2015 CLINICAL ANNUAL REPORT innovation & patient-centered care ANNUAL REPORT 2015 hen I assumed the position of Chair of the Medical Staff in 2014, it was with the knowledge that I would have the honor of working with an exemplary medical staff with a history of W successes and accomplishments. As 2015 draws to a close and I look back on what was achieved during the year, it is clear that this tradition of excellence has continued. If I may, I would like to highlight a few of these accomplishments: • HCAHPS Physician Communication scores that are consistently at the CMS target or higher. • Planned implementation of a pilot program to address the growing healthcare needs of the geriatric population by the early identification and management of patients with cognitive impairment and delirium. • Selection of Michael Bernstein, MD as the 2015 recipient of the Dr. Melville G. Magida Award. • Recognition of four physicians for their commitment to their patients and the Stamford Community as “Physician of the Quarter” — Kevin Dwyer, MD, Jennifer Henkind, MD, Sarah Kahn, MD, and Kirsten Hohmann, MD. • Successful accreditation surveys by the Department of Health, Joint Commission Triennial Accreditation, and Recertification of programs in Stroke, Joint Replacement and Spinal Fusion, in large measure to the quality of medical staff and the care provided to patients. Re-accreditation of Breast Center and Heart Failure Program. • Successful implementation of ICD-10 that could not have been achieved without the full cooperation and leadership of the medical staff. • Expansion of SHIP. • Medical staff that is extremely loyal to Stamford Hospital as evidenced by the results of the Physician Engagement Survey that showed that almost two-thirds of the medical staff are either employed, closely affiliated or closely aligned with the Hospital. • Appointment of Suzanne Rose, MS, PhD, as Director of Research, to provide support to the medical staff in their research and scholarly pursuits. • Outstanding clinical faculty that helped achieve 100% match in the Hospital’s residency programs. There is little doubt that 2016 will be another stellar year, despite the challenges that we face due to external financial constraints beyond our control. In early fall, we will have a fully operational, state-of- the-art, technologically superior hospital that will enable our organization to fulfill its commitment to patient safety and quality. But, in the end, Stamford Hospital is comprised of more than bricks and mortar. The members of the medical staff, under the guidance of their Department Chairs, are the heart and soul of the organization. From the bottom of my heart, I want to thank each of the Department Chairs for their leadership, commitment and hard work. To the division chiefs that support their chairs in their work, a special thanks is extended too. I look forward to working with you all in the coming year in a spirit of collegiality and mutual respect. My very best wishes to you and your families for a healthy and happy New Year. Joshua Herbert, MD Chair, Medical Staff 2015 CLINICAL ANNUAL REPORT | 3 ANNUAL REPORT 2015 his year, the focus of our Clinical Annual Report is on Innovation & Patient-Centered Care — two areas that define our 10 clinical departments. Over the last year, innovation has been T in the addition of several new procedures, including: FATE (focused assessment transthoracic echocardiography); TAVR (transcatheter aortic valve replacement); Convergent; CardioMEMS™; Fuse® endoscopes in GI; and a new state-of-the-art “robot” to advance minimally invasive surgery. At the same time, we have fostered excellence in the patient experience with multidisciplinary programs, such as: new ED staffing models; new collaborative pain management approaches; safer imaging techniques; and the delivery of efficient lung cancer screening. We have also added the first Office of Research at Stamford Hospital and this will pave the way for even more advanced approaches. The Chairs open with a year in review, which provides a sense of the scope of the departmental efforts and strategy. The overarching theme that emerges is one of collaboration and teamwork for the purpose of providing world-class quality patient care. This is exemplified in the development of new programs and the expansion of others; recruitment of new talent; medical education and research; and many, many accreditations and accolades. Of note, this year we have added two new full-time department chairs — in Family Medicine and Radiology — reflecting the changing dynamics in our market and the need for focused clinical leadership in strategic areas. Additionally, we have added 49 new medical staff in nine departments. Of these three unique physicians serve on committees to advance patient care at Stamford Hospital. Our mission, “Together with our physicians, we provide a broad range of high-quality health and wellness services focused on the needs of our patients,” comes to life on the pages that follow. Toward this end, this year we completed the first physician engagement survey of the medical staff. Participation was significant with 50% of responses from independent physicians. We learned that there is a divergent opportunity to engage and align our staff based on their professional relationships with Stamford Hospital, and the Chairs have initiated plans to address the feedback from the medical staff. Of note however, is that nearly 76% of physicians strongly/ agree that they are proud to work at Stamford Hospital. I want to thank the medical staff, the Chairs and all the Hospital departments for this incredible body of work. Together we move forward faster, and I look forward to continuing to share this journey with each of you. Sharon C. Kiely, MD, MPM Senior Vice President, Medical Affairs Chief Medical Officer Patient Safety Officer 4 | ANNUAL REPORT 2015 table of CONTENTS Anesthesiology 6 Emergency Medicine 12 Family Medicine 20 Medicine 28 Obstetrics & Gynecology 58 Pathology 68 Pediatrics 76 Psychiatry 86 Radiology 92 Surgery 100 2015 CLINICAL ANNUAL REPORT | 5 innovation in ANESTHESIOLOGY Recognized as the only Center of Excellence for regional anesthesia in the Northeast. 6 | DEPARTMENT OF ANESTHESIOLOGY DEPARTMENT OF ANESTHESIOLOGY: ANNUAL REPORT 2015 A MESSAGE FROM THE CHAIR: our Department in 2016, data will now be automatically uploaded into a national registry to allow comparison to The Year in Review millions of other anesthetics performed in the country. In 2016, the Department will be able to routinely present the anesthesia quality score card to committees and the data can be adjusted as core measures are changed in time. In response to increasing volume in the cardiac surgery Betty-Ann Robustelli, MD operating room and the development of the structural Chair, Department of Anesthesia heart program, we have redesigned the cardiothoracic anesthesia coverage model to now include four fellowship- trained cardiothoracic anesthesia doctors. Our cardiac anesthesia team includes Drs. Amy Crane, Margot Denham, Vlad Frenk and Andrew Sosa. These physicians are not only experts in delivering anesthesia for our sickest patients t is with great pleasure that I write my first annual report undergoing open heart surgery, but they are also all board Ias Chairman of the Department of Anesthesiology. I certified in transthoracic echocardiography including began working for Stamford Anesthesiology in 2003 after the use of 3D echocardiography which has become the completing my residency at Mount Sinai Medical Center. standard of care for cardiac valve replacement surgery. The For the past two years, I have been the Associate Chair and structural heart program has successfully launched the also held the role of the Medical Director at the Tully Health transcatheter aortic valve replacement (TAVR) program Center. In October of this year, I took over for Dr. Theresa this year. It has allowed patients who are non-operative Bowling, who successfully led our department for the past candidates for valve replacement to successfully replace two years. Everyone at Stamford Anesthesiology greatly their valves percutaneously. The multidisciplinary procedure appreciates all of her hard work and dedication. Dr. Steven has strengthened our growing cardiac program and we are Finkel has been appointed the Associate Chairman as well happy to play such a large role. as the Medical Director of Tully. Dr. Finkel joined Stamford Anesthesia after completing his residency at Cornell in 2005. In February of last year, 30% of our Department became Both of us are excited for the future and look forward to the certified to perform a Focused Assessment Transthoracic growth and expansion of our Department into the new Echocardiogram exam (FATE). FATE is a non-invasive hospital opening in 2016. procedure that assesses cardiac function in the real time prior, during and after an anesthetic to assist in tailoring 2015 has been an exciting year for the Department of the anesthetic to a patient who is acutely unstable and Anesthesiology. The Department has continued to grow to when there is no time to have a complete cardiac exam by support the expanding and new service lines that Stamford a cardiologist. This has been shown to decrease mortality Hospital has been developing. We have recruited talented in certain patient populations compared to controls most new staff who have come to us from some of the finest notably in patients undergoing hip fracture repair surgery. institutions in the country. We have also trained our existing We have utilized this modality to avoid surgical delays. staff in progressive new techniques to improve outcomes especially for our sickest patients in order to continue to Our Department continues to offer unique anesthetic provide the safest anesthesia possible. solutions for complex medical problems even outside the operating room. This past year we started offering our The Department has also joined the Anesthesia Quality patients with fractured hips, who wanted to avoid surgery, Institute, AQI, a quality management program that was the option of a continuous peripheral nerve block to treat created by The American Society of Anesthesiology.