Smilow and Yale Cancer Center Town Hall | October 2021

October 08, 2021

Information

Hosted by Dr. Nita Ahuja | Presentations by: Drs. Kevin Billingsley, Stephanie Halene, Jane Kanowitz, Kerin Adelson, and Robert Fogerty

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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.