transplant and Comprehensive Liver Center Opens in MOB

The renovated Transplant and Comprehensive Liver Center officially opened with a ribbon-cutting ceremony Dec. 10. The center is located in Suite 320 of our Medical Office Building.

The new facility reflects the excellence of our center staff and leadership and helps fulfill our mission of offering innovative and complex care for our region.

The center is a big step in our development of the institute model of delivering coordinated, multidisciplinary care in one convenient location.

Research and Academics

Call For Abstracts on Improving Patient Experience

How did you or your area improve the patient experience? You are invited to submit an abstract about it for a tabletop poster display on "The Patient Experience - Connecting With Purpose" for the First Annual HHC Patient Experience Event on April 12, 2013.

The event, to be held at Heublein Hall, is designed to showcase best practices and innovation across HHC.

Staff can submit an abstract in one of three categories: Improved Transitions of Care, Innovation, or Enhanced Patient and Family Centered Care. A winner and runner-up will be chosen in each category. The winner will be asked to present a brief presentation.

The deadline for submission is Friday, Jan. 11. We encourage you to take advantage of this exciting opportunity and share with other health care practitioners how you or your area improved the patient experience. Download the rules and application form here.


S.T.A.B.L.E. Program - A LIFE STAR Educational Opportunity

There will be a LIFE STAR S.T.A.B.L.E. program session on Saturday, Jan. 12 from 8 a.m.-4:30 p.m. in JB-118.

S.T.A.B.L.E. is an educational tool developed for maternal/child health care providers to organize care during the post-resuscitation/pre-transport stabilization period. It is the most widely distributed and implemented neonatal education program to focus exclusively on this care for sick infants. It stands for the six assessment and care modules in the program: sugar, temperature, airway, blood pressure, lab work and emotional support.

Instructors will be Jason Doonan, RN, and Michael Frakes, APRN. Registration is $25, and includes continental breakfast, lunch and afternoon snack. For more information, contact Patrick Dowd at 860-545-4369 or

Care Coordination

Hospital Implements SurgiCount Safety Sponge System in ORs

Hartford Hospital is the first hospital in the state to implement the SurgiCount Safety-Sponge® System to improve patient outcomes by eliminating the risk of retained surgical sponges. The system is used in the Operating Room, Women’s Health Cesarean Section Operating Rooms and Labor and Delivery Rooms, West Hartford Surgery Center and the Electrophysiology Lab.

The system uses computer technology to maintain an accurate real-time count of all the Safety-Sponge® products used on a procedure to help ensure none are left inside a patient.

Other hospitals and systems that use the system include the Mayo Clinic, Cleveland Clinic Health Care System and Massachusetts General Hospital.

Operational Update

Change in Social Security Tax Withholding

Because of the lateness of Congress’s decisions about changes in tax laws to avoid the “fiscal cliff,” our Payroll Department was unable to implement the 2 percent increase in Social Security taxes Congress called for beginning Jan. 1, 2013.

Therefore, this added 2 percent deduction will NOT be reflected in your pay this week (the week of January 4). However, in the next weekly pay cycle (for your January 11 paycheck), your Social Security deduction will be increased by 4 percent (2 percent for each of the two weeks). From January 18 going forward, your Social Security deduction will include the Congressionally mandated 2 percent increase.

This will affect all staff who are paid weekly from Hartford Hospital, Hartford HealthCare, Hartford HealthCare Medical Group, MidState Medical Center, Natchaug Hospital, Windham Hospital, Clinical Laboratory Partners, and Rushford.


Quint Studer To Visit as Executive in Residence Feb. 7-8

on February 7 and 8, Quint Studer will be an executive in residence at Hartford Hospital. Quint is a national leader in health care whose expertise is in achieving organizational excellence, a wonderful speaker, and the author of several best-selling books including Hardwiring Excellence, and Results That Last.

He is the founder of Studer Group which has worked with more than 800 organizations nation-wide and was the recipient of the 2010 Malcolm Baldrige National Quality Award.

Please take a few minutes to answer a quick survey/assessment. We will use the results of this data during our time with Quint. This survey is completely confidential and will take less than 5 minutes to complete. The deadline to complete this survey is Friday, January 11. President Jeff Flaks expects 100% participation from the leadership team.

To access the survey, click on the following link:

If you have any questions, please contact Diana Niro at 860-545-2349 or email

HH In the News

Out on the Town

Hartford Magazine, Dec. 10

The Arthritis Foundation honored doctors from Connecticut Children’s Medical Center, Hartford Hospital and Saint Francis Hospital and Medical Center at the Doc, Dine & Wine celebrity chef dinner at The Riverview in Simsbury, which featured a six-course meal created by local chefs.

Doctors honored were: Andrew E. Caputo, Hartford Hospital; Mark Ruderman, Hartford Hospital; Kristan A. Pierz, Connecticut Children’s Medical Center; John J. Mara, Saint Francis Hospital; and Thomas J. Terenzi, Saint Francis Hospital.


Hillary Clinton hospitalized after doctors discover blood clot

NBC news, Dec. 31, 2012

Secretary of State Hillary Clinton was admitted to a New York City hospital on Sunday after doctors discovered that a blood clot had formed, the State Department said in a statement. A deep vein thrombosis could be serious, but not necessarily life-threatening, and would require months of treatment with blood-thinning drugs, said Dr. Inam Kureshi, chief of neurosurgery at Hartford Hospital in Hartford, Conn. "Usually hospitalization is more of a precaution," Kureshi said.


After Newtown: A rethinking of Connecticut law on outpatient commitment

CT Mirror, Jan. 2

Forty-four states have laws that allow court-ordered treatment, under certain circumstances, for people with mental illness who are not hospitalized -- a concept known as outpatient commitment, or assisted outpatient treatment.

Connecticut is one of six states without such a law, and at least until recently, there was little appetite for creating one. Advocates for people with mental illness say Connecticut's system is at the leading edge of a model that takes the opposite approach, with a focus on having people with mental illness make choices about their treatment, the same way a cancer patient would.

"We have swung all the way from that very, very liberal interpretation of how people can be committed to very, very restrictive interpretations requiring very imminent sense of harm to self or others and even then allowing only very, very short hospitalizations," said Dr. Harold "Hank" Schwartz, psychiatrist-in-chief at the Institute of Living in Hartford.


What Don't Shooters Feel That The Rest Of Us Do?

Hartford Courant, Dec. 28 , 2012

FBI profiles tell us something about who mass shooters are, but not why.
Commentary by DR. HAROLD I. SCHWARTZ.


Report: Mental health care system fragmented, inadequate

CT mirror, Jan. 2

There are too few hospital beds and child psychiatrists for people seeking mental health and substance abuse treatment in Connecticut. There are too many barriers to getting services that could prevent crises. There's too much pushback from insurers over covering inpatient care even after a patient attempts suicide. And people with private health insurance often face some of the biggest challenges to getting treatment, according to a report issued Wednesday by the state Office of the Healthcare Advocate.

In one case described by Dr. Mirela Loftus, a child and adolescent psychiatrist at the Institute of Living in Hartford, an insurance company refused to pay for more than four days of inpatient care for a 13-year-old girl with schizoaffective disorder who had been found walking on the side of I-84 in Cheshire to find her imaginary in-laws, who she believed had kidnapped her imaginary triplets. Loftus said the insurer's medical director told the hospital that "walking on the side of the highway may be illegal but not dangerous," according to the report.

In the HHC System

Surgical Errors Climb, Bed Sores Decline In State's Hospitals

Hartford Courant, Dec. 31, 2012

Reports of wrong-site surgeries increased by 62 percent in the past year in Connecticut hospitals, while the number of patient deaths or disabilities resulting from surgery or falls also rose, a new state report shows.

At the same time, reports of patients suffering from serious pressure ulcers declined, as a number of hospitals made progress in preventing the painful bed sores.

The new Adverse Event Report, compiled by the state Department of Public Health and covering 2011, marks the second year that acute-care hospitals and other medical facilities have been publicly identified by name as they report errors that caused harm to patients.

The five hospitals with the highest rate of adverse events in 2011, calculated per 100,000 inpatient days, were: Charlotte Hungerford Hospital in Torrington (49.2); Sharon Hospital (35.4); New Milford Hospital (32.9); Stamford Hospital (19.7); and the Hospital of Central Connecticut in Southington and New Britain (19.3).

In Memoriam


Dr. James Krieger


Dr. James Krieger, co-founder of Jefferson Radiology, died Dec. 29, 2012 at his home in Chester, Vermont. He was 87.

Dr. Krieger was a board certified radiologist. In 1963 with three other radiologists, he founded the Jefferson X-Ray Group, now Jefferson Radiology and the largest radiological group in the state.

He is survived by his wife of 61 years, Eleanor, and seven children.

Coming Events

January 8 (Tuesday):

Cardiology Grand Rounds

11 a.m., JB 118

Topic: Age and Cardiovascular Care: Reconsidering Clinical and Research Priorities Amidst Current Aging Demographics

Presenter: Daniel E. Forman, MD, Associate Professor of Medicine, Harvard University, and director of the Exercise Testing Laboratory and Cardiac Rehabilitation, Brigham and Women’s Hospital


January 10 (Thursday):

Medicine Grand Rounds

8 a.m., Gilman Auditorium

Topic: Cardiology Cases

Presenter: Heather Swales, MD


January 10 (Thursday):

Neurology Grand Rounds

8 a.m., JB 118

Topic: Epilepsy and Sleep

Presenter: Yan Zhang, MD, PhD - Assistant Clinical Professor of Neurology, Hartford Hospital


January 17 (Thursday):

Medicine Grand Rounds

8 a.m., Gilman Auditorium

Topic: Medical Risk Management (1.5 hours)

Presenter: Peruvamba Venkatesh, MD, and the MRM Staff


January 17 (Thursday):

Psychiatric Grand Rounds

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

Topic: Walking the Clinical Tightrope: Treating Behavioral and Psychological Symptoms of Dementia in the Era of Blackbox Warnings

Presenter: Rajesh Tampi, MD, Yale University School of Medicine


January 24 (Thursday):

Department of Surgery Presentation: Side Effects of Transplant Medications

11 a.m., Bliss 303

Dr. John McNab, PA-C, MHS, Team Leader


April 12 (Friday):

First Annual HHC Patient Experience Event

Heublein Hall


For more coming events, click here.

Hot Topics in Healthcare

Sharing Orders With Patients

NEJM, Jan. 2

Roni Zeiger, a world class informatician who provided physician leadership for the Google Health project in the past, recently suggested an idea which may have the potential for significant innovation in the world of patient and family engagement - Patient Friendly Orders.

Imagine if every patient had access to a web page of their current hospital orders in patient friendly terminology…


13 Top Healthcare Buzzwords for 2013

HealthLeaders Media, Dec. 28, 2012

It's that time of year, again, when any self-respecting healthcare provider looks to bone up on the latest terms in the lexicon. This article gives information on these 13:
1. Oculostenotic Reflex
2. The Three Biases: Confirmation, Pro intervention, and Pro technology
3. Highly Reliable Organization or HRO
4. 'All Cause' Measurement Science
5. 'All-or-Nothing' Measurement Science
6. Sustainability
7. The Choluteca Bridge
8. Medical Extensivist
9. Human Factor Analysis
10. Innovation That Is Not
12. Population Health
13. Transforming or transformative.


Fiscal Cliff Stopgap Delays 'Doc Fix," but Hits Hospitals

HealthLeaders Media, Jan. 3

There was more exasperation than applause coming from the major players in the healthcare sector this week after Congress approved a stopgap measure to delay until March 1 a trip off the so-called "fiscal cliff."

Passage in the House late Tuesday of the "American Taxpayer Relief Act of 2012" (HR8) essentially delayed most of the tax hikes and sweeping budget cuts that were to begin on Jan. 1. The Senate version passed early Tuesday morning.
Impact on Physicians
The Taxpayer Relief Act features major provisions affecting funding of Medicare and Medicaid. The most significant healthcare provision is the continuation until Dec. 31, 2013 of the Medicare Physician Fee Schedule Sustainable Growth Rate, which had been scheduled for a draconian 26.5% cut on Jan. 1.

Voices Of Our Patients

Kudos to Dr. John Welch and Paul Vignati

I have always been proud to work for Hartford Hospital and have recommended our hospital to others. Now I can tell you first-hand what it is like to be a patient here. I was brought in on Nov. 18, received care in the ER and was transferred to Bliss 8.

They are not kidding about the “Bliss” part of Bliss 8. I received such wonderful care there. I had the BEST nurses and PCAs anyone could ask for. I just want to recognize all of you for the excellent care you gave me.

I cannot begin to thank you for all that you did for me during my stay. Not only do I commend my nurse, but my surgical team, Drs. John Welch and Paul Vignati and the countless residents, PAs and students. I was greeted early each morning by my “team.”

I would also like to thank my caregivers in the O.R., anesthesia and PACU. It was very comforting to see familiar and caring faces.

Thank you Steve for bringing me back to room on Bliss 8. I visited radiology as well they were also wonderful.

Administration has a lot to be proud of. I observed excellent teamwork, and watching the interaction between the staff indicated that we are more than just coworkers, we are a family.

I am looking forward to returning to work soon.
Thank you so much,
Cindy LaPier


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.