Smilow Cancer Hospital Town Hall | June 28, 2023

Transcript

• 00:00Agenda Today
• 00:07we'll be starting off with some
• 00:10clinical updates that Kim and I,
• 00:12as always, are pleased to share.
• 00:15Our Director, Doctor Weiner will
• 00:18be briefing our community about the
• 00:20very concerted efforts that our
• 00:22senior leaders both in the School
• 00:25of Medicine and in the Yale New
• 00:27Haven Health System are working on.
• 00:31To align the efforts of our partner
• 00:35organizations for improved patient care,
• 00:39service and financial performance,
• 00:42we have Michelle Kelvi,
• 00:44Albert and Doctor Scott Huntington who
• 00:46will be updating us on our ASCO Medical Home.
• 00:49We have some very exciting developments and
• 00:53our inpatient services that will involve
• 00:57the formation of a medical oncology.
• 00:59Consult team for inpatients, Dr.
• 01:03Liz Presage will be talking about that with
• 01:09additional input from Doctor Ann Chang.
• 01:12And as everyone in our community knows,
• 01:14we have been plagued with
• 01:17challenging oncology drugs shortages.
• 01:19This is not unique to our organization,
• 01:22but we have an incredible pharmacy
• 01:25team who's working on that and Eric
• 01:27KB has joined us this evening.
• 01:30To give us an update,
• 01:35Kim, I think I'll kick it
• 01:37over to you for the masks.
• 01:39All right. Thanks, Kevin.
• 01:42So welcome everyone.
• 01:43And this is a timely town hall,
• 01:46so we can just remind everyone
• 01:49of the updated masking policy.
• 01:51So as we know, a few months ago,
• 01:53we loosened up a lot of our restrictions,
• 01:56but beginning Saturday,
• 01:57the Saturday, July 1st.
• 01:59We are removing all masking
• 02:02requirements except for obviously
• 02:05isolation precautions when indicated
• 02:08for for all patient care and.
• 02:13And so that will be optional for patients,
• 02:15visitors and staff at Yale Medicine
• 02:17and Yale New Haven Health System.
• 02:19I do want to let our community
• 02:21know though that there are some
• 02:24ongoing conversations with our
• 02:25cellular therapy team and infection
• 02:27control to understand if there's
• 02:29anything different we should be
• 02:32doing and those environments.
• 02:34But but overall the the staff will
• 02:36mask when indicated and inpatient for
• 02:39isolation in the outpatient setting staff.
• 02:43A mask in rooms of patients
• 02:45with respiratory symptoms.
• 02:49We also wanted to take the time to
• 02:51congratulate our SMILO Cancer team
• 02:54at Saint Francis Medical Center for
• 02:57achieving their ASCO Kobe recertification.
• 03:00This is a wonderful accomplishment
• 03:01and as many of you know,
• 03:03the Kobe standards really focus on the safe.
• 03:09Safe practices and high quality care
• 03:11that we have around chemotherapy,
• 03:14ordering, prescribing,
• 03:16dispensing and administration.
• 03:18So a wonderful accomplishment and we
• 03:20want to congratulate our teams and
• 03:22thank you for all their hard work.
• 03:26We also like
• 03:26to take this time to.
• 03:28Announced new leadership positions and
• 03:30so we want to welcome Megan Berry,
• 03:34who many of you may know
• 03:35in the Smile community.
• 03:36She will be starting in mid-july
• 03:39as our Assistant Patient Services
• 03:41Manager for the Centers of Derby,
• 03:44Torrington and Waterbury for those sites.
• 03:47She started her oncology nursing
• 03:49career at Bridgeport Hospital on
• 03:51the oncology unit and she has been,
• 03:54she was an infusion nurse since
• 03:56Milo Trumbull and most recently
• 03:58she was the APSM for the medical
• 04:01oncology unit at Bridgeport Hospital.
• 04:02So she's returning to the ambulatory
• 04:05environment as an APSM and we're excited
• 04:08about her joining those locations.
• 04:11I'm going to turn it over to Kevin
• 04:12for a couple other announcements.
• 04:17So one of the things that is truly exciting
• 04:20in my role is to be able to announce
• 04:23the launch of new clinical programs.
• 04:26As many of you know Doctor A Hood
• 04:28or UDI Mendel has been on our
• 04:31neurosurgical faculty for over a year.
• 04:34We had the good fortune to recruit Dr.
• 04:37Mendel from Ohio State University of
• 04:40the James Cancer Institute where he.
• 04:43Developed a world class spine oncology
• 04:48program and he has launched that
• 04:50program now and we're taking that under
• 04:53Udi's leadership to the next level of
• 04:56multidisciplinary care and integration.
• 04:58And the Spylo Neuro Spine Tumor
• 05:01Board will be starting in July.
• 05:04Like all great clinical and
• 05:06research efforts in oncology,
• 05:08this is very much a team effort.
• 05:11Doctor Mendel's partner with this and in
• 05:14this effort primary partners Doctor on Yee,
• 05:19a radiation oncologist.
• 05:22There is also engagement from oncology,
• 05:26pain management,
• 05:27neuro radiology and of course
• 05:30medical oncology.
• 05:31And I think one of the things that
• 05:33is really exciting about this is that
• 05:35patients with a variety of tumors.
• 05:39Are vulnerable to metastatic
• 05:42disease in the spine,
• 05:45and this can be enormously
• 05:47debilitating in terms of pain,
• 05:49mobility and difficulties
• 05:52tolerating additional therapies.
• 05:54So this combined multidisciplinary approach.
• 05:58That is designed not only
• 05:59to keep patients functional,
• 06:00mobile and out of the hospital,
• 06:03but to keep them comfortable and pain free
• 06:04even in the setting of metastatic disease.
• 06:07So really exciting program
• 06:08and great to see this moving
• 06:10forward And I'd like to thank
• 06:13Doctor Mendel and colleagues for all
• 06:16of their hard work. Next slide please.
• 06:22Another thing that I'm really excited
• 06:24about is announcing the appointment of
• 06:27Doctor Scott Huntington is our Interim
• 06:29Chief Quality Officer for Spylo in
• 06:32the Cancer Hospital Cancer Center.
• 06:37Dr. Huntington probably needs very
• 06:39little introduction to this audience.
• 06:41He is an esteemed clinician.
• 06:43He's a leader in our lymphoma program.
• 06:46He wears a number of administrative
• 06:48hats already, including firm
• 06:49chief leadership on NP7.
• 06:52From chief leadership on NP11,
• 06:55Scott's a graduate of Mount Sinai.
• 06:57A resident at Vanderbilt did his fellowship
• 07:01at the University of Pennsylvania,
• 07:04where he also picked up a
• 07:06master's degree in health policy.
• 07:08So he is enormously qualified to be
• 07:11a leader and the quality space and
• 07:14we're really delighted that he's.
• 07:17Stepped into this role,
• 07:19as many of you know,
• 07:21Doctor Adelson did great work in this space.
• 07:25Happy to see her move on to other
• 07:28great things and just delighted
• 07:29that we have in our midst a really
• 07:32great group of leaders and happy
• 07:34to see Scott move into this role.
• 07:36Thank you, Scott.
• 07:38And you'll be featured soon
• 07:41on our program this evening.
• 07:43So I think Doctor Weiner. I think it's.
• 07:47I think you're next on that on the agenda.
• 07:51It's a deal. Hi everyone.
• 07:54So before I start I have to say that my
• 07:58colleague who used to be the chief of.
• 08:01Hematology and oncology at the
• 08:03University of Pennsylvania, and who
• 08:05Scott knew well when he was a fellowship,
• 08:08was in the fellowship there.
• 08:10Sent me a selfie of the two of
• 08:12them at ASCO and then had to add.
• 08:15Don't worry, I'm not recruiting him
• 08:18because she knew that if I thought
• 08:22she were that I would become.
• 08:25Just a little frustrated to say the least.
• 08:28But Scott, we're we're thrilled to
• 08:30have you in this role and everything
• 08:33Kevin said is true and more.
• 08:35So I'm going to take about 3 minutes
• 08:39and and just talk for a second or two
• 08:42about alignment between the healthcare
• 08:46system and the School of Medicine.
• 08:49I think it's fair to say that it
• 08:52with most of the history of the of.
• 08:55The healthcare system or what was
• 08:57originally the hospital, Yale,
• 08:59New Haven Hospital and the School
• 09:02of Medicine that the two didn't
• 09:05always work so well together.
• 09:07There has never been a joint strategic
• 09:10plan and I think for years and years
• 09:14you could accuse the School of Medicine
• 09:17of not being very helpful in terms of
• 09:20getting patients seen in the hospital,
• 09:22the faculty when I was a.
• 09:25Medical student and then a resident.
• 09:28Even the clinical faculty thought that
• 09:32the taking care of patients was a very,
• 09:34very, very parttime job.
• 09:37And at the same time,
• 09:38I think that the hospital didn't
• 09:41really recognize how important
• 09:43it was to be associated with a
• 09:46worldclass School of Medicine.
• 09:48All of that has changed now, I will say.
• 09:52In fairness,
• 09:53it changed in the Cancer Center in
• 09:57Smilo over the course of the past
• 09:59decade and long before I came here
• 10:02as a result of efforts that Tom
• 10:05Lynch and colleagues had made and
• 10:08then Laurie and Charlie had made.
• 10:11The two were, that is,
• 10:13the Cancer Center and Smilo
• 10:15were much more closely aligned.
• 10:18But what has changed on a system wide level?
• 10:22Is that Nancy Brown,
• 10:23the Dean of the School of Medicine,
• 10:26and Chris O'Connor,
• 10:27the CEO of the healthcare system,
• 10:29have really come together and
• 10:31decided that if we're going to
• 10:34be a great healthcare system that
• 10:36we have to be totally aligned.
• 10:39And there have been a series of meetings
• 10:43over the course of the last year,
• 10:45Lots and lots of discussions,
• 10:48a number of retreats.
• 10:50And it all just keeps becoming
• 10:53more and more real.
• 10:55And I think that what you will
• 10:57continue to see over the next year
• 10:59or two is greater and greater
• 11:01alignment between the two,
• 11:03both in terms of finances and
• 11:06in terms of strategy.
• 11:08And if we're going to be a
• 11:11great healthcare system,
• 11:12we really have to do this totally
• 11:15handinhand now, I'm pleased to say.
• 11:18That whenever Lori and I are in
• 11:20these meetings and retreats,
• 11:22everyone is always pointing to
• 11:24the Cancer Center is the
• 11:26example of how to do it.
• 11:28Now whether or not we really are
• 11:30the very best, I don't know.
• 11:33But we're happy to take credit for being
• 11:35far along this path and you can be sure
• 11:38that a lot of the work that's going
• 11:41to be done over the course of the next.
• 11:44Next couple of years will be piloted
• 11:47first in the Cancer Center and then
• 11:50will slowly trickle out to the rest
• 11:54of the the the two institutions.
• 11:56So you'll hear more and more about this.
• 11:59I'm going to say one other thing which
• 12:01is you may some of you may have also
• 12:03heard a term called funds flow and this
• 12:06manages to get some people very anxious.
• 12:09It doesn't make me terribly anxious.
• 12:12And it simply refers to a somewhat
• 12:16different financial relationship in
• 12:18the way that physicians and maybe
• 12:22ultimately other providers are funded
• 12:25by the healthcare system and and funds
• 12:28are transferred to to Yale Medicine.
• 12:31And for most of you,
• 12:33for virtually all of you,
• 12:35this should be something that
• 12:36just doesn't really affect you.
• 12:38It does affect it.
• 12:40It does affect the chairs to some
• 12:44degree because the whole all the
• 12:48decisions around hiring and productivity
• 12:51are going to be affected by this.
• 12:54But I don't think in the Cancer Center
• 12:56it's going to make a big difference.
• 12:58And if anything,
• 12:59I think it's just going to push us
• 13:01all to do our job a little bit better.
• 13:03So I'm happy to answer questions
• 13:05from people one-on-one.
• 13:06You know,
• 13:07anytime in the future you can call me,
• 13:09you can e-mail me, you can text me,
• 13:10you can do anything you want.
• 13:12But I wouldn't get remotely bent
• 13:15out of shape about this and I think
• 13:18I would just consider it part of
• 13:20the great alignment.
• 13:21And so that's really all I had.
• 13:24Laurie.
• 13:24I don't know if you want to
• 13:26make any additional comments.
• 13:28I was just trying to do this very briefly.
• 13:30No, I think it's great.
• 13:31You said everything that I think is
• 13:33important to be said at this point.
• 13:34I think that the only thing I add is
• 13:37that we will engage folks who are
• 13:41out there in the world of the Cancer
• 13:44Center and Smilo, this will be.
• 13:46A team sport like no other team sport.
• 13:50And so you know, we may not have
• 13:53the game plan completely mapped out,
• 13:56but I think we have a very strong strategy
• 14:00and vision for what that needs to look like.
• 14:02There are a lot of things that we are already
• 14:04beginning to execute on and I think that.
• 14:07We will learn as we go.
• 14:09We don't want to necessarily be
• 14:10completely prescribed because we
• 14:12believe that engagement is going
• 14:14to help drive a lot of what that
• 14:16ultimate road map looks like.
• 14:18And you know I think it's wonderful that
• 14:22cancer is being given the opportunity to
• 14:25to sort of get this out of the gate early.
• 14:30There are other service lines that will be.
• 14:33Right behind us that are high priority.
• 14:35So you know we want to make sure that
• 14:39we're thoughtful on how we do this so
• 14:41that you know it can help the rest
• 14:43of the the system in the school as well.
• 14:46So it's very exciting
• 14:49and you know we look
• 14:50forward to engaging everybody
• 14:52in this work. You
• 14:54all may or may not know this,
• 14:55but cancer is actually one of the top.
• 15:006 priorities of the university at
• 15:03large from a research perspective,
• 15:05I mean, the the university is
• 15:07obviously supportive of clinical care.
• 15:10But in in in the research world,
• 15:15cancer was not originally in the top five.
• 15:19They dealt with that not by removing one
• 15:21of the others that were in the top five,
• 15:23but by making it the top six. So.
• 15:26So we're there front and center.
• 15:29All right, Kevin,
• 15:30we'll turn it over to you and Kim,
• 15:37you're on mute.
• 15:40I think we may have asked
• 15:41go medical home next.
• 15:44We do great. I can share slides. Scott,
• 15:52as you're pulling it up, this is,
• 15:55you know basically an update from
• 15:58Michelle and her great team and
• 16:00all the work that's been done and.
• 16:02The two pilot sites,
• 16:03you know their frontline staff,
• 16:05their clinicians really has
• 16:08supported this work and so we
• 16:10wanted to thank all of you for that.
• 16:12The ASCO Patient Center in cancer care
• 16:15is a future kind of quality initiative.
• 16:19So kind of the next generation of of
• 16:22Kobe and Yale was one of 12 centers
• 16:26that really reached out to ASKO and
• 16:29worked on developing this pilot in 2021.
• 16:31And in doing so,
• 16:33we selected two clinic sites,
• 16:36so Smile of Guilford as well as the
• 16:38Smile of Breast Center and really
• 16:41got this PC-4 or medical home up
• 16:44and running at those two sites.
• 16:45And we were thrilled to see that
• 16:48we have those two sites accredited
• 16:50early this spring.
• 16:52And so really the next phase is to identify,
• 16:56you know,
• 16:56what we've learned from this
• 16:58program and make it better.
• 16:59And then over time,
• 17:00I'll roll it out across the enterprise,
• 17:02move
• 17:02on to the next slide.
• 17:06So why did Yale, sorry, and that's okay.
• 17:11So why did Yale participate
• 17:12in this in this pilot,
• 17:13it really allowed us to have a voice early
• 17:16during the development of this program.
• 17:18It allows us to demonstrate
• 17:20successful review of practices,
• 17:22making sure that we have high quality
• 17:24of cancer care delivery across the
• 17:26continuum and it really confirms value
• 17:28not only to patients but also to payers.
• 17:30The idea of this medical home is that
• 17:33unlike what's going on right now with
• 17:36value paste kind of payments where
• 17:38there's lots of different models
• 17:40more than say 30 or 40 nationally,
• 17:42the idea is that if we adopted this,
• 17:44there'd be.
• 17:44Kind of alignment across payment models.
• 17:47And so this is really a pilot
• 17:49to move that vision forward.
• 17:51And the goal over time is to replace
• 17:54the quote be which is relatively narrow.
• 17:57As Ken mentioned that it's mostly
• 17:59focused on outpatient administration
• 18:00of cancer therapeutics,
• 18:01whereas this program as you'll see
• 18:04in the coming slides really covers
• 18:06the entire cancer care delivery of
• 18:09of our therapeutics and management.
• 18:12Go to the next slide.
• 18:14So the purpose of this program
• 18:16really was to improve access to care,
• 18:18increase care coordination and enhance
• 18:21quality with attention at rising
• 18:23cost and and increasing efficiencies.
• 18:29The goals of the pilots that we had
• 18:31at our two sites and and really at
• 18:33the 12 sites across the country or
• 18:3512 systems was really to develop
• 18:37quality standards that build on
• 18:39prior works of a College of care
• 18:41model among other pavement models.
• 18:43And to really provide this framework
• 18:46so that we could identify key kind
• 18:49of quality measures and use those
• 18:52for future both quality improvements
• 18:54but also payment models.
• 18:56And Michelle's going to really focus
• 18:58on the seven kind of pillars of this
• 19:01program and the challenges and successes
• 19:03that we had at these two sites.
• 19:06Thanks, Scott. So as we look at
• 19:09what were the standards that we
• 19:12needed to implement with our teams,
• 19:15there were 7 standards in the
• 19:18ASCO Medical Home, what we,
• 19:20as we looked at how we were going
• 19:22to implement this across our sites.
• 19:26We decided to only do six of the
• 19:30standards and leave the chemotherapy,
• 19:32the Kobe standard,
• 19:34separate for this implementation.
• 19:36We really felt for two reasons
• 19:38that it was a lot for the team
• 19:40to take on and we were able to
• 19:42kind of stagger the certification
• 19:44because we were in that pilot of 1
• 19:47of 12 that we were still given the
• 19:50opportunity to keep this separate so.
• 19:53As we did that,
• 19:54it gave us a little bit of time to be
• 19:57able to kind of phase in some of the
• 19:59other standards with the pilot groups.
• 20:02So I'm going to in the next slide
• 20:04really go into what each of these
• 20:07standards are and kind of what we
• 20:10needed to do for each of those.
• 20:12So what we had to do and you'll
• 20:15see in in subsequent slides some
• 20:18snapshots of a little bit of our data,
• 20:20the first standard was around
• 20:22patient engagement.
• 20:23And so really this centered on how
• 20:25do we get information out to you know
• 20:28what is a medical home in our welcome
• 20:32packages to patients on our websites,
• 20:34any discussions that we're having.
• 20:37So really so patients understood.
• 20:40That we were,
• 20:41we were establishing a quality
• 20:43framework and also coordinated care.
• 20:45And within that we had to really
• 20:48look at also financial counseling,
• 20:51which was actually a bit of a
• 20:53challenge for us as far as all the
• 20:55requirements that Asko wanted us to
• 20:58meet in that that we did proactive
• 21:00financial counseling for patients.
• 21:02And so this was something that we
• 21:05worked really closely with the.
• 21:07Young New Haven patient financial
• 21:10counseling departments on how we could,
• 21:13how do we do things proactive and and
• 21:15we've got more work to do on this,
• 21:17but we really kind of identified some
• 21:20things that were really helpful for us,
• 21:22the access to care.
• 21:24So this is where we looked at patient
• 21:27tracking across the continuum from Ed visits,
• 21:31hospital admissions, readmissions.
• 21:33Also symptom triage and how patients
• 21:37accessed when they have issues,
• 21:39how do they access their care providers,
• 21:43Canceled appointments,
• 21:44missed appointments?
• 21:44Do we have processes for that evidence
• 21:47based care And this really was something
• 21:50that we really already had in place
• 21:53looking at our treatment pathways.
• 21:55All of our clinical research,
• 21:58this one I would say out
• 21:59of all the pilot sites,
• 22:01we were probably one of the
• 22:03leaders in this standard and and
• 22:05everything that we already had
• 22:07in place and actually many of the
• 22:09pilot groups kind of came to us to
• 22:12understand what we were doing.
• 22:13The team based care really it's
• 22:16talking about where are we at at
• 22:19the hub being the medical home,
• 22:20how do our teams work together,
• 22:22what is the communication look like,
• 22:24the medical oncology is directing that care,
• 22:27looking at all of our supportive services
• 22:29and and how do patients access that And
• 22:33then looking again at HealthEquity and
• 22:35are we looking at this is where we really.
• 22:39Came together with our colleagues
• 22:41at the Cancer Center of different
• 22:43HealthEquity projects that were that we
• 22:46are collaborating on quality improvement.
• 22:48So any of our quality improvement
• 22:50work that we're currently doing our
• 22:53performance improvement project,
• 22:54our plan through SMILO.
• 22:56And our patient experience survey
• 22:58and and one of the pieces of the
• 23:02patient experience survey was can we
• 23:04start providing A physician dashboard
• 23:08for their results.
• 23:10And so that was something that we
• 23:12implemented during this pilot and
• 23:15palliative care and end of life.
• 23:17So really looking at advanced care
• 23:20planning and patients goals at the
• 23:22end of life and developing clear
• 23:24processes for that.
• 23:28So as I get into the really kind of nuts and
• 23:31bolts of implementation and how we did that,
• 23:34I'd be remiss if I didn't mention
• 23:38really our key team that put countless
• 23:41hours as you're going to see.
• 23:43And in another slide Vicki Taiwo,
• 23:47Donna lapo Kara.
• 23:49Carol Esquivel and Chloe Shavlin really
• 23:53was the core team that did all the
• 23:57education and training and communication
• 24:00throughout this with our two pilot sites.
• 24:02Originally we had him,
• 24:04we were ambitious and we thought we would
• 24:07be able to implement the this program
• 24:10with all of our ambulatory settings.
• 24:12And really when we looked at that,
• 24:15it, it didn't make sense.
• 24:16We needed to pare it down.
• 24:18There was a lot of changes
• 24:20not only from a workflow,
• 24:21from a technology,
• 24:24just how we communicate differently,
• 24:27how we collect data.
• 24:28And so it made more sense to just pick
• 24:32two sites and as as Scott mentioned,
• 24:35that was our Guilford care
• 24:37center and our breast.
• 24:39Center and York Street and I
• 24:42really think that has allowed us
• 24:44to really look at how we can do
• 24:48this and expand this across our
• 24:52enterprise and by looking at our,
• 24:54you know,
• 24:55best practices and lessons learned.
• 24:59And so this is just kind of a snapshot
• 25:03what we went live as of January 30th with
• 25:07our of this year with our two pilot sites.
• 25:10So only five months in, you know this
• 25:13is just kind of giving you a sense of.
• 25:16Why It made sense for us to do 2 pilot sites
• 25:19then try to do this across the enterprise.
• 25:22There were countless hours of of
• 25:24meetings with our two teams of
• 25:27making sure that our nursing staff,
• 25:29our administrative staff,
• 25:30our physicians knew what we were doing,
• 25:33how we were doing it, training,
• 25:35rounding, making sure that you know,
• 25:38we were at the sites,
• 25:40not just doing this virtual and
• 25:43then really look.
• 25:44Looking at our infrastructure
• 25:46from a reporting and epic making
• 25:49sure we were testing and during
• 25:52this implementation and so all of
• 25:55this really was very important And
• 25:58during this we developed office,
• 26:00we had office hours, so our team.
• 26:03Every other week on a Wednesday or Thursday,
• 26:06we're there for 30 minutes.
• 26:08So any of the two teams could call and say,
• 26:11you know,
• 26:12we're struggling with this standard or
• 26:13we were having some problems with our
• 26:16technology or this isn't working correctly.
• 26:18And Epic and we could really in
• 26:21real time address their concerns
• 26:23and we did tips and tricks.
• 26:25So we would send things out that
• 26:28would apply to the nursing team or
• 26:30to the physicians or the front desk.
• 26:33Things for them to remember when we
• 26:36were doing our social determinants
• 26:38of health screening,
• 26:39how the workflow with with passing
• 26:42out our iPads and that's how we
• 26:44were doing the screening.
• 26:46So there was a lot we tried to make
• 26:49sure we were communicating and we
• 26:52were available as people needed us.
• 26:55So just to give you a little sense,
• 26:57I we took two of our measures.
• 27:00Which was our SDOH screening
• 27:02and our symptom triage.
• 27:04And so you know we're continuing I
• 27:07think to make some great strides
• 27:10from remember these were the SDOH,
• 27:13we were not doing the screening by iPad.
• 27:16So we were kind of start,
• 27:17we had done a pilot in.
• 27:21In 2019, but then with COVID,
• 27:24we had stopped that.
• 27:25So this is currently where
• 27:27we are for compliance.
• 27:29You know,
• 27:30there's a lot that goes into
• 27:33the workflow for the SGOH.
• 27:36So I'm really happy to see where
• 27:38we are and where we'll continue
• 27:40to be and with our symptom triage.
• 27:42This was a different way for us to be
• 27:45not just documenting when a patient
• 27:48calls on the phone for a medical form.
• 27:52This was are we documenting if
• 27:55someone has a fever or any or
• 27:58nausea that those things rise to,
• 28:01those symptoms rise to the top
• 28:02of the list so that somebody's
• 28:04responding in a timely fashion.
• 28:08And so part of the team,
• 28:11Donna and Chloe really wanted to talk
• 28:13about how do we continue sustainability.
• 28:16So we're five months in,
• 28:17we've got the summer coming.
• 28:19You know how are we going to keep this going.
• 28:21So they developed a summer incentive
• 28:24program and these were three
• 28:27of the measures that we were,
• 28:29we were hoping to track and it really
• 28:33was there's a baseball theme in this
• 28:36and so messages are going out and.
• 28:38There'll be some celebrations and awards
• 28:41on the teams in achieving the goals.
• 28:43And so you can see for our SDOH,
• 28:46our, our goal is 75% compliance.
• 28:50Our stretch is 85 with our symptom
• 28:53triage with our RN's again 75 goal,
• 28:5885% for a stretch and with our
• 29:01physicians with our electronic
• 29:03goals of care documentation,
• 29:06we raised the bar with our
• 29:07physicians a little bit.
• 29:08But based on our baseline data,
• 29:10the goal was 85% with a stretch of 90.
• 29:14So we will be monitoring that
• 29:16over the next several weeks.
• 29:18It just started I believe
• 29:19on the week of the 19th.
• 29:22And so we'll be monitoring this
• 29:23over the next couple of months
• 29:25and hoping to gain some momentum
• 29:28to to reach our goals on that.
• 29:32I wanted to share a little bit of a
• 29:36a patient story because one of the as
• 29:40part of our social determinants of health,
• 29:44we used community health workers
• 29:47as far as the screening.
• 29:50And so currently over the last
• 29:52five months we have to date we
• 29:55have 106 referrals have been made
• 29:57to our community health workers.
• 29:58So this kind of just gives you a little bit.
• 30:00I'm going to read this of.
• 30:02What's happening in with our
• 30:04community health workers and these
• 30:06are this one resource that we
• 30:08have for both of our pilot sites.
• 30:10This is a health system resource,
• 30:13it is not a smile resource and
• 30:17we're hoping to show a case that
• 30:20this really is working and hope
• 30:22that we will get more resources.
• 30:24Our community health worker received
• 30:26a late afternoon phone call from
• 30:28one of our social workers who is
• 30:30looking for assistance for a patient
• 30:32whose Medicaid coverage labs.
• 30:34The patient was scheduled for
• 30:35surgery the next morning.
• 30:37The community health worker was able to
• 30:39contact Medicaid for expedited service.
• 30:42The situation was resolved by
• 30:43removing an estranged family member
• 30:45from the account and reviewing
• 30:47eligibility and the patient received
• 30:49approval and coverage and was in
• 30:51place in time for her surgery.
• 30:53So it's really,
• 30:54really kind of depicts how important that
• 30:58this patient might have missed their
• 31:01scheduled surgery if the social worker,
• 31:04if the community health worker
• 31:06had not intervened in in that.
• 31:11And I'm going to just kind of summarize
• 31:13a bit for the next steps and then see
• 31:16if Scott has anything he wants to add.
• 31:18So as we're looking at over
• 31:20the next you know few months,
• 31:22we're we're rolling out our
• 31:24summer program looking at the
• 31:26sustainability as I mentioned.
• 31:27So we'll be continuing to monitor that.
• 31:30We are developing a dashboard for all
• 31:33of our measures and so that will be
• 31:37able to easily access the data and
• 31:40for our teams to be able to access the
• 31:42different data for the medical home.
• 31:44And we're really going to be working
• 31:47with our senior leadership.
• 31:49Our team has been working with Scott
• 31:52and Kim Slusser on what that might
• 31:54look like as far as expansion across
• 31:57our enterprise and I really think.
• 32:00Lessons learned and the best
• 32:02practices that we will see from our
• 32:05two pilot sites will really help us
• 32:07make some really good decisions.
• 32:09I think two things that we know right
• 32:13away that as it makes sense in certain
• 32:16sites that have the community Health
• 32:18worker resource we will be looking
• 32:21at the SDOH roll out and working
• 32:24with our care coordinators on making
• 32:28post discharge phone calls as part.
• 32:30Of our patient tracking.
• 32:31So those are two things that
• 32:34were really underway right now.
• 32:36Scott,
• 32:36is there anything that you'd like to add?
• 32:40No,
• 32:40I think you did a great job.
• 32:43This is just one program,
• 32:45there's there's several others and we're
• 32:47really looking for alignment across
• 32:49the programs and certainly engage.
• 32:51Everyone in the clinic as we think about,
• 32:54you know, do we phase this out
• 32:57clinic by clinic or intervention,
• 32:58you know, by intervention.
• 32:59So that's more to come in
• 33:01the coming weeks to months.
• 33:04Thanks everybody for your time.
• 33:09Scott and Michelle, thank you very much.
• 33:12This is an exciting program.
• 33:14I applaud your efforts as well
• 33:17as all of your team members who.
• 33:21I know have put as you said countless
• 33:23hours into this and I I think these are
• 33:25this is kind of the hard work that does
• 33:28improve care across our organization.
• 33:31No, I I think one of the things
• 33:34that we are aiming for under
• 33:37Doctor Weiner's leadership is to
• 33:39provide not just good cancer care,
• 33:43but the very best cancer care
• 33:46and part of that is bringing.
• 33:50Expertise to our patients,
• 33:51not just in the ambulatory setting
• 33:54but in the inpatient setting as well.
• 33:57And in an effort to do that,
• 34:00we will be launching a medical oncology
• 34:03specialty consult service for our inpatients.
• 34:08Liz Persich, our
• 34:13NP12 firm CHIEF has had this headed
• 34:17this organizational effort up.
• 34:19With the assistance of Ann Chang
• 34:21and of course the participation
• 34:22of all of our faculty.
• 34:24And I think, Liz, you'll be
• 34:26giving us the the rundown.
• 34:29Take it away.
• 34:33Give me one moment. I'm just
• 34:34going to share my screen here.
• 34:35Thanks for your patience.
• 34:39Are right. So I know many of
• 34:41you have heard this before.
• 34:42I'm going to keep the overview a little
• 34:45higher level for the group today.
• 34:48Disease specific oncology consults
• 34:49something that we have been working on
• 34:52for the past several months and Chang,
• 34:54Harry Deshpande and I have been
• 34:56collaborating closely with faculty and
• 34:58stakeholders from throughout Smiloan
• 34:59Institution and we're really thrilled to
• 35:02present the work we've been doing today.
• 35:04So to cut to the chase,
• 35:06starting on July 5th, we'll be working as.
• 35:09Disease specific oncology consults
• 35:11at the York Street campus.
• 35:13So our consult service will be staffed
• 35:16by 4 separate disease specific
• 35:18attendings coming from breast,
• 35:19head and neck.
• 35:20Thoracic will be combined,
• 35:22Ji and sarcoma will be combined
• 35:23as well as Gu and Melanoma and
• 35:25weekend and holiday coverage will
• 35:27remain unchanged with the general
• 35:29consultative model as before.
• 35:31This has really been a vision
• 35:33for the Cancer Center.
• 35:34I know Eric Weiner has been really
• 35:37a wonderful sponsor along with Roy
• 35:39Herbst and others to make this work a
• 35:41reality and to bring the best possible
• 35:43care to our patients on the inpatient side.
• 35:45So the goals of this project have
• 35:47been to create a disease specific
• 35:49medical oncology consultation on
• 35:51the inpatient side to really improve
• 35:53the care quality and continuity
• 35:55for our patients who are admitted
• 35:57during a true time of crisis.
• 35:59And as well as to improve the faculty
• 36:01experience by allowing them to focus
• 36:03within their subspecialty practice both
• 36:05outpatient and on the inpatient side.
• 36:09So I'll be reviewing the
• 36:11guiding principles today,
• 36:12the current and future state of the
• 36:15inpatient consultative service and how that
• 36:17relates to the inpatient care on MP12,
• 36:19some operational details and education
• 36:21and then end with a moment of gratitude.
• 36:24So the guiding principles of this
• 36:25are really to improve the patient
• 36:27care and experience through Med
• 36:29on disease based consultation.
• 36:31So when our patients, our loved ones,
• 36:33when we ourselves are admitted
• 36:35we want to see our.
• 36:37Primary oncologists or somebody
• 36:38who works closely with them,
• 36:40we want to improve the faculty
• 36:41experience through focus,
• 36:42subspecialty inpatient practice.
• 36:44We have such a wonderful focus,
• 36:47subspecialty,
• 36:47focus docs here and as we know
• 36:50cancer care has just become so
• 36:52some specialized and specific.
• 36:53We want to allow them to practice
• 36:55within their area of expertise
• 36:57in the inpatient setting.
• 36:58Furthermore,
• 36:58we want to promote excellent education
• 37:00as well as mentorship for fellows,
• 37:02residents and students,
• 37:03whether they're interested
• 37:04in oncology or not.
• 37:05I think there's so much our
• 37:07specialists can teach and provide to
• 37:10not just patients but our learners.
• 37:12And throughout this process,
• 37:13we've really focused on engagement
• 37:15of stakeholders from throughout the
• 37:17Cancer Center, throughout our faculty,
• 37:19our APP's,
• 37:20our nurses and we've been moving forward
• 37:22with as much transparency as possible.
• 37:23There's a lot of details and.
• 37:26It's been a really a labor of love
• 37:28over the past several months.
• 37:30So as we began this work,
• 37:32what we wanted to do was speak to other
• 37:34cancer centers to learn about what went well,
• 37:36what what we could learn from and and
• 37:38what other institutions have been doing.
• 37:41We've interviewed more than 420,
• 37:43brother.
• 37:43Cancer centers throughout the country,
• 37:46I wish they were in person,
• 37:47they were virtual and we learned about
• 37:49what other groups do in the inpatient side.
• 37:52Most places do have general consults
• 37:54where medical oncologist will see a
• 37:56variety of of subspecialties throughout
• 37:58the hospital regardless of disease type.
• 38:01Some groups did disease based
• 38:03consultation but focused
• 38:04primarily on new patients only.
• 38:06Others directly consult to the
• 38:09outpatient oncologist without a
• 38:11designated inpatient consultant per se.
• 38:13And then in select institutions really
• 38:17were able to promote comprehensive
• 38:20disease specific both inpatient and
• 38:22consultative care primarily at disease
• 38:25specific centers such as Sloan.
• 38:27So what we took away from this was the
• 38:30we identified an opportunity for Yale
• 38:32to really differentiate ourselves with
• 38:34the disease specific consult service.
• 38:36The inpatient commitment for our faculty,
• 38:38for faculty in the inpatient consult
• 38:40setting is variable and largely
• 38:42dependent on hospitals engagement.
• 38:44And I think I can speak for our team in
• 38:46that this disease specific work would
• 38:49not be possible without the wonderful
• 38:51support of our SMILO hospitals.
• 38:53There are different support models
• 38:55for the inpatient consultative
• 38:57services using an APP.
• 38:58We're very fortunate to have a dedicated
• 39:01APP on our consult service fellows,
• 39:04consults and nurse coordinators
• 39:05and also hospital support.
• 39:08So I'm going to go
• 39:09into the current model and the future model.
• 39:11So currently we have three attending
• 39:13staffing are two teaching services
• 39:14which we call Blue and White.
• 39:16Those are the teaching services
• 39:18primarily focused on MP12.
• 39:20And then a third physician from our
• 39:22oncology faculty who is a who works on
• 39:25the consult service with our fellow APP.
• 39:27Starting on July 5th,
• 39:28we're going to have four separate disease
• 39:30specific attendings that will be only
• 39:32practicing within their area of expertise.
• 39:34Again breast, head and neck,
• 39:36thoracic GI and sarcoma and Geo Melanoma.
• 39:39Of those four,
• 39:40two will be dedicated to attending
• 39:42teaching rounds in the morning with our
• 39:44house staff and our hospitalists and our.
• 39:47Medical students that are rotating on
• 39:49the inpatient service and another of
• 39:51those four faculty will be focused on
• 39:53the consult service and attend consult
• 39:55checkin rounds and will be available
• 39:57to see undifferentiated patients.
• 40:00So patients with new malignancy
• 40:02without a you know biopsy etcetera.
• 40:04So this is all starting July 5th.
• 40:07In effect, what does this mean for you?
• 40:10So when you place the console,
• 40:11everything is going to look
• 40:12the same on your end.
• 40:13You do the consult order the usual way.
• 40:15You can reach out to the
• 40:17dynamic role with any questions.
• 40:19All the attendings will be
• 40:21listed under Q genda.
• 40:23As usual.
• 40:23So you won't see a difference in
• 40:25terms of when you place that order.
• 40:26The difference will be that your
• 40:29patients will be seeing a disease
• 40:32specific oncologist within 24
• 40:33hours of the consult order.
• 40:36So I think that will be a huge benefit to
• 40:39your patients and and we'll be tracking,
• 40:41I'll get into this on the research bit,
• 40:43but we'll be tracking outcomes and
• 40:45metrics based on these major shifts so.
• 40:49Another big change that we've made
• 40:51with this disease specific work is a
• 40:53change in the education on this service.
• 40:55So with one attending rather than two
• 40:57attending on the teaching service we wanted
• 41:00to expand the opportunities for teaching.
• 41:02We have two separate afternoon sessions
• 41:04available per week where our disease
• 41:07specific oncologists and others will
• 41:09rotate through to offer learning
• 41:11opportunities and case based lectures
• 41:13not just for our house staff on the
• 41:15blue and white teaching teams but
• 41:17also for the for the consult team.
• 41:19A PP fellow and students and
• 41:22residents that are rotating.
• 41:24So those will take place on
• 41:26Tuesday and Thursday afternoons.
• 41:27I have a few pictures here of some of
• 41:29our faculty who have been participating.
• 41:31We've had fellows,
• 41:32we've had physicians not just
• 41:35from medical oncology,
• 41:36but surgical oncology and interventional
• 41:39poem infectious disease and others.
• 41:42And it's just been a really fun and
• 41:44wonderful way to learn about the care of
• 41:46our patients from many different viewpoints.
• 41:49So I encourage anyone who's
• 41:51interested in education,
• 41:52please reach out to me.
• 41:53We'd be happy to host you.
• 41:55I want to thank those of you who
• 41:56are on today who who've been
• 41:58involved for your efforts as well.
• 42:02Finally, I'll review.
• 42:03I think I've reviewed a lot of this
• 42:05already with the educational piece,
• 42:07but one specific dissatisfier that we
• 42:09learned about through our innovation
• 42:10work was for fellows that are
• 42:12rotating on disease specific teams.
• 42:14The burden of talking to four different
• 42:16attendings at a given time was really
• 42:19a challenge and detrimental to
• 42:21education and sanity to be honest.
• 42:23So what we've done is the fellows will
• 42:25be rotating only with two faculty at
• 42:27a time and they'll switch mid month.
• 42:29And I really want to express
• 42:31gratitude for us.
• 42:31Milo APP who's been supportive of
• 42:35this organization and transition
• 42:36to maximize the educational
• 42:38opportunities for our fellows.
• 42:40So they'll be deep diving into two
• 42:42disease subspecialties for the first half
• 42:44of the month and then the compliment
• 42:46of the second-half of the month.
• 42:47They'll be involved in the firm
• 42:49education as well and we're hoping
• 42:50not just to promote education,
• 42:52but also mentorship and the sense
• 42:53of community among the consult
• 42:55team and the inpatient team.
• 42:59So my final slide, I wanted to
• 43:01express gratitude to everyone who's
• 43:03been with us along this journey.
• 43:05The emoji represents not
• 43:07just prayer and preach,
• 43:08but I it's a high five as well,
• 43:10which I wasn't aware of and I
• 43:12think we can all be grateful for
• 43:13all the hard work we've done.
• 43:15And we're looking for the
• 43:16launching on July 5th.
• 43:18So next steps July 5th is our launch.
• 43:20We'll be having weekly checkins for
• 43:22the first eight weeks with incoming
• 43:23and outgoing faculty, fellows,
• 43:25students, APP's and hospitalists.
• 43:28We anticipate this will be an iterative
• 43:30process that will be changes.
• 43:31We can always make things better.
• 43:33So that is part of our plan and they'll
• 43:35be research forthcoming we'll be looking at.
• 43:38Time to consult,
• 43:39length of stay, readmission,
• 43:40faculty volume and feedback
• 43:42comparing pre and post launch.
• 43:44So I think you know this is a really
• 43:47unique opportunity that we have to
• 43:49learn about how disease specific
• 43:51transitions can benefit our patients,
• 43:53our faculty and our trainees.
• 43:56And that's all I have.
• 43:57I know Harry Deshpande and Anne Chang
• 43:59who've collaborated and supported
• 44:01this project from the get go are also
• 44:03on to answer questions and I'm just
• 44:06grateful for everybody's support as
• 44:07we've built this over the last five months.
• 44:12Thanks. We'll add that Liz is a
• 44:15total Wiz with the schedule and
• 44:18the service guide which which is a
• 44:21reference for anybody who wants to look
• 44:24at you know really the detail around that.
• 44:27Kevin, do you want me to answer
• 44:29that question or you want us to?
• 44:31You know, I think why don't we go ahead
• 44:33and get to Eric and we can circle
• 44:36back to it in the Q&A period.
• 44:37I want to make sure we cover
• 44:40the drugs shortages when we
• 44:41kick it over to you, Eric.
• 44:44Cabbie safe. Dr. Weiner.
• 44:48All right, give me a second here.
• 44:50Let me just share my screen.
• 44:56All right. Could you see my slide?
• 45:00Yes, great. Thank you,
• 45:03Doctor Billingsley and good evening to
• 45:06those who are attending this town hall.
• 45:08As Doctor Billingsley mentioned earlier,
• 45:11oncology drug charges have made national
• 45:15headlines as hospitals clinics.
• 45:18Private physicians offices are
• 45:21challenged with obtaining drugs such
• 45:24as cisplatin and carboplatin and
• 45:27these drug shortages are negatively
• 45:29affecting our care to our cancer
• 45:32patients specifically these these
• 45:35the most recent drugs drug shortages
• 45:38started in late December of 2022.
• 45:40This was due to a generic
• 45:44manufacturing plant.
• 45:46Located overseas that halted production
• 45:48of their drug line per the FDA due
• 45:52to quality and documentation issues.
• 45:55And as you can see on the right,
• 45:57this is a diagram I pulled from the FDA.
• 46:01Approximately 37% of drug shortages are
• 46:05due to quality and manufacturing issues.
• 46:08This specific plant produced up to 30
• 46:12to 40% of some of the oncology drugs
• 46:16listed below for the US market and
• 46:19unfortunately it's not expected to
• 46:22resume production until later this summer,
• 46:25early fall.
• 46:28So where do we stand today with drug
• 46:31shortages within this Myelo network?
• 46:33The American Society of Health
• 46:35System Pharmacists is HP.
• 46:37As currently 240 medications
• 46:40with disruptions and drug supply.
• 46:44Eighteen of these drugs are oncology
• 46:48related and eight are currently
• 46:51critical drug surges nationally and
• 46:54within the elder haven health system.
• 46:57Again here is the list of the current
• 47:01oncology drug shortages that we
• 47:03are challenged with and just kind
• 47:06of go over them very briefly.
• 47:08BCG vaccine has been on worldwide
• 47:11shortage for over 2 years and
• 47:14currently the one drug that we have
• 47:16instituted dose limitations with
• 47:18specific patients receiving 130 dose.
• 47:21But we've been successful in
• 47:23obtaining a supply,
• 47:25a healthy supply and I have
• 47:27become a referral site for BCG
• 47:29treatment within the region.
• 47:31As I mentioned earlier,
• 47:33CARBO and Cisplatin are probably the
• 47:36most critical shortages that we are
• 47:38dealing with at this time and spent
• 47:40a lot of our work with the FDA just
• 47:43recently approved the importation of
• 47:46a Apple tax brand which is from China.
• 47:50And we are building and continue to build
• 47:53supply of cisplatin as well as carboplatin.
• 47:56And we're hoping soon that the
• 47:59FDA will also approve some type
• 48:01of impartation with carboplatin.
• 48:05Luthera being as a drug that we
• 48:07are watching very, very closely.
• 48:09We are micromanaging our supply
• 48:12to meet our patient needs.
• 48:15And then methotrexate just
• 48:17jumping down challenge,
• 48:18you know we're challenged with obtaining
• 48:21preservative free formulations as we
• 48:24utilize them for our intra fecal dose,
• 48:26all the other medications.
• 48:29We are watching those very carefully
• 48:32but we are always challenged with
• 48:35trying to obtain specific bio
• 48:37sizes or specific concentrations
• 48:40but but in summary we are.
• 48:43We currently do have enough drug supply
• 48:45to meet our patients needs with no
• 48:48clinical restrictions at this time.
• 48:50We are constantly communicating
• 48:52with our distributors,
• 48:54our drug representatives and
• 48:56understand the outlook of these
• 48:58shortages and immediately taking
• 49:00advantage of any supply releases
• 49:02and allocations through the drug
• 49:05committee themselves or a distributor.
• 49:08We we don't have a crystal ball.
• 49:10And what new drug surges may
• 49:12appear or the challenges that
• 49:14may suddenly come in the future,
• 49:17but we have created an evolving
• 49:19process to help manage our shortages.
• 49:23This is a little bit of a busy slide,
• 49:25but if you look in the upper
• 49:27left hand corner,
• 49:28the first step of this process
• 49:31is identification of shortages.
• 49:32And that really starts with
• 49:34escalation from our frontline staff,
• 49:36our clinicians who.
• 49:38May have trouble ordering the
• 49:40medications or have heard of potential
• 49:42drug shortages through colleagues or
• 49:45listers across the country or that
• 49:47may be using different distributors.
• 49:50And I I just want to stress that you know,
• 49:52you know escalation is extremely important.
• 49:56You know this is is where it makes a
• 49:59difference where we could potentially
• 50:01be able to build an overstock of
• 50:03you know one to two months supply.
• 50:05Or you know,
• 50:06we are now facing a drug shortage that
• 50:09may occur within one to two weeks.
• 50:11Once we hear about the drug shortages,
• 50:14pharmacy will investigate,
• 50:16conduct and impact analysis,
• 50:19monitor the situation depending on the type,
• 50:22the cause or predicted duration
• 50:24of the shortage.
• 50:26We have weekly and sometimes
• 50:28daily meetings about shortages,
• 50:29depending on the drugs and
• 50:31severity of the shortages.
• 50:33We then will brainstorm,
• 50:35implement and mitigation strategies
• 50:37such as maximizing our allocations
• 50:40through our multiple locations,
• 50:43move to multi use of vials if appropriate,
• 50:46recommend drug alternatives,
• 50:48toast rounding and lastly
• 50:51clinical restrictions.
• 50:53Finally, there is work with procurement,
• 50:56storage and redistribution.
• 50:57We have made our Smilo Cancer Hospital
• 51:01pharmacy located on the 8th floor
• 51:04as an Overstock hub and through
• 51:07this hub we distribute medication
• 51:10throughout the Smilo network.
• 51:13We address any type of storage constraints,
• 51:17but we also have to be cost conscious too,
• 51:19especially in this challenging
• 51:22financial environment.
• 51:24So I hope was able to provide you a quick
• 51:26summary of our current drug shortages.
• 51:29Happy to entertain any questions,
• 51:32but before I do,
• 51:33I really want to thank the technicians,
• 51:36the pharmacists,
• 51:37the clinicians,
• 51:38our procurement team who are really,
• 51:39really involved to the daytoday
• 51:41management of these shortages.
• 51:42They have been truly amazing
• 51:44and building our current drug
• 51:46supply and assuring that we are
• 51:48able to provide these lifesaving
• 51:50drug treatments to our patients.
• 51:52Thank you everyone for your time.
• 52:00Roy, Roy, what am I saying,
• 52:02Kevin, if I can just add a word.
• 52:04Thank you, Eric.
• 52:06You know, around the country
• 52:07this has been a huge problem.
• 52:08In some places there are
• 52:11incredibly severe drug shortages.
• 52:13I congratulate our pharmacy here for
• 52:17not running into this same problem.
• 52:20It's really complicated.
• 52:21ESCO has been trying to
• 52:23play a major role in this.
• 52:26As Rick Pastor told us at at ESCO when
• 52:29he came to meet at the ESCO board.
• 52:32It's actually doesn't fall
• 52:33into the purview of the FDA,
• 52:36but there's their attempts to lobby
• 52:40Congress to try to have a larger
• 52:44storehouse for drugs like these.
• 52:46And as Eric said,
• 52:48much of this relates to problems
• 52:50in the manufacturing system
• 52:52in at at overseas sites.
• 52:55It's it's really challenging and I
• 52:58think what frustrates many of us so
• 53:01much is that it's also in many ways
• 53:03a symptom of the fact that the drug
• 53:05industry of course is fundamentally
• 53:09geared towards making drugs that.
• 53:12Turn a big profit and these drugs
• 53:14which are of course generic
• 53:16and do not result in a profit,
• 53:18just get ignored and we got to
• 53:19come up with some better way
• 53:21of dealing with this situation.
• 53:27So
• 53:29thank you. I think it,
• 53:30I I will say as a surgeon this is
• 53:34not a problem that is unique to the.
• 53:37The medical side,
• 53:38we're also experiencing supply
• 53:40chain disruption in operating room
• 53:43equipment and sterile supplies.
• 53:45So this is
• 53:48kind of spanning the the breadth
• 53:50of all of our healthcare operations
• 53:53and it is truly stretching us all.
• 53:56And I think unfortunately I have
• 53:58to agree with you doctor Weiner
• 54:02devices and products that
• 54:04are not lucrative tend to be.
• 54:07Supply chained in a precarious
• 54:09way and we were feeling this. Now
• 54:15let me just maybe ask the first question.
• 54:19I don't see other questions in
• 54:21the chat or the Q&A right now
• 54:23unless I'm missing anything.
• 54:25Kim, are you seeing anything?
• 54:26No, I just, I didn't want to forget
• 54:29about the question that somebody put in
• 54:32for around the inpatient consulting.
• 54:35Maybe we could.
• 54:35I don't see that written right now.
• 54:37And do you remember what that is?
• 54:39Could you answer that we put off earlier?
• 54:42Sure, I I answered it,
• 54:45but then it goes to a different screen.
• 54:46So the question was will the new
• 54:49plan structure be able to move the
• 54:52goals of care conversations forward
• 54:53when appropriate when patients are
• 54:55admitted and at the end of life,
• 54:57how will the multidisciplinary team members
• 54:59be involved in this new structures?
• 55:02Structure in relationship to planning
• 55:03for the patient needs discharge barriers
• 55:06to care and this is a great question.
• 55:08It must be very informed because
• 55:10this is basically one of the
• 55:12exact reasons why we think this,
• 55:14we wanted to do this and why we
• 55:17think it's going to really help
• 55:18the patients is that if you have a
• 55:21lung cancer patient who's there.
• 55:24And and and the attending on service
• 55:27previously was a breast cancer patient,
• 55:30breast cancer doc.
• 55:33That breast cancer doc is really
• 55:35not going to feel as comfortable
• 55:37discussing the ins and out of what the,
• 55:39what the possible treatments are and
• 55:42what the prognosis is for this patient,
• 55:45for a new patient that breast cancer
• 55:47doc who's a fantastic breast cancer doc,
• 55:50but it's not going to feel as comfortable.
• 55:53Moving the the work up and and
• 55:55asking for the what what the the
• 55:58latest you know tumor profiling or
• 56:02or those types of details that would
• 56:05inform the patient's care.
• 56:07And so we think that that's going to
• 56:09really help the patient get a faster
• 56:11work up and a better work up and I
• 56:14think that our surgeons who have been
• 56:17doing this for a long time Kevin you see.
• 56:19GI patients and and you don't you're
• 56:22not seeing general surgery patients.
• 56:25So I think you guys are have expressed
• 56:27to us on on different calls that
• 56:29you're really excited about this plan
• 56:32and and I think overall it's going
• 56:34to be real satisfier for patients
• 56:36and and for docs and staff,
• 56:38I don't Liz or Harry if you want to add.
• 56:42I was going to add,
• 56:43I think you know we're we're kind
• 56:45of effectively taking out the
• 56:46middleman or removing one line of
• 56:47this telephone game that we have.
• 56:49You know let me talk to this doc
• 56:50and we talk to that doc.
• 56:51We're a little bit closer to the
• 56:53patient's primary if not actually
• 56:54the patient's primary at the bedside.
• 56:56And I think we can have these assumptions
• 56:58and hopes that this will be how it will work.
• 57:00But we're also going to
• 57:01be looking at the data.
• 57:02So we're going to look at length this day,
• 57:04we're going to look at their readmissions,
• 57:05we're going to look at their.
• 57:07Mortality in their Hospice
• 57:08utilization and see if you know
• 57:10talking to their primary earlier
• 57:11is making a concrete difference.
• 57:13I know from a patient and caregiver
• 57:15perspective that that would make
• 57:17a big difference for me,
• 57:18but what is the data show us and
• 57:20we'll be looking at that certainly.
• 57:21So anonymous attendee,
• 57:22thanks for you for your question.
• 57:24Yeah. And Liz, I just want to point out
• 57:26that both with this initiative and the
• 57:29ASKO Medical Home that both of the teams
• 57:32working on this engaged our patient
• 57:34and family Advisory Council and their
• 57:36feedback informed some of this work.
• 57:39And I just really think that's
• 57:40important as we continue to move
• 57:42forward with our initiatives that
• 57:43we're engaging our patients and the
• 57:45voice of our patients in that work.
• 57:47And so I I think we honored what
• 57:50the feedback that we got from them
• 57:52and both of these projects and.
• 57:54Looking forward to seeing the
• 57:55results of the of the service and
• 57:57same with from the nurses,
• 57:59I think we the the inpatient nurses
• 58:01here all the time from patients
• 58:03that they want to either see their
• 58:05oncologist or see somebody who
• 58:08understands you know their cancer.
• 58:10So I I'm real excited
• 58:12about seeing the outcomes.
• 58:19Well, on that note,
• 58:20I think I'm going to thank all of
• 58:23our panelists and and participants
• 58:25for being here this evening.
• 58:27A lot of exciting things happen
• 58:30happening and more than anything,
• 58:33I know Kim and I want to express our
• 58:35gratitude to our teams that are working
• 58:37hard to care for patients and families
• 58:40to cross the organization every day,
• 58:42keep up the good work and also
• 58:44make some time to enjoy the summer
• 58:47with yourselves and your families.
• 58:49Have a great evening.