Smilow Cancer Hospital Town Hall | January 26, 2023

Transcript

• 00:00A couple. A couple of things that I
• 00:04think we will try to bring forward over
• 00:06the coming months is that for the last
• 00:09several months, the smile and Yale
• 00:11Cancer Center executive team has
• 00:13spent a fair amount of time really
• 00:15trying to hone in on what we would
• 00:17consider to be
• 00:18the highest priorities that we need to be
• 00:20focusing on strategically. It's so easy
• 00:22to to develop pages
• 00:24and pages and pages of
• 00:26things that we would consider to be
• 00:28high, highly prioritized. But what
• 00:31happens when you do that?
• 00:32Is that you diffuse things. And
• 00:34so we have been working hard to really
• 00:36try to narrow down what what, what seems
• 00:40to be the most pertinent strategic
• 00:44priorities. And we
• 00:45will look forward to sharing
• 00:47those with you very soon.
• 00:49And not only in this forum,
• 00:50but we will find other
• 00:52forums for engagement and
• 00:54the work that we do over the course of
• 00:56not only this calendar year, but as we
• 00:58also move into the following year. So
• 01:01thank you all for being here. And
• 01:03the I'm going to turn the floor
• 01:05over to Doctor Billingsley
• 01:06and and Kim and
• 01:08we look forward to maybe
• 01:09addressing any questions you
• 01:10might have about later
• 01:11in the town hall.
• 01:14Thanks, Lori. And I'm just going to share my
• 01:16screen and I think right before I do that,
• 01:18we'll say that for those joining,
• 01:21you can use the chat to ask questions.
• 01:24We'll try to answer them as we go along.
• 01:27We may decide to answer some of them live.
• 01:30And as Lori said,
• 01:30hopefully at the end we'll have a
• 01:32good 10 minutes or so for for Q&A.
• 01:35But welcome everyone,
• 01:37this is exciting to resume our town halls.
• 01:41I know Kevin's going to
• 01:43be sharing some words.
• 01:44As well and we have a jam packed agenda.
• 01:48So I'm going to just go ahead
• 01:50and and and go right to that.
• 01:52Umm. So this is our agenda for
• 01:54for our first town hall of 2023.
• 01:57Ken and I are going to go over
• 01:59some announcements and recognition.
• 02:02I will go over our glint survey
• 02:05engagement results for the the large
• 02:08for our entire smilo enterprise.
• 02:11Again that was an engagement survey that.
• 02:14That our employees that of the
• 02:17hospital were able to participate in.
• 02:19We have Maureen major camp hosts
• 02:22and Doctor Sarah Shellhorn here to
• 02:24talk about the Center for Breast
• 02:27Cancer Relocation back to NP1.
• 02:29We have Michelle Kelby Albert,
• 02:31our director of quality and patient
• 02:33safety to go over FY23 performance
• 02:35improvement plan and we have doctors
• 02:38Ratner and Damast here to give us
• 02:41a GYN oncology program highlight.
• 02:43So very jam packed.
• 02:45Agenda excited about this evening
• 02:47and we will just move
• 02:48forward. Within this health, within
• 02:51our health system, we start many of
• 02:53our meetings with the patient story.
• 02:55And it was just ironic that today of all
• 02:58days two of our nurses and our GI Medical
• 03:01Oncology clinic were recognized for a great
• 03:04catch for what they did for a patient.
• 03:07And we just couldn't think of a better
• 03:09way to open up our town hall this evening.
• 03:12And we want to congratulate Amanda and
• 03:14Macy for what they did for this patient.
• 03:17So I'm just going to take a moment
• 03:19and read this and.
• 03:20Even me reading this story I
• 03:21don't think does it justice.
• 03:23But it's an it's an amazing story.
• 03:25So we had a patient that came to
• 03:27our clinic for a discussion about.
• 03:30Their treatment and potentially
• 03:32having to restart treatment.
• 03:35The patient stated that they needed to go
• 03:38to inpatient treatment for detox before
• 03:41they would be able to to restart treatment,
• 03:44but the patient declined at
• 03:47that time to pursue that.
• 03:49Macy made a note to herself to
• 03:51follow up with this patient because
• 03:52she was very concerned,
• 03:54and to to make a phone call to
• 03:56the patient after a week or two.
• 03:59She called the patient two weeks later
• 04:01to check in and the patient stated,
• 04:03I can't believe you called.
• 04:05Why did you call now?
• 04:07I was just thinking if I should call 911.
• 04:10I need help.
• 04:11I am very depressed and I need help.
• 04:14He stated. He did not want to live anymore.
• 04:17Amanda, Macy's colleague,
• 04:18stayed on the line with him
• 04:21while Macy called 911.
• 04:23They stayed on the line with
• 04:25the patient until emergency
• 04:26services arrived on the scene.
• 04:28Thank you, Macy and Amanda,
• 04:30for that wonderful patient story
• 04:32and for really being there in
• 04:34that moment of patient need.
• 04:35And and it's just,
• 04:37it's just amazing.
• 04:37It's just an amazing story of the
• 04:40commitment of our team members
• 04:42to our patients every day.
• 04:43So thank you so much.
• 04:47And I'm going to turn it over
• 04:49to Kevin and he's going to say
• 04:50a few words and and move on to
• 04:52some of our other recognition.
• 04:55Kim, thanks so much as well.
• 05:00I I will just open by saying how delighted
• 05:04I am to be here doing a town hall again
• 05:08with our fabulous community of clinicians,
• 05:12leaders, staff, technicians,
• 05:14all of our people who come together
• 05:18every day to care for our patients.
• 05:21You know, one of the things that this
• 05:25leadership team is committed to is.
• 05:28Communicating in a really proactive
• 05:30way with all of you who are on the
• 05:34front lines caring for our patients.
• 05:37We understand that this is central to
• 05:40engagement and to the well-being of
• 05:43our faculty and our staff and our part
• 05:47of our our mission and our effort in
• 05:51these town hall forums is to provide.
• 05:54Not only kind of updates and practical
• 05:57information about what's happening across
• 05:59the Cancer Center in the clinical program,
• 06:02but bringing all of you in,
• 06:04in a conversation about where
• 06:06we are going as an organization.
• 06:09This is an incredible time in cancer
• 06:11care and in our organization.
• 06:14Although we face challenges,
• 06:15we have enormous opportunities
• 06:17in front of us.
• 06:18Cancer care changes and evolves in
• 06:21an exciting way every day and it's.
• 06:24Critical for all of all of us to
• 06:26be sharing these developments,
• 06:28but communication is never just
• 06:31One Direction.
• 06:32Our our aim and our hope is for
• 06:34this forum to be bidirectional.
• 06:36So we will do everything we can
• 06:39to leave some time at the end for
• 06:41a question and answer session.
• 06:43And in addition to town halls,
• 06:46we are going to be reaching out and
• 06:48engaging with our teams as much
• 06:50as we can in a variety of forums.
• 06:52Our leadership team has started
• 06:55a very intentional rounding.
• 06:58Process where you will be seeing many
• 07:01of us in a variety of operational areas,
• 07:04not just here in New Haven,
• 07:06but across the entire enterprise.
• 07:08And we will be interacting with
• 07:10frontline staff and caregivers.
• 07:12And we really want to use this
• 07:15opportunity to hear directly from
• 07:17all of you about what's going well,
• 07:20what's,
• 07:20what's going great and what most
• 07:23importantly could be better.
• 07:26So we will look forward to that.
• 07:28Umm.
• 07:29One of the things to kick us off that
• 07:31I'm most excited about is that we really,
• 07:34we had a fabulous conclave at the New
• 07:38Haven Country Club several weeks ago
• 07:40and it was very exciting to witness
• 07:43our award winners across a variety of areas.
• 07:46I wanted to take this opportunity
• 07:49to recognize yet again our award
• 07:52winners in the clinical arena
• 07:54and hats off to Aaron Medoff's
• 07:57nurse practitioner who this year.
• 07:59On the Ruth Mccorkle oncology
• 08:02advanced Practice Provider award
• 08:04and congratulations to doctors
• 08:07Manju Prasad and Saral Mehra.
• 08:11Dr. Prasad is a pathologist.
• 08:12Dr.
• 08:13Mara is a head and neck surgeon for
• 08:16winning jointly the Yale Cancer Center
• 08:19Award for Excellence in Clinical Care.
• 08:22Very inspiring work from these folks.
• 08:26It's also a real pleasure for me to
• 08:30recognize some of the superstars
• 08:32we have among our our faculty,
• 08:35our very own doctor.
• 08:37Pat Larusso,
• 08:38leader of our Phase one unit,
• 08:40has been a a pillar and a rising
• 08:43leader and the American Association
• 08:46of Cancer Research. That's AACR.
• 08:49Pat is up for a leadership position as
• 08:53the President of this organization.
• 08:57Um, she's been nominated by her peers,
• 09:00and we all do have an opportunity to support
• 09:04Pat and vote for her through this link.
• 09:07I think that she is really one of
• 09:11the nation's leaders and early
• 09:14therapy development and this is a
• 09:17huge already honor and recognition
• 09:20of her presence in this space.
• 09:23So want to share that with the Community
• 09:26and certainly support Pat in this effort.
• 09:32One of the things that has been
• 09:35most exciting in the past year
• 09:37or so has been the arrival of a.
• 09:40Huge salt array of new faculty
• 09:43members across all of the clinical
• 09:46disciplines in cancer care.
• 09:48In the interest of time,
• 09:50I probably won't read all of these names,
• 09:52but you can see we've recruited outstanding
• 09:55individuals from across the country
• 09:58and around the world and virtually
• 10:00every program including surgical oncology,
• 10:03genetics, GYN onc,
• 10:05a variety of other surgical disciplines.
• 10:09Radiation oncology or therapeutic radiology,
• 10:12hematology imaging as well as
• 10:15solid tumor medical oncology.
• 10:18Next slide.
• 10:22The growth of our faculty is
• 10:25across the entire enterprise,
• 10:28not just here in New Haven,
• 10:29but in all of our sites of care,
• 10:31including places such as Westerly,
• 10:35RI and Waterbury, CT.
• 10:39And Greenwich, CT. Next slide.
• 10:49Thanks, Kevin.
• 10:50I'll go ahead and Umm also announce
• 10:53a few nursing promotions that we've
• 10:55had over the last couple months.
• 10:57So Christina Capretta,
• 10:59who was our clinical program
• 11:01director at Greenwich Hospital,
• 11:03Smilow at Greenwich has been
• 11:05promoted to the Patient services
• 11:07director for SMILO at Bridge in the
• 11:09Bridgeport area in Greenwich Area.
• 11:11So we're very excited about
• 11:14Christina taking on this expanded
• 11:16scope and and we look forward
• 11:18to supporting her in that work.
• 11:20We also wanted to announce Christina Matusek,
• 11:23who is one of our nursing professional
• 11:26development specialist who has focused her
• 11:29time in the ambulatory practice space.
• 11:31Previously we were we received a grant
• 11:34from the Frederick A DeLuca Foundation
• 11:37to start a new graduate nurse and a PP
• 11:41program for ambulatory Oncology and
• 11:43Christina will be leading those efforts.
• 11:46So we're very excited about her.
• 11:49Her change to a fellowship
• 11:52specialist to support that program.
• 11:54And then we also have Brooke Schramek.
• 11:57Schramek who was our Assistant
• 11:59Patient services manager for
• 12:01the care centers in Derby,
• 12:03Torrington and Waterbury and she
• 12:05has been promoted to the clinical
• 12:07program manager of those sites.
• 12:09So we look forward again to supporting
• 12:11her into seeing her leadership and
• 12:14supporting our teams and working with all
• 12:17of the interdisciplinary team members.
• 12:22We're going to go over just a
• 12:25couple announcements before before
• 12:27we have our presenter start.
• 12:29We did hear this week that the Yale
• 12:32New Haven Hospital is scheduled for
• 12:35their Joint Commission accreditation
• 12:37survey and what that means is
• 12:40that we could expect to see them
• 12:43at any time as early as Monday.
• 12:46We do expect that they probably
• 12:48will not be here until.
• 12:50Um, maybe February or through March but,
• 12:54but now they could come at any time.
• 12:56We are scheduled for a five day survey
• 12:59because of the size of our hospital.
• 13:01So they will arrive on a Monday.
• 13:03So we know that if they don't arrive on a
• 13:05Monday then we're good for the next week.
• 13:07But I think this is a time for us
• 13:09to be ready and we should always
• 13:12be Joint Commission ready,
• 13:13but it's even more of a a time
• 13:15where we need to be really vigilant
• 13:18about our environment and.
• 13:20And and in our documentation and
• 13:23just be ready for those surveyors
• 13:26to come around and and talk to us.
• 13:30It does include all of our
• 13:33ambulatory sites that are YNH.
• 13:35So and at our last survey several years ago,
• 13:38they did visit the majority
• 13:40of our smilo sites.
• 13:42So I would expect that especially because
• 13:44of the patient population that we care for,
• 13:47we give a lot of high risk treatments.
• 13:50And so our areas of our areas are ones
• 13:52of focus for the Joint Commission,
• 13:55the risk areas that our hospital
• 13:58regulatory department has.
• 14:00And really trying to share up in our
• 14:02practice and in our policies is really
• 14:05focusing on some of our documentation,
• 14:07our hand hygiene compliance and some
• 14:10of our infection control practices
• 14:11and the surgical attire that should
• 14:13only be worn in the OR settings.
• 14:16So those are some of the areas
• 14:18that are of high risk for us that
• 14:21we'll be paying attention to over
• 14:24these next several weeks.
• 14:25The other thing that we wanted to go over
• 14:29and Kevin talked a little bit about this,
• 14:32about our refocus on engagement this fall.
• 14:36Again,
• 14:37we had our.
• 14:38All of our Yale New Haven Hospital
• 14:41smilow staff were able to participate
• 14:44in a glint engagement survey where
• 14:47they were able to give feedback
• 14:49about their work environment,
• 14:51their sense of how they work
• 14:54with their team members,
• 14:55and their feeling of connection with
• 14:57the hospital and the health system.
• 15:00And we get scored on that based
• 15:02off of a national benchmark
• 15:04of how engaged are our teams.
• 15:06So you can see here that we had.
• 15:09A 77% response rate.
• 15:12So that is very good.
• 15:14We very much appreciate everyone that
• 15:16responded to this survey because then
• 15:19we can really take this feedback and
• 15:22and truly work with all of our team
• 15:24members to improve our work environment.
• 15:26Our engagement score though was at a 68,
• 15:29which we really would like
• 15:31to see that at around a 74.
• 15:34Umm that is really a a.
• 15:38Silently engaged team and
• 15:41you can see that we were at that benchmark
• 15:44back in 2020 and in 2021 in early 2021.
• 15:48But you can see the last two
• 15:50times we've had this survey,
• 15:51we've been holding steady around at the 68.
• 15:54So I know that all the local leaders
• 15:56are working with their teams on
• 15:58their local action plans that are
• 16:00due at the end of this month.
• 16:02But as a senior leadership team,
• 16:04we also have a responsibility to
• 16:06look at these results and say how
• 16:08can we help make a difference?
• 16:10And support and engaged work environment.
• 16:14So we just wanted to share some of
• 16:18those strengths and opportunities
• 16:19that we saw across all of smilo.
• 16:22So some of the things that our teams
• 16:24told us that we're doing well is that
• 16:27they feel they have opportunities for growth.
• 16:30They feel it's a respectful work
• 16:32environment and that there are
• 16:34opportunities to be recognized.
• 16:36But yet where we really need to
• 16:38focus over this next year is action.
• 16:40Taking on these results not just
• 16:42in Smilo but across the hospital,
• 16:45staff want to see that their voices
• 16:47are being heard and that real
• 16:50action is being taken again,
• 16:52opportunities around leadership and
• 16:54primarily around visibility and
• 16:57communication and then opportunities
• 16:59to stay focused on well-being.
• 17:02So these are all areas again like I
• 17:04said at the local level they have all
• 17:06of their results and teams are engaged
• 17:09locally to have their own action plan.
• 17:11But this evening,
• 17:12I'm just going to briefly talk
• 17:14about what our action plan is for
• 17:17the senior leadership at Smilo.
• 17:19So we are really committed to increasing
• 17:22our visibility and communication.
• 17:24So one of those things is having
• 17:26these monthly town halls and
• 17:28other forms for communication.
• 17:30And as Kevin said, it really being
• 17:33bidirectional again making sure that
• 17:34all of our sites are getting rounded
• 17:37on at least quarterly by the senior
• 17:39leadership team so that we have.
• 17:41Opportunities to recognize the
• 17:43things that are going really
• 17:45well and as Kevin mentioned,
• 17:46really understanding those
• 17:47opportunities and challenges and how
• 17:49we can help support our teams and
• 17:52and breaking down those barriers.
• 17:55So with that I'm going to stop
• 17:58sharing my screen and we're going to
• 18:01start with our first presentation
• 18:03which is Maureen and and Sarah,
• 18:06you guys are going to give
• 18:07the NP1 Breast Center update.
• 18:11I'm just validating that you
• 18:12guys can see the one screen.
• 18:14Is that correct? Can't
• 18:15see anything, Maureen.
• 18:16Oh, great. Oh, I understand. OK, hold on.
• 18:21Well, Maureen and Sarah work on
• 18:24this multimedia presentation.
• 18:26I'm going to interject and say.
• 18:29I cannot be more grateful
• 18:32to these two leaders.
• 18:33We are going on three years here,
• 18:36and Sarah has an oh, she's got it.
• 18:40Sorry. Well, I figured you could keep
• 18:42talking, Kevin, because I was like,
• 18:43hear those accolades. You keep going,
• 18:46but all of the moves that we have had
• 18:49to do to manage care of our cancer
• 18:53patients through COVID has largely been
• 18:56orchestrated under the very thoughtful
• 18:59direction of these two leaders.
• 19:02So I, I, we are all grateful.
• 19:05We can't thank you enough.
• 19:06It's been quite a journey and we're
• 19:09getting into the final laps here.
• 19:13Sorry, you went. That was the
• 19:15that was the secret signal for it.
• 19:16We can see two slides.
• 19:19There we go. How's that?
• 19:21Perfect. There you go. OK.
• 19:24Thank you, everybody and thank you,
• 19:26Kevin, for your comments.
• 19:28Yes, this presentation will really focus
• 19:30on the state of ambulatory services,
• 19:33mostly focusing on the York Street campus.
• 19:36So I'm going to turn it
• 19:37over to Doctor Shellhorn,
• 19:38who is going to go through the very
• 19:41many steps in our process of change.
• 19:45So I I we will whip through these
• 19:48first couple of slides quickly,
• 19:51but I just want to show you how many times
• 19:55we have moved since the spring of 2020.
• 19:58Each of these arrows is a project
• 20:01in and of itself that's orchestrated
• 20:03not just by the two of us by,
• 20:05but by entire teams of various
• 20:11multidisciplinary components
• 20:13to get each of these moves.
• 20:15First away from the York Street campus and
• 20:19then gradually back into our original space.
• 20:22In the spring of 2020, we vacated the
• 20:25North pavilion in almost its entirety,
• 20:27and in the fall of 2020,
• 20:29we started to make some progress coming
• 20:32back to the York Street campus again.
• 20:35Each of these moves a very intricate
• 20:38dance between lots of different
• 20:40members of our institution.
• 20:42We'll go to the next slide
• 20:44to show you where we were.
• 20:45The fall of 2020 through the spring of 2021,
• 20:48again more moves as we came,
• 20:52as our footprint looked more and
• 20:54more similar to where we started.
• 20:57I'll bring you to where we are
• 20:58now on the next slide.
• 21:00Maybe it's
• 21:02just a lot of moves.
• 21:03I mean I think the in in the last
• 21:07two years we've remained relatively
• 21:10stable in our current footprint with
• 21:13most of the North pavilion occupied,
• 21:15although some notable exceptions
• 21:17included the SRC, the Smilo rapid
• 21:20Evaluation Clinic which was in the
• 21:23previous breast center displacing the
• 21:25breast center up to the 4th floor and
• 21:28a number of our teams in North Haven.
• 21:31In the first and second floors with
• 21:34some infusion capacity on the 2nd
• 21:36and 4th floors of the 6th Devine St.
• 21:39Building in.
• 21:40However, at the beginning of this month,
• 21:43the SRC formally disbanded and we
• 21:46are now incorporating those patients
• 21:48who had COVID positivity into
• 21:51their local units and the breast
• 21:53center moved back to its space on
• 21:57on on NP1 as indicated here.
• 22:02Guenoc is still on the other side of NP1,
• 22:05but the prior NP1 infusion does remain
• 22:08part of the hospital as a medicine
• 22:11overflow unit and GI medical oncology.
• 22:14Some of the thoracic program liver
• 22:18and infusion remain in North Haven.
• 22:21And go to the next slide
• 22:22and I think I'll turn
• 22:23it over to Maureen.
• 22:24Thanks Sarah. And you know I think
• 22:27that you know those slides really
• 22:29just in many ways really typify the
• 22:32hard work that everybody has done to
• 22:35get us back to where we are today.
• 22:37And we couldn't have done any
• 22:39of this work without the senior
• 22:41leadership support really at the
• 22:44highest levels pushing for relocation
• 22:46of teams back to their home base.
• 22:48So on January 9th,
• 22:49the rest program moved back to.
• 22:51And P1 and just for a moment,
• 22:54I'd like to highlight what that rest program
• 22:57will look like today and in the future.
• 23:00First, it is reuniting our breast
• 23:02imaging colleagues with our breast
• 23:05surgeons and the medical oncologist
• 23:07and our plastics colleagues that will
• 23:10all see patients in the breast center.
• 23:13But the enhancements that we can
• 23:14now really that have been on a wish
• 23:16list and we can dream about or have
• 23:18been dreaming about can really
• 23:20start to become reality.
• 23:21As we look at ancillary
• 23:24programs like cancer genetics,
• 23:26joining us working side-by-side
• 23:27to really help partner with our
• 23:31clinicians and caring for our patients
• 23:33in extended expanded presence of
• 23:36our breast plastic surgery program
• 23:39for breast reconstruction options
• 23:41for our patients is vital to the
• 23:44patient experience and as well
• 23:47reuniting the breast program and this
• 23:50multidisciplinary practice back to MP.
• 23:52Time allows us to again resume our
• 23:55pilot site work and so the breast
• 23:57program as well as Guilford will
• 24:00be looking will be a pilot sites
• 24:02for the ASCO Medical Home program
• 24:04which we're really excited about.
• 24:07And as well we are the best program will
• 24:10be an operational pilot site for for a
• 24:13checkout and fluid rooming optimization.
• 24:16So it's really recognizing that
• 24:20across all of our areas we are.
• 24:23Um, struggling with checkout.
• 24:24And so we've looked at processes,
• 24:26many teams have looked at processes
• 24:28throughout the last two to three years
• 24:31during this transformation effort.
• 24:33And one of the pilot sites will be
• 24:34the breast program where we have
• 24:37this multidisciplinary practice.
• 24:38So it is really exciting to think
• 24:40about what the breast program we'll
• 24:42look like in a year from now.
• 24:45But with the move of the breast
• 24:48program from NP4 down to NP1,
• 24:52it does allow us some capacity on NP4,
• 24:56which for many, many years we have not.
• 24:59We've been asked for additional space.
• 25:01Many of you have asked us for that
• 25:03in the audience and oftentimes
• 25:06we accommodate where we can.
• 25:08This is the first time where we
• 25:11will have actually an opportunity
• 25:13to create new programs.
• 25:15For expanding programs,
• 25:17So what we will backfill and
• 25:20P4 space with not all of it,
• 25:23there's nine exam rooms is
• 25:26strategic data-driven,
• 25:27thoughtful placement of programs
• 25:29to allow for growth so that we
• 25:32can better care for our patients.
• 25:34And this is the real opportunity
• 25:36within the cancer program,
• 25:37especially in New Haven is to allow
• 25:39us to think about what we can really
• 25:41use that space for that will best
• 25:43enhance the care delivery that we provide.
• 25:46Our patients, the one challenge and
• 25:49something we have to be mindful
• 25:52of is that who returns to NP4,
• 25:55if it's medical oncology teams that need to
• 25:59treat their patients with chemotherapeutics,
• 26:02we still do our minus 18 chairs from NP1
• 26:07that remains a medicine overflow unit.
• 26:10So what does that,
• 26:11what is the challenge for that?
• 26:12That is really an operational
• 26:15opportunity for us to.
• 26:16We focus our efforts and our efficiencies to
• 26:20increase infusion capacity capacity on NP8.
• 26:23We have 38 chairs there.
• 26:25We know that we have capacity
• 26:28issues and scheduling challenges.
• 26:30It will be a real opportunity for us
• 26:33to really provide a refocused effort
• 26:36on adjusting addressing that capacity,
• 26:38which will allow for better treatment
• 26:41opportunities for our patients.
• 26:43And then finally,
• 26:44we'll be able to optimize
• 26:46workflow enhancements.
• 26:47Optimization to create efficiencies
• 26:49and maximize care delivery.
• 26:51So those are the exciting things that we
• 26:54have to look forward to in the upcoming year.
• 26:59And I I would be remiss if I did
• 27:01not thank the local clinical teams,
• 27:03both the multidisciplinary
• 27:05leadership team of NP4 and the
• 27:08clinical team and leadership of NP1.
• 27:11They worked.
• 27:12They were resilient,
• 27:14they showed humility,
• 27:16they showed focused patient care
• 27:18during all these moves and then coming
• 27:20back to the breast program was was
• 27:23truly seen as a victory for them.
• 27:25And I would thank Camille Servidio and
• 27:27all of her team on their hard work
• 27:29and dedication and bringing our team,
• 27:31our patients back to the breast program.
• 27:33But we couldn't have done that
• 27:36without relocating.
• 27:37Sarah mentioned the rapid evaluation
• 27:39clinic closed and the IT closed
• 27:41because we were now.
• 27:43Able to we agreed that we needed
• 27:45to think about processes to locate
• 27:47COVID care in the local units and
• 27:50so our COVID positive patients
• 27:52have been absorbed by the local
• 27:54disease team outpatient units.
• 27:56Visitor policy is very important
• 27:58because we know that we still in order
• 28:01to keep our patients and staff safe.
• 28:03I did put the visitor policy up here.
• 28:06I will just remind everybody
• 28:08that a patient and one caregiver
• 28:11is allowed to enter the.
• 28:13Facility,
• 28:14they are screened just for location
• 28:16of where they're going prior to their.
• 28:20Transition up to their local units
• 28:22for care and there are exceptions
• 28:25that will be made,
• 28:27but it's a joint discussion
• 28:29and collaboration between local
• 28:31leadership and operational management.
• 28:33If we want to expand to more than
• 28:36one caregiver and that is something
• 28:39that is it is not, it can't.
• 28:41The answer is no you the answer
• 28:43is let us all work on trying to
• 28:46get multiple family members in if
• 28:48that's the right thing to do,
• 28:49but we are really asking for.
• 28:51Our clinicians and our teams to support
• 28:54one family member as a caregiver
• 28:57to join the patient in that visit.
• 29:02So I'm going to escape that is really
• 29:07our update on our. The return to NP1.
• 29:10I don't know if we want to take
• 29:12questions or if you'd like to wait.
• 29:15We will hold questions till the end.
• 29:18Thank you both for it.
• 29:21Superb presentation is
• 29:22always an incredible work.
• 29:25It's a pleasure for me to
• 29:27introduce Michelle Kelvey Albert,
• 29:29our director of Quality and safety,
• 29:31who will update us on work
• 29:34doing work we're doing with the
• 29:36performance improvement plan.
• 29:41Got to remember to get myself off mute.
• 29:43Thank you Kevin for that.
• 29:45So I'm going to try to get through this
• 29:47pretty quickly so we have time for
• 29:49our questions and our next presenter.
• 29:52So thank you again for inviting
• 29:53me this evening to go over this.
• 29:58If my slides will advance,
• 30:00we'll be doing really good.
• 30:01OK, here we go.
• 30:04So performance improvement plan,
• 30:05our Pi plan for smilo.
• 30:07So we really start where it focuses
• 30:10on our current smilo initiative
• 30:12initiatives and also alignment with
• 30:14Yale New Havens corporate objectives.
• 30:17And really that's twofold because we need
• 30:20to look at what is currently happening,
• 30:22how are we resource for that,
• 30:24looking at efficiencies.
• 30:25And we also know that if we
• 30:27can align with other corporate
• 30:29objectives that are happening,
• 30:31we have access to data and access support.
• 30:34And shared practices across the system.
• 30:39So our API plan is completed annually.
• 30:42And really when I first
• 30:43started about 2 1/2 years ago,
• 30:45we had about 10 priorities,
• 30:48I think, in our plan.
• 30:49And as Kim Slesser and Karen Allison
• 30:51and I have been looking at it,
• 30:53we're really trying to pare it down
• 30:56till somewhere around four or five and
• 30:58really to to to look at those initiatives,
• 31:01we want to make sure any initiatives
• 31:03that we're picking that we are
• 31:05creating measures of success,
• 31:07we're picking targets,
• 31:08we're looking at that.
• 31:10For opportunities for improvement,
• 31:12we're establishing meeting standards
• 31:14so that there's shared learning
• 31:17best practices and we're making
• 31:19sure that we're able to promote
• 31:21staff involvement and participation.
• 31:24So if we for the meetings for
• 31:26each of these projects,
• 31:27it's not just the leaders,
• 31:29it's the frontline staff and the folks
• 31:31that are doing the work to be able to
• 31:34participate in success of the projects.
• 31:36So the priorities for this
• 31:38fiscal year and I'm going to go
• 31:40through them pretty high level,
• 31:42we had focused on 4.
• 31:45The first one is our ASCO medical home,
• 31:48which Maureen had mentioned.
• 31:50This is the American Society for Clinical
• 31:53Oncology Medical Home certification.
• 31:55We have looked at implementing
• 31:57this across all of our ambulatory
• 31:59settings and we realized we got
• 32:02a little ambitious and needed
• 32:04to kind of step back a bit and
• 32:06we felt it was better to pilot.
• 32:08This in two of our locations.
• 32:10So the the breast program on York
• 32:12Street and our Guilford Care Center
• 32:15really to to see how this will
• 32:18work and then be able to look at
• 32:21how our rollout will look across
• 32:23all of our ambulatory sites.
• 32:25I'll talk a little bit more in
• 32:26a next in a few more slides of
• 32:29why we decided to participate in
• 32:31the ASCO medical home.
• 32:32We also have our length of
• 32:34stay accountability project.
• 32:35So this is impatient focus we've all.
• 32:38Then on many meetings both on some of
• 32:41the morning safety for the hospital
• 32:44and the oncology morning safety
• 32:47huddles and timely discharges and
• 32:50the boarding in the Ed continues
• 32:53to be an issue across our system.
• 32:56And so the length of stay Accountability
• 32:59project will focus in on NP 11 and 12
• 33:03and really looking at reducing discharges,
• 33:07increasing mobility.
• 33:08And when appropriate discharges to
• 33:12Hospice care and the increase of mobility,
• 33:16we're hoping will also help
• 33:18us with our decreasing our
• 33:21falls patient experience.
• 33:22So we've had patient
• 33:24experience and RPI plan before,
• 33:27but this year in our ambulatory setting,
• 33:29we've now rolled out and implemented a
• 33:32new MD survey in our ambulatory settings
• 33:36and one of the reasons we wanted to do.
• 33:39That is as all of our clinics have been
• 33:42tracking their comments and their scores,
• 33:45we did not have a way to be able to kind
• 33:49of capture our physicians comments and
• 33:53the care that our clinicians are giving.
• 33:56So this survey which would was
• 33:59implemented on January 2nd,
• 34:01we provided very specific physician questions
• 34:05which will be looking at working on.
• 34:10A provider scorecard.
• 34:11So I'm, I'm very excited about that.
• 34:13I think that's going to be
• 34:15a really great initiative.
• 34:16And then our checkout process project.
• 34:18So this is something that myself that
• 34:20doctor Shellhorn and Kate Gill have been
• 34:23working on for well over a year now.
• 34:25And this was really to increase
• 34:29our disposition compliance.
• 34:31And I can describe this a bit of
• 34:34we've now have a a new smart order
• 34:37set in Epic and it really looks like.
• 34:41For those of you that might remember
• 34:43the old bubble sheet where you could
• 34:46circle the patient needs to come
• 34:48up back for follow up for labs for
• 34:50imaging for with the physician.
• 34:52But the other key part of this is
• 34:55so now to have one thing in a smart
• 34:57set that everything is there,
• 34:59but now it goes to a work queue and
• 35:01that work queue is really important
• 35:04from the scheduling perspective so
• 35:06that we're hoping this is going to
• 35:08cut down on some of the back and
• 35:10forth and that patients will leave.
• 35:11With their follow up orders and so we
• 35:14are starting to implement this and
• 35:16roll this out in different locations.
• 35:21So we need to remember when we're
• 35:24putting the Pi plans together,
• 35:27you know what else is happening
• 35:29across Milo because again we have to
• 35:31look at resourcing and and staffing.
• 35:34And so just a few things to keep in mind.
• 35:36Kim brought up the Joint Commission
• 35:38that we're in that window,
• 35:40but we also have our fact accreditation
• 35:43that we're looking at probably late spring,
• 35:46early summer for that survey to happen,
• 35:50our ASCO medical home.
• 35:52We will be completing our
• 35:55compliance documentation.
• 35:57So that's a bit of a show and tell if we
• 35:59say we have a policy or a new workflow,
• 36:01we have to show a report or a chart
• 36:04audit to prove that and that will
• 36:06be done in March of this year and
• 36:08hoping to get the recognition in June.
• 36:11And then our Commission on cancer for Yale,
• 36:14New Haven, that survey will be
• 36:18happening in October of this year.
• 36:22So just to take a minute to say,
• 36:24why are we participating
• 36:25in the ASCO medical home?
• 36:27Because this is across,
• 36:29again, a lot of domains.
• 36:31It's 7 standards.
• 36:33And really we're participating in this
• 36:36program because the requirements align
• 36:38with our mission for patient centered,
• 36:41highly coordinated care.
• 36:42And it really enables us to
• 36:45continue our work and to build
• 36:48on our practice wide quality
• 36:50standards and our future for value.
• 36:52This payment and just a couple of
• 36:54examples that I wanted to highlight.
• 36:57So for the standards and the things
• 36:59that we'll be rolling out and going
• 37:02live with starting on January
• 37:0430th is our end of life care.
• 37:06So ensuring that each patient
• 37:09has a documented goals of care
• 37:12conversation in a new E chemotherapy,
• 37:16a new I'm sorry a new chemotherapy E consent.
• 37:19Care coordination supporting our
• 37:21patients who have been hospitalized
• 37:24or in the Ed throughout the state,
• 37:26screening all our patients for
• 37:28challenges and social determinants of
• 37:30health and referring them for health.
• 37:33And lastly,
• 37:33making sure all patients have access to
• 37:36education are around advanced care planning.
• 37:38So those are,
• 37:39there's many more pieces to that,
• 37:41but I think those are some examples
• 37:44of why we wanted to do this program.
• 37:50So in our quality kind of strategic vision,
• 37:55something that Doctor Adelson, Dr.
• 37:57Billingsley, Kim Slosser and myself
• 37:59had been working on for probably about
• 38:026 to 8 months is our newly formed.
• 38:05Smilow quality and Safety Council.
• 38:07And so this was really exciting.
• 38:09We really wanted, we did have a
• 38:12forum for this when I first started,
• 38:14we kind of paused that needed to
• 38:16relook at it and see, you know,
• 38:18how we could make this a little bit better.
• 38:21And so we really form this starting in
• 38:24this past October of 2022 and it really
• 38:28was meant for an interdisciplinary
• 38:31leadership team across the smilo
• 38:33enterprise and really the goal of this.
• 38:35Was to oversee the development
• 38:37of this Pi plan.
• 38:39So they, this team,
• 38:41this Council will be helping decide
• 38:43what those priorities are really to
• 38:46review and monitor key quality metrics.
• 38:49It starts with the data.
• 38:51We need to be looking more at our data
• 38:53and making that actionable and really
• 38:56to promote a system wide culture of
• 38:58safety and in support of the principles
• 39:01of high reliability organization.
• 39:03So that's where we started.
• 39:06And So what I'm hoping that's going to do
• 39:09is help us break down some of the silos.
• 39:12Not to say that all our areas have silos,
• 39:15but we still have some.
• 39:17And so I think this Council is going
• 39:20to help us bridge that and with
• 39:22that hope so that we're all pedaling
• 39:25in that same direction and that
• 39:28quality care is everyone's mission.
• 39:30And we,
• 39:31if we can achieve that through
• 39:33the Quality Council this year,
• 39:35I I think we'll be.
• 39:36Doing what we set out to do,
• 39:39but in order to do that we've got some
• 39:42culture change and so really for smilo
• 39:45to advance on our delivery of high
• 39:48quality care, patient center care,
• 39:50you know we need our clinical teams,
• 39:52we need data transparency.
• 39:53So some of that when I was talking
• 39:57about the patient experience,
• 39:58the new survey looking at our scores,
• 40:02having now a provider scorecard
• 40:05reviewing those key.
• 40:06Metrics and also promoting the
• 40:08culture of accountability.
• 40:10And when I think about this,
• 40:13it makes me think of that,
• 40:14you know,
• 40:15phrase do what you say and say
• 40:17what you do and I think that's the
• 40:20accountability that we need as part
• 40:22of our quality and safety program.
• 40:24So I think that is my last slide.
• 40:27It is. So I'm going to stop sharing.
• 40:32And then hope to get some
• 40:34questions at the end. Thank you
• 40:35for letting me go through that.
• 40:37Thank you, Michelle.
• 40:40Our teams in the front lines don't
• 40:42always see the efforts that we're
• 40:44making to improve quality and safety.
• 40:46So kind of having that comprehensive
• 40:48view is very helpful and we,
• 40:51I think we will all aim as you say
• 40:55for a say to do ratio of 1 to one.
• 40:59So last but certainly not least.
• 41:02I it's a pleasure for me to introduce
• 41:05two of our clinical superstars who
• 41:08need really no introduction and I will
• 41:11share early on in the presentation.
• 41:13We highlighted our.
• 41:15Two of our recent this year Smilo
• 41:20Clinical Excellence CL Cancer Center
• 41:23Clinical Excellence Award winners.
• 41:25Both of our presenters this evening,
• 41:28Doctor Damast and Doctor Ratner
• 41:30are prior winners of the El Cancer
• 41:33Center Clinical Excellence Award.
• 41:35They both here are here representing
• 41:38different facets of the GYN oncology program.
• 41:41And as many of our audience know,
• 41:44January is cervical cervical Cancer
• 41:46Awareness Month and we asked
• 41:48Doctor Damask and Doctor Ratner to
• 41:50give us a brief program update.
• 41:53Thank you for being here.
• 41:56Thank you so much at the Billingsley.
• 41:58Thank you for the opportunity to
• 41:59be able to be with you today and
• 42:02give you this a brief update it.
• 42:04Doctor Thomas and I will kind of go
• 42:06back and forth to talk to you about the
• 42:08state of affairs for cervical cancer.
• 42:10And this kind of presentation is just
• 42:13speaks to the privilege and the honor
• 42:15that I have working with Doctor Thomaston.
• 42:18How we give this talk is how we take care
• 42:20of patients together and collegially and
• 42:23with great respect for each other so.
• 42:25Thank you for giving us both this
• 42:28opportunity to share with you.
• 42:30I will share my screen.
• 42:32I have been fortunate over the past
• 42:36couple of weeks to be able to give
• 42:40a bunch of TV interviews or news
• 42:43interviews because there has been a
• 42:46lot of stuff in the lay literature or.
• 42:50TV news about the advances of cervical
• 42:53cancer and what a difference it has made.
• 42:57So that the mass and I'm very excited
• 42:59to speak with you about management
• 43:01of cervical cancer and I am actually
• 43:03super excited to talk to you about
• 43:05prevention of cervical cancer,
• 43:07which is really just such a model
• 43:09in cancer care.
• 43:10You know,
• 43:11so much of what we do is about early
• 43:13detection and even better of course
• 43:16prevention and in cervical cancer
• 43:18amazingly and luckily we actually have.
• 43:20Be able to accomplish it with
• 43:23the use of vaccines.
• 43:25So I will take the first few minutes.
• 43:27I was asked to give a little update about the
• 43:30department and Division of Joanne Oncology.
• 43:33So Juan,
• 43:34oncology at the Smilow Cancer
• 43:36Center has greatly expanded.
• 43:39We have started with three faculty members.
• 43:44You know a few years back when I
• 43:46took over this division and now
• 43:47there's nine of us and there will
• 43:49be 11 hopefully by this summer.
• 43:51And that just speaks to the to the
• 43:56fact that we are very busy that we
• 43:59cover the entire state and also
• 44:01speaks to how we are changing the
• 44:04the way that you want to college
• 44:06works and we work collegially as a
• 44:08team taking care of our patients.
• 44:12We are really only as good as we are
• 44:15because of incredible support of our teams,
• 44:19both the nursing teams and our AP teams.
• 44:22We are incredibly fortunate to have really
• 44:25the best people with us taking care of
• 44:28our patients who are so dedicated to the
• 44:31practice and to the care of our patients.
• 44:33And again just we incredibly just
• 44:37fortunate and blessed to have
• 44:39such an incredible strong.
• 44:41Team just so happens women,
• 44:44which is in itself a blessing,
• 44:46taking care and partnering with us in
• 44:49the care of our patients both on the
• 44:52outpatient side and the inpatient side.
• 44:54Do you want ecology has multiple sites and we
• 44:58take care of women all throughout the state,
• 45:02all the way to Greenwich Hospital,
• 45:04Umm in in the South with big full
• 45:08time practices and Bridgeport.
• 45:11And all the way to Waterford
• 45:15as well as Waterbury.
• 45:17And we are just so privileged and
• 45:20so lucky to be able to provide care
• 45:24to women close to home where they
• 45:27are and be able to do surgeries
• 45:30for them in that setting as well as
• 45:33work with our medical and college
• 45:36colleagues to provide chemotherapy.
• 45:38We are very surgically busy.
• 45:40We do great number of cases.
• 45:42We have a.
• 45:43Quite high patient volume.
• 45:45Together with Doctor Mcgillian,
• 45:47we are incredibly dedicated to
• 45:50next day excess and something that
• 45:53really has transformed our practice
• 45:55since Doctor Mccallion started
• 45:57this outreach a few years back.
• 45:59We do probably give our own chemotherapy
• 46:01and we have a great number of patients
• 46:04who undergo chemotherapy at a time.
• 46:06And we also maybe because survivorship
• 46:08you know do you want to college you
• 46:11would really separates separates us
• 46:12here from many national other programs
• 46:14is that we're very big into quality of
• 46:18life and sexuality and survivorship.
• 46:21We have founded the very first in
• 46:25the nation's program of sexuality,
• 46:27intimacy and menopause that now has
• 46:30been replicated by many other programs
• 46:32nationally and internationally
• 46:34and a program that both.
• 46:36With the mast and I play a very big role
• 46:38and something that's really important to us.
• 46:41And we also have a pre Viber program
• 46:43where we work very closely with
• 46:45our breast colleagues and genetics
• 46:48taking care of women who are at
• 46:50higher risk of various cancers.
• 46:51And both of these, these programs are very,
• 46:55very important and really at
• 46:58the heart of our practice.
• 47:00Umm, we do do our own trials.
• 47:04We truly believe in personalized medicine.
• 47:07There's a great number of different trials
• 47:09that we offer for both of you in Canton,
• 47:11the Metrial cancer and cervical cancer.
• 47:14Some of them are research started by us.
• 47:17Some of it is national society trials.
• 47:23And we are very fortunate to be able to
• 47:25offer our patients multiple personalized
• 47:28targeted options according to their.
• 47:30These and again we are very happy that
• 47:34we're able to offer a lot of these trials
• 47:37in throughout the state in other settings,
• 47:40not just at Yale,
• 47:41New Haven.
• 47:46So now we're going to take like the
• 47:49mass and I will take a few minutes
• 47:51to talk about cervical cancer.
• 47:53You know I have been very pleased really
• 47:56over the past month and actually didn't
• 47:59realize kind of being on the inside
• 48:01of it the the world perception as to
• 48:04what's happening with cervical cancer.
• 48:06And we certainly as physicians and
• 48:08providers of course see decrease in
• 48:11cervical cancer that could Mastani
• 48:13definitely see decrease in later.
• 48:16Cancer, but I also see a great
• 48:18decrease in pre cancer lesions.
• 48:20A lot more.
• 48:23A lot less of women requiring procedures
• 48:27that influence their childbearing.
• 48:29So in the clinical practice,
• 48:31things have really,
• 48:32really changed and there's
• 48:34truly this paradigm shift.
• 48:35And of course it has to do with
• 48:38screening and with HPV vaccines.
• 48:40We know that cervical cancer,
• 48:43like some other cancers is really
• 48:45predominantly caused by the HPV vaccine,
• 48:48but the HPV infection,
• 48:49so the fact that we have started adding.
• 48:53HPV subtyping to our PAP smears really
• 48:56very much changed the prognostic
• 48:59nature of these PAP smears and has
• 49:03allowed us to catch precancerous
• 49:05and cancerous much earlier.
• 49:08Vaccines truly changed the nature
• 49:11of cervical cancer, you know,
• 49:13and all the interviews I've done.
• 49:14There's now a lot of debate,
• 49:15of course about vaccines.
• 49:16I feel like a few things are more
• 49:18debatable currently, the vaccines.
• 49:20But vaccine for HPV has been there,
• 49:23has been available for many years.
• 49:25It has only gotten better with time.
• 49:27When the vaccine first became available,
• 49:30it would vaccinate against just two and
• 49:33then four different subtypes of HPV.
• 49:35Now the vaccinates against nine and
• 49:38a vaccinates against high risk HPV
• 49:42that causes cancer and precancer,
• 49:44but it also vaccinates against low risk HPV,
• 49:47which causes genital warts,
• 49:49which are also very significant quality
• 49:52of life issue for men and women,
• 49:54but really particularly women.
• 49:56So this vaccines are recommended for
• 50:00young girls and boys starting at age 9,
• 50:03and if they get this vaccine before age 15,
• 50:05all you need is 2.
• 50:06If you get it after age 15,
• 50:09then you need three.
• 50:10And then you exciting thing that has
• 50:12happened over the past couple years
• 50:14is that it's no longer recommended
• 50:16just for adolescents with children.
• 50:18It is now acceptable to offer
• 50:20it to women until age 45,
• 50:23which is really something
• 50:24that kind of caused.
• 50:26Change again the course of
• 50:27this because a lot of women,
• 50:30even though they were exposed
• 50:31to HPV and have one of the HPV
• 50:34that they're already exposed to,
• 50:36there's others that they're not.
• 50:38And there's actually a large
• 50:40number of women even older in
• 50:43the 45 to get this HPV vaccines.
• 50:45You know,
• 50:46a lot of women are widowed or
• 50:48divorced and start dating again
• 50:50and exposed again to new sexual
• 50:52partners and receive these vaccines
• 50:54at different ages to be able to.
• 50:56Benefit from it.
• 50:59So you know again I think the
• 51:02most exciting thing about
• 51:03surgical cancer nowadays is
• 51:04really this, it's prevention.
• 51:05You know we are doing better,
• 51:07we can do much more minimally
• 51:10invasive procedures.
• 51:11You know we do,
• 51:12we do much better now cone biopsies,
• 51:15we use special lasers and we
• 51:17do everything we can to try to
• 51:20prevent women from having pregnancy
• 51:22complications for management of
• 51:24these pre invasive cervical lesions
• 51:26because unfortunately that is
• 51:27something that has been a very big.
• 51:29Risk we do a lot of surgeries
• 51:31in a fertility sparing.
• 51:32You know we do all kinds of things
• 51:35to try to allow women to continue
• 51:38living their lives and be able to
• 51:40carry pregnancies or get pregnant
• 51:43or we spare their ovaries we moved
• 51:45them out of the way for radiation.
• 51:48So we do a lot of truly personalized
• 51:51quality of life sparing procedures.
• 51:53But I think again the the exciting
• 51:56thing about cervical cancer right
• 51:57now is not necessarily this it's.
• 51:59Really the prevention and significantly
• 52:02less numbers of cervical cancers that
• 52:05we are seeing and taking care of.
• 52:07That's the best if you like to
• 52:09take it over for radiotherapy.
• 52:11Sure.
• 52:11So, so when the cancer
• 52:15is not going to be surgical,
• 52:16so that's going to be anything
• 52:18where it's stage two and higher.
• 52:20So that means it's involving the parametrium.
• 52:21Then those are patients that are
• 52:22going to get referred for radiation,
• 52:24they're not candidates for for surgery.
• 52:27But similar to advancements that Doctor
• 52:29Ratner was talking about in early stage,
• 52:31in the past 10 to 15 years,
• 52:33we've seen tremendous advances in the
• 52:35quality and the safety and the efficacy
• 52:38of the radiotherapy side as well and.
• 52:41I spoke about that a little bit a
• 52:42few weeks ago in the grand rounds,
• 52:44so I'm not going to go into detail here,
• 52:46but the treatment involves radiation
• 52:48with nowadays we use what's
• 52:50called image guided brachytherapy,
• 52:52which incorporates MRI imaging
• 52:54to allow us to very,
• 52:56very carefully place needles and break
• 52:59the therapy applicators into the target.
• 53:01We're able to do this better than
• 53:03we've ever done it before with more
• 53:05specificity and more guidance.
• 53:06And there's been trials now that show
• 53:09that this results in about a 90%.
• 53:11Local control for these patients.
• 53:13So that's really we're doing better and
• 53:15there's fewer and fewer toxicities.
• 53:16So this is when the cancer is advanced.
• 53:20The good news is that our treatments
• 53:21have really gotten much better and
• 53:23more tolerable with fewer toxicities.
• 53:25And I did want to mention one of the
• 53:28unique things about working at Yale,
• 53:30I think is working with Doctor
• 53:31Ratner and her department.
• 53:32And she mentioned the sort of
• 53:34the continuity and the closeness
• 53:35of all these different groups,
• 53:37whether it's the clinical trials or The
• 53:39Sims Clinic or the GYN oncology teams.
• 53:41And if you can advance to the next slide,
• 53:43Elena,
• 53:44I was going to say that within
• 53:47our own brachytherapy service,
• 53:49I did want to recognize that we have
• 53:52a lot of different providers and
• 53:54team members who are part of it.
• 53:55And I just wanted to recognize some of
• 53:57the providers within our department,
• 53:59Director Young and Doctor Campbell.
• 54:00And then we have a huge amount of
• 54:02folks who work on breakey therapy,
• 54:04but recognizing some of the the
• 54:06lead folks would be Lisa Simmons,
• 54:09who's our coordinator, Sabrina,
• 54:10who's our lead breakey therapy.
• 54:12Nurse Catherine Waldron,
• 54:13who's our lead therapist, Doctor Tian,
• 54:16who's our lead physicist and these
• 54:18are our lead dosimetrist as well.
• 54:20So there's a lot of coordination and
• 54:22effort within our department and then
• 54:23within our two departments as well.
• 54:29So we do not want to take more time and
• 54:31we certainly do not want to run over.
• 54:34The exciting thing again about systemic
• 54:36therapy for cervical cancer is this
• 54:39truly personalized approach that we
• 54:41are able to provide our patients.
• 54:43You know all the tumors get subtyped.
• 54:46There's a lot of success in
• 54:48immunotherapy which really has
• 54:50been a miracle for this disease.
• 54:52You know there's women who whose tumors
• 54:54truly just melt away with immunotherapy
• 54:56and we have been able to really.
• 54:58Change the nature of the treatment of this
• 55:00cancer with these targeted approaches.
• 55:05So this was an example of bringing
• 55:07immunotherapy just to the upfront setting.
• 55:09So it's made a huge advance in the
• 55:12recurrent and metastatic setting.
• 55:14But now with the trial open at Yale,
• 55:16looking at whether this can improve
• 55:18outcomes even in the upfront setting as
• 55:20well and this is enrolling currently.
• 55:24And then again we mentioned before
• 55:26that the survivorship and the
• 55:28sexuality is actually in particular
• 55:29so important in this population and
• 55:31women with rectal cancer on internal
• 55:34cancer and something that is so,
• 55:35so important to provide care to
• 55:37women with combination of medical,
• 55:39hormonal surgical interventions as
• 55:42well as psychology, we are working,
• 55:46we work very closely with our psychology
• 55:49partners in this practice to provide
• 55:52really comprehensive survivorship care to.
• 55:54Women so thank you so much
• 55:56for this opportunity.
• 55:57I'm sorry we ran a few minutes late.
• 56:03Alina and Sherry, thank you so much.
• 56:06It you know it is encouraging
• 56:09in the course of our clinical
• 56:12careers to witness that really the.
• 56:14The literal transformation of
• 56:17this very daunting disease,
• 56:19and not only are we carrying
• 56:21it more effectively,
• 56:23but carrying it with modalities that
• 56:25preserve function and quality of life.
• 56:28I know the hours late.
• 56:29There may be some questions if
• 56:32I could have the panelists stay
• 56:34for a few more minutes.
• 56:37Renee, let us know if you're
• 56:39seeing anything and we will look
• 56:41to see if there's anything on
• 56:43our questions coming in on chat.
• 56:53You know, I, uh, I may
• 56:55ask the first question.
• 56:59Of our of our 2G1 oncologists
• 57:02for women who are.
• 57:06Diagnosed with invasive cervical cancer,
• 57:09how many of them are undergoing
• 57:11radical hysterectomy at this point?
• 57:13Are the majority treated with non
• 57:16surgically or is surgery still a major
• 57:19pillar in the care of this disease?
• 57:23Yeah, managing question,
• 57:24Kevin, you know it depends.
• 57:26It's actually geographically it depends
• 57:29on the geography of the institution.
• 57:33It all depends on the late stage
• 57:35or early stage that women present.
• 57:37If women present at early stage,
• 57:39we certainly prefer surgical
• 57:40options and a lot of them again
• 57:43are fertility sparing options.
• 57:45So some of them are fertility sparing
• 57:47options and then more advanced disease
• 57:49as after the mass said managed with
• 57:51radiotherapy and I feel like nowadays.
• 57:54It's actually much more we find the
• 57:56cancer's a little bit later because I
• 57:58feel like the women who get the vaccines,
• 58:01it's prevented in the 1st place and
• 58:03unfortunately it's the women who do
• 58:04not have good medical care or women
• 58:06who are immigrants from elsewhere and
• 58:08unfortunately they cancers are quite
• 58:09advanced and we use we do much less
• 58:11surgery and much more radiation cherry,
• 58:13do you agree?
• 58:14I agree. And also MRI I think has
• 58:16increased finding parametrial
• 58:17extension a little bit earlier,
• 58:20so perhaps patients that
• 58:21before we were using widely.
• 58:24Using MRI, maybe they had a hysterectomy.
• 58:26Now we're kind of catching the
• 58:27parametrial extension early and
• 58:28referring them to radiation.
• 58:29So I think it's an interesting question.
• 58:31We don't see a lot of radical
• 58:32hysterectomies like Doctor Ratner said,
• 58:33they're either very early or very late.
• 58:38Thank you. I think, uh,
• 58:42in respect to the hour.
• 58:45We will look forward to our next town
• 58:48hall and I think we will wrap it up.
• 58:50Thank you to all of our panel.