Smilow and Yale Cancer Center Town Hall | October 2021

Transcript

• 00:00Welcome to and get and our monthly yield.
• 00:03Cancer Center, Smilow Cancer Hospital,
• 00:06town hall. It's really good to see all
• 00:08of you and I hope you're all doing well.
• 00:11If you can rename,
• 00:12move to the next slide please.
• 00:14OK, so as you know we had the
• 00:17closer to free right again.
• 00:18Unfortunately it was virtual,
• 00:20but the good part is, as always,
• 00:23the teams were unstoppable
• 00:24and we raised over two.
• 00:27There were 2000 writers from 30 States
• 00:30and two countries and we raised over
• 00:332.1 million hospital to support Cancer
• 00:35Research and patient care at both.
• 00:37Are y'all Cancer Center and smile oh
• 00:39cancer hospital so thank you to all
• 00:41who participated and also to all of
• 00:43our teams outstanding and what a great.
• 00:46Picture next slide.
• 00:48K.
• 00:48As you know,
• 00:49we usually talk about sort of new
• 00:50announcements and new folks who joined.
• 00:52So these are like all great stuff
• 00:54in terms of new announcements.
• 00:56This is sort of somewhat bittersweet.
• 00:57Doctor James you you've met
• 00:59previously is leaving our institution,
• 01:02but it's I'm excited to announce
• 01:03Dr Lynn Wilson,
• 01:04who has presented at this town hall
• 01:06before as our Deputy Chief Medical
• 01:09Officer for Radiation Oncology.
• 01:11So welcome Doctor Wilson in your new role.
• 01:13Also in another announcement,
• 01:15Margaret Gill Shannon, who is been.
• 01:17Working with us and the Yale
• 01:19Cancer Center joined the Yale
• 01:21Cancer Center about a year ago.
• 01:23As our director of Senior Director,
• 01:25Finance and Administration,
• 01:27and his was also leading the
• 01:29integrated business operations for
• 01:31the Department of Pathology that
• 01:33we recently appointed as our Deputy
• 01:35Director of Finance and Administration.
• 01:37In that role,
• 01:38Margaret will be overseeing all the
• 01:40various facets or clinical operations,
• 01:42business finance, research,
• 01:44management and clinical trials.
• 01:46Take most of you know Margaret are ready,
• 01:48but if you haven't.
• 01:49You will be meeting her soon
• 01:51and she's been now.
• 01:52She's 100% as part of her team and we're
• 01:55really excited to make that happen.
• 01:58Uhm,
• 01:58we talk a lot about clinical
• 02:00trials and also about how this
• 02:02is important for our patients,
• 02:04but also our physicians and our teams.
• 02:07And this is a big entity and making
• 02:09this make sure that all of the parts
• 02:12aligned together means that the cancer,
• 02:14the CTO director really needs a team and
• 02:18it's really nice to see the team expands.
• 02:21So we have announced 2 new roles
• 02:23and Assistant medical director
• 02:24for the Clinical Trials Office
• 02:26for Smilow Cancer Hospital.
• 02:28And another one for care center
• 02:30networks or doctor Stacy sign has
• 02:32stepped in as our system medical
• 02:34director for the Clinical Trials
• 02:36Office for the Cancer Hospital
• 02:38and then Doctor Neo Fishback.
• 02:40We think most of you know is the
• 02:43is for our care center network.
• 02:44So congratulations to both of them.
• 02:47The search committee.
• 02:48I thank the search committee for
• 02:50all their hard work and helping
• 02:52us pick two great leaders.
• 02:54New appointments starting
• 02:55September of this year.
• 02:57Doctor Christy Kim.
• 02:58Has joined us as Assistant Professor of
• 03:01Clinical Medicine and joined the Smilow
• 03:04Cancer Hospital Care Center in Waterford.
• 03:06She starts on November 22nd and Doctor
• 03:08Kim is a General Medical oncologist.
• 03:11But I've met her and she has a special
• 03:13interest in gynecological cancers,
• 03:15breast cancers and lymphoma.
• 03:17Dr Ansley Roach has joined us in in
• 03:22auto laryngologist in the Department
• 03:23of Surgery and she cares for patients
• 03:25with head and neck cancers in both
• 03:27in New Haven and also our site.
• 03:29At Trumbull.
• 03:31And then Doctor Shannon Moore
• 03:33joins us as assistant professor of
• 03:36psychiatry focusing on Psycho Oncology
• 03:38program for our cancer hospital,
• 03:40and she's also joined by Doctor Jennifer
• 03:43Quelques, who's also an assistant
• 03:45professor of psychology psychiatry.
• 03:46But she focuses on psychological medicine.
• 03:48So welcome to all of our new
• 03:51physician leaders. Next slide.
• 03:53OK, good news in for one of the parts.
• 03:57I think in connecting all of our missions,
• 03:59you know we do.
• 04:00How do we connect?
• 04:01All of that is all offer amazing research
• 04:04that happens each and every day.
• 04:06So Dr Marcus, musician who heads our CMC.
• 04:09Oh,
• 04:09which is the Center for Molecular and
• 04:12Cellular Oncology was recently awarded
• 04:14this NCI Outstanding Investigator award.
• 04:16This is a huge honor so really
• 04:19excited and proud of Doctor Mission
• 04:21and this is a matter of pride
• 04:23for also of the Cancer Center.
• 04:25This comes to someone who supports
• 04:28scientists who really are at the premier
• 04:31levels of productivity and innovation.
• 04:33And provides more than 7 million
• 04:35in funding over seven years for
• 04:37groundbreaking Cancer Research.
• 04:39Also excited to mention Doctor
• 04:41Suchitra Krishnan Sarin,
• 04:42who's a professor of psychiatry and
• 04:44a member of her cancer prevention
• 04:46and Control research program.
• 04:48She's been appointed to serve on the
• 04:50steering committee of the New American
• 04:52Association for Cancer Research,
• 04:53Research, Cancer Prevention Working Group,
• 04:56which is dedicated to supporting
• 04:59cancer prevention research.
• 05:01More news Doctor Matthew McConnell
• 05:03was an instructor in medicine as
• 05:05part of the Digestive diseases Team
• 05:07and Doctor Sean Go in lab medicine.
• 05:09Are they normal?
• 05:10Award?
• 05:11Ease of the JJ Millstone up
• 05:13fund to support their project,
• 05:14which is the role of platelets in
• 05:17the pathogenesis of alcohol related
• 05:19liver disease and high throughput.
• 05:21Diagnostic evaluation of patients with
• 05:24platelet disorders by my mass cytometry.
• 05:26So congratulations to all of them.
• 05:29Renee next slide. More good news.
• 05:31Doctor Sabrina Browning is who's an
• 05:34assistant professor in hematology
• 05:36division has been selected as your
• 05:39faculty representative to the
• 05:40Deans Faculty Advisory Council
• 05:42through October of 2024.
• 05:44Congratulations and thank you for
• 05:46serving in this critical role.
• 05:47Sabrina, I think your faculty chose you.
• 05:50Your peers chose you as as their
• 05:53representative doctor Naveed Hafez,
• 05:55who's in is also an assistant
• 05:57professor in medical oncology,
• 05:58has been awarded.
• 05:59Bristol Myers Squibb Foundation
• 06:01and National Medical Fellowship.
• 06:03Diversity in clinical trials.
• 06:05Career Development award through ACR.
• 06:07Also, congratulations Naveed.
• 06:09And then Elizabeth Claus,
• 06:12who's a professor in Biostatistics
• 06:13and a member of the cancer Prevention
• 06:16and Control Research Program,
• 06:17was appointed a
• 06:20U2U2C grant from the NCI National
• 06:23Cancer Institute to support her
• 06:25proposal optimizing engagement in
• 06:28discovery of molecular evolution
• 06:30of low grade glioma or the acronym
• 06:33OPTIMUM and then last but not least,
• 06:35Michael Cicchini,
• 06:36who many of you know was also an
• 06:38assistant professor in medical oncology.
• 06:40Just has been awarded a Keyway Career
• 06:43Development award for his research
• 06:45and development of two investigator
• 06:47initiated clinical trials for
• 06:49patients with colorectal cancer,
• 06:50under the mentorship of the inevitable.
• 06:53But Doctor Patricia Lorusso really
• 06:55outstanding and you can see that the
• 06:58level of talent and also at all levels,
• 07:00which is kind of nice to see as a
• 07:03director that we have people at the
• 07:05assistant professor in all the way of
• 07:07senior physicians for getting national award.
• 07:10So congratulations.
• 07:10So all of you next slide
• 07:13part of her cancer centers,
• 07:14of course,
• 07:14also our nursing teams and our
• 07:17other frontline teams.
• 07:18And we had the Frederick De Luca words.
• 07:21Those were outstanding.
• 07:22Leslie DeLuca joined us and we
• 07:24had 10 be announced.
• 07:2510 nursing scholarships were awarded to
• 07:28recipients who are currently enrolled in
• 07:30an accredited School of Nursing program.
• 07:32Each of the award ES embraces the
• 07:35mission and vision of Smilow Cancer
• 07:37Hospital and demonstrates a commitment
• 07:40to oncology nursing patient care.
• 07:42The ability to communicate and
• 07:44collaborate effectively in a
• 07:46commitment to lifelong learning.
• 07:48Think you can see the congratulations
• 07:49and I have to say the ceremony was
• 07:51fabulous and I want to thank all the
• 07:53people who organized that wonderful event.
• 07:55But the the the Awardee's work here in
• 07:58London and ambulatory Care Care Associates,
• 08:01in pediatric hematology oncology.
• 08:03Noel Kyle,
• 08:04who's also a PCA in NP12 Kristen White
• 08:07who's a PC in surgical oncology on MP15.
• 08:11Delilah Langley frac Franks.
• 08:12Susan Ambulatory Care Associates
• 08:14for the women's program.
• 08:16Yvette Hernandez,
• 08:17who is in Guilford Martha crack,
• 08:19who's a patient, services in North Haven.
• 08:23Arlene Mangione,
• 08:24who's in practice nurse in Guilford?
• 08:27Christina Capriotti,
• 08:27who is in our Greenwich site.
• 08:30Amanda Kardes,
• 08:31who does outpatient oncology infusion
• 08:34in Waterbury and broke Szarmach who
• 08:37is at helps the centers in Derby,
• 08:40Waterbury and Torrington.
• 08:42So congratulations.
• 08:44To all of our vendors really proud of
• 08:46you and so glad and I want to thank
• 08:48Mr Luka for support of this program.
• 08:50For our trainees.
• 08:51Alright, that was fast and furious,
• 08:54but now we have more sort of
• 08:57a panel discussion today.
• 08:58First up,
• 08:59you just heard about the De Luca Awards,
• 09:02but there's also delucas entrance.
• 09:04Doctor Stephanie Helene is going
• 09:05to be giving us a little update
• 09:07followed by Doctor Jean Kennewick is
• 09:09going to talk about how do we think
• 09:11about treating our older patients?
• 09:12And can we do risk calculators in this
• 09:15idea of informed decision making?
• 09:18Doctor Karen Adelson is going to talk
• 09:19to us a little bit about supply chain.
• 09:22Issues and then no meeting in recent
• 09:24months as would be incomplete without
• 09:26talking about some of the challenges
• 09:29that we continue to face around capacity.
• 09:31And of course, as always your very own CMO
• 09:34doctor Billingsley is joining us as always,
• 09:36so with that I'm going to turn it over to
• 09:38Doctor Helene to talk about her center.
• 09:46Thank you so much,
• 09:47needle and turn. OK, 'cause
• 09:49the slides look OK.
• 09:51Yeah, thank you so much needed for
• 09:53allowing me to present today so it's a
• 09:56pleasure to present the DeLuca Center
• 09:58for Innovation in Hematology research,
• 10:01which was really a transformative 5 year
• 10:04grant from the Frederick DeLuca Foundation,
• 10:07and I have the pleasure to Co
• 10:10leaders with Michael Smission
• 10:11about whom you have just heard.
• 10:14And this five year Grant
• 10:16focuses on actually five key
• 10:18aspects for hematology research,
• 10:21and one is to build a biorepository
• 10:23and clinical database.
• 10:24One is the state of the art Malecki
• 10:27annotation development of novel
• 10:29technologies Pilot 5 pilot grants per
• 10:31year to advance hematology research and
• 10:33one to your career career development
• 10:36award per year to provide protected
• 10:38research time to hematology faculty.
• 10:40We are now just about 2 1/2 years into this.
• 10:44And let me tell you what we have,
• 10:46what we have done,
• 10:47and what we're planning to do.
• 10:49So we recently had a wonderful internal
• 10:52Advisory Board meeting with Barbara Burtness.
• 10:55Peter Glaser practices.
• 10:56Of course they are Mark Lemon and Pam Kuntz,
• 10:59and we need to look at what would have
• 11:02we achieved and where are we going.
• 11:05There was an amazingly fruitful
• 11:07compensation and we will have these
• 11:09meetings on A6 monthly basis to take
• 11:11us forward in a meaningful way.
• 11:15And So what have we chief?
• 11:17So let me tell you about
• 11:20the hematology tissue bank,
• 11:21where we're really trying to accrue samples,
• 11:24collected samples from patients
• 11:26with all humility, logic disorders,
• 11:27malignant benign,
• 11:28and over the last many years we
• 11:32have collected over 5000 samples
• 11:34from over 2002 1500 patients,
• 11:36and I think the first thing here
• 11:38goes to the patients who are willing
• 11:40to participate so that we can learn
• 11:43more about their diseases and
• 11:44ultimately develop new treatments.
• 11:46The samples include bone marrow,
• 11:48preferred blood,
• 11:49lymph node and tissue biopsies and come.
• 11:52And during COVID we also started
• 11:55specialized process or also processing
• 11:58of COVID samples and will also
• 12:00provide specialized processing for
• 12:02clinical trial samples in hematology.
• 12:05Uhm, database and Sutter repository
• 12:08is only useful if it can write.
• 12:11If it's samples can be used and
• 12:13once you have this many samples it
• 12:15is really important to have a state
• 12:18of the art electronic database that
• 12:20is also accessible to interested
• 12:23scientists and identified manner
• 12:25and so currently we're building
• 12:26this freezer words by repository
• 12:28database and that is led by Jennifer
• 12:32Fanwood and Hoven.
• 12:34And ultimately,
• 12:35we would like to also build
• 12:37a red cap clinical database.
• 12:40We have in the meantime provided
• 12:4212 pilot grants.
• 12:43I will show you some examples.
• 12:44We have aborted one career development
• 12:47awards and I will show you that too.
• 12:51We are building a team to provide
• 12:53Technical Support for correlative
• 12:55studies and data analysis,
• 12:57and that includes Jennifer Padma Melanie,
• 13:00who just recently joined us, Ameesha and Ron.
• 13:03I have actually moved on to
• 13:05their next careers.
• 13:07And we're also working on providing
• 13:09access to novel technology,
• 13:11single cell DNA sequencing,
• 13:13single cell cytokine assays etc.
• 13:15Uhm and so let me tell you briefly about
• 13:19the the database progress we're making,
• 13:23and this is a wonderful
• 13:25collaboration with Wade Schultz and
• 13:27laboratory medicine and his team.
• 13:29And here you see the Freezer
• 13:32works database with our samples.
• 13:34The goal to build a Redcap clinical
• 13:36database and the important thing is that
• 13:39it's databases don't stand in isolation,
• 13:42but that they talk to each other and so.
• 13:45Wade and I can't tell you so
• 13:47much about this computation.
• 13:49Has platform bed 'cause it is beyond me,
• 13:51but wade with his team is building
• 13:54this amazing central data hub where
• 13:58all these individual databases
• 14:00can feed into that.
• 14:03Ultimately, we can, you know,
• 14:05learn about patient outcomes mutations,
• 14:08use samples, than in functional studies,
• 14:11etc.
• 14:11And so this is ongoing and I just learned
• 14:15from Jennifer that there may be a week.
• 14:17Away from the final import of
• 14:20all the of the data for all the
• 14:23samples that we have collected.
• 14:25Uhm so uhm. Sorry about that.
• 14:29So again,
• 14:30I just told you about this
• 14:32freezer works database on the.
• 14:33UM,
• 14:34it's really state of the art data
• 14:36based on watts and with every iteration
• 14:39they have improved it and in this.
• 14:43Version what is very very
• 14:44interesting to us is that
• 14:46patients and samples are organized
• 14:49by studies which may ultimately
• 14:51also provide some opportunities to
• 14:54support clinical trials or really
• 14:56project based on research studies.
• 14:58We have been very successful in collecting
• 15:00blood and bone marrow samples and we
• 15:02have recently created a small team and
• 15:04we're getting help from these acodec
• 15:06who's assistant professor and surgery
• 15:09to expand our acquisition into Internet.
• 15:13Tissue biopsies,
• 15:14in particular lymph nodes,
• 15:15and so Lisa and Jennie grocery in Attalla G,
• 15:18are teaming up with us to achieve this,
• 15:22so let me tell you a little bit about the
• 15:25pilot grants and career development award.
• 15:27So shelling Kosar is actually our
• 15:30first career development award.
• 15:32E&T is particularly interested
• 15:34in treating mental seven former,
• 15:36which is a very aggressive lymphoma
• 15:39and he is devising novel strategies
• 15:42to activate apoptosis.
• 15:43And he's mentored by Sam Katz
• 15:46and Pathology and Marcus Vision.
• 15:48The other important thing to note
• 15:50is that these are examples of three
• 15:52pilot grants we were able to award.
• 15:54We like team science and what we would
• 15:56like to do with pilots is to bring in
• 15:59people who don't normally think about him,
• 16:01not dermatologic diseases.
• 16:03And so this is, for example,
• 16:05a grant.
• 16:06Withers is Sophie.
• 16:07In hematology I mean are showing
• 16:09him pathology and Jordan Pober
• 16:12and vascular biology.
• 16:13This pilot here is led by Alex Pine
• 16:17was interested in COVID with Alfred
• 16:20Lee and Kilchurn from cardiology
• 16:22and this is a grant by Monash,
• 16:24Paula and Kara.
• 16:25Now current catalog power isn't irony.
• 16:28Splicing expert in M B&B.
• 16:34And here's just a list of
• 16:36additional pilot grants,
• 16:38so they really spend from basic
• 16:41science to clinical science and just
• 16:43show you a couple of results of of
• 16:47the effect such pilots grandkids have.
• 16:50So, for example, these are two papers
• 16:52with the team around Scott Huntington
• 16:54looking at cost effectiveness of
• 16:55first line versus third line is broken
• 16:58up in patients with untreated CLL,
• 16:59and there's another cost effectiveness
• 17:01study of looking at second line
• 17:03use of their tumor mapping.
• 17:05Older transplant ineligible patients with
• 17:07multiple myeloma and again this is really
• 17:11teams coming together with the copper center.
• 17:13Natalia is my normal
• 17:16specialist Scott Huntington,
• 17:17a former specialist whose teams
• 17:19coming together and the pilot
• 17:21grants allow us to do this.
• 17:24And this is our we have given out
• 17:26three years of pilot grants so far.
• 17:28And again, here are additional award
• 17:30design and some of them are more recent,
• 17:33but I want to highlight
• 17:35a paper by Alfred Lee,
• 17:37Anne Shelton and team.
• 17:39And this is actually from early from
• 17:42last year describing endothelial apathy
• 17:45in COVID-19 associated quagga apathy.
• 17:48And this paper is absolutely amazing,
• 17:51and you can tell that it has already
• 17:53been cited by more than 200 and.
• 17:5580 publications and it really has
• 17:57very early on in the pandemic,
• 17:59elucidated some of the mechanisms
• 18:02of this devastating infection and.
• 18:05Alfred also end until turn also have
• 18:07a paper on neutrophil activation
• 18:09signature that predicts illness
• 18:10and mortality in COVID-19,
• 18:12and this incredibly irrelevant as people who,
• 18:15for example, study immunity,
• 18:17improve it,
• 18:18realize that people have different
• 18:20antibodies that may have different effects
• 18:23on this beautiful activation signature.
• 18:25So I just would like everybody to
• 18:27stay tuned for the call for the
• 18:30next pilot and CD applications.
• 18:32We will put out the call.
• 18:33N1 asked for a letter of intent,
• 18:35assemble one.
• 18:36Not that as exclusionary,
• 18:38but it helps us to understand how
• 18:40many applications people get and
• 18:41get the review team together,
• 18:43and we plan to and then receive
• 18:45for proposals in January and make
• 18:48awards by March 1.
• 18:50So what our future plans you know,
• 18:53just some simple structural plans.
• 18:55So we want to complete.
• 18:56Complete and maintain the database
• 18:58to enhance use of the samples.
• 19:00We want to expand tissue banking
• 19:02by disease collection side.
• 19:04We would like to know what people want,
• 19:08what questions people want to
• 19:10answer and help them accrue patients
• 19:12and samples to do this.
• 19:14We're very we really want to
• 19:16foster collaborations in clinical,
• 19:17translational basic sciences.
• 19:20And we would also like to collaborate.
• 19:24For example,
• 19:25was with the nurses who you know.
• 19:27I've also shown, right?
• 19:29There's received smaller grants,
• 19:31but I think there's a lot of
• 19:34opportunities for collaboration
• 19:35across political and and science.
• 19:37We want to build the infrastructure for
• 19:40clinical trial, correlative studies,
• 19:42and then inevitably,
• 19:44there was also support programmatic
• 19:46rose by allowing us to reduce faculties,
• 19:49clinical load build programs.
• 19:52And recruit outstanding physician
• 19:55scientists and.
• 19:57Work on executive support and then of course,
• 20:00this is an amazing grant and support.
• 20:03We always have to think about maintaining
• 20:06so future funding and cost recovery.
• 20:08And so thank you for listening
• 20:11and we welcome suggestions, ideas,
• 20:13support collaborations here.
• 20:14Our emails, Twitter handle and
• 20:16stay tuned for the website.
• 20:20Thank you Doctor Helene that was very
• 20:23nice presentation and I hopefully
• 20:25everyone noted the upcoming pilot grants.
• 20:28I just rounded on NP11 and I think
• 20:30the nursing team talked about
• 20:31and everyone talked about how
• 20:33clinical trials are important too,
• 20:35and research is important to our patients.
• 20:38So thank you. I'm gonna leave questions
• 20:39for the instance I want to make sure
• 20:41we get through some of the key parts,
• 20:43so please type your questions for Doctor
• 20:45Helene in the chat and we can also answer.
• 20:48But next step is Doctor Kanowitz
• 20:50going to talk about informed.
• 20:51Decision making with our patients.
• 20:55Thank you for inviting me to talk
• 20:59about our quality improvement project.
• 21:02The population is aging and the
• 21:06over 70 demographic is the fastest
• 21:10growing sector of the population.
• 21:14Older patients present with
• 21:17unique clinical challenges.
• 21:20The cancer and Aging Research Group
• 21:23was founded by Doctor RT Courier in
• 21:272006 to foster collaboration within
• 21:31the oncology community to eradicate
• 21:35ageism in all aspects of care and
• 21:39research for older oncology patients.
• 21:42Their work is sanctioned by ASCO,
• 21:46my interest in geriatric oncology was.
• 21:50Ignited when I heard her speak
• 21:52at ASCO a number of years ago.
• 21:55This group has developed validated risk
• 21:58assessment tools for the population and
• 22:02as of 2018 ASCO guidelines recommends
• 22:06completing a geriatric risk assessment
• 22:09on all patients over the age of 65.
• 22:13Nonetheless,
• 22:14clinical uptake remains low.
• 22:18The literature suggests that we
• 22:20both over and underestimate the
• 22:22risk of chemotherapy administration.
• 22:25About a third of the time,
• 22:28and that means that we're both
• 22:30over and under treating this cohort
• 22:33of patients a third of the time.
• 22:35One of our network quality improvement
• 22:39projects was to have each physician
• 22:42complete 10 risk assessments using the
• 22:46Karg chemotherapy risk calculator in
• 22:49patients over the age of 70 prior to
• 22:53starting a new chemotherapy regimen,
• 22:56and we did this during the winter
• 22:58and spring months of 2021.
• 23:00The 11 simple questions in the calculator.
• 23:05Address all domains of function.
• 23:08Our team thank you completed
• 23:11the calculator on Go back.
• 23:14Well, we'll get to that our team.
• 23:20G and over who started a new regimen.
• 23:23If the calculator was not done by one of
• 23:26the network doctors over this timeframe,
• 23:30there were about 350 new chemotherapy starts.
• 23:35Our team consists of Alex Medway,
• 23:40he's a he's doing a postdoc
• 23:43research fellowship in geriatrics.
• 23:45I was introduced to Alex by doctor Carrie
• 23:48Gross from the School of Public Health.
• 23:51Doctor Gross is actually an
• 23:54inaugural member of Karg.
• 23:57Alex is now thinking about
• 23:59doing an oncology fellowship.
• 24:02Uhm, so he can further this work.
• 24:05Russell Lewis is part of our team.
• 24:07He's a third year he monk fellow and
• 24:11Paula Pike compliments the the team
• 24:14with her endless energy and enthusiasm
• 24:18for improving the patient experience.
• 24:21She is our clinical program manager
• 24:24and of course there is our mentors,
• 24:27Jeremy and Dan,
• 24:28and they just need first names.
• 24:30Kind of like Oprah. And share.
• 24:34Our team did the following.
• 24:35We created a hyperlink to the
• 24:38card tool in in the EHR.
• 24:41We provided a dot phrase to simplify
• 24:47documentation and we provided education.
• 24:50Right now we're collecting
• 24:52data on the clinical outcomes,
• 24:56but we reported on the implementation
• 24:59of the project in abstract form.
• 25:02Next slide,
• 25:03please.
• 25:06The abstract was accepted at the
• 25:112021 ASCO Quality Care Symposium
• 25:14as a poster next site, please.
• 25:20And this is what we've learned so far.
• 25:23We had each physician complete
• 25:26a brief survey regarding their
• 25:28experience using the calculator.
• 25:31The majority found that the tool was very
• 25:35helpful in making treatment decisions
• 25:37and especially helpful in discussing
• 25:40chemotherapy toxicities and risk.
• 25:4550% of physicians either attenuated dose
• 25:49attenuated the treatment plan selected a
• 25:53different regimen than originally intended,
• 25:56or chose not to treat on the
• 26:00basis of the Karg tool.
• 26:02We found that for the most part it caught.
• 26:04It took us less than five minutes
• 26:07to complete supportive care.
• 26:09Referrals were proactive in
• 26:12lieu of reactive about a.
• 26:14Third, at the time and the use of the
• 26:18tool lead to meaningful goals of care.
• 26:21Discussion greater than 50% of the time.
• 26:26We anticipate that the outcomes data
• 26:30will fuel sustainability of this project.
• 26:34This was a brief presentation,
• 26:36so I I think we have time for
• 26:38for any questions or thoughts.
• 26:42Being I'm going to leave the questions
• 26:44for the end for all of us,
• 26:45but I I think I already see
• 26:47what I saw was 70% of the folks
• 26:49finished it in less than 5 minutes.
• 26:50So which says that it's can be adopted
• 26:54in clinical practice, so stay tuned.
• 26:56I suspect that a lot of people may
• 26:58be reaching out to see how they
• 26:59can use the calculator Next up.
• 27:02Are you like and Jeremy one named Karen?
• 27:07We're only going with the
• 27:08superstars alright alright
• 27:09we're very haunted. Trails and
• 27:11talking yeah. Alright, let me.
• 27:18Can you see this? Does it is, but it's
• 27:21not. It's not
• 27:22in it's like now you are perfect
• 27:24OK good alright so like Jane.
• 27:27First of all I want to
• 27:29say that was fantastic.
• 27:30I like by nature I like to dazzle
• 27:32you with wonderful new programs
• 27:34that are going to improve care,
• 27:36delivery to our patients.
• 27:39This presentation is not that.
• 27:43Instead I'm going to take a book
• 27:45out of a page out of rob forward
• 27:47fogarty's book and talk to you.
• 27:49About honestly and openly about
• 27:52some of the sort of realities
• 27:55that we're facing this week.
• 27:57So there is a national shortage
• 27:59of ABRAXANE due to manufacturing
• 28:01delays at Bristol Myers Squibb.
• 28:04This is not generated here at Yale.
• 28:07It's a national problem and at
• 28:09this point we don't know when this
• 28:11situation will be resolved and the
• 28:14supply chain will return to normal.
• 28:16At present the supply we have
• 28:18today and we have been our amazing
• 28:21pharmacy team led by Sam Abdul
• 28:24Ghani and many Merle who works on.
• 28:27All of our sort of pharmacy
• 28:29policy have been avidly working
• 28:31to get as much as they can.
• 28:33Our current supply would run out
• 28:35in one week if we continued at
• 28:38our current usage rate and we are
• 28:41not expecting any large influx of
• 28:43new vials in the next few weeks.
• 28:46So at this time we needed to develop
• 28:49criteria to guide the allocation
• 28:51of our limited supply and provide
• 28:55alternative treatment options.
• 28:57So we pulled together a group of
• 29:00disease team leaders and heavy ABRAXANE
• 29:02users who have the most patients on
• 29:05ABRAXANE across the system and came
• 29:08up with the following guidelines.
• 29:10So for any new patients starting treatment,
• 29:13please choose alternative therapy and,
• 29:17if clinically appropriate,
• 29:19considered deferring treatment with ABRAXANE.
• 29:21I do think it's important to point out
• 29:25that ABRAXANE is just albumin bound.
• 29:27Paclitaxel,
• 29:27it is not a novel or different
• 29:30drug for the most part.
• 29:33So of all things to be in shortage,
• 29:35this is one where we really
• 29:36do have viable alternatives.
• 29:38Currently we are going to we have
• 29:41to restrict the ABRAXANE supply to
• 29:44patients who have curable disease
• 29:47and to allow them to finish the
• 29:50treatment that they're currently
• 29:51undergoing for all of our other
• 29:54patients who are on non curative
• 29:56or palliative treatment we need to
• 29:59convert them to alternative options.
• 30:01So far it looks like this is a little
• 30:04bit above 50 patients across our system.
• 30:07So for breast and
• 30:09gynecological malignancies we.
• 30:10Recommend using an equivalent dose
• 30:12of paclitaxel if patients have
• 30:15had infusion reactions to taxal.
• 30:17Talk to your pharmacist.
• 30:19We will have guidelines for re
• 30:21challenging patients who have had
• 30:23prior reactions and we have lots
• 30:26of experience for doing this.
• 30:28For patients who are undergoing
• 30:30pancreatic with her patients with
• 30:32pancreatic cancer undergoing palliative
• 30:34treatment with gemcitabine and ABRAXANE,
• 30:37which is often used in the second line,
• 30:39setting options will need to
• 30:41be individualized depending on
• 30:43the line of therapy.
• 30:45So options include gemcitabine
• 30:47as a single agent.
• 30:49Other gemcitabine based
• 30:51combinations or modified folfirinox,
• 30:54folfiri or folfox.
• 30:56So gemcitabine
• 30:58and paclitaxel has not been studied.
• 31:01It doesn't mean it doesn't work,
• 31:02it's just that this study
• 31:05was done with ABRAXANE.
• 31:06This could be an option to consider,
• 31:08but it's important to recognize the
• 31:11absence of any data supporting this
• 31:13benefit or or refuting the benefit.
• 31:16And there is some biological theory that
• 31:18the albumin bound paclitaxel could be more
• 31:21effective in a pancreatic population.
• 31:24There is phase two data.
• 31:26At least supporting safety and activity
• 31:29of docetaxel with gemcitabine and the
• 31:33advanced pancreatic cancer population.
• 31:35So if you have any questions,
• 31:37please reach out to our disease team leaders.
• 31:40They're more than happy to talk to you
• 31:42on a case by case basis and work with
• 31:45your pharmacist if you are not sure.
• 31:48Sort of what the appropriate alternative
• 31:50regimen is for your patient.
• 31:54The other thing that we need to talk about
• 31:56is how we message this to our patients,
• 31:58because this is not easy and these
• 32:01are not easy discussions to have.
• 32:03I wish we didn't have to have them,
• 32:05but I think the best approach is
• 32:07to be open and honest to tell them
• 32:10that the shortage is a result of the
• 32:13manufacturer delay that our priority
• 32:15is to continue their treatment with
• 32:17safe and proven options and that
• 32:20we are actively working to obtain
• 32:22an increased supply of ABRAXANE.
• 32:25As next steps,
• 32:26our pharmacy team is working with VMS
• 32:29and our distributors to obtain supply.
• 32:32It is a trickle.
• 32:33It's not a flood and you know we we
• 32:37will continue to communicate with
• 32:39you as we have updates and certainly
• 32:42let you know if we can restart.
• 32:44Yeah, new ABRAXANE containing regiments.
• 32:47Thank you.
• 32:50Thank you Doctor Adelson. I think
• 32:52this is tough decision discussions.
• 32:54But you know, I think the messaging
• 32:56store patient to reassure them and and
• 32:59I I'm glad to hear that the dark teams
• 33:01are available to answer questions.
• 33:02So I I'm going to leave the
• 33:04questions for the end.
• 33:05Or if as we go along 'cause I do
• 33:07want to have give a chance for
• 33:09Rob to also talk about what's
• 33:11happening with the capacity issues.
• 33:14So I think Rob you presented
• 33:16before on this forum,
• 33:17but welcome back Dr Fogarty and come.
• 33:21I don't know do you have flights
• 33:22or are you know OK alright,
• 33:25well floor is yours stuck for ready
• 33:29so I everybody. I didn't prepare
• 33:33any slides just because I there's
• 33:36nothing left to put in type really.
• 33:39And so I I mean, we all we've all went
• 33:42into health care to take care of people,
• 33:43so I'm just going to share
• 33:45with you some stories that our
• 33:47colleagues have shared with me.
• 33:48Over the past couple of weeks. To try to.
• 33:54You know, just just to show one so
• 33:57that they felt heard because it's a
• 33:59lot of people are really struggling.
• 34:02And two, because there's no sugarcoating,
• 34:05it's just really bad and continues to be bad.
• 34:08And I've I've I've.
• 34:11Uh, I told another group.
• 34:13I don't know.
• 34:13Two weeks ago that the the Canary is dead.
• 34:17And now it is dead and cold,
• 34:19and the winter.
• 34:21If if what September was for us any kind
• 34:28of prognostic factor I shared with the
• 34:31senior leaders of the institution and
• 34:33the health system that it is a possibility,
• 34:36maybe not a probability,
• 34:38but it is a possibility that we will
• 34:41no longer function during flu season.
• 34:43I think it's that it's that grim,
• 34:45so some.
• 34:47Just some stories we today.
• 34:49The Children's Hospital.
• 34:51The Children's Emergency room has.
• 34:54That ten treatment based and
• 34:57at 8:00 o'clock this morning
• 34:59they had 14 boarded patients.
• 35:01So that has always been an area that has
• 35:04been protected because of what it is
• 35:06and we were no longer able to protect it.
• 35:10The Adult Emergency Department
• 35:12today was a good day.
• 35:14They only had 80 borders.
• 35:16Uh,
• 35:1730 of them were behavioral health,
• 35:20which I understand is is not a
• 35:22traditional medical surgical patient,
• 35:24but is a patient with a disease
• 35:26and occupies a treatment room.
• 35:29So they had about a third of
• 35:32their capacity staring a Thursday
• 35:35in the fall with nice weather.
• 35:38With the rise in interpersonal violence
• 35:41and crime, that is a tough sell.
• 35:45Uhm, some other emergency department.
• 35:48In September,
• 35:48we broke all the boarding records
• 35:51and when it was really bad,
• 35:53the bed managers would come in in
• 35:55the morning and assigned beds.
• 35:56Two patients that had been
• 35:58waiting for 72 hours or more in
• 36:02in the emergency departments.
• 36:04The ER at York Street had all of
• 36:07their resuscitation rooms occupied
• 36:09with critically ill patients and had
• 36:12a penetrating trauma come in and had
• 36:15to treat that patient in the A side,
• 36:17which is normally where you would
• 36:20put someone who comes in with.
• 36:22A migraine or a new?
• 36:28Non critical abdominal pain.
• 36:29And they did what they could,
• 36:32and they saved that person's
• 36:33life and it was truly remarkable.
• 36:36We had at 1.24 ambulances in
• 36:40our arrival bays.
• 36:43Which is about double what we have
• 36:45and we had 24 and all of them
• 36:47had patients in them and the wait
• 36:50was so long that the Ed staff
• 36:52were going to the ambulances.
• 36:54And performing triage diagnostic
• 36:55workups in the back of the ambulance.
• 37:01And I could keep going on and on,
• 37:04but I I think that that proves the point.
• 37:07And flu hasn't arrived yet.
• 37:10So I'll take a moment and just share
• 37:11with you what we know about flu,
• 37:13which is not a lot we normally
• 37:16pick our flu vaccine.
• 37:17It's been picked.
• 37:18The four strains have been picked.
• 37:20They're growing in the eggs,
• 37:21but I guess now they're probably in vials,
• 37:23but but either way.
• 37:26Australia did not have much of a flu season.
• 37:29They still had a lot of societal lockdowns.
• 37:33Whether or not that's something that
• 37:35is agreed with me, that is a fact.
• 37:38They had very aggressive lockdowns,
• 37:40so we don't really know
• 37:41what's going to happen,
• 37:42but there's early data out of Australia
• 37:45that the virus is put in the vaccine.
• 37:48Maybe we're not a good match,
• 37:49but the sample size was infinitesimally
• 37:52small, so we really have no
• 37:54idea what we're up against.
• 37:57There were two studies in
• 37:59pre print out of Pittsburgh.
• 38:01That are not encouraging
• 38:04and they invoke that.
• 38:06One of them was very well done.
• 38:08If anybody wants them,
• 38:09I'm happy to send them to you.
• 38:10Just send me an email.
• 38:11My name's in the corner
• 38:12or you can you can just.
• 38:14I don't know,
• 38:15everybody knows how to
• 38:15get ahold me these days.
• 38:16So one of the studies out of
• 38:18Pittsburgh looked at historic trends.
• 38:20When you have a a light influenza
• 38:22season and what happens the following
• 38:24year and there's a rebound effect
• 38:26where the influenza tends to be more
• 38:29severe and they extrapolated that based
• 38:31on what we saw last year and it is,
• 38:34it is not encouraging.
• 38:36Of that,
• 38:37the.
• 38:38You know,
• 38:38people talk about acuity and usually
• 38:40what they're talking about is
• 38:42this thing called casemix index,
• 38:43and I know most of you know what that is,
• 38:44but if there's one person who doesn't.
• 38:47It's an adjustment based on
• 38:49DRGS assigned to inpatients.
• 38:51And it's a crude measure for how
• 38:54much resource a patient needs,
• 38:56how intensive their inpatient courses.
• 38:59In our CMI just keeps its went up.
• 39:02It has not gone back down and people
• 39:04say it's edging down a little bit,
• 39:05but it's still.
• 39:06It's still markedly higher
• 39:08than it was before.
• 39:09And then the discharge side is one of the
• 39:13reasons why I don't have any hair left.
• 39:16The discharge process is dependent
• 39:18on people outside of our control,
• 39:21so sniffs are having staffing problems
• 39:23where they have units that are closed
• 39:25because they can't find staff.
• 39:27AMR excuse me AMR,
• 39:29which is our largest provider
• 39:32of ambulance services.
• 39:33I think three weeks ago had 200 unfilled
• 39:36shifts over the course of a weekend.
• 39:39And they have to they triage
• 39:40911 in EMS calls first,
• 39:42because those are the sickest patients.
• 39:44So just this morning I learned of
• 39:47three patients that Hadamar delays
• 39:49that actually prevented their
• 39:51discharge because AMR couldn't
• 39:53get around and the endoscopy
• 39:55center on the on the in the North
• 39:57pavilion and smile has all sorts
• 39:59of problems getting patients
• 40:01back out. And at one point AMR actually,
• 40:05for all of New Haven, the New Haven region
• 40:08only had three paramedics on a shift,
• 40:10which doesn't work right. That just.
• 40:13That would be like having three
• 40:15nurses for NP15. It just doesn't.
• 40:17It just doesn't compute, so it's a real.
• 40:20It's a real challenge.
• 40:21We had a DME provider that's
• 40:22going to back out of the space.
• 40:24So now we have to find a new provider
• 40:26for some of those DME equipment.
• 40:28Uhm, so it is.
• 40:29It is really an affront
• 40:31on everywhere you turn.
• 40:33There's a challenge.
• 40:34But the good news is that
• 40:36I'm I'm really trying.
• 40:38To be more positive these days and
• 40:40the good news is that there is
• 40:43entire alignment like I've never
• 40:45seen when it comes to trying to
• 40:48fix these processes and bringing
• 40:50the entire force of the university
• 40:52and the medical school and the
• 40:54health system and even our contacts
• 40:56through the CCA and the government,
• 40:58the state government to fix these
• 41:00problems and to leverage where we
• 41:01need to leverage and to not be nice
• 41:03because this is not functional.
• 41:05We are a public.
• 41:06Entity that needs to provide for our
• 41:09community and we will be unable to do that.
• 41:12So we've talked to DPH.
• 41:14We've talked to CCA.
• 41:15We actually had some some conversations
• 41:17with other hospitals in Connecticut.
• 41:19Everybody is feeling the same thing.
• 41:21Just last week we held the national
• 41:23symposium with a whole bunch of
• 41:25health systems across the country.
• 41:27They're all feeling the same
• 41:29thing to some degree.
• 41:30I think we're where maybe above
• 41:32average because that's where we live.
• 41:35But either way,
• 41:35I think we're we're kind of at the
• 41:37busier side for some of our peers.
• 41:40And there's now a coordinated
• 41:44institutional effort.
• 41:46Where a whole lot of people have had
• 41:48their basically their normal day jobs
• 41:50put on hold and they're going into that.
• 41:52They opened up their calling the war rooms.
• 41:54Two different war rooms are getting opened,
• 41:56one looking at the discharge process
• 41:57and one looking at the provision
• 41:59of care in the inpatient setting.
• 42:00They're just getting launched this week.
• 42:02They'll probably probably getting
• 42:03ahead of the messaging a little bit,
• 42:05but I figure I'm here and you might as well.
• 42:09It's going to be.
• 42:10No, there are no more third rails, right?
• 42:12If something is broken,
• 42:13bring it up and let's try to fix it because.
• 42:17That's that's kind of where we are.
• 42:19As far as the near term indicators for COVID,
• 42:22everything looks really good.
• 42:23There are are the CDC has moved
• 42:26Connecticut into a jurisdiction of
• 42:29expected decreasing hospitalizations.
• 42:31We just moved into that this week.
• 42:33Positive ITI rate in the health system in
• 42:35the state is hovering around 2% or so,
• 42:37which is much better than it was even
• 42:39a month ago. Our COVID census went up.
• 42:42It went up from 20 something to 30,
• 42:45something over about a week,
• 42:46but that's manageable.
• 42:48We can absorb that.
• 42:49For now, and I think that's
• 42:53just some normal variation.
• 42:55And that's kind of the state of affairs.
• 42:59I figured it would be easier just
• 43:00to talk to you for a little bit.
• 43:02Then have a whole bunch of slides.
• 43:04But if anybody wants me to jot this
• 43:06down and put a slide deck together,
• 43:08I'm happy to do that.
• 43:09And I can distribute
• 43:10it. Thank you, rob.
• 43:11I think you got the message.
• 43:12I think the key,
• 43:14as you articulated to everybody that
• 43:16you know our health care system
• 43:17and we are an essential service for
• 43:19the state for many of our people.
• 43:21So it's been stretched and you
• 43:23gave some very vivid examples.
• 43:25And so I think.
• 43:26The message, but you know,
• 43:27as the part that I'm gonna say,
• 43:29is the Canary Canary is not dead,
• 43:31we're resuscitating it with sort
• 43:33of this concerted effort and Dr.
• 43:35Fogarty mentioned some of the pieces
• 43:37where the the supreme alignment that
• 43:40I've seen in the last few weeks when
• 43:43things have really just gone into this later,
• 43:46and we have now people on
• 43:47the school on the hospital,
• 43:48the nursing teams and I've rounded twice
• 43:51in the last few days at the war room,
• 43:53and the Capacity Command center
• 43:55Mike and I were.
• 43:56There this afternoon,
• 43:57Michael Holmes and the the
• 44:00good ideas keep coming,
• 44:02and that's what I also want to stress
• 44:04that we need to start thinking about
• 44:06how this is a throughput problem
• 44:08because the patients in the emergency
• 44:10department need our health care.
• 44:11And that means that we have
• 44:13to actually think about how we
• 44:15discharge patients on time,
• 44:17and we still have that as an
• 44:18issue that a lot of patients stay
• 44:20here longer than they should.
• 44:22So there's going to be a lot of
• 44:24talk on all of the units around
• 44:26the length of stay and.
• 44:27We do for discharge.
• 44:28This afternoon we were talking
• 44:30about early mobilization,
• 44:31so you're gonna hear more and
• 44:33more from the teams around.
• 44:35Even one discharge from one unit
• 44:37can make a huge difference if
• 44:38you look at all our pods.
• 44:40So again, yes, it will be hard.
• 44:43But just like Doctor Edelson talked
• 44:45about the ABRAXANE shortage,
• 44:46this is just coming.
• 44:47You know we're in the midst of
• 44:49a pandemic still,
• 44:49and we're seeing the the effects of that.
• 44:52Whether it's in supply chain as
• 44:54we heard about the chemotherapy
• 44:55or now delayed health care.
• 44:57And people were presenting sicker either,
• 45:00but sickler disease or with you know,
• 45:02mental health problems.
• 45:03So again, part of what we are.
• 45:05I think my ask of all of you is
• 45:07to also take care of each other
• 45:09as we are the folks who are taking
• 45:11care of our patients.
• 45:12So I do we ask that you all of the
• 45:14teams look out for each other.
• 45:16This is not an easy answers,
• 45:18but these are what I do have is
• 45:20faith in all of us,
• 45:21in our ingenuity and thinking
• 45:23around how we can solve problems together.
• 45:26I've seen it over the last.
• 45:28Sort of waves of COVID and I have
• 45:30full faith in all of us and our
• 45:32nursing teams and our physicians and our APS.
• 45:35So again,
• 45:36some of this will mean changes or
• 45:38as Rob mentioned,
• 45:40the third rails that we have to think smart.
• 45:43We can't just work our way,
• 45:44it's harder out of this.
• 45:45So again, stay tuned.
• 45:47The good news is the COVID
• 45:48numbers that are real low and
• 45:50that is really good to see.
• 45:52And that I think we should celebrate.
• 45:55I want to take a few minutes
• 45:56to answer some questions so.
• 45:58A couple in the chat gene for you,
• 46:01one was from Paula.
• 46:02Why do you think the clinical uptake
• 46:05of employing a geriatric assessment
• 46:07has been lacking in practice?
• 46:13Just had a unmute I I think as I'm
• 46:18cologist we've we've been taught that.
• 46:22Uhm, palliative chemotherapy improves
• 46:25patients quality and quantity of time,
• 46:29and I think over the past decade we've
• 46:32been taught that molecular profiling is the
• 46:35future and we need to target the tumor.
• 46:39And this is a different way of thinking,
• 46:41because there are are a lot of ways
• 46:44to provide palliation that don't
• 46:47involve chemotherapy administration,
• 46:50and we don't just have to tailor
• 46:52our therapy to the tumor,
• 46:54we need to tailor it to the patient.
• 46:57So I, I think it's the world changes
• 46:59the way we think about how we treat
• 47:02our patients needs to change as well.
• 47:05Indeed, remind me the tool is easily
• 47:07accessible. How do we access the tool?
• 47:10Right now it's in the tools
• 47:13section of Epic and it if
• 47:16you're going to up to date,
• 47:18which we do on a regular basis,
• 47:21it's in that column.
• 47:24Perfect and and so on,
• 47:26St to to reach out to me and I I can
• 47:28help them walk through it. Perfect
• 47:30I think just sometimes a lot of
• 47:32it is not just making it your
• 47:34workflow and I think the more we
• 47:35disseminated make it 'cause it seemed.
• 47:37I saw that it was less than five
• 47:39minutes and that's the kind of easily
• 47:41accessible tool we want Kevin this
• 47:43and this one maybe for you here.
• 47:46Dr Krueger, Harriet asked,
• 47:47is there any thought to expanding
• 47:49ECC capacity ASAP to keep some of
• 47:51her on patients out of the hospital?
• 47:53We need nurses,
• 47:54physicians and extra beds in the ECC.
• 47:56And run it around.
• 47:57The clock will also help the Ed.
• 48:00The short answer is yes.
• 48:02I think we are all convinced that
• 48:04that's the right idea and our next
• 48:08move and we are. I will share.
• 48:10We are in the process of working
• 48:12with health system leadership
• 48:14to both identify alternative
• 48:16spaces within smilow and do
• 48:18the necessary moves to
• 48:21free those spaces for expansion
• 48:24of clinical programming.
• 48:26And I think that that will open the door
• 48:28and then there is the staffing issue.
• 48:31You know, I think one of the
• 48:32things that was helpful about
• 48:35Rob's presentation is he.
• 48:37Very poignantly demonstrated.
• 48:39Not only do
• 48:40we have issues with space and
• 48:44acuity in clinical volume,
• 48:46but we as a health system as
• 48:48is every other health
• 48:49system across the country,
• 48:50are struggling with staffing shortages.
• 48:53So once we develop the clinical space,
• 48:58we will also be challenged, some with
• 49:01getting staffing to expand to provide
• 49:04those services. And I'll say that.
• 49:07These are things that we're working on
• 49:09in in parallel,
• 49:10not in series, but
• 49:12you know, that's the work
• 49:13we have to do to move forward,
• 49:15and I appreciate the question.
• 49:18Thanks Kevin, and I think Rob I.
• 49:20To me it seems like if it
• 49:22keeps patients out of the E D.
• 49:23This may be an opportunity for us to sort
• 49:25of say as part of this new thinking.
• 49:27You know solutions that make an impact.
• 49:29This one may be and take it to the top.
• 49:32So this is the kind of
• 49:33thinking we want you know.
• 49:35Again the ideas that may have an impact
• 49:37and assessing them if they work,
• 49:39use them if not so again different way
• 49:41for us to think than in the past but
• 49:44as Rob has mentioned things have been
• 49:45at a crisis where we have hundreds of
• 49:48patients sitting in the Indian Head as a.
• 49:51Huge impact on all of our services.
• 49:55Karen, I guess a question for you.
• 49:57While people feel more
• 49:58comfortable asking questions,
• 49:59do you have a sense when the shortage
• 50:02will like nap or is that unclear for you?
• 50:05We don't know yet.
• 50:07And I wish I did, yeah.
• 50:11One thing that when we talk about
• 50:13some of the inpatient issues
• 50:14I do think we have a culture,
• 50:16especially in oncology of doing
• 50:19everything a patient might need in
• 50:22the course of their hospitalization,
• 50:25and I'm beginning to do some work
• 50:27on the system level with this.
• 50:29But one thing to think about is
• 50:32before ordering or telling your
• 50:33house staff to order a test,
• 50:36think about will this test help
• 50:38get the patient home sooner.
• 50:40Will this konsult help get
• 50:42the patient home sooner?
• 50:43And if the answer is no,
• 50:45really think about doing those
• 50:47things in the outpatient setting
• 50:49and I know there are issues with
• 50:51getting those things scheduled,
• 50:52but that kind of change in
• 50:55philosophy will shorten our length
• 50:57of stay and will help to some
• 50:59degree with our capacity issues.
• 51:02I think that's a really good point.
• 51:04I you know, as Rob mentioned,
• 51:06we had this whole meeting
• 51:07across the entire health system,
• 51:09but the chairs, the leaders,
• 51:10the hospital leaders around thinking,
• 51:13and one of the things that Mike
• 51:14Holmes brought up is that well,
• 51:15consoles get asked for and people are waiting
• 51:17for a konsult before they get discharged.
• 51:20I guess I wonder,
• 51:21do you really need that console
• 51:22to wait for your discharge,
• 51:23or is that an outpatient visit?
• 51:25I think these are the little things that
• 51:28every service can sort of figure out.
• 51:30Are we putting the orders the night before?
• 51:32Are we waiting to sort of?
• 51:33Figure out someone is leaving,
• 51:35you know, I think a lot of us know
• 51:37when patients are coming for discharge,
• 51:40and the more we can plan and also
• 51:43encourage our patients to be around.
• 51:45Sort of thinking around.
• 51:46You know it's this is this is a busy place.
• 51:49This is not a place to recover.
• 51:51You know this isn't high acuity place
• 51:53and we need it for the folks who are
• 51:55the sickest so I think this this will
• 51:57require all of us to sort of work
• 51:59together and think of the little things.
• 52:01It's not just one simple solution.
• 52:04But I I'm glad to hear Karen you pointing it,
• 52:06and I suspect Rob has other things
• 52:08he can ask the teams that we hear
• 52:10about you know rounding early,
• 52:12making sure those orders are in RV
• 52:14and they're getting all the sniff.
• 52:16Are there fewer people who need to
• 52:18go to sniff and one of the things
• 52:20that happened in the war room is,
• 52:21if we mobilize patients early
• 52:23and start getting them surgeons.
• 52:24I've always known that, right?
• 52:26You get your patient walking the
• 52:27next day that maybe they don't need
• 52:29to go to a sniff if they have been
• 52:31walking all the time, so again.
• 52:33Again, all of these are little things.
• 52:35None of this is like a home run,
• 52:37but rob any other thoughts that we can
• 52:39encourage our various teams to think about,
• 52:42and then Dr Billingslea Kim Slusser.
• 52:45Karen Adelson,
• 52:45another skin talked to the police teams.
• 52:48So if there are something,
• 52:49this is our opportunity
• 52:50to sort of bring those up
• 52:53yet. So one of the one of the
• 52:55things I'll point out is the.
• 52:57And I realize I'm a hospitalist.
• 52:58I've had 1/2 day of outpatient in
• 53:00the past ten years, so I'm going to.
• 53:03I'm not going to stay
• 53:04within my swimlane here,
• 53:05but in the inpatient setting.
• 53:09In early September.
• 53:11The MRI cue was something that
• 53:15had never happened before,
• 53:17so the when we come in in the morning,
• 53:19the number of adults.
• 53:20Adult MRI orders on inpatients is usually
• 53:23around 20 or 30 for the whole house.
• 53:26And we came in and it was 86.
• 53:30I don't know.
• 53:31You know they book them in 15 minute
• 53:33increments and this is where I'm
• 53:35starting to get out of my my swimlane,
• 53:38but that's almost impossible to
• 53:39accomplish with the number of
• 53:41magnets that we have and that
• 53:43is with wiping everything else.
• 53:45So all of that stuff that is is
• 53:47just kind of easy to get 'cause the
• 53:49patient sitting there in front of you.
• 53:51It's going to become less easy
• 53:53to get a lot of those things so
• 53:56I would keep an eye on that and
• 53:59turn around times and.
• 54:01The granular thing is if you do
• 54:03have a patient going to a sniff.
• 54:05Uh,
• 54:05if if you're the if you're the
• 54:07clinical team walking in the room,
• 54:09you have a lot of authority with
• 54:11with how that goes and work with
• 54:14your case manager and and try to
• 54:17engage in that process earlier.
• 54:19You know,
• 54:19go to transitions of care rounds and
• 54:22answer those questions about medical
• 54:24readiness and what's discharged
• 54:25dependent if you click that.
• 54:27If someone clicks that discharge
• 54:29dependent button on an order.
• 54:31It will move up in the queue
• 54:33and it will happen,
• 54:34but someone else will move down,
• 54:36so it's a tool, but it's a 0 sum game
• 54:38and if you need to do it to get someone out,
• 54:40push that button.
• 54:42It'll get done.
• 54:43And the last thing I'd say is.
• 54:46There's a, there's a.
• 54:47There's a misperception in the community that
• 54:50things are back to normal in the hospital.
• 54:52We all know they're not.
• 54:55We live it every day.
• 54:58And that's dangerous because you don't want
• 55:00people to not seek care when they need it.
• 55:02But what I've what I would say,
• 55:04and this is me, rob,
• 55:05this is not, you know,
• 55:06anything other than that.
• 55:07I don't speak for anyone else.
• 55:08I've been very open and honest when
• 55:10people ask me in my private life,
• 55:12how is it at the hospital?
• 55:13And I take that opportunity to educate them.
• 55:16And last time I was on service.
• 55:17I did that with my patience
• 55:18and I think it it helped.
• 55:20It helped around the discharge
• 55:22discussion and the sniff placements.
• 55:25Uh, and it lowers the temperature
• 55:26in the room for everybody.
• 55:28In your case,
• 55:29managers will feel heard.
• 55:30So think about those studies if
• 55:31you if you don't actually need it,
• 55:34but Doctor Who just said
• 55:35please don't do it
• 55:36if you need to pull the trigger on that
• 55:38discharge dependent button, do it.
• 55:41And work early with your case managers.
• 55:44There's nothing they love more than having
• 55:46an attending walk in the room and say hi,
• 55:47I'm here for transitions of care rounds.
• 55:49You may have to brush up on your
• 55:52syncope stabilization because they
• 55:53just might fall into their chair.
• 55:55Uhm, but that is a huge huge win for them.
• 55:58They can just get all their questions
• 56:00answered very quickly and nobody
• 56:01knows it better than the the the
• 56:03you know the service attending.
• 56:06I think some really good thoughts
• 56:08and then I think another plug for
• 56:09the ECC and the care centers Kevin.
• 56:11So I think folks like the idea
• 56:13of extending in using the ECS for
• 56:16keeping our patients out of the
• 56:18Kelly Olino asked the same question,
• 56:20but putting it in our network.
• 56:22So again, I think you know I suspect
• 56:24I don't know if it's possible,
• 56:26but certainly sees some a lot of agreement.
• 56:28OK Dr Helene, I think the announcements
• 56:31for the pilot hopefully will be out soon
• 56:33so folks can get some of those grants.
• 56:36Thank you.
• 56:37Or presenting that really
• 56:39great biospecimen collection.
• 56:41Thank you to all our panelists.
• 56:42It's 559 and I want to wish everyone
• 56:44a good evening and and please keep the
• 56:47good ideas coming with your teams and
• 56:49with Doctor Billingsley and Karen Adelson.
• 56:51And with your floor leaders so we
• 56:53can think about the little micro wins
• 56:56we can to make sure that discharges
• 56:58happen on time and so we can continue
• 57:00to take care of all of our patients.
• 57:02Thank you everybody.
• 57:03Have a good evening.
• 57:05Also, make sure to attend the
• 57:06the the Cancer Center.
• 57:08Director talks we had one
• 57:09yesterday and I know Anna is making
• 57:11sure it gets in your site.
• 57:13So keep a lookout for next week.
• 57:16OK take care bye bye.