From the Offices of Stuart Markowitz, MD and Jeffry Nestler, MD

In This Issue...

October 6, 2013 Edition

HAND HYGIENE
Wash In - Wash Out

Wash

HH Physician Compliance - May to September

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HH Facts:

2000 - Uterine fibroid embolization, a minimally-invasive procedure, was pioneered in Connecticut by Drs. Michael Hallisey and John Greene.


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Top News

Hartford HealthCare Reorganizes Into Three Regions; Dr. Stuart Markowitz Named Hospital President

Becker's Hospital Review, Sept. 24

Hartford HealthCare announced it is reorganizing its facilities into three regions, and it announced leadership changes as part of the reorganization. Jeff Flaks, the current CEO of Hartford (Conn.) Hospital, has been named the first COO of Hartford HealthCare. The health system did not previously have a COO position.

MarkowitzMarkowitzMarkowitzDr. Stuart Markowitz, Hartford Hospital's CMO, has been named senior vice president at Hartford HealthCare and president of the Hartford Region, which includes Hartford Hospital, Hartford HealthCare Rehabilitation Network and academics.

Lucille Janatka (middle photo) has been named president of the Central Region, which includes MidState Medical Center in Meriden, and The Hospital of Central Connecticut in New Britain. She currently serves as president and CEO of MidState, and will also serve as CEO of HOCC.

David Whitehead (right photo) was named senior vice president at the health system and president of the East Region, which includes Backus Hospital in Norwich, and Windham Hospital in Willimantic. He will also serve as CEO of both the hospitals.

 

See also:

Hartford Business Journal: Hartford HealthCare restructures executive suite

Hartford Courant: Hartford HealthCare Reorganizes Into Regions

 

MarkowitzDr. Jack Greene Named HHC Regional VP of Medical Affairs

Dr. Jack Greene, who is well known to Hartford Hospital, will assume the position of Hartford HealthCare regional vice president of Medical Affairs for the Hartford Region and Hartford Hospital.

Jack has been part of the Hartford Hospital staff since beginning his residency here in 1983. He is board certified in Ob-Gyn and has received numerous awards and recognitions for his clinical, quality and teaching performance over the years.  Most recently he assumed the position of chief medical officer at Midstate Medical Center.

"I am pleased that Jack is able to return to Hartford Hospital to work with all our leadership teams and clinical practices to continue to advance the mission and vision for the Hartford region," said Dr. Stuart Markowitz. "Please join me in congratulating and welcoming Jack back to Hartford Hospital.  He will be a fantastic addition to our team."

 

Letter From Jeff Flaks About The Reorganization

Sept. 30, 2013

My belief is that every system is perfectly designed to get the results it gets. As we come to the close of the 2013 fiscal year today, we look back on results that included many high points in terms of improved patient experience, better quality measures and the expansion of our system into Eastern Connecticut. But our financial results were very disappointing, in part due to cuts in government reimbursements and a decline in volumes.

We know that if we want different results, we need a different system. Last week, Hartford HealthCare President and CEO Elliot Joseph wrote to describe a new, better-integrated organizational structure designed to help HHC execute on its strategy, standardize practices across the system and reduce the cost of delivering care. The end point is uniformly excellent and well coordinated patient care. I am writing today to provide more detail about this new, streamlined regional structure and to underscore the importance of this transformation for the people we serve.

Within the next 45 days, we will put into place regional and service-line leadership teams that will truly integrate the leadership of our hospitals. This simplified structure will make it easier to execute, standardize and respond to changes in our market. It will help us sustain consistent and system-wide quality, improve the patient experience and control costs – the three building blocks of value. Increasingly, payers and patients are looking for value in health care. We will be their first choice.

I can assure you that the new structure is not an organizational chart to be pinned to a bulletin board and forgotten. It is a tool for decisive action and firm resolve.

Here are the leadership teams for our regions.

Hartford Health Care - Hartford Region

  • HHC SVP and Hartford Region President – Stuart Markowitz, MD
  • Bimal Patel, HHC Regional VP, Operations
  • Jack Greene, MD, HHC Regional VP, Medical Affairs
  • Gerald J. Boisvert, HHC Regional VP, Finance
  • Cheryl Ficara, RN, MS, NEA-BC, HHC Regional VP, Patient Care Services
  • Peter Fraser, HHC Regional VP, Human Resources

These regional executives will have related responsibilities at Hartford Hospital, currently the only acute-care facility in the Hartford Region. The regional structure will allow for further regional growth. The leadership positions at Hartford Hospital reflect its size and its status as an academic medical center and research hub.

Hartford Health Care - East Region

  • HHC SVP and East Region President – David Whitehead
  • Carolyn Trantalis, RN, BSN, MSN, HHC Regional VP, Operations
  • Peter Shea, MD, HHC Regional VP, Medical Affairs
  • Dan Lohr, HHC Regional VP, Finance
  • Mary Bylone, RN, HHC Regional VP, Patient Care Services
  • Theresa Buss, HHC Regional VP, Human Resources

Hartford Health Care - Central Region

  • HHC SVP and Central Region President – Lucille Janatka
  • (Vacant), HHC Regional VP, Operations
  • Steven D. Hanks, MD, HHC Regional VP, Medical Affairs
  • Carolyn Freiheit, HHC Regional VP, Finance
  • Catherine Stevens, RN, MSN, OD, HHC Regional VP, Patient Care Services
  • Mary Morgan, HHC Regional VP, Human Resources

The regional team for the Hartford HealthCare Behavioral Health Network, under the direction of HHC Senior Vice President Stephen Larcen, PhD, will include Paul Maloney as HHC Regional VP, Finance. Other team members will be named by mid-November. Not included in the above charts are our non-acute care organizations, which are critically important to our mission to provide care across the entire continuum. In the next year, we will focus on further consolidation in these services, especially in support and back-office functions. In addition, we want to fully leverage the expertise and talent of our non-acute staffs across the entire system. System functions that will be part of our System Support Office, including Finance, Information Technology Services, Human Resources and Planning & Marketing also are working on changes and refinements to better support the new organizational structure.

You may ask why we’re moving forward with these changes in a short month and half. The simple reason is that it’s the right thing to do – and doing the right thing is one of our core values. We know that these changes will mean that some well-respected and long-time members of our leadership teams will be leaving Hartford HealthCare. With our values as our guide, we want these individuals to be clear about their situations. We want to honor their contributions and assist them as they move on to new stages in their careers. The other reason to act quickly is that we must move forward with urgency as a single system and with a strong sense of purpose. We face great opportunities and hard decisions ahead, and we want to tackle them both thoughtfully and decisively.

I know that many of you are anxious about these changes. It can be difficult to work in new ways and to adapt to new organizational structures and behaviors. But there is a huge plus side for all of us as we transform our system. As we create the health care system of the future, we are also opening up exciting new opportunities for staff development, advancement and collaboration. Most important, we are creating a much stronger foundation for our system and making sure that we will always be here for the patients who need us – especially the most vulnerable. Thank you for being part of this new chapter in the story of Hartford HealthCare – and for all you do every day.

Sincerely,
Jeffrey A. Flaks

 

JohnsonHand Hygiene Update: Continued Improvement

  • As of the end of September, the overall rate of hand hygiene compliance by HH physicians was 87%. The institutional target is 90%.
  • This is up over the previous two months, when it was 78% and 73%.
  • It is up 23% over February, when it was 64%.
  • We wash entering the room 82% of the time to protect the patient, and 91% of the time leaving the room to avoid being a vector of infection to our next patient and coworkers.
  • HHC physicians overall are at 84%, and Hartford Hospital overall is at 84%.

Congratulations to Hartford Hospital physicians, who are protecting our patients and thier families, and our coworkers. Their safety is in our hands.

 

Tiger Text (secure HIPAA compliant text app) To Be Provided Free To Physicians

Physicians often use their smartphone’s text messaging capabilities to support clinical communications with colleagues, care team members, medical staff and patients. However, the basic SMS messaging applications pre-loaded on most smartphones today are neither secure nor HIPAA (Health Insurance Portability and Accountability Act) compliant. Clinicians exchanging patient-related text messages over a public Wi-Fi or cellular connection create significant security risks and compliance problems for the hospital.

We will provide (free of charge) an encrypted HIPAA compliant text messaging app called Tiger Text for all physicians, APRNs, PAs, and fellows in the HHC system. TigerText enables physicians to use their Smartphones, tablets and laptops to securely send and receive HIPAA compliant text messages with colleagues, care team members, administrative staff and patients.

A pilot test of Tiger Text has been completed at MidState Medical Center, with very positive response from physicians.

We will be deploying TigerText across the system in October and November, with extensive vendor support and assistance. Please watch for more information.

 

JohnsonRegister Now! Becoming a High Reliability Organization: Elimination of Harm, With Kerry Johnson On Oct. 15

At Hartford Hospital we are committed to eliminating medical harm, and as a physician you play a leadership role in our journey towards high reliability. Our commitment includes providing mandatory training to every employee of Hartford HealthCare incorporating team-based practices and communication skills borrowed from other high risk industries, such as nuclear power and aviation.

Because of your key role, we have arranged for a nationally known expert to kick off this program on Tuesday, October 15 with a special training session geared for Hartford Hospital and HHC Medical Group physicians. For employed providers, this will satisfy the requirement for mandatory training in 2014.

Kerry Johnson is chief innovation officer of Healthcare Performance Improvement (HPI) and nationally known for his work in patient safety and high reliability. Kerry is a dynamic and interactive speaker and will share tested approaches and techniques in achieving and sustaining reduction in events of preventable harm. Don't miss this opportunity to hear this speaker!

Please join us on October 15 at one of the two sessions in Heublein Hall at Hartford Hospital: 8-10:30 a.m. or 5-7:30 p.m.; or in Meriden at the Pomoroy Conference Center from 1-3:30 p.m.

Participants in this session will be eligible for 2 AMA PRA Category 1 Credits. To register, please contact Joanne Sommers at joanne.sommers@hhchealth.org

If you are unable to attend this session, please note that multiple sessions will be offered at Hartford Hospital during the year (taught by in-house trainers).

 

Grand Opening of South Windsor Family Health Center

Hartford Hospital held a grand opening of our South Windsor Family Health Center Sept. 28 as part of our emphasis on increasing awareness of and access to care east of the river. The center includes Hartford HealthCare Medical Group primary and urgent care physicians, specialty care, and lab and rehabilitation services.

Excellence

Gifts in Memory of Dr. Bernstein

Family and friends of the late Dr. Scott Bernstein have honored his memory with contributions to the Transplant Program. The gifts will be used to support transplant and dialysis patients, families, and nursing education.

 

Dr. Joseph Klimek To Speak on Creativity in Art and Medicine

The Fifteenth Annual Crombie Lecture on the Humanities in Surgery is scheduled for Friday, October 11 in the Heublein Hall (ERC Building) from 6:45 a.m.with art exhibit to follow until 1 p.m. Dr. Joseph J. Klimek, vice president, Physician Relations, Hartford Hospital will be the speaker, and his topic is “Creativity in Art and Medicine.”

Submit your artwork: Physicians are invited to submit artwork (up to three pieces) to be included in the exhibit entitled "Creativity in Art and Medicine." Please bring your work to Heublein Hall on Thursday, Oct. 10 between noon and 3 p.m. The exhibit is the next day. You will remove your artwork Friday, Oct. 11 from 3-5 p.m. Please respond to Dr. Klimek by Friday, Oct. 4 at joseph.klimek@hhchealth.org if you would like to be included in the exhibit.

 

Suicide Week Activities Succeeded in Raising Awareness

World Suicide Prevention Day was recognized at the Institute of Living, Hartford Hospital on September 10 with a conference that focused on adolescents and young adults. More than 250 members of the greater Hartford professional community attended the conference, which was co-sponsored by the DMHAS, Ct Suicide Prevention Advisory Board.

The conference began with a presentation by Rosemary Baggish of the data on suicide thoughts, plans and attempts by adolescents in independent schools from the Independent School Health Check, a national survey offered through the IOL. The keynote address by Dr. David Rudd was entitled “Knowing what works with Suicidal Adolescents and Young Adults.”

Two case presentations were offered by IOL staff: Dr. Meredith Schwartzman presented the adolescent case and Dr. David Bendor presented the young adult case. The two cases were discussed by Dr. Rudd and Dr. Robert Sahl,medical director of Child and Adolescent Services and Dr. Steven Madonick, medical director of Young Adult Programs.

Dr. Hank Schwartz opened and closed the conference by sharing the commitment of the Institute’s medical and professional staff to better understand and to improve its ability to effectively manage and prevent suicide attempts with the people under their care.

 

Hartford Med: Living Miracles To Air Oct. 10

An all-new episode of "Hartford Med: Living Miracles" will be aired on Thursday, Oct. 10 at 7:30 p.m. on WFSB TV-3.

It will feature Drs. Gary Spiegel, section chief of Interventional Neuroradiology, David Hemphill, Jason Gluck, cardiology, and Inam Kureshi, chair of the Department of Neurosurgery.

The episode features three patients who made it, against all odds, and the staff that treated them. One is Todd Lentocha, a police officer from East Hartford who was critically injured in a car accident and spent more than five weeks here in a coma.

Audience members can chat online or by phone with the doctors after the show.

Research and Academics

Hep C Summit To Feature Staff From Liver Center and Transplant Program

There will be a Hepatitis C Summit in the ERC on Thursday, Oct. 17 from 7:30 a.m.-3:15 p.m. Speakers are:

Dr. Patricia Sheiner, director of the HH transplant program

Dr. Michael Einstein, medical director of Hepatology in HH's Comprehensive Liver Center

Dr. Colin Swales, medical director of Transplant Hepatology in HH's Comprehensive Liver Center

Dr. Jack Ross, director of infectious diseases, HIV and Epidemiology

Dr. Joseph Singh, nephrologist in the HH Transplant Program

Dr. Jonathan Israel, hepatologist in HH's Comprehensive Liver Center

Dr. Caroline Rochon, hepatobiliary and transplant surgeon

Dr. Mona Tiernan, HH's Comprehensive Liver Center and Transplant Program

Dr. Eva Urtasun Sotil, medical director of the Living Donor Liver Transplant Program at Columbia University College of Physicians and Surgeons

Christian Andresen, Connecticut Department of Public Health

Physicians: $75; residents, PAs, APRNs, nurses: $50; all others: $35. Includes continental breakfast and lunch.
Physicians may register online at www.harthosp.org/HepSummit. All other participants please call 860-545-1888 or toll-free 800-545-7664.

 

7th Annual Fred Cohen Symposium: 
“Brain Tumors-Standard Therapy and Why We Need a Bigger Boat:  Tumor Morphology or Molecular Array”

Hartford Hospital special Grand Rounds is the 7th Annual Cohen Symposium: “Brain Tumors-Standard Therapy and Why We Need a Bigger Boat:  Tumor Morphology or Molecular Array,” will be held on Friday, Nov. 1, from 7:30-8:30 a.m. in JB-118.

Speaker will be Dr. Craig Patrick Nolan, neurologist at Memorial Sloan-Kettering Cancer Center, NY, NY.

Target audience includes neurologists, neuro-oncologists, neurosurgeons, APRNs, oncology nurses, geriatric specialty  nurses, clinical nurse specialists, physician assistants, pathologists, pharmacists, oncology surgeons, medical oncologists, radiation oncologists, hospitalists, speech therapists, occupational therapists, physical therapists, nutritionists and dietitians, psychologists, psychiatrists, psycho-oncologists, and other interested oncology clinicians and specialists.

For more information, contact Sandi Beggs at ext. 5-2309 or sandi.beggs@hhchealth.org.

 

Drs. DiGiuseppe and Vafaii Present at American Society of Clinical Pathology Meeting

Drs. Joseph DiGiuseppe (director, Hematopathology and Special Hematology Laboratory) and Poopak (Pardis) Vafaii (PGY3 in Pathology) presented a poster describing the flow cytometric detection of monoclonal B-cell populations in CSF from patients with demyelinating disease at the annual American Society for Clinical Pathology meeting, which was held in Chicago. Their abstract was a finalist in the Best Lab Practice Poster award competition.

Dr. DiGiuseppe also presented a workshop at the meeting on "Practical Flow Cytometry in Hematopathology."

 

Drs. Deckers and Morosky To Speak at Neonatal-Perinatal Conference

Drs. Elizabeth Deckers and Christopher Morosky will speak on the “March of Dimes 39+ weeks Quality Improvement Initiative” at the 6th Annual State of the State Neonatal-Perinatal conference on November 13 at Heublein Hall.

Dr. Deckers in the medical director of Labor and Delivery at Hartford Hospital, and Dr. Morosky is an attending physician in the Division of General Obstetrics and Gynecology at Hartford Hospital and the Hospital of Central Connecticut.

 

Trauma After Care Program's Annual Gathering

The Trauma After Care Program is sponsoring its Annual Gathering, where bereaved families, volunteers, and hospital staff come together to learn about grief and bereavement. It will be held on Sunday, Nov. 3 from 2-4 p.m. at the Glastonbury Riverfront Community Center.

It is a special time for anyone to remember loved ones who have died and to honor them by learning about ways of coping that might be helpful during the holiday season. 

This year the speaker is Karen Carney, RN, LCSW, FT, author of the Barklay and Eve Children’s Books www.barklayandeve.com. She is the Bereavement Program director at the D’Esopo’s A Safe Place to Grieve Foundation and Resource Center in Wethersfield. 

Space is limited and pre-registration is required by Oct. 28.  Please RSVP to Heide Weise at heide.weise@hhchealth.org or call 860-972-5418.

Chief's Corner

Welcome To "Chief's Corner"

We recognize the need for sharing information about activities throughout the hospital more widely with our Medical Staff.

Chief's Corner will bring 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, senior vice president at Hartford HealthCare and president of the Hartford Region

Markowitz

Medical Necessity New Rule Creates 2-midnight Standard; Change in Defining Inpatient Status

As a condition of payment for hospital inpatient services under Medicare Part A, there is a requirement for physician certification of the medical necessity that such services be provided on an inpatient basis. Citing several reasons, including increasing use of observation, longer LOS in observation, and provider requests for a change, CMS has issued the 2014 IPPS Final Rule that includes a significant change in defining inpatient status.

This new rule adopts a time-based system creating a 2-midnight standard for inpatient admission; please read on for specific guidance.

We are working closely with IT to incorporate the required documentation elements. CMS requires that the admitting provider document if a patient will require hospital care that spans 2-midnights (inpatient), or if that care can be provided in less than the 2 midnight benchmark (observation or outpatient); as well, careful documentation of the reason (medical necessity) for an inpatient admission must appear in the medical record.

The 2 midnight benchmark does include actual care provided in an ED or outpatient setting prior to the actual admit order. An additional change in workflow requires that the admission order placed by a resident, PA, or NP be co-signed by the Attending MD. We are also working with IT to automate the process flow for obtaining this co-signature.

The effective date of this new rule is October 1, but CMS is providing a grace period during which time we will work to bring our hospital into full compliance.

Effective Oct. 1, 2013, hospital physicians will be required to change the way that Inpatient Level of Care determinations are documented in order to meet the new Medicare regulations. The new process for the assignment of level of care for all patients will include the following:

· In order for a patient to be assigned Inpatient status, he or she must require two (2) midnights in the hospital.

· For a patient admitted through the Emergency Department (ED), the time a patient spends in the ED being evaluated contributes to meeting the two (2) midnight requirement; wait time prior to the initial start of ED care is excluded.

· The only exception to the 2-midnight rule is for a patient being admitted to the hospital for procedures included on Medicare’s Inpatient Only List (this mainly applies to the Surgery, Cardiovascular and Orthopedic services).

· Hospital stays expected to last less than two (2) midnights are generally inappropriate for inpatient hospital admission: in such cases, please see the following instructions:

§ Emergency Department: please assign the patient to Observation

§ Procedure areas: please assign the patient to an Outpatient level of care

· As occurs today, a patient may progress from Observation level of care to Inpatient level of care:

§ If the patient has already passed 1 midnight as observation or in routine recovery post-procedure, the physician should consider the 2 midnight benchmark met if he or she expects the patient to require an additional midnight in the hospital.

§ If the physician determines that inpatient level of care is appropriate, and expects that care will surpass 2 midnights, but the patient condition improves, the patient is transferred to a higher level of care, signs out AMA, or expires prior to reaching the second midnight, the level of care shall remain inpatient.

· Please note the patient must still meet medical necessity for Observation or Inpatient level of care.

· Key point: the judgment of the physician and the physician’s order for inpatient admission should be based on the expectation of care surpassing 2 midnights with both the expectation of time and the determination of the underlying need for medical care at the hospital (supported by complex medical factors such as history and comorbidities, the severity of signs and symptoms, current medical needs, and the risk of an adverse event). IPPS Final Rule CMS-1599, Federal Register, p. 50944

Further direction will be forthcoming; the case coordination department will be partnering with physicians to assist in interpreting and applying these new rules. We sincerely appreciate your patience as we move forward together.

Enhancing The Patient Experience

Voices of Our Patients: Kudos To Dr. Pepe Wagner

Dear Dr. Wagner:

My radical prostatectomy on Aug. 23 was successful and i would like to compliment you, your staff and the hospital personnel on my efficient, careful and friendly treatment.

Before arriving at your offices in early August, i had consultations at Memorial Sloan Kettering, Johns Hopkins Cancer Center, Lenox Hill Hospital (NYC), and Norwalk Urology Associates, which performed the biopsy. Each of these consultations lasted between 5 and 10 minutes, and touched on my Gleason score and good chances for a successful operation. They were polite and reassuring conversations, but were superficial in terms of the full range of possible outcomes and alternative procedures.

I was referred to your practice through David McGinnis, former president of the Philadelphia Urologic Society, who commented to a friend that he would select you as his surgeon if he or a family member were to be diagnosed with prostate cancer.

i found your consultation to be extremely thorough, covering the full range of technologies available and related statistical projections for recovery and success. i had already researched the medical literature, but your 35-minute presentation gave me a much clearer insight into the risks and rewards of available treatments. The contrast between your consultation and my previous visits with prostate surgeons was striking, and I felt much more confident about what lay ahead.

Thanks, again, for a great job with the surgery and all the professional treatment provided by your staff and the Hartford Hospital.

Anonymous

Operational Update

Hospitalists Using Electronic Progress Notes

The Hospital Medicine team has recently started using the SCM-based electronic progress notes on all patients throughout Hartford Hospital. This is an important step to improve communication, capture quality and throughput-related information for each patient. This note is filed under a tab on SCM document section listed as "provider progress note."

This process not only allows other providers to access hospitalist notes but also helps as a channel of communication to patients using a standardized plan of care document designed to update on their daily plan. This process will set the stage for an upcoming HHC Unity project and prepare us better for EPIC adoption.

For more information regarding this note, please contact Dr. Syed Hadi or Dr. Marc Palter.

 

Seeking Nominations for Medical Staff Elections

We are seeking nominations from the entire medical staff for eight open positions in medical staff leadership – four officers: president, vice president, treasurer and secretary - and four at-large members of the Medical Executive Committee.

A nominating committee (Drs. Michael Conway, Joel Sorosky, AJ Smally and Jeff Nestler) has been formed to bring forward a slate of candidates for the open positions. Please nominate a colleague or yourself, and if possible, indicate the position in which the candidate has interest.

The election will take place in the third week of November.

Please e-mail your nomination to Martha.santilli@hhchealth.org

 

Medical Group Support Grows for 2014 Black & Red

Medical group support of the 2014 Black & Red continues to grow with Connecticut Multispecialty Group donating an additional $10,000 and upgrading to Producer Sponsor. Medical groups participating to date include:

Producer Sponsors, $20,000
• Connecticut Multispecialty Group
• Hartford Anesthesiology Associates
• Jefferson Radiology
• Orthopedic Associates

Director Sponsors, $10,000
• Hartford Pathology Associates

Spotlight Sponsor, $5,000
• Gynecology & Obstetrics

For a list of sponsors, visit https://giving.harthosp.org/blackandred.

We thank the physicians serving on the Black & Red Medical Staff Advisory Committee, chaired by Dr. Hank Schwartz, for their support. We also thank the members of the Community Advisory Committee and gala co-chairs Jonathan and Robyn Gengras for their support. A listing of committee members can be found at https://giving.harthosp.org/blackandred.

The gala, which will take place Jan. 25, 2014, at The Bushnell, supports the Psychiatry Program at the Institute of Living. Funds raised through the event will be used for research, increased services and treatments, and to provide education to those impacted by mental illness.

Only 1,200 tickets will be sold for this signature event, featuring entertainment by the band Barenaked Ladies, so please be sure to purchase tickets early. For more information about the Black & Red and to support the gala, please contact Carla Burgess at 860-545-1932 or carla.burgess@hhchealth.org.

 

New Inpatient Orders Questions When PICC Line or Midline Is Ordered

In an effort to ensure appropriate use of PICC line and Midline Insertions, we are incorporating some questions into inpatient orders. When a PICC or Midline is ordered, you will be asked:

  • The anticipated duration of therapy
  • If the patient will be discharged with venous access
  • Does the patient have chronic kidney disease?

MarkowitzYou will see the patient’s most recent eGFR result and you will be asked to consider an alternate form of access if the eGFR is <30.

Alternative options include:

  • Pro-line, a tunneled 5 French IJ catheter
  • Temporary (non-tunneled) IJ Triple Lumen catheter
  • Temporary (non-tunneled) Femoral Triple Lumen catheter

  This initiative has two purposes: to reduce the use of PICC lines and Midlines for short term therapy; and to “save the arm” for patients on dialysis or patients who will likely need dialysis in the future. Saving the arm, allows patients to receive an AV fistula for dialysis, which is best practice and the safest form of access.

Please note that a “Dialysis Precautions” order already exists and will continue to be available.

eGFR will display just below the Creatinine.

 

 

 

 

Make Your Pledge to The Medical Staff Annual Fund

Join your colleagues and make your Annual Campaign gift or pledge by September 30 and continue keeping Hartford Hospital the very best in the region. One hundred percent of your donation goes to programs and services that make a difference for our patients and the community we serve.

Dr. Sharon Diamen is the chair of the Medical Staff Annual Campaign. To date, 155 physicians have contributed nearly $100,000 to the Annual Campaign.

Your gift can be directed to an established department fund or to the Medical Staff Annual Fund, which this year has provided support so far to the Institute of Living (through Behavioral Health Case Management), the Health Assistance Intervention Education Network (HAVEN), the CT Medical Society Medical Malpractice Campaign, Hartford Hospital's Outpatient Transplant Center, and to medical education through a summer pre-med research program.

For more information, please contact Mary Parola in Fund Development at 860-545-2322 or mparola@harthosp.org. You can also make your gift online at https://giving.harthosp.org/medstaffdonation

 

New Issue of Clinical Integration Newsletter, Connected Care, Available Here First

In the new Sept. 9 issue of Connected Care, the Clinical Integration newsletter for Hartford HealthCare, Dr. James Cardon, CEO of Integrated Care Partners and HHC chief integration officer, writes about better care transitions.

"Effective care transitions are critical to improving the quality of care and patient satisfaction, enhancing population health, and reducing health care costs," wrote Dr. Cardon. " All of these are aspects of health care reform and all are the right thing for us as providers to strive to accomplish."

 

State Mandated CME Renewal Available Free To HH Doctors on Jubilant Learning Portal

State mandated CME for physician license renewal is available free on the Hartford Hospital Jubilant Learning Platform. You will need your Novell sign on information to access the portal. If you have forgotten your sign on, please call the HELP desk 55699 (outside: 860-545-5699).

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 home page of the intranet (inside HH), click on the Learning Portal for Medical Education and Training link. Once you’ve clicked on the 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 maryanne.pappas@hhchealth.org.

HH In the News

Join Us At The Liver Life Walk

The Hartford Courant, Sept. 25

The American Liver Foundation will be hosting the 13th Annual Liver Life Walk, presented by Hartford Hospital, on Sunday, Sept. 22nd at Rentschler Field in East Hartford. With liver cancer, hepatitis C and fatty liver disease being among the many liver diseases on the rise, proceeds from the walk, will support the Connecticut Division of the American Liver Foundation's mission to facilitate, advocate and promote education, support and research for the prevention, treatment and cure of all liver diseases.

 

Brain May Never Fully Recover From Cocaine Addiction

Post, Sept. 24

Researchers have found that even long-term abstinence from cocaine does not result in a complete normalization of brain circuitry. Scientists are currently trying to answer some of the questions surrounding the abuse of drugs.

One of those questions is whether individuals who abuse psycho stimulants like cocaine are more impulsive and show alterations in brain reward circuits as a consequence of using the drug, or whether such abnormalities existed prior to their drug use. In the former case, one might expect brain alterations to normalize following prolonged drug abstinence.

To address these questions, Krishna Patel at Institute of Living/Hartford Hospital and colleagues compared neural responses between three groups of people who were asked to complete a task that resembles bidding on eBay items.

 

'Avenging Angel' Workshops Help Women Thrive After Domestic Abuse

West Hartford News, Sept. 23

“Living well is the best revenge” is the theme of the My Avenging Angel WorkshopsTM being offered this winter in Avon and Wethersfield, Connecticut. Susan Omilian of West Hartford is the workshop’s award-winning originator and facilitator, described by participants as “life-changing.” The workshop provides a critical “next step” for women to break permanently out of the cycle of violence and “thrive” after abuse.

Sponsored by the Hartford Hospital Domestic Violence Prevention Program and supported by Connecticut Alliance for Victim of Violence and Their Families Inc. (CT-ALIVE), the workshops are free of charge. Each will be held in two sessions on Saturday, October 5 and 12 in Wethersfield, CT and on Saturday, November 2 and 9 in Avon, CT. Participants should plan to attend both sessions of each workshop.*

 

TigerText Provides Integrated, Secure Communication Network For Hartford HealthCare

Street Insider, Sept. 24

TigerText, the leader in secure, real-time messaging for the enterprise, today announced that it has added Hartford HealthCare, the premiere health care network in Connecticut with more than 16,000 employees, as well as the University of Connecticut’s School of Medicine Residency Program to its growing client roster. With these customer wins, TigerText now provides Residents in the University of Connecticut’s School of Medicine with a connected and integrated communication network across the hospitals and institutions in which they’re pursuing their medical education.

As the major teaching hospital affiliated with the University of Connecticut Medical School, Hartford HealthCare is deploying TigerText’s secure messaging app across Hartford Hospital, Hospital of Central Connecticut, MidState Medical, Windham Hospital and the Hartford HealthCare Medical Group in an effort to streamline communication among staff, improve clinical workflow and provide more efficient care to patients.

“Hartford HealthCare is committed to bringing the industry leading services to both our patients and our physician staff,” said Dr. Rocco Orlando, senior vice president and chief medical officer of Hartford HealthCare. “With TigerText, our physicians are now able to communicate patient information in a secure and protected environment across all of our organizations, enabling us to provide consistent, high-quality care.”

 

Flu's Coming; Get a Shot, Say Health Officials

Hartford Courant, Sept. 26

Federal health officials said Thursday that more Americans are getting flu shots than in previous years but that more work needs to be done.

Dr. Jack Ross, director of infectious diseases at Hartford Hospital, said the flu season hit Connecticut in earnest around Thanksgiving and peaked a few weeks into January. He emphasized the importance of older people getting a flu shot. Of the nine flu-related deaths at the hospital, he said, all were elderly people and five were over 90.

Connecticut had 23 flu deaths last season. Four of the victims were between the ages of 55 and 65. The rest were older than 65 years old.

For the first time, Saint Francis Hospital and Medical Center will require vaccinations for all hospital personnel this year. Dr. James Mazo, medical director for occupational medicine, said employees can request exemptions for reasons related to either health or religion. A committee will review the exemption requests. Exempt employees, he said, must wear a mask to cover their mouths whenever they are within 6 feet of a patient.

Hartford Hospital began requiring vaccinations of personnel in 2012. Although there was some resistance from union leaders, Ross said, all but 70 out of 7,000 employees were vaccinated. Those who were granted exemptions had to wear a mask.

In the HHC System

Cancer Centers Form Alliance

NBC Connecticut, Sept. 18

Hartford Healthcare and the world-renowned Memorial Sloan-Kettering Cancer Center in New York City are forming a new alliance that will bring cutting edge clinical trials and care to patients in Connecticut.

"This is a new initiative that is going to be transformational," said Dr. Craig Thompson, the president of the Memorial Sloan-Kettering Cancer Center.

Under the alliance, Memorial Sloan-Kettering will share its clinical and research knowledge with physicians at Hartford Hospital and the four other hospitals in the Hartford Healthcare network, Dr. Thomspon said.

They will also expand access to clinical trials run by Memorial Sloan-Kettering and make those treatments available to patients in Connecticut at their local hospitals.

"This is most important for people who don't even know they need our help, the people we know who are going to be diagnosed with cancer down the road," said Elliot Joseph, the president of Hartford Healthcare.

Health Care News In the Region

CT Health Exchange Premiums Among The Nation's Highest

Hartford Courant, Sept. 26

Connecticut consumers who buy insurance on the new exchange will pay some of the highest premiums in the nation, according to a report released Wednesday by the U.S. Department of Health and Human Services.

Although the report lauds lower-than-expected prices nationwide, it shows that the premium for a benchmark insurance plan, dubbed a "second lowest cost silver plan," would cost an average of $436 a month in Connecticut — 33 percent higher than the national average, and fourth-highest in the country after Alaska, Mississippi and Wyoming.

State exchanges, including Connecticut's Access Health CT, will offer "bronze," "silver" and "gold" policies that vary in coverage, deductibles and co-pays. Consumers may begin to enroll for insurance on Oct. 1, with coverage beginning Jan. 1. Some consumers will be able to qualify for federal tax credits to help defray their insurance costs.

Hot Topics in Health Care

Should Hospitals Offer All Patients Single Rooms?

Medical News Today, Sept. 25

The Scottish government has decided that all new hospitals should have 100% single rooms to offer privacy and reduce hospital acquired infections. On bmj.com, two experts debate the issue.

Hugh Pennington, Emeritus Professor of Bacteriology at the University of Aberdeen, argues that single rooms in hospitals "are important in preventing and controlling healthcare associated infections."

They also increase patients' privacy dignity, and confidentiality, as well as facilitating family involvement in patient care and increasing the opportunities for treatment at the bedside, he adds.

Opponents to the universal provision of single rooms have claimed that there is no evidence that they reduce hospital acquired infections, he writes, but "the evidence that physical barriers are good at preventing the spread of microbes is strong."

 

ACP Publishes Brief Guide to ACA Health Exchanges

Medical News Today, Sept. 25

The American College of Physicians (ACP) has written a brief to explain how health exchanges, or health insurance marketplaces, will work when the Affordable Care Act begins to roll out late this year.

By 2014, most individuals who do not have health insurance will have to acquire health insurance or pay a fine. The marketplaces were created under the ACA with the hope of enabling individuals to objectively compare private health plans that meet the minimum standards set by the government and also meet their budget and health needs.

Legal residents without access to affordable, comprehensive insurance, and business with up to 100 employees can access the marketplaces online, via toll free number, or in person to research and purchase an appropriate health benefits package.

 

How Affordable Are Affordable Care Act Premiums?

CBS Evening News, Sept. 23

One week from Tuesday, a major portion of the president's health care reform law will go into effect and change the way millions of Americans get their health care. On Oct. 1, they can start signing up to buy insurance on the new state exchanges.

Obamacare is officially the Affordable Care Act, but how affordable are the premiums?

 

Device Prices Plunge as Hospitals Pay Less To Fix Hearts

Bloomberg, Sept. 23

Prices paid in the U.S. for medical devices, including those that regulate the heart’s rhythm and replacements for hips and knees, have plunged as much as one-third since 2007 as hospitals clamped down on spending.

The average inflation-adjusted prices for seven of the largest categories of medical devices fell through 2011, according to a study released today from the Advanced Medical Technology Association. Drug-coated stents used to prop open arteries sold by Boston Scientific Corp. (BSX), Abbott Laboratories (ABT) and Medtronic Inc. (MDT) had a 34 percent decline. Artificial knees from Johnson & Johnson (JNJ), Zimmer Holdings Inc. (ZMH) and Stryker Corp. (SYK) fell the least at 17 percent.

The results suggest medical technology isn’t responsible for driving up health-care costs in the U.S., where prices for devices have risen at less than half the pace of goods in the U.S. economy for two decades, said Stephen Ubl, chief executive officer of the industry group known as AdvaMed. The open market works for medical devices, he said.

Coming Events

October 11 (Friday)

Surgery Grand Rounds: The Fifteenth Annual Crombie Lecture on the Humanities in Surgery

Heublein Hall, 6:45 a.m.

Creativity in Art and Medicine
Presenter: Joseph J. Klimek, M.D., F.A.C.P. vice president, Physician Relations, Hartford Hospital
Art exhibit to follow

 

October 15 (Tuesday)

Women Physician Organization Meeting

The Hartford Golf Club, West Hartford, 6:30-8 p.m.

Presentation on the HHC Women's GI Center, with Drs. Maria Johnson, Kiran Sachdev, and Kristina Johnson

Register on line at www.harthosp.org/meetings or call 860-545-1888.

 

October 15 (Tuesday)

High Reliability Training With Kerry Johnson

Heublein Hall, 8-10:30 a.m. or 5-7:30 p.m. , or in Meriden at the Pomoroy Conference Center from 1-3:30 p.m.

Special training session geared for Hartford Hospital and HHC Medical Group physicians. Kerry Johnson is chief innovation officer of Healthcare Performance Improvement (HPI) and nationally known for his work in patient safety and high reliability. Kerry is a dynamic and interactive speaker and will share tested approaches and techniques in achieving and sustaining reduction in events of preventable harm. Participants in this session will be eligible for 2 AMA PRA Category 1 Credits

To register, please contact Joanne Sommers at 860-545-2625 or joanne.sommers@hhchealth.org

 

October 17 (Thursday)

Hepatitis C Summit

ERC Heublein Hall, 8 a.m.-3:15 p.m.

The Hepatitis C Summit is a one day conference focusing on the screening, diagnosis, pharmacological treatment and surgical management of people with Hepatitis C.

The event is sponsored by the Hartford Hospital Comprehensive Liver Center, Hartford Hospital Transplant Program and Connecticut Department of Public Health.

Physicians-$75; Nurses, PAs, residents-$50; Others-$35. Physicians may register online at www.harthosp.org/HepSummit. All other participants should call Health Referral Service at 860-545-1888.

 

November 1 (Friday)

7th Annual Cohen Symposium: “Brain Tumors-Standard Therapy and Why We Need a Bigger Boat:  Tumor Morphology or Molecular Array”

JB-118, 7:30-8:30 a.m.

Hartford Hospital special Grand Rounds is the 7th Annual Cohen Symposium: “Brain Tumors-Standard Therapy and Why We Need a Bigger Boat:  Tumor Morphology or Molecular Array,” will be held on Friday, Nov. 1, from 7:30-8:30 a.m. in JB-118. Speaker will be Dr. Craig Patrick Nolan, neurologist at Memorial Sloan-Kettering Cancer Center, NY, NY.

For more information, contact Sandi Beggs at ext. 5-2309 or sandi.beggs@hhchealth.org.

 

November 3 (Sunday)

Trauma After Care Program's Annual Gathering

Glastonbury Riverfront Community Center, 2-4 p.m.

The Trauma After Care Program is sponsoring its Annual Gathering, where bereaved families, volunteers, and hospital staff come together to learn about grief and bereavement. It will be held on Sunday, Nov. 3 from 2-4 p.m. at the Glastonbury Riverfront Community Center.

 

Nov. 5 (Tuesday)

Update in Urology and Kidney Disease for the PCP

5-8 p.m.

An education event for primary care physicians on updates in the care of the patient with urologic conditions or kidney disease.

Dinner and CME provided. No charge to attend. Angelo's on Main-Rockledge in West Hartford.

Speakers will be urologists and nephrologists from the Tallwood Urology and Kidney Institute.

Registration link.

 

Nov. 7 (Thursday)

8th Annual Interdisciplinary Transplant Symposium

Sheraton Hartford South Hotel in Rocky Hill, 7:45 a.m.-4 p.m.

The Transplant Symposium provides an opportunity for experts in the fields of kidney, liver and heart transplantation to present cutting-edge information to individuals working with transplant recipients and living donors. It also provides an opportunity for individuals interested in transplantation to learn more about this dynamic field.

Registration fees: (Early bird discount through September 30):

  • Hartford HealthCare Employees: $50 ($75 after Oct. 1)
  • Non-Hartford HealthCare Employees: $75 ($100 after Oct. 1)
  • Students: $25 ($50 after Oct. 1)

Participants paying the $100 registration fee may register online at www.harthosp.org/TransplantSymposium. All others should call the Health Referral Service at 860-545-1888 or toll-free 800-545-7664.

For more information, contact Eliz Valentin, Transplant Program, at Eliz.valentin@hhchealth.org or 860-972-4339.

 

November 21 (Thursday)

Annual Meeting of the Hartford Hospital Corporators

Heublein Hall, 11:45 a.m.-2 p.m.

 

November 21 (Thursday)

Semi-Annual Meeting of Medical Staff

Gilman Auditorium, 6:45 a.m.

 

 

January 25, 2014 (Saturday)

Black & Red

Bushnell Center for the Performing Arts, 6 p.m.

Featuring the music of Barenaked Ladies.

 

 

 

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.