Medical Staff News Newsletter for the Medical Staff of Bridgeport Hospital | July 2018

From the desk of the CMO

Like many of you, I find summer is a great time to read. There are a number of books that are not as easy to read as Mostly for pleasure, but I do like some reading related to the ones I’ve listed so far, but if you are so inclined, they are work as well. Over the years, I have found several books interesting. For example, there are some excellent books worth reading for their insights into some aspect of my about decision-making. My favorites are Nudge and The work. I decided to pass along a few of the titles, I think they Paradox of Choice. Science now knows quite a bit about are all worth the time and effort to read. how people make decisions and given the many decisions physicians make every day, it is worth knowing more about Good to Great by Jim Collins is a classic in the business how our brains process information and make decisions. literature and an easy read. The author looked at corporations that had gone from being successful I strongly recommend all books by Malcolm Gladwell. A companies to being exceptionally successful and sustained talented writer and thinker, he tackles a lot of unusual and that level of success. It isn’t going to surprise you, but challenging topics and makes them comprehensible and leadership matters a lot. This book identifies several key easy to read. concepts that make organizations prosper or not. Many books may help you deal with the stress of our roles If you’re interested in some of the practical aspects of and the tensions that are constantly pulling us in different physician leadership, read The 6 P’s of Physician Leadership directions. I liked the book, Remedy for Burnout by Starla by Bruce Flareau, MD. It is quick, clear and insightful, Fitch, MD. I strongly recommend The Happiness Advantage and the lessons he draws are relevant. Physicians are like by Shawn Achor. The field of positive psychology has solo athletes and so managing us is not quite the same as learned a lot about human psychology over the years, and managing most other types of professionals. Dr. Flareau the author does a great job making the advances applicable gives his perspective, and I think it is a useful way to look to everyday life. at leading. I’ll also make a pitch for NEJM Catalyst (catalyst.nejm.org), You should read the books written by Atul Gawande, MD. an online resource produced by the New England Journal of If, however, you want to read only one, make it Being Mortal. Medicine. They are constantly updating it with articles on Every adult in the country should read his insights into how to improve the care we provide. You won’t be interested end-of-life care in the . The good news is that in every article, but you will be interested in enough of them Dr. Gawande is a practicing surgeon and that authenticity to make it worthwhile. comes across. He is also a gifted writer which makes Enjoy the summer. reading his books a pleasure. Michael Ivy, MD, chief medical officer One of the best books about the patient experience is In Shock by Rana Awdish, MD. The book works on many different levels. Some of you may have read her article in the New England Journal of Medicine, but the book is still worth reading. It’s a fascinating story about her experience as a critically ill patient and is full of insights from her intensivist background.

1 Medical Staff Executive Committee Additions at Park Avenue Medical Center June 4, 2018 William Jennings, president and CEO: Douglas Talentino, MBA- Park Avenue Medical Center continues to expand its MPH student at Ohio State, is Administration’s summer intern. services, by adding new physicians in the fields of pediatrics, April operating margin was over budget and over last year, largely due to improvement of state treatment of provider tax. Year-to- primary care, urology/gynecology and plastic . date operating margin is behind plan, but ahead of last year. – Northeast Medical Group’s primary care physicians Discharges behind plan, but outpatient volume remained very strong. Surgery volume up, deliveries down to plan. The case Andrew Cutney, MD; Bhawna Gupta, MD, and Alla mix index went down slightly. Expenses higher than optimal, Chesky, MD, are now seeing patients at PAMC. especially with travelers in perioperative services, the ICU and the cath lab. PT/OT plan has been implemented. Behavioral – Yale Medicine’s Oz Harmanli, MD, urology/gynecology, Intervention Team is starting up. Optimism in length of stay sees patients in the Specialty Physician area. (LOS) numbers from April. Transition of care rounds are helpful. About 6 percent of patients account for a full extra day in LOS. – Yale Medicine plastic surgeons John Persing, MD, and Michael Ivy, MD, CMO: Rockman Ferrigno, MD, won the J. Grant Thomson, MD, and community provider Greater Bridgeport Medical Association’s Physician of the Year. Bridgeport Hospital staff were honored with a system award Elizabeth Stirling Craig, MD, are available for patient for clinical redesign for the adoption of a system-wide opioid consultations and treatment. standard of practice. A patient experience and Bridgeport Hospital award was given for work on the impact of a unit In the Yale New Haven Children’s Hospital Pediatric medical director on patient LOS and satisfaction. Visage will be replacing the Synapse PACS for radiology. The soft rollout will Specialty Center at Park Avenue, the following new begin in mid-July. Synapse is done at end of July. There will be providers are available in these specialties: extra help available in the ED, ICUs and the OR. Ryan O’Connell, MD, vice president, Performance and Risk Adolescent gynecology Management: Doing well with readmissions and disclosures – Alla Vash-Margita, MD of SSEs, a bit better on infection rates, although C. difficile remains a challenge. Issues remain about appropriate testing. Throughput measures not stellar. For context, ED visits up over Allergy/Immunology 1,000 in April. Surgery measures doing well. On CMS measures, we continue to perform well on mortality metrics, but less so for – Tamar Rubin, MD readmissions. There will be a clinical re-design project for heart failure readmissions. Hematology/Oncology Pamela Scagliarini, executive vice president and COO: Press – Shilpa Hattangadi, MD Ganey satisfaction scores dipped and came back up, but some have gone back down. Likely related to volume. The increase in Otolaryngology night nursing ratios should have impact, as should rounding with purpose. Having a designated hospitalist on units for three- – Cecilia Helwig, MD month blocks is beneficial for team development. Two drivers of satisfaction are IV sticks and patients held in hallways. Shannon – Eric Waldman, MD Kemp was a secret shopper, provided insightful feedback. A sorting nurse role will be created and a dashboard monitoring Nephrology patients will be instituted, as well as addressing business associate late shift fatigue. Y Access for direct admission of – Olivera Couloures, MD patients will soon be available. Community physicians will receive direct education about process. PAMC had dip in satisfaction – Jillian Warejko, MD scores, to 76th percentile. There have been challenges with radiology scheduling and way-finding, which will receive focused Neurology attention. Sixteen teams addressing the budget mitigation process for FY 2019. This process must be resolved by – Viviana Benitez, MD early August. For more information on pediatric specialty services at Park Avenue Medical Center, contact 203-785-4081. Newsmakers The following residents received graduate medical education Quality Awards in June for their efforts: Ying Yuan, MD, PGY 2, Internal Medicine, assisted on a busy night in the MICU during an Epic downtime. Dr. Yuan wrote transfer notes and placed handwritten orders for new admissions, allowing other team members to focus on patient care. Rami Sulaiman, MD, PGY 3, Radiology, responding to a last-minute request, assisted during a recent Saturday night coverage void. Xiomara Okonkwo, MD, PGY 1, Podiatry, used her creativity to assist a patient with a severe hearing deficit by writing out key words to aid in communication.

2 Bill Jennings monthly breakfast forum All Cysview phase III clinical trials across over 1,800 patients, using blue light cystoscopy with Cysview, resulted Medical Staff members are invited to join President and in statistically significant improvement in detection of Ta/ CEO Bill Jennings and a guest from YNHHS leadership T1 tumors over using white light cystoscopy alone. monthly on Mondays, 7 - 9 am, in the Medical Staff Lounge for breakfast and discussion. Additionally, another study in BJU International (Hermann et al. 2011) investigated whether Cysview could detect July 9 – Rob Goodman, MBBCh, chair, Radiology and residual tumors after a white-light guided resection. The Biomedicial Imaging, Yale School of Medicine; Interm chief, study confirmed that 90 patients had bladder cancer on Radiology and Biomedicial Imaging, YNHH biopsy after white light resection. In 49 percent of these patients, residual lesions were found with Cysview after the August 13 – Ian Schwartz, MD, vice president, initial TURBT. Clinical Operations. Chair, Radiology and Biomedical Imaging. Studies show that Cysview reduces the rate of recurrence by 10.9 percent and lowers the rate of disease progression. When improving tumor detection, TURBT is a critical first Blue light cystoscopy with Cysview for step in diagnosing and staging bladder cancer. Combining advanced management of non-muscle TURBT with blue light also increases diagnostic accuracy. invasive bladder cancer Using blue light cystoscopy may lead to a more complete resection, fewer residual tumors, better patient management The National Cancer Institute reports that there were decisions and more optimal patient care. Blue light approximately 79,030 new cases of bladder cancer in 2017. cystoscopy with Cysview is becoming the standard of care Currently, greater than 696,400 people are living with at cancer institutions. bladder cancer in the U.S. In Fall 2017, Bridgeport Hospital obtained blue light In non-muscle invasive bladder cancer, up to 61 percent of cystoscopy with Cysview. Other future advancements for tumors recur one year later after a transurethral resection of urology at Bridgeport Hospital include using Enhanced bladder tumor (TURBT) procedure. At five years, up to 78 Recovery After Surgery (ERAS) for urologic , MRI percent of tumors recur. In addition to recurrence, up to 17 US fusion prostate biopsy for improved detection of prostate percent progress to muscle invasive disease at the one-year cancer and SpaceOAR gel insertion for radiation therapy mark. At five years, the progression increases to 45 percent. treatments of prostate cancer. These recurrence rates are due to incomplete resection or microscopic lesions not observed at the initial TURBT. Caregivers honored by patients Bladder cancer is one of the most expensive cancers to treat The Bridgeport Hospital Foundation announced the due to costs of diagnosis, treatment, continued surveillance following clinical staff members were recognized by and high risk of recurrence. patients in May with a gift to the Honor Your Caregiver In 2016, the American Urological Association and Society program: Michele Attard, LMT; Krysta Carri, RN; Edward of Urologic Oncology issued a joint guideline that clinicians Pinto, MD; Christopher Rillstone, RN; Robert Young, PA. should offer blue light cystoscopy at the time of TURBT to increase detection and decrease recurrence.

3 What are facility fees, and why do we Yale New Haven Health hospitals and other healthcare have them? providers are required by law to notify patients of facility fees before medical appointments. Recognizing that facility You might have seen recent media coverage about facility fees can be a hardship for some patients, YNHHS in 2017 fees, the charges included in some medical bills when recalibrated its pricing to mitigate the impact of these patients receive care at hospitals or hospital-owned fees on patients. The health system also offers a variety of physician practices and medical clinics. programs to help patients pay for their medical care.

Hospitals nationwide have long charged facility fees for “Yale New Haven Health has robust programs to help inpatient hospital stays and emergency department visits, patients pay their hospital bills,” D’Aquila said. “We work as well as visits to hospital-owned physician practices and with every patient on an individual basis to help them pay outpatient centers. Hospitals throughout Connecticut, for their healthcare.” including those that are a part of Yale New Haven Health, charge these fees to support critical services such as trauma centers and 24/7 emergency care. Additionally, hospitals are Conflict of Interest and CMS Open held to much higher regulatory standards than freestanding facilities and private practice provider offices, Payment upcoming activity and the difference between the costs of care reflect that Mid-September 2018, the Office of Privacy and Corporate higher regulatory standard. Compliance (OPCC) will be launching our Conflict At the same time, the state of Connecticut has chronically of Interest (COI) attestation survey to Northeast Medical and severely underfunded Medicaid while imposing Group physicians and certain advanced practice providers historic taxes on hospitals, so the need to fund our 24/7 (APP). Our survey participants will receive an email operational capacity is under constant pressure, said with a unique, secure link to their survey and we ask for Richard D’Aquila, YNHHS president. your participation and complete the survey within the requested timeframe. “Yale New Haven is now the largest taxpayer in the state, and will pay more than $300 million this year alone,” he In July, the OPCC will begin reviewing the CMS Open said. “Unfortunately, funds that could be used to reduce Payments data for our physicians. Open Payments is a charges or enhance patient care are being redirected to CMS federally run program that provides transparency state coffers.” and increases public awareness of financial relationships between the healthcare industry and physicians. This Unlike other states, Connecticut does not have state- is accomplished by collecting and making public any funded safety-net hospitals, so hospitals like Bridgeport payments or transfers of value from drug and device and Yale New Haven bear enormous costs associated with manufacturers to physicians or teaching hospitals. patients who are uninsured or under-insured. Two-thirds This data becomes public on June 30, 2018. You may be of YNHHS patients are insured by government payers that contacted to complete your COI attestation survey compensate us well below our real costs. Last year alone earlier than September depending on your relationship YNHHS provided more than $450 million in free care, with the industry. charity care and under-reimbursed care to guarantee access for all patients the health system serves. If you have any questions regarding these upcoming initiatives, please contact the Office of Privacy and Facility fees have garnered more attention in recent years Corporate Compliance directly at 203-688-8416. because the charges appear on bills for patients who do not visit the hospital, but receive care at an affiliated doctor’s office or other hospital-owned facility. With an increasing number of hospitals and health systems integrating physician practices and more patients being seen in hospital owned multispecialty ambulatory facilities, more patients are seeing facility fees on their bills.

4 New Physicians Mammography screening Tarek Mikati, MD Medicine / Hospital Medicine guidelines reminder Northeast Medical Group 267 Grant St. Norma Pfriem Breast Center, part of Smilow Cancer Bridgeport, CT 06610 Phone: 203-384-4677 Hospital, is dedicated to providing a comprehensive Fax: 203-384-3135 network of services for complete breast health and wellness. Medical School: American University of Beirut, Beirut, Lebanon : Internal Medicine, Yale New Haven Hospital The multidisciplinary team of breast cancer specialists Fellowship: Infectious Disease, Memorial Sloan Kettering Cancer Center, provide one-on-one care with dignity, , NY; Prevention Medicine and , Weill Cornell Medical College, New York, NY privacy and warmth, in a serene, comfortable and Board-certified: American Board of Internal Medicine professional setting. Ernest Retland, MD Medicine / Hospital Medicine Below is a reminder of the current mammography Bridgeport Hospital screening guidelines: 267 Grant St. Bridgeport, CT 06610 Phone: 203-384-4677 1. Women of average risk should begin routine, annual Fax: 203-384-3135 screening as early as age 40 but no later than age 45. Medical School: Wayne State University School of Medicine Residency: Internal Medicine, Detroit Medical Center, Detroit, MI Board-certified: American Board of Internal Medicine 2. Screening under age 40 may occur for women who are at increased risk for breast cancer. John David Schwerdt, DPM Surgery / Podiatry Yale Podiatry Group 3. Patients with dense breasts may benefit from annual 4 Corporate Dr. Ste. 384 supplementary screening which can include breast Shelton, CT 06484 Phone: 203-734-4806 ultrasound or MRI screening depending on individual Fax: 203-734-8265 Medical School: New York College of Podiatric Medicine, New York, NY risk factors. Residency: Podiatric Medicine and Surgery, NewYork-Presbyterian/ Queens, Flushing, NY 4. The screening schedule should continue as long as the Board-certified: American Board of Foot and Ankle Surgery

woman is in good health. Xiaochuan Guo, MD Anesthesiology / General Anesthesia Norma Pfriem Breast Center, with locations in Bridgeport, Bridgeport Anesthesia Assoc. 267 Grant St. Trumbull and Fairfield, is an accredited breast center, per Bridgeport, CT 06610 the standards established by the National Accreditation Phone: 203-384-3632 Fax: 203-384-4619 Program for Breast Centers (NAPBC). The NAPBC requires Medical School: China Medical University, Shenyang, China these guidelines be shared on an annual basis to referring Internship: General Surgery, Vanderbilt University Medical Center, Nashville, TN providers. Residency: Anesthesiology, SUNY Downstate Medical Center, , NY For more information on services offered by the Breast Board-certified: American Board of Anesthesiology

Center, contact 203-384-3392. Moe Tun Kyaw, MD Medicine / Hospital Medicine Northeast Medical Group 267 Grant St. Bridgeport, CT 06610 Phone: 203-384-4677 Fax: 203-384-3135 Medical School: Institute of Medicine, Yangon, Myanmar Residency: Internal Medicine, Brooklyn Hospital Center, Brooklyn, NY Board-certified: American Board of Internal Medicine

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FaciliNet system to enhance Facilities and Maintenance functions health system-wide

When nurses want to review a patients’ test results, they FaciliNet will be designed to: check the computer. When it’s warm in an Operating – Make it easier for clinical and other staff to request Room, the staff adjusts a thermostat and additional chilled repairs, projects and space water cools the room. To sterilize surgical instruments, the Central Sterile Processing staff press a few buttons on – Provide real-time information on current requests, as machines that release steam into the sterilizer. well as email updates on repair status – Be user-friendly and accessible to all staff members via Stephen Carbery, vice president, Facilities Design, the intranet Construction and Real Estate, says that staff members involved in patient care don’t have to think about where – Improve regulatory readiness with an updated “clean the electricity, chilled water or steam comes from – or any and safe rounds” feature of the other basic utilities they need to do their jobs – and Planning for FaciliNet began over a year and a half ago that’s the way it should be. That is why we are working to with input from Nursing, Corporate Supply Chain, ITS, the improve our maintenance and work-order systems so they Internal Consulting Group, Finance and other departments have that same feeling and reliability. throughout the health system.

This fall, Corporate Facilities is scheduled to launch its new FaciliNet is one component of a large, digital transformation online portal, called FaciliNet. The portal will organize initiative that integrates Facilities functions – from many of the behind-the-scenes processes that make patient maintenance requests and project cost information to space care possible at all five Yale New Haven hospitals and management and real estate. Watch for more information on hundreds of other locations. this exciting project. Currently, each delivery network uses a different system to receive, respond to and track Facilities’ projects and maintenance requests. FaciliNet will bring all of that information into one specific database and enhance the

efficiency of staff and employees throughout the system.

Designer: Stephen Jones Stephen

Editor: ) [email protected] ( Parry Julie

Executive Editor: Executive ) [email protected] ( MD Ivy, Michael

Marketing and Communications and Marketing

Medical Staff News Staff Medical YNHHS by monthly published is

Bridgeport, Connecticut 06610 Connecticut Bridgeport, 267 Grant Street Grant 267