From the Offices of Stuart Markowitz, MD and Stacy Nerenstone, MD

 

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In This Issue...

January 12, 2014 Edition

HAND HYGIENE
Wash In - Wash Out

Wash

 

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HH Facts and Firsts:

2002 - Hartford Hospital was the first in New England to participate in the VHA Transformation of the Intensive Care Unit (TICU) project to enhance ICU services.


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A Message From Dr. Rocco Orlando, HHC Chief Medical Officer

HHC Unity: CareConnect Project On Track With Epic Electronic Health RecordOrlando

Dr. Rocco Orlando

Our transformation is on track.

In September, Elliot Joseph unveiled HHC Unity: CareConnect, our project to revolutionize care across our system. Using the Epic electronic health record as a tool, we are building a platform that will help us realize our vision of consistently high-quality and well-coordinated care.

CareConnect will help us create healthier communities and will make Hartford HealthCare stand apart as organization that offers high-value care and a great patient experience every time.

I am happy to report that all but a handful of the 160 positions on the CareConnect core team have been filled. This new staff – drawn from departments across our system – began this important work Jan. 6.

The core team is based at a site in Farmington. Program leaders are in the process of identifying Subject Matter Experts from across the organization who will provide knowledge and feedback in both clinical and non-clinical areas that will be touched by CareConnect.

The focus of the Core Team for the first three months will be to complete Epic education and certification requirements. In January, members will travel to the Epic training center in Verona, Wis. A list of Core Team members is available on the CareConnect website.

The Core Team is really part of a much bigger team. To make sure CareConnect is truly transformative, we’ll need contributions of time, skill and wisdom from everyone whose work and patient care will be shaped by this initiative. It will take more than a village; it will take our entire system.

That’s why keeping all HHC employees informed about the CareConnect developments is and will continue to be a priority. With that in mind, I want to share a few other developments and key dates.

  • With the planning and hiring phase complete, a permanent governance plan for HHC Unity: CareConnect has been approved and work to identify members of a governance committee has begun. The committee is set to start meeting in February.
  • Epic staff is scheduled to begin conducting site visits the first week of February. The visits are intended to provide Epic with an overview and understanding of our facilities and workflows. A schedule with details of these visits will be provided at a later date.
  • Between March and May, three validation sessions are scheduled at the Farmington Marriot. These sessions allow the team to evaluate workflow and validate that the flow of information to the system is correct. The dates of the three sessions are: March 4-6, March 31-April 2, and May 5-7.

CareConnect is the largest and most ambitious system-wide effort ever at Hartford HealthCare and it will have a huge impact on our patients and families. I would like to thank the CareConnect leadership, the Planning Advisory Committee and the many individuals in a variety of roles across our system who have created the early framework and helped to keep a complex effort on schedule.

Top News

Flu Season Is Here

The flu is now widespread across Connecticut with more than 680 confirmed cases and two deaths as of Jan. 8. We are treating cases throughout our Hartford HealthCare facilities.

Because of our Universal Influenza Prevention Program, HHC staff members are better prepared to face the flu while keeping our patients, coworkers and ourselves as safe as possible. Throughout our system, we achieved immunization rates of almost 100 percent.

There can be no compromise on safety. In that spirit, we must continue to be vigilant when it comes to the flu.

  • Beginning Dec. 20, 2013, every staff member with a flu-vaccine exemption must wear a mask whenever within six feet of an area where patients/clients may be encountered, such as clinical units, hallways, lobbies and public dining areas. This requirement is in effect until the end of the flu season.
  • Remember to follow standard cough and respiratory hygiene, including: covering the mouth and nose with a tissue when coughing or sneezing; disposing of the tissue in the nearest waste receptacle; and washing or disinfecting hands after contact with respiratory secretions or contaminated material.
  • An employee with a fever, vomiting or diarrhea should stay home.
  • Those with cold symptoms, such as a cough, sneezing or a sore throat, should stay home and return to work when they are feeling better.
  • Hartford HealthCare institutions will follow their protocols related to the masking of patients and family members who have symptoms of respiratory illness.
  • Standard and droplet precautions will be followed as usual.

With our Universal Flu Prevention Program, we have taken an extraordinary step together to safeguard our patients and fellow employees. Let’s continue to do everything we can to live our values on behalf of the people we serve.

 

Flu Infection Control/Testing Recommendations

Influenza testing will be performed by PCR technology.

  • Turnaround time is 2 hours and will be available 24 hours a day/7 days a week.
  • Between the hours of 12 midnight and 7 a.m., the tests will be batched and perfumed twice during these hours.

Patients should be placed on DROPLET PRECAUTIONS when influenza is suspected or confirmed.

  • Precautions may be discontinued if PCR test regulates are NEGATIVE.

CRITERIA FOLR DISCONTINUING ISOLATION:

  • 7 days after start of symptoms or 24 hours after resolution of symptoms, whichever is LONGER (i.e., fever, body aches.)

Patients with confirmed influenza may be cohorted with patients of the same influenza type - i.e.,

  • Influenza A with Influenza A
  • Influenza H1N1 2009 with Influenza H1N1 2009
  • Influenza B with Influenza B

 

 

Stop the Stigma of Mental Illness - The Theme for HH's Fundraising Gala

Hartford Courant, Dec. 20

Hartford Hospital is kicking off a campaign to end the stigma of mental illness at the annual Black & Red gala on Jan. 25 at The Bushnell. The goal is to obtain 5,000 individual pledges, spreading the message that changing attitudes can begin to change minds.

Harold (Hank) Schwartz, M.D., Hartford HealthCare Regional vice president, Psychiatrist-in-Chief Institute of Living at Hartford Hospital, says for some people, a mental illness may be a lifelong condition, like diabetes. "However, as with diabetes, proper treatment enables many people with a mental illness to lead fulfilling and productive lives. By helping combat the stigma associated with mental illness, we can help increase the number of people that seek treatment."

Those wishing to take the pledge will sign their name to the following:

  • I pledge: To teach by sharing my own experiences with mental illness and encouraging others to share their stories with me; I will learn in order to change.
  • I pledge: To show compassion by reaching out to those in need of help; I will not let anyone suffer in silence.
  • I pledge: To have the courage to speak up and challenge stereotypes and attitudes; I will not tolerate or perpetuate stigma.
  • I pledge: To demand a change in how we view and address mental illness; I will help lead the way.

"We will be looking to our employees of Hartford Hospital and across the Hartford HealthCare system to take the pledge. As a healthcare leader in the community and the state, it is our duty to set the example and stop the stigma associated with mental illness. Together, we can do it," said Stuart Markowitz, M.D., president Hartford Hospital and Hartford Region, senior vice president Hartford HealthCare.

Ask everyone — fellow employees, volunteers, patients, the community — to “take a pledge.” It is online now at www.StopTheStigmaCT.org.

 

Hartford Hospital Campaigning For Mental Health Awareness

Fox CT, Dec. 19, 2013

Driving into downtown Hartford on I-84 East, you have probably seen a bizarre billboard with the word “psycho” on it. The billboard actually shows the word on a piece of paper being torn in half.

It’s a sign of things to come in a mental health awareness campaign by the Institute Of Living at Hartford Hospital. Other ads will appear in newspapers and magazines, urging people to stop using words like “psycho,” “crazy,” and “insane” to describe people.

The words, Hartford Hospital’s chief psychiatrist said, encourages a stigma.

“These words stand in the way of treating individuals who may happen to have a mental illness,” Dr. Hank Schwartz, Hartford Hospital Behavioral Health Vice President, said. The campaign culminates with the Black And Red Gala, to be held January 25, as a fundraiser for mental health programs.

Read more here.

 

 

James Watkins Named President of HHC MG

James Watkins Jr. has come on board as president of Hartford HealthCare Medical Group. He was most recently vice president of Physician Services at Backus Hospital.

Watkins brings extensive financial and managerial experience to this critical leadership post. Prior to joining Backus Hospital, he served as executive director and vice president for Faculty Enterprise at Women and Infants Hospital of Rhode Island. In this role, his responsibilities included the establishment of the faculty practice plan for 110 physicians affiliated with Brown University as well as serving as the senior executive for network and business development strategy.

From 2000 to 2005, he served as assistant vice president of finance for Southern New Hampshire Health System, where he was responsible for all the financial functions of a 120-provider multispecialty group. He led the group to its highest financial performance in its 10-year history.

From 1998 to 2000, Watkins was director of finance for UMass Memorial Medical Group, developing and implementing a physician compensation plan. While there, he directed the design and implementation of the health system’s capitated reporting system in support of the system’s strategy to participate in full-risk contracting.

During his career, he has achieved improvements in revenue-cycle performance and restructured core financial systems. He brings a passion for the development and growth of high-performing medical group practices.

Dr. Kent Stahl, who has been serving as interim president of HHC MG, will be able to bring his full attention to the critically important growth of the primary care division in his role as vice president.

Dr. Jeff Cohen will continue to build on his successful work as vice president of the specialty care division.

 

The Clinical Integration Newsletter Is Now Called the ICP News

We’ve changed the name from ConnectedCare to ICP News, which will be distributed the first Monday of each month.

This issue’s feature story is “Reducing Readmissions: Another Step in Reform.” Read how ICP will use The Hospital of Central Connecticut’s very successful model to reduce readmissions of heart-failure patients and what that means for physicians and patients.

You can read the latest issue of the Integrated Care Partners newsletter here.

 

Women’s Health Program Makes List of Great Programs

Becker's Hospital Review, Dec. 23, 2013

Hartford Hospital is among 100 hospitals that Becker’s Hospital Review has named to its list of “100 Hospitals with Great Women’s Health Programs.”

These hospitals offer outstanding women's health programs, such as gynecology, obstetrics, reproductive medicine and other women's health needs. The hospitals were selected for the list based on clinical excellence, quality care, and women’s health awards.

Two other Connecticut hospitals were also named to the list: St. Vincent's in Bridgeport, and Yale New Haven.

To read the full story, click here.

 

December Finances: Mostly Good News

Inpatient volumes based on discharges for the month of December were 0.3% below budget. The comparison to the prior year shows December, 2013 discharges approximately 0.5% above the prior year. Outpatient revenues exceeded budget by approximately 2.8% for the month. The favorable outpatient revenue variance was driven by Perioperative services, Radiology and Laboratory services.

Through the first quarter of fiscal year 2014, inpatient discharges are on budget and 0.9% greater than the first quarter of the prior fiscal year. Outpatient revenues are 8.3% above budget for the three months ending December 2013. Year to date, the favorable outpatient revenue variances are in Perioperative services, Radiology, Cardiology, Emergency services and Laboratory services.

 

 

Save These Dates:

 

Medical Staff Interim Meeting - March 26

We will be having a Town Hall Style meeting with the hospital and medical staff leadership on Wednesday, March 26 in Gilman Auditorium, 5:30-7 p.m.

Medical Staff Spring Event - May 22

The Board of Directors and Medical Staff Spring Event will be held Thursday, May 22, starting at 6 p.m. with a cocktail hour in Heublein Hall at the ERC. The awards ceremony will begin at 7 p.m. We will present five awards: the Physician in Philanthropy Award; the Distinguished Service Award; the David Hull, MD, Young Practitioner Award; the John K. Springer Humanitarian Award; and the Quality and Safety Award.

 

Excellence

Dr. Klimek Receives Proclamation of Appreciation

Dr. Joseph Klimek, who retired on Dec. 31 after 41 years of service, was honored with a proclamation at Management Forum on Dec. 17.

Dr. Klimek served as director of the Dept. of Medicine, VP of medical affairs, VP of physician relations, and chair of the AIDS program.

His many achievements also include developing the Integrative Medicine Program, initiating the Hospitalist program and Physician Relations Program, and initiating the 24-hour patient transfer center. He received the Distinguished Service Award from the Medical Staff in 2013.

President Stuart Markowitz, Dr. Sharon Diamen and Dr. Jack Ross spoke about Dr. Klimek’s contributions to Hartford Hospital at the meeting.

"I was humbled and appreciative that I had been given such a wonderful opportunity," Dr. Klimek said.

 

Christine Waszynski To Present Program on Delirium at Memorial Sloan-Kettering

Christine Waszynski, APRN in the Division of Geriatrics of the Department of Medicine, has been invited to present on the topic of delirium in the oncology population at Nursing Grand Rounds at Memorial Sloan-Kettering Cancer Center.

The geriatric task force at MSK is planning a “Delirium Week” March 24-28 with the intention to improve recognition, assessment, and management of delirium at their facility, and invited Waszynski to kick off their hospitalwide initiative.

 

Our Physicians Are Great Sources For Local Media

Dr. Fred Tilden was interviewed on Fox CT on Dec. 31 about the flu.

Dr. Jack Ross was interviewed on WTIC AM on Jan. 2 about the flu; and on Fox CT on Jan. 7 about the flu.

Dr. A J. Smally was interviewed on NBC CT on Jan. 2 about hypothermia and frostbite; and on NBC CT and Fox CT on Dec. 31 about the flu.

Dr. Kenneth Robinson was interviewed on Channel 3 on Jan. 2 about hypothermia and frostbite.

Dr. Jeff Finkelstein was interviewed on NBC CT on Jan. 1 about safety precautions during frigid weather.

Dr. Shawn London was interviewed on Fox CT on Jan. 2 about hypothermia.

Dr. Hank Schwartz was interviewed on WNPR on Dec. 30, 2013 about the Sandy Hook report.

Dr. David Tolin was quoted on WNPR on Jan. 6 about the canary trial, a study underway to help people with anxiety disorders.

Dr. Kelly Johnson-Arbor was interviewed on News 8 on Jan. 7 about CO poisoning.

Dr. Vasanth Kainkaryam was interviewed on WFSB on Jan. 10 about exercising when you have a cold.

Research and Academics

Hyperbaric Training Course Offered for Healthcare Providers

Hartford Hospital in collaboration with the OxyHeal University, is offering a 40-hour course in Hyperbaric Training for Healthcare Providers on Feb. 24-28 at the Backus Wound and Hyperbaric Center in Norwich. It will meet daily from 8 a.m.-5 p.m.

The Hyperbaric Training for Healthcare Providers Course is designed to meet the requirements of a Designated Introductory Course in Hyperbaric Medicine and will introduce to physicians, registered nurses, technicians and other allied health care providers the clinical indications, documentation and operational requirements of a Clinical Hyperbaric Medicine Facility. NBDHMT 40 Category A Credits.

This course is required for physicians who wish to supervise and bill for hyperbarics, and for nurses and technicians who would like to sit for the National Certification Exam. Free of charge to any Hartford HealthCare employee. 

Call Michael Powers at 860-798-8155 with questions. Register today: mpowers@oxyheal.com or michael.powers@hhchealth.org

 

Dr. Barry Stein Presents at Four International Symposia

Dr. Barry Stein, vice chair of the Department of Radiology and director of Cardiovascular MRI & CT, and the Advanced Analysis & Quantitative Imaging Core Laboratory, was invited faculty to present on cardiovascular imaging and intervention at the following international symposia in November:

  • VEITHsymposium: The 40th Annual Symposium on Vascular and Endovascular Issues, Nov. 19-23 in New York
  • AIMsymposium - The 21st Annual Symposium on Advanced Interventional Management, November 13-16 in New York
  • AVIDsymposium: The 24th Annual Symposium on Advances in Vascular Imaging and Diagnosis, Nov. 21-22 in New York

In addition, he was among the invited faculty at the 99th Scientific Assembly and Annual Meeting of the Radiological Society of North America in Chicago in December, where he presented on the Strategic Value of Radiology to a Healthcare System and Cardiovascular Imaging.

 

Dr. Ajay Kumar Serves As Course Director of TransFuse 2014: Transformative-Fusion of Innovative Patient Blood Management

Hartford Hospital and the Mayo Clinic are offering TransFuse 2014, a 3-day multidisciplinary conference devoted to exploring the current state-of-the art techniques and program development to implement a blood management program in hospitals. It will be held March 26-28 at the JW Marriott Desert Ridge Resort and Spa in Phoenix, Arizona.

Dr. Ajay Kumar, chief of the Department of Medicine, is one of the course directors.

Also on the faculty from Hartford Hospital are Dr. Elizabeth Deckers, Ob-Gyn; Dr. Steve Shichman, chair of the Department of Urology; and Chris Donovan, executive director of fiscal services.

REGISTER ONL INE NOW! http://www.mayo.edu/cme/anesthesiology-2014r455

HHC members gets a discount with registration at the Blood Summit.

 

Webinar on the Two-Midnight Rule

There will be a webinar called "From Policy to Practice: Case Studies on Implementing the 2-Midnight Rule" on Thursday, Jan. 16 from 3-4 p.m. It aims to help sort out the confusion around the two-midnight rule, including implementation and potential impact on length of stay and observation numbers.

It is offered by SHM. Register here.

 

CESI Renews Contract To Train Navy Doctors and Submarine Medics

The Center for Education, Simulation and Innovation (CESI) has successfully renewed its contract for training U.S. Navy doctors, as well as submarine medics, with a commitment to a total of 15 training sessions for 25 participants.

The doctors come from throughout the country to train at CESI prior to deployment. The physician course is a one-day course that includes dealing with trauma; developing skills such as suturing and inserting chest tubes; and handling burns, the effects of chemical agents, and mass casualties. The submarine medics’ course is a two-day course.

The Navy doctors and medics were last at CESI in November.

Chief's Corner

GreeneWelcome 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. Should you have any comments or suggestions along the way, please share them with us.

- Dr. Jack Greene, Hartford HealthCare regional vice president of Medical Affairs for the Hartford Region and Hartford Hospital

“Safety Starts with Me” Training Session

Patient safety is our priority. Our goal is to train all physicians who care for patients in our hospital to fully participate in this effort.

The medical staffs at THOCC and Backus have already undergone this training. Dr. Peter Shea, the vice president for Medical Affairs in the Eastern Region, will conduct a training session for physicians on Monday, February 3 In Gilman Auditorium. This session will take place from 11:30 a.m.-1 p.m. during the time set aside for our combined clinical chiefs/MEC meeting. Members of these groups will be expected to attend. We are also inviting all members of our medical staff.

This training will be mandatory over the next year and multiple other sessions will be scheduled. Please take advantage and attend this kick-off session if at all possible. Feedback from those who have attended other sessions has been outstanding.

The safety behaviors that are included in the hospitalwide training include clear communications, effective hand-offs, attention to detail, mentoring and coaching others and practicing with a questioning attitude. These safety behaviors have been successfully deployed in more than 300 other hospitals nationwide, resulting in reduction of preventable harm rates of 85-90 percent on average.

HH’s goal with the HRO journey is to substantially reduce incidents of preventable harm, to the eventual goal of to at least one year without an incident. It’s part of our commitment to do the safe thing for every patient, every time.

 

 

GreeneHelen & Harry Gray Cancer Center Disease Management Teams

 

By Dr. Andrew L. Salner, Director of the Helen & Harry Gray Cancer Center

Cancer care at the Helen & Harry Gray Cancer Center has evolved into a team-based program.

Over the last two years, we have formally organized cancer physicians and staff into nine disease management teams (DMTs) for the purpose of coordinating care and optimizing communication and collaboration:

  1. Breast cancer
  2. Neurologic tumors
  3. Thoracic cancer
  4. GI cancer
  5. Urologic cancer
  6. Skin cancer/melanoma
  7. Hematologic tumors
  8. Head and neck cancer
  9. Gynecologic tumors

(We also have a comprehensive hepato-oncology team (part of the GI DMT) that sees patients in a multidisciplinary setting and provides highly advanced care for patients with liver neoplasms.)

Nearly 200 physicians including surgeons, medical and radiation oncologists, pathologists, radiologists, dentists, neurologists, urology, GI, ENT, neurosurgery and pulmonary MDs and other appropriate specialists comprise the teams.

Each team has a physician lead and coordinator, as well as a nurse navigator who reaches out to the patient and family to provide support, education, and information about our system of care and assist in facilitating prompt access to the right specialists. Each team also includes nurses, genetics counselors, research nurses, social workers, psychologists, and others to assure that the care we deliver is comprehensive, holistic, and patient focused.

Additional DMTs are in the planning phase.

Hartford Hospital cancer physicians continue to be known for delivering highly complex and innovative care. Cancer conferences for each tumor site team occur every 1-2 weeks to facilitate discussion of complex cases and continually improve our system of care. Our goal is to develop an evidence-based personalized and tailored individual treatment plan for each patient.

Our survivorship APRN develops a treatment summary and survivorship care plan for patients as they complete their active treatment regimens. We are committed to communicating with the patient’s primary care physician and their other providers to ensure well-coordinated care.

A variety of support functions designed to help the patient and family cope with their diagnosis and function optimally during their cancer journey are readily available. That’s just one reason why our patients tell us they wouldn’t go anywhere else for their care!

We are an NCI Community Cancer Center, so research is also an important part of our portfolio. We have one of the largest cancer research programs in Connecticut, and can frequently offer access to novel therapies otherwise unavailable in our state.

Our integration across Hartford HealthCare in creating the HHC Cancer Institute will help to ensure one excellent standard of cancer care across our whole system, and facilitate the coordination of care necessary as patients move across various practices and organizations to have their cancer care needs met.

Our alliance with Memorial Sloan-Kettering Cancer Center (MSK) in New York City will enhance and accelerate our development of these standards as we engage in the MSK disease management team activities.

The MSK Alliance will also offer HHC cancer physicians and their patients access to truly unique and exciting clinical research trials, many of which explore molecular and genomic tumor characteristics. Prior to our key alliance with MSK, patients would have had to travel out of state to access these types of cutting edge research trials. Now, they will be available here in Connecticut in each of the communities we serve.

The nurse navigators and cancer team members at the Gray Cancer Center stand ready to help you and your staff, or your friends and family members in providing prompt access to our highly personalized expert cancer care and support. One call to our Cancer Connect nurse at 860-545-6000 will provide immediate access and information about our programs.

Enhancing The Patient Experience

Voices of Our Patients: Kudos To Drs. Ogbonna and Tigadi

Greetings.

My wife and I would like to express our appreciation for the fine work done by the 5th floor staff during my mother-in-law’s visit last week before & after hip surgery.

My mother in law, Sophie Berlin (room 510), has dementia and being in a hospital setting is not easy for her. Confused and frustrated, she was a difficult patient, to say the least. Your staff, from top to bottom, were consistently attentive, responsive and respectful in trying to help her. We especially want to thank nurses Renata and Kim and Chaplain Khaliah, all of whom obviously chose the right professions!

We are also appreciative of the thoroughness with which Drs. Onyechela Ogbonnaand Supriya Tigadi approached their responsibilities and their willingness to spend time fielding questions from us and providing clear and helpful explanations.

My wife and I are not strangers to Hartford Hospital, but the job done by your staff last week in dealing with a difficult situation was beyond our experience and exceeded our expectations.

Please pass along our thanks and appreciation to your staff, especially those mentioned above. And keep up the good work!

Rich Sperber & Helene Berlin

Operational Update

New Medical Staff Office Manager Named

Cathleen Aquino has accepted the job of manager of the Medical Staff Office. She will start in her role at Hartford Hospital on February 3, and we look forward to having her join our team.

She has been in the role of medical staff coordinator and/or credentialing coordinator since 2004. Since August 2011 she has served as the credentialing coordinator at The William Backus Hospital.

Aquino is currently also the vice president of the Connecticut Association of Medical Staff Services and a member of the national organization. She received her certification as a Credentialing Specialist (CPCS) in 2009.

 

A Review of Policy on DNR Orders

A DNR order restricts only cardiopulmonary resuscitation and may not be used to deny a patient any other form of treatment.

The DNR Order form may be used to indicate other treatments that may be withheld. Other therapy may be appropriately limited for an individual patient based on reasonable medical judgment and discussion with the patient or his/her authorized representative.

Decision-making with respect to DNR orders and associated treatment plans should always be conducted in a manner respectful of individual patient’s rights of self-determination.

Pre-existing DNR Orders During High Risk Procedures or Treatments

A pre-existing DNR order for any patient scheduled for a high risk procedure or treatment (meaning all operative and other procedures that expose patients to more than minimal risks, including but not limited to surgical procedures, procedures involving anesthesia, interventional radiology procedures, and endoscopic procedures) must be specifically reviewed as to its applicability during the procedural period.

Automatic enforcement or automatic revocation of a DNR order is not permitted. The responsible practitioner, e.g. surgeon or his/her designee, and decision maker (patient or legally authorized representative) should review the implication of the DNR order as it relates to the procedural period. The procedural (post-operative) period begins when the patient leaves the floor for the OR/other department and ends when the patient returns to the floor post procedure. If the patient is transferred to a critical care area, the period will end 4 hours after the surgery or procedure.

This discussion may result in one of the following actions:

a. The DNR order is suspended for the procedural period

b. The pre-existing DNR order is modified

c. The DNR order remains as previously written

Physicians, other health care personnel directly involved with the patient, as well as patients and families, are encouraged to consult with the Ethics Committee for assistance in interpretation of this policy and in situations complicated by conflicting viewpoints.

Do We Know the Goals of Care?

“The family doesn’t want to change code status…they are afraid that the patient will get less care.”

One of the cornerstones of palliative care is to use our curiosity to explore patient’s preferences and values as they inform our care. As you begin to think about Goals of Care, it is important to distinguish legal advance directives, code status and goals of care. Knowing the patients code status does not tell you anything about the patient’s goals of care.

We often characterize goals of care into three general paths:

1. Restorative/Curative

2. Conservative medical management

3. Allow a natural death/Aggressive symptom management

If the code status is DNR we know that order restricts only cardiopulmonary resuscitation. A DNR does not tell us what the patient hopes for from medical care. The patient may be interested in surgical options, critical care interventions or forms of artificial life support. (E.g. dialysis, artificial nutrition.)

Goals of care are established through an iterative process. The team communicates what is medically possible (including diagnosis and prognosis) and the benefits of available treatments. The patient (or their legal surrogate) will inform us of their values and preferences for care. The patient will tell us the burdens of pursuing available treatment.

We find that goals of care frequently evolve as we get more data (results of biopsies, tests and treatments) and as time passes and we can evaluate the patient’s response to treatment. Time also informs the patient as they have a lived experience and may adjust their goals accordingly.

If a patient has a DNR order in place when you meet them, it is our greatest hope that we understand that a patient’s code status is only one facet of a patient’s preferences for care. It does not tell the entire story.

What gives them joy? Sustains their hope? What are they looking forward to…a graduation, a wedding, raising their family? What important work lies ahead? How can we customize and individualize their medical care to maximize their quality of living?

Do we know the goals of care?

 

 

Please Take This Brief Survey: Center For Global Health

We are developing a Center for Global Health at Hartford Hospital in order to identify our footprint, create value, establish lasting partnerships, and strengthen our opportunity to provide world-wide impact.

Integration and coordination of current HH activities will promote collaboration; improving cost-effectiveness and sustainability, both domestically and abroad.

Please take this brief survey to hlep us identify the global health activities of our physicians, clinicians, and staff, as well as your interest in participating in future opportunities.

Survey results will be used in the development of Hartford Hospital's first global health database.

To participate in this 5-10 minute survey please click here. ( https://redcap.harthosp.org/surveys/?s=Dbb8n9HJv3)

(You may have already taken the Hartford Hospital Humanitarian Mission Survey last February. This is not the same survey. This survey is designed to more accurately capture data that can be collected in the Center for Global Health's database.)

 

 

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.

 

HHC's New Defined Contribution Line-up Getting Industry Kudos for Best Practices

InvestHedge, Dec. 2013/Jan. 2014

HHC is leading what could be an emerging trend among corporate pensions in offering its employees a hedge fund option in their defined contribution plan.

The forward-thinking plan selected Neuberger Berman's daily liquidity 40 Act fund of hedge funds, the first of its kind, for plan participants.

Read more here.

 

Remind a Colleague: Wash In, Wash Out

All health care workers and patients should feel comfortable reminding any other health care worker to sanitize regardless of their role. This should always be done in a courteous and constructive manner. All health care workers should respond courteously and gratefully when reminded.

If you remind another health care worker to sanitize, and he or she responds with irritation or hostility, please notify their department chief, Dr. Jamie Roche or Dr. Jack Ross, who will communicate with them to prevent recurrences.

Did You Know?

Supply Cost Stats

In FY2013, the Hartford Hospital Laundry purchased more than $1.9 million worth of linen, scrub wear and textiles.

Countdown To The Upgrade: 261 Days To ICD-10

Roughed Up By An Orca? There's a Code For That!

The New York Times, Dec. 29

Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.

Been injured in a spacecraft? There’s a new code for that, too.

Roughed up by an Orca whale? It’s on the list.

Overnight on Oct. 1, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.

The new set of codes, known as I.C.D.-10, allows for much greater detail than the existing code, I.C.D.-9, in describing illnesses, injuries and treatment procedures.

Some doctors and health care information technology specialists fear major disruptions to health care delivery if the new coding system isn’t put in place properly.

“If you don’t code properly, you don’t get paid,” said Dr. W. Jeff Terry, a urologist in Mobile, Ala., who is one of those who thinks staffs and computer systems, particularly in small medical practices, will not be ready in time. “It’s going to put a lot of doctors out of business.”

Read more here.

HH In the News

Docs Seek Mergers For Scale, Savings, Security

Hartford Business Journal, Jan. 6

About four years ago, Dr. Lawrence Pareles saw the writing on the wall.After three decades as a cardiologist, the healthcare industry was rapidly changing, creating difficulties for his small Greater Hartford physician group to do business.

Facing uncertainty over insurance reimbursement rates, greater demands for more expansive use of electronic medical records, and the need to offer higher level, more coordinated patient care, Pareles' group Cardiac Care Associates decided to seek a partner to meet the demands of modern day medicine.

In July, the six cardiologists agreed to merge with Hartford's Connecticut Multispecialty Group, one of the largest physician practices in the region. Pareles said he and his fellow Cardiac Care docs thought long and hard before merging with CMG, to leverage CMG's back office capabilities and scale.

With 105 doctors, CMG offers more extensive business support services than Cardiac Care could afford: revenue cycle management, compliance, coding, finance, and human resources. CMG even owns a regional health IT support company. CMG's size will also gain Cardiac Care leverage in contract negotiations with insurers and suppliers, Pareles said.

Dr. Jarrod Post, CMG's CEO, said his group has expanded gradually over the years, going from 35 doctors in 1998 to just over 100 today. The independent practice is mutually-owned by its doctors. CMG's strategy, Post said, is to grow "smartly" based on the clinical needs of the community. The company added Pareles' group, for example, because it wanted to beef up its cardiology services. In 2014, CMG would like to add five to 10 more doctors, Post said. "We don't grow for the sake of growing," Post said.

Hospitals and medical groups are also expanding their physician ranks to meet the changing demands of the industry. One goal of healthcare reform is to move doctors and hospitals away from the traditional fee-for-service model. It's leading to new payment models that offer medical providers a fixed sum to care for a group of patients, particularly individuals with chronic illnesses. To manage those patients effectively, hospitals, doctors, and other care providers must work more collaboratively. CMG, for example, has close ties with Hartford Hospital, where more than 20 of its doctors practice.

Post said CMG has always used an integrated approach to medicine within its own practice. Now it's looking for ways to better align itself with outside care givers. The group, for example, is developing a transitional care clinic program to help patients have smoother transitions after leaving the hospital. The program could include placing its doctors in outpatient centers to ensure patients are taking proper medications and receiving education about their follow-up care after a hospital visit.

"Allowing care to flow from one venue to another is significant," Post said. "We are going to need to embrace tighter relationships with various entities."

Read more here.

 

 

5 Changes in CT Health Care To Watch in 2014

CT Mirror, Dec. 31, 2013

Hospitals are joining larger networks, and some are exploring going for-profit. For years, a common line among health care experts in Connecticut was that the state’s hospital landscape would one day be dominated by two players: Yale and Hartford Hospital.

The wave of consolidation going on among hospitals in Connecticut hasn’t followed that script exactly, but it’s not too far off. Hartford Hospital’s parent company, Hartford HealthCare, now includes five hospitals. The Yale New Haven Health System now includes three hospitals (as well as the former Hospital of St. Raphael, which Yale-New Haven Hospital acquired in 2012), and it could soon include two more.

There are other hospital networks emerging, including Western Connecticut Health Network, which includes Danbury and New Milford hospitals. And a national for-profit hospital chain, Tenet Healthcare, could potentially own all or part of four Connecticut hospitals in the near future.

The reasons behind the trend toward consolidation include the need to access capital to pay for electronic medical record systems and facility upgrades. Hospital officials expect new payment models to require more efficient operations, something that makes economies of scale appealing.

Read more here.

 

 

Data on ECHN Hospitals Could Influence Decisions in Buyout

Journal Inquirer, Jan. 1

Only 30 percent of the 118 available beds at Rockville General Hospital were occupied in 2012, when 44 percent of the 283 available beds at Manchester Memorial were occupied. Just a single Connecticut hospital had a lower occupancy rate than Rockville — New Milford Hospital, where 25 percent of its 95 available beds were occupied.

Occupancy rates higher than those at Manchester Memorial, meanwhile, were recorded at 22 other hospitals, including the hospital’s primary competitors in the north-central health care market — Hartford Hospital, where 79 percent of 802 available beds were occupied, and St. Francis Hospital and Medical Center in Hartford, with a 72 percent occupancy rate.

Read more here.

 

 

Duncaster And Hartford HealthCare Present: "Joint Health"

Hartford Courant, Dec. 20, 2013

Joint health will be the topic of the next Art and Science of Graceful Aging series Jan. 23 at Duncaster Retirement Community in Bloomfield. It will be presented by Courtland Lewis, MD. Dr. Lewis' practice and specialty are orthopedic surgery.

The program is part of Duncaster's "The Art and Science of Graceful Aging," presented by Hartford Hospital. The series features notable physicians leading discussions on improving health and engaging in life.

Read more here.

 

 

Newtown shooter report falls short, Connecticut panel says

Reuters, Dec. 20, 2013

Members of a Connecticut panel charged with recommending ways to prevent gun violence in schools after last year's massacre at Sandy Hook Elementary School said a state attorney's report failed to address the role of the shooter's mental health in the attack. The commission complained that the report, which concluded that questions about shooter Adam Lanza's motive "may never be answered conclusively," limited their ability to advise Governor Malloy on how to improve school safety.

Dr. Harold Schwartz, psychiatrist-in-chief at Hartford Hospital's Institute of Living, noted that the report fails to explore his mental health.

"I have a number of questions about the report and all the unanswered questions concerning his Asperger's autism spectrum diagnosis," said Schwartz. Schwartz added that services for autism-related conditions are often "the most difficult to find."

Read more here.

 

Mental Health Debate Continues In Wake Of Sandy Hook Report

Fox CT, Dec. 20, 2013

The Sandy Hook tragedy sparked a national debate about mental health and prompted Connecticut’s General Assembly to allocate $27 million to mental health services. One program includes support for pediatricians who may encounter patients with mental health issues. Another program provides in-school-training for educators to help them identify problems in students.

Dr. Hank Schwartz, Chief Psychiatrist for Hartford Hospital’s Institute of Living and member of the Sandy Hook Advisory Commission, said the $27 million is a good start but it is not enough.

“If we look at what it is really going to take to address mental health issues in the very same way that we treat cardiac issues and cancer and all the other major diseases […] the commitment has to be ongoing,” Schwartz said.

Read more here.

 

 

Hartford Hospital Security Officers Bring Christmas Magic To Hartford Family

NBC CT, Dec. 27, 2013

A Hartford woman was able to give her grandchildren a Christmas, thanks to some caring public safety officers from Hartford Hospital.

Arthur Bouchard, a public safety officer working at Hartford Hospital on Christmas Day, found a letter that had been torn in two and tossed on the ground. Call it Christmas magic, but Bouchard decided to pick it up and read it for some reason. The letter was a plea for help, written by a woman whose husband had been sick. Kim Liggins had been too busy taking care of her husband to shop for Christmas gifts for her grandchildren, 5-year-old Amya and 2-year-old Avery, who live with her.

When Bouchard read the letter, he knew he had to help. He told NBC Connecticut he called the family and asked what they needed.

Bouchard, along with his public safety co-workers Ray Brodeur and Miguel Bermudez contacted Connecticut Children's Medical Center, which had some gifts available to bring to the family, according to Hartford Hospital.

The three officers hand delivered the gifts to the family, giving the girls a Christmas after all.

In the HHC System

Local and National Health Care Changes in 2013: HOCC and MidState

The Bristol Press, Dec. 29, 2013

It’s been a rough year for the health care in this country, but our local hospitals have continued to supply world-class health care, even moving forward despite the financial and regulatory storms.

The Hospital of Central Connecticut took a big hit when the state’s budget forced it to cut tens of millions from its budget. The hospital responded with tighter fiscal controls, streamlined leadership and increased economies coming from its relationship with Hartford HealthCare.

Lucille Janatka, president and CEO of Midstate Hospital in Meriden, added HOCC to her responsibilities when she became CEO of Hartford Healthcare’s Central Region, consolidating management of those two hospitals. Clarence Silvia, the former chief of Bradley Memorial who led the HOCC through its merger with Hartford a few years back, retired, and other senior leaders who had contributed much also left.

Read more here.

 

 

Natchaug Hospital Opens Young Adult Outpatient Center

The Day, Dec. 28, 2013

Young adults in southeastern Connecticut facing depression, anxiety, drug or alcohol abuse, social withdrawal and other mental health problems have a new resource to help them cope with the stresses and challenges specific to their age group.

"We realize their needs are unique," said Carrie Pichie, psychologist and director of ambulatory services for Natchaug Hospital. "We're just trying to meet the needs in the community."

Natchaug Hospital, based in Mansfield, this month expanded its Care Plus outpatient center in Groton to add programs for 18- to 25-year-olds, responding to a need identified by the General Assembly's Bipartisan Task Force on Gun Violence Prevention and Children's Safety after the Sandy Hook massacre on Dec. 14, 2012. Adam Lanza, the 20-year-old who carried out the massacre, had been diagnosed with Asperger syndrome and had been extremely withdrawn socially, although these conditions are not directly linked to violent behavior, Pichie noted. Still, the tragedy brought more awareness to gaps in mental health services for this age group, she said.

Read more here.

 

 

HOCC First in State to Adopt VolparaDensity Software To Improve Early Detection of Cancer in Women With Dense Breasts

PR Web,Jan. 7

The Hospital of Central Connecticut (HOCC) is the first facility in Connecticut to adopt VolparaDensity™ breast imaging software, designed to help overcome the limitations of mammography to detect cancer in women with dense breasts. The Enterprise installation of HOCC provides the ability to offer objective volumetric breast density values for mammograms performed annually at six facilities on eight Hologic full-field mammography systems.

Serving Greater New Britain, Conn., The Hospital of Central Connecticut’s comprehensive breast program is the first such program in Connecticut to be recognized as a Certified Quality Breast Center of Excellence in the National Quality Measures for Breast Centers™ Program. This distinction signifies the hospital’s commitment to providing the highest level of quality health care to patients in its community.

“Utilizing VolparaDensity allows us to remove the subjectivity from the evaluation of breast density to be more consistent in our measurements, from time to time, image to image, mammogram to mammogram, and radiologist to radiologist,” said Jean Weigert, M.D., director of Breast Imaging at HOCC. “This consistency means our screening process is more accurate for our patients. For example, if we base decisions to perform more testing on subjective values, we may include women who do not need supplemental imaging and exclude women who do. This automated, volumetric density measurement tool helps ensure that the proper women are being evaluated in a proper, consistent manner.”

 

 

HOCC Takes Aim At Mental Health Awareness

Southington Patch,Jan. 6

The Hospital Of Central Connecticut, part of the new Hartford HealthCare Behavioral Health Network, will host a forum as a starting point to “raise awareness and break down barriers” related to mental health.

As part of an ongoing effort to help improve public understanding of mental health issues in Connecticut, the Hartford HealthCare Behavioral Health Network and The Department of Psychiatry at HOCC are sponsoring a free public event on Jan. 23 at HOCC in New Britain.

The event, titled “Raising Awareness, Breaking Down Barriers,” will feature speakers who are experts in behavioral health as well as an opportunity for questions and answers from the audience.

 

 

State Names Board for Bioscience Fund; Includes HHC's Dr. Steven Hanks

Hartford Courant, Dec. 17

The state’s newly created, $200 million Bioscience Innovation Fund now has an advisory committee filled with some of Connecticut’s high-powered figures in the field.

The fund, overseen by Connecticut Innovations, the state’s quasi-public technology investment and assistance arm, was created by the governor as a way to target drug development projects and other bioscience innovations, at firms or universities, with public money that could also attract private investment. The fund, to be disbursed over 10 years to projects that show commercial promise, is scheduled to award $10 million the first two years, $15 million for the third and fourth years, and $25 million in years five through 10.

The board, with members appointed by Gov. Dannel P. Malloy or legislative leaders, includes:

  • Claire Leonardi, CEO of Connecticut Innovations, chair
  • Peter Farina, Ph.D., executive in residence at Canaan Partners;
  • Steven Hanks, M.D., vice president of medical affairs for the central region at Hartford HealthCare;
  • Joseph Kaliko, CEO of Gaming Innovations International;
  • Marc Lalande, Ph.D., chairman of the Department of Genetics and Developmental Biology, and head of genomics and personalized medicine programs at UConn
  • William LaRochelle, Ph.D., an executive at Roche 454 Sequencing Solutions International;
  • Charles Lee, Ph.D., scientific director at The Jackson Laboratory;
  • Alan Mendelson, general partner of Axiom Venture Partners;
  • Edmund Pezalla, M.D., national medical director for pharmaceutical policy at Aetna;
  • Carolyn Slayman, Ph.D., professor of genetics and cellular and molecular physiology and deputy dean at Yale School of Medicine;
  • Eleanor Tandler, founder and CEO of Novatract Surgical.

Health Care News In the Region

Connecticut hospital scorecard: Who owns your hospital?

CT Mirror, Dec. 24, 2013

Connecticut has long been dominated by locally run, independent hospitals or those in small regional networks, but that’s changing. The number of hospitals joining larger networks has grown dramatically in recent years, and experts expect the trend toward consolidation to continue. Who owns your hospital?

See what hospitals are affiliated through ownership.

Hot Topics in Health Care

For Young Doctors, Hospital Paycheck Trumps Solo Practice

Kansas City Star, Dec. 30, 2013

An independent practice doesn’t hold the same attraction for new doctors as it did for earlier generations of physicians. Independent practice means managing a business and working long, unpredictable hours for what’s become an increasingly less certain income. Instead, growing numbers of doctors of the millennial generation are choosing employment, most often by hospitals.

Millennial physicians are entering the job market at a time when hospitals nationwide have been hiring thousands of doctors and snapping up hundreds of practices of older, independent doctors. Hospitals want doctors in their employ to secure — or expand — their share of a rapidly changing health care marketplace.

But it’s the career inclinations of young doctors, as much as the economic ambitions of hospitals, that may be dooming the iconic small, independent doctor’s practice to a marginal role in medicine’s future. Some observers say we may already have reached the tipping point where doctors who work for systems of hospitals and clinics will become the rule, rather than the exception.

Hospital employment was the No. 1 career choice among medical residents in their final year of training, a 2011 survey by a physician recruitment firm found. Only 1 percent of these new doctors said they wanted their own solo practices.

Read more here.

 

 

How Much Does A New Hip Cost? Even The Surgeon Doesn't Know

Kaiser Health News, Dec. 6

Do you know the cost of a medical device — the kind that gets implanted during a knee or hip replacement? Chances are you have no clue. The surgeons who implant those devices probably don’t know either, a just-published survey shows.

Medicare spends about $20 billion each year on implantable medical devices — nearly half of it for orthopedic procedures. And as the population ages and more Americans get joint replacements, that number is only going up, which will have a bigger and bigger impact on the nation’s health care spending.

But orthopedic surgeons were only able to correctly estimate the cost of a device 21 percent of the time. Their guesses ranged from 1.8 percent of the actual price to 24.6 times the actual price.

Unlike pretty much every other consumer industry, health care costs are not transparent, even for the surgeons. Each hospital system and purchasing group negotiates deals with device manufacturers and signs a nondisclosure form, promising not to share the details of those prices with anyone else. That’s because “medical device manufacturers strive to keep their prices confidential so that they can sell the same implant at a different price to different health care institutions,” the study authors write.

But costs matter: for a total knee replacement, the actual piece of machinery that gets implanted can cost anywhere from $1,797 to $12,093, depending on the negotiated price. And there’s little evidence that one particular device is any better than another for the patient.

Read more here.

Coming Events

January 16 (Thursday)

Webinar on Two-Midnight Rule

3-4 p.m.

There will be a webinar called "From Policy to Practice: Case Studies on Implementing the 2-Midnight Rule" on Thursday, Jan. 16 from 3-4 p.m. It aims to help sort out the confusion around the two-midnight rule, including implementation and potential impact on length of stay and observation numbers.

It is offered by SHM. Register here.

 

January 25 (Saturday)

Black & Red

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

Featuring the music of Barenaked Ladies. Sold out!

 

February 3 (Monday)

"Safety Starts With Me" - High Reliability Training

Gilman Auditorium, 11:30 a.m.-1 p.m.

Dr. Peter Shea, the vice president for Medical Affairs in the Eastern Region, will conduct a training session for physicians We are inviting all members of our medical staff. This training will mandatory over the next year and multiple other sessions will be scheduled. Please take advantage and attend this kick-off session if at all possible. Feedback from those who have attended other sessions has been outstanding.

 

February 7 (Friday)

Surgery Grand Rounds: Trauma Resuscitation 2014 - What's New?

Gilman Auditorium, 6:45 a.m.

Dr. Kimberly A. Davis, Vice Chairman of Clinical Affairs and Chief of the Section of Trauma, Surgical Critical Care & Surgical Emergencies at Yale University School of Medicine; and Trauma Medical Director and Surgical Director, Quality & Performance Improvement at Yale New Haven Hospital

 

March 26 (Wednesday)

Medical Staff Interim Meeting

Gilman Auditorium, 5:30-7 p.m.

We will be having a Town Hall Style meeting with the hospital and medical staff leadership. Put it on your calendar now!

 

May 22 (Thursday)

The Board of Directors and Medical Staff Spring Event

Heublein Hall at the ERC, 6 p.m.

A cocktail hour begins at 6 p.m. The awards ceremony will begin at 7 p.m.This year we will present five awards: the Physician in Philanthropy Award; the Distinguished Service Award; the David Hull, MD, Young Practitioner Award; the John K. Springer Humanitarian Award; and the Quality and Safety Award.

 

 

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. Stacy Nerenstone, Medical Staff president, at (860) 545-3043.