Smilow Cancer Hospital Town Hall | May 18, 2023

Transcript

• 00:04Good evening everyone.
• 00:05I am just delighted to welcome our
• 00:08community to our Smilow Town Hall.
• 00:11We have a busy and exciting agenda
• 00:16this evening that I'm really delighted
• 00:20to be sharing with our community. Can
• 00:27we put the agenda slide up?
• 00:33I'll just tell the audience,
• 00:35we're going to kick things off with some
• 00:38clinical announcements and then I'm
• 00:41going to ask my partner Kim to share
• 00:44some updates in our nursing service.
• 00:48We're just coming off the heels of our
• 00:50nursing week with a number of gettogethers
• 00:53and some incredible announcements and awards,
• 00:56but our nurses won.
• 00:58And from there, we'll go on to an update
• 01:01on our diagnostic imaging services.
• 01:04I'm really pleased to have two guests
• 01:09with us this evening for Town Hall, Dr.
• 01:12Rob Goodman, who's our Chair of Radiology
• 01:15and Biomedical Imaging and Dan Alexa,
• 01:19who's the Executive Director
• 01:21of System Radiology Operations.
• 01:24No, I think is virtually.
• 01:26Everyone who cares for cancer patients
• 01:29knows diagnostic imaging is one of
• 01:33these central services that touches
• 01:36really all of our patients at every
• 01:39phase of their care through the
• 01:42organization and virtually every site.
• 01:45So we critical partnership for us.
• 01:49So I'm really thrilled to have
• 01:51Doctor Goodman and Mr.
• 01:53Alexa here to update us on.
• 01:55Developments in these services,
• 01:58we'll also be hearing from Doctor
• 02:00Jensen Morris,
• 02:01Doctor Cece Calhoun and Tracy Carafino,
• 02:03our Director of Nursing about a really
• 02:09thrilling development that will be
• 02:12transforming some of how we deliver
• 02:14care and SMILO and extending our
• 02:16services throughout the organization.
• 02:18And then of course is always in Town Hall.
• 02:21We'll have some time at the end.
• 02:24For question and answers,
• 02:27can I have the next slide?
• 02:31So I did want to take a minute
• 02:33to just review with people.
• 02:35I have to say, if anyone's like me,
• 02:38the past several days have
• 02:40been really delightful.
• 02:42I've been impressed to see that
• 02:45some people are actually really
• 02:47great looking without masks.
• 02:49And I think we've all been
• 02:51enjoying a bit more freedom as
• 02:53we wander around the institution
• 02:55without our masks on all the time.
• 02:59I do want to remind people that
• 03:01mask use is still required in the
• 03:03following locations when we are in
• 03:05patients hospital rooms and when
• 03:07we're in procedure or exam rooms or
• 03:09other closed spaces or is required
• 03:13by specific patient transmission
• 03:15based or isolation policies.
• 03:18I think as people are no
• 03:20or they're experiencing,
• 03:21there are major areas of our
• 03:25institution where wheel are
• 03:27allowing masks to be optional.
• 03:29Those are rehab rooms and when
• 03:31we are out in the hallways or
• 03:34out in more public facing areas,
• 03:38all of our faculty and staff.
• 03:41Are certainly allowed to continue to use
• 03:44masks at their discretion if they feel that,
• 03:47if they're more comfortable and
• 03:49certainly if they have any elements of
• 03:53of concern about particular patients.
• 03:57We are allowing patients and
• 03:59visitors to enter the institution
• 04:02without requiring masks of course.
• 04:04Anyone with a possible respiratory
• 04:06tract infection should be asked
• 04:08to masked in all ambulatory areas,
• 04:11and of course anyone who's
• 04:14unknown isolation or other for
• 04:18or at risk for any other reason.
• 04:21Once masks are used,
• 04:23it should be discarded with very
• 04:27few options for extended use for
• 04:30patients who are not on isolation.
• 04:33Next slide please. No.
• 04:36One of the other exciting developments
• 04:40that is really we've been looking
• 04:43forward to sharing both Kim and I is
• 04:46that we have been certified in two of
• 04:49our major clinical sites as an ASCO
• 04:53patient centered cancer care facility.
• 04:56For those of you who do not know the ASCO
• 05:00PC-4 patient centered care designation.
• 05:04Requires adherence with a single set of
• 05:09comprehensive expert backed standards
• 05:11for patient centered care delivery.
• 05:13We were one of 12 clinical sites
• 05:17throughout the country that served
• 05:19as a pilot site for this program.
• 05:22We do plan to extend this throughout the
• 05:25organization over the next several years.
• 05:27But as a start,
• 05:29we have achieved this certification
• 05:31at two of our busiest sites and
• 05:33Guilford and the Breast Center
• 05:35here on the York Street campus.
• 05:37So I think we have a lot to be proud of.
• 05:40Our teams have done a lot of work
• 05:42in a lot of different areas to
• 05:45ensure patient centered care.
• 05:46And it provides A framework for us
• 05:49to continue to build on throughout
• 05:51the rest of our organization.
• 05:53So hats off to the work of of a
• 05:55number of individuals and thank
• 05:57you for these efforts.
• 06:01Kim, I think I'll kick it
• 06:02over to you for nursing.
• 06:04All right. Thanks Kevin.
• 06:05So it's it's wonderful that we're having
• 06:08a town hall this month because it is
• 06:11oncology nursing month and we did just
• 06:13come off of celebrating nurses week.
• 06:15So I get to say happy nurses month to all
• 06:20of our nurses watching today and all of
• 06:23our advance practice nurses and all of
• 06:25our care associates and really everyone that.
• 06:29That is providing care to our patients
• 06:31and all of our team members and
• 06:33part of oncology nursing month is
• 06:35obviously celebrating our nurses.
• 06:37But I know that our nursing profession
• 06:40also loves to recognize during this month
• 06:43all of our partners and delivering care.
• 06:45I am going to just share a few highlights
• 06:48of some initiatives that we have going on.
• 06:51I'm going to talk a little bit about
• 06:53what's happening in nursing across the
• 06:56country and then of course end it with.
• 06:59Just sharing again for those who couldn't
• 07:01make it last week during our awards ceremony,
• 07:05who, who who was awarded our Excellence
• 07:09Awards and our scholarships last week.
• 07:14So smile on nursing at a glance.
• 07:16We are very obviously large service
• 07:19line and I'm not sure if people
• 07:22you know realize we have over I
• 07:24put 568 plus because it feels like
• 07:26we're always adding to our nursing.
• 07:28Colleagues,
• 07:29but we have 568 registered nurses
• 07:33across all of Smilow and over
• 07:35100 advanced practice providers.
• 07:3877% of our nursing workforce has a
• 07:41bachelor's degree or higher and 35% of
• 07:44our nurses are are specialty certified.
• 07:46Most of our nurses are certified in oncology,
• 07:50but some of our nurses also have
• 07:53certifications and specialties such
• 07:55as palliative care or transplant
• 07:57or breast cancer.
• 07:58And I just want to take a minute to thank
• 08:01all of our nurses who are committed
• 08:03to either achieving or maintaining
• 08:06their specialty certification.
• 08:07It really is a commitment to validating
• 08:10your expertise and to really being a
• 08:14lifelong learner because it does require
• 08:17our nurses to to stay educated and
• 08:20competent in their area of specialty when
• 08:23they continue their their certification.
• 08:26So thank you so much to all
• 08:28of our certification.
• 08:28By nurses.
• 08:31I just wanted to I, I I just want to describe
• 08:35a little bit about what's happening.
• 08:38I know that nursing is not the only group
• 08:41that has had disruption due to the pandemic.
• 08:45But since we are talking about
• 08:48our nursing colleagues today,
• 08:50I just wanted to highlight some of the
• 08:53things that we are challenged with.
• 08:56Over the next over,
• 08:58right now and into the future,
• 09:01the pandemic has been very disruptive
• 09:03to the nursing profession.
• 09:04Across the country,
• 09:07there are 5.2 million registered
• 09:09nurses in the United States.
• 09:12Every two years,
• 09:13the National Council of the State
• 09:15Board of Nursing and the National Forum
• 09:17of the of State Nursing Workforce
• 09:19Centers conduct a national survey
• 09:21focused on the entire US nursing
• 09:23workforce and we have historically
• 09:26used this survey as the nursing
• 09:28profession to really understand.
• 09:30What are,
• 09:31what are nursing colleagues are
• 09:33going through and and things that
• 09:36we need to focus on.
• 09:37It surveys anything to where you're working,
• 09:41what specialty you're in, your age,
• 09:43how long you've been a nurse.
• 09:45But it also focuses on other things
• 09:47such as what your experience is like.
• 09:50And while we have been challenged with
• 09:53these with these issues in the past,
• 09:55they have only heightened since
• 09:57the disruption of the pandemic.
• 09:59As you can see,
• 10:00more than half of our registered
• 10:02nurses across the country feel
• 10:04that they have experienced an
• 10:05increase in their workload,
• 10:07and they feel emotionally drained,
• 10:09used up,
• 10:10and fatigued when they wake up in
• 10:12the morning at least once a week,
• 10:15with 1/4 of those nurses feeling
• 10:18this way every single day.
• 10:21And almost a third of our nurses
• 10:23plan to leave their position or
• 10:25retire in the next five years.
• 10:28In addition,
• 10:28there has been an increase in moral
• 10:31injury in our nursing workforce,
• 10:32which is really the feeling that
• 10:35follows when a nurse feels their
• 10:37personal values have been compromised.
• 10:40And while they know what the
• 10:41morally right thing to do is,
• 10:43there are constraints that make doing
• 10:45the right thing nearly impossible.
• 10:48So I think this is,
• 10:49this isn't just to be a doom and gloom,
• 10:52but I think that this is what I
• 10:54know that I really want to stay
• 10:57centered on And as we continue to
• 10:59try to find ways to stabilize our
• 11:02our our Smilo nursing workforce
• 11:05and to recruit and retain our
• 11:08nursing professionals at Smilo and.
• 11:11I'm hopeful that we can work on
• 11:14stabilizing our teams and that I know
• 11:17that they love what they do every
• 11:19single day when they come to work,
• 11:20and I'm hoping that we can reduce some
• 11:22of the physical and emotional distress
• 11:25that accompanies their work all too often.
• 11:31So what does that mean for SMILO?
• 11:33You can see here, our vacancy rate
• 11:36right now is at 14.3% and our
• 11:39turnover rate is around 11 percent.
• 11:42We are slowly reducing our vacancy
• 11:45rate and you can see we had a very
• 11:48high vacancy rate back in October,
• 11:50almost close to 17%,
• 11:54just to put that in perspective,
• 11:55prior to the pandemic in 2019.
• 11:59Our turnover rate and SMILO was 7.6%.
• 12:02So this is really feels very different
• 12:06to I'm sure everyone and Smilo,
• 12:10not just our nursing staff
• 12:12because we did have a very,
• 12:14very stable team prior to the Pandemic.
• 12:18We have had to utilize our our
• 12:20current staff and ask them to work
• 12:23extra and utilize shortterm staffing,
• 12:25incentive pay and overtime pay to.
• 12:29To ensure that we have adequate
• 12:30staffing for our units and in addition,
• 12:33we have travel nurses now in our
• 12:36locations both in the inpatient
• 12:38and ambulatory environment where
• 12:40prior to COVID we did not have to
• 12:43rely on a traveler nurse workforce.
• 12:46We have amazing individuals currently
• 12:48in and entering the nursing profession
• 12:50and I am inspired every day when I
• 12:52round and hear about the care that
• 12:55our nurses are providing our patients.
• 12:57The loved ones of our patients and
• 12:59our colleagues and partners and I
• 13:02know that we're all going to work
• 13:04together to continue to improve this
• 13:06experience for our patients and our nurses.
• 13:09Like I said before,
• 13:10I know we're not alone and the impact
• 13:12the past few years have had on our wellbeing,
• 13:14but I just felt they wanted to
• 13:16highlight that today.
• 13:17And now I'll go over a few
• 13:19initiatives that we have in regards
• 13:20to recruitment and retention.
• 13:25So these are some of our activities
• 13:27that some of them are things that
• 13:29we have done for years and some of
• 13:31them are newer or evolving programs.
• 13:33So because Milo is part
• 13:35of the New Haven hospital,
• 13:38there are things that we do.
• 13:41Because we are part of that hospital
• 13:43and programs that our nurses can
• 13:45engage in because we are part
• 13:46of Yale New Haven Hospital and
• 13:48part of a magnet organization,
• 13:50There are some things that we do
• 13:52within Smilo to again recruit and
• 13:54retain our oncology nursing workforce.
• 13:56Only 3% of nurses are in this country
• 14:00are identified as oncology nurses.
• 14:02So again, it's so important that
• 14:05we recruit top talent and that
• 14:08we retain our nurses.
• 14:09When they want to work in oncology
• 14:12and the ones that are in bold on
• 14:14this side are the are the things that
• 14:17we engage in and Smilo specifically
• 14:19for recruitment and retention.
• 14:21I'm going to highlight two of these programs,
• 14:23the Flynn fellowship and then new
• 14:26graduate RN&APP Ambulatory fellowship.
• 14:29I do want to recognize our Smilo Nursing
• 14:32Rewards and Recognition committee,
• 14:34everything that's happening this
• 14:36month during oncology nursing month.
• 14:38That committee has has really
• 14:40done a wonderful job organizing
• 14:42and executing on these events.
• 14:44They are also responsible for recognizing,
• 14:48putting everything in place to
• 14:51plan for recognizing our awardees,
• 14:53for our scholarships and our
• 14:55education stipends.
• 14:56They are responsible for reviewing the
• 14:59applications of selecting the awardees
• 15:02and really also out there trying to.
• 15:07Build a culture where people are
• 15:09wanting to recognize one another.
• 15:11They will help.
• 15:12If you've never written a nomination before
• 15:15for either an internal or an external award,
• 15:17they are available to help.
• 15:19And so they really want to promote an
• 15:22environment where we are taking every
• 15:25opportunity we can to to to recognize
• 15:27our team for the wonderful work they do.
• 15:30I also want to recognize our nursing
• 15:33professional development program and all
• 15:36the educational opportunities that they
• 15:38have put in place for our nursing staff.
• 15:41There are so many CE opportunities
• 15:44and an educational programs available
• 15:46to our nursing staff throughout the
• 15:48year and they have put together some
• 15:51programs as well during on college and
• 15:53nursing month that I hope people are
• 15:56taking part in and then I will go over.
• 15:59Very briefly,
• 15:59some of the efforts that we're focusing on,
• 16:02on wellbeing specific to Smilo.
• 16:06So the Flynn Summer Fellowship is
• 16:08a program for nursing students the
• 16:10year before their senior year that
• 16:13are interested in oncology nursing.
• 16:15They basically work as a student nurse
• 16:18intern that summer before their senior year.
• 16:20And this is a program that
• 16:22started at Greenwich Hospital.
• 16:23Even before the integration of Smilo,
• 16:25Susan Flynn was a patient that was treated.
• 16:29For cancer at Greenwich Hospital
• 16:31and she did ultimately pass away,
• 16:34but her husband started this foundation
• 16:36in her name because of the care that
• 16:39she received at Greenwich Hospital.
• 16:41So that this program not is not
• 16:43only offered at
• 16:44Greenwich, it's it's offered at
• 16:46multiple hospitals and schools of
• 16:49nursing across the northeast area,
• 16:51but it did originate through the
• 16:54through at Greenwich Hospital.
• 16:56Last year we were able to expand
• 16:58that beyond Greenwich Hospital and
• 16:59we had three fellows here at Yale,
• 17:01New Haven Hospital.
• 17:02And this year we're expanding to seven
• 17:04fellows and we are going to have two
• 17:06fellows at Smilo Trumbull this year.
• 17:08This will be our first time
• 17:11putting us nursing students in the
• 17:14fellowship in our ambulatory area.
• 17:16We currently have 15 former
• 17:18fellows that work at Yale New
• 17:20Haven Hospital with 12 of them here
• 17:22in our oncology Smilo locations.
• 17:25So this is a great way to get
• 17:27people nursing students engaged
• 17:29in a career in oncology nursing
• 17:32and it's a wonderful program.
• 17:34And I want to thank Christina
• 17:36Capretti and Tracy Carafino for all
• 17:39their work and working with Mr.
• 17:41Fred Flynn on this program.
• 17:45The other, the other way we are
• 17:48trying to really advance how we are
• 17:52recruiting and retaining nurses and
• 17:55oncology is to develop a new graduate
• 17:58ambulatory fellowship program.
• 18:00So this is we have not historically
• 18:03hired new graduates into our ambulatory
• 18:06space prior to this and we were fortunate
• 18:09enough to receive a grant from the
• 18:11Frederick A De Luca Foundation to be
• 18:12able to put this program in place.
• 18:14It really protects a new graduate
• 18:17nurses time for nine months to really
• 18:20get immersed and learn about oncology
• 18:22nursing so that they can be prepared to
• 18:25take care of patients in the outpatient
• 18:28setting after that nine month period.
• 18:30I'm hoping that also this will help
• 18:32stabilize some of our turnover in the
• 18:35inpatient area because historically
• 18:36we have required new graduates to
• 18:38work an inpatient for a few years
• 18:41and then transition to outpatient.
• 18:43So I'm hoping that this will have
• 18:46some indirect effect also on our
• 18:49inpatient nursing retention.
• 18:51And I want to thank Christina Capretti,
• 18:53who is really our program specialist
• 18:55who has spent a lot of time putting
• 18:58this program in place.
• 18:59We began our first cohort of
• 19:026 nurses in July.
• 19:03We had over 20 nurses interested
• 19:06in these six positions.
• 19:07So we had great interest across the state
• 19:10and very excited about this program.
• 19:13And then we're taking our lessons
• 19:15learned from the nursing program to
• 19:17also start a cohort of three advanced
• 19:20practice providers next year in 2024.
• 19:24And then we are also really trying
• 19:27to bring more mindfulness and
• 19:30resilience offerings to our staff.
• 19:33Again, this may not be, you know,
• 19:36some people may not be interested in
• 19:38this type of work while they're at work.
• 19:41But we feel really that we want
• 19:43to bring things closer to where
• 19:45our nurses are delivering care.
• 19:49And so we have small groups and micro
• 19:51sessions and staff meetings and then we have.
• 19:54A mindfulness and adaptive awareness
• 19:56expert actually round on our units
• 19:58to to really just in time help our
• 20:00teams put some of these things
• 20:02they're learning in this small
• 20:04group sessions and staff meetings
• 20:06into place and to their daily work.
• 20:09We have expanded this program to our
• 20:12Greenwich and Bridgeport areas and
• 20:13where our goal is to expand to all
• 20:16small smiley sites in the next year.
• 20:18We're also very committed to.
• 20:21To our diversity, equity,
• 20:23inclusion and belonging.
• 20:24Efforts at this really started
• 20:27even before May of 2022.
• 20:29We had some of our smile of sights
• 20:32at the local level really engage
• 20:34in increasing our awareness and
• 20:36also putting things in place to to
• 20:39make our environment more inclusive
• 20:41and to have everyone feel like
• 20:44they belong and can be their whole
• 20:46selves when they come to work.
• 20:48But we did have an oncology nursing
• 20:51leadership microaggressions workshop
• 20:52back in May of 2022 and I am so
• 20:54proud of our of our leaders that are
• 20:57really engaging with their staff and
• 20:59their staff meetings and in other
• 21:02offerings to really bring DEIB into
• 21:04the fabric of who we are at SMILO.
• 21:08We will continue to focus on
• 21:10engaging with the Yale New Haven
• 21:12Hospital Nursing DEIB Task force
• 21:14recommendations which will include.
• 21:16Symposiums,
• 21:17A manager immersion program where
• 21:20our managers will have training and
• 21:24will be able to simulate activities
• 21:27in the DEIB space and our Nursing
• 21:30professional Governance councils will
• 21:32also have goals that will include DEIB.
• 21:37Lastly, I just want to highlight our
• 21:40nursing Professional Governance Council
• 21:41because we are a magnet organization,
• 21:43we truly believe that our nurses
• 21:46should have a voice in their practice
• 21:48and in their work environment.
• 21:51And so our nursing Professional
• 21:53Governance Council has three projects
• 21:56that they focus on each year whether
• 21:58it's it's a nurse sensitive indicator,
• 22:00nurse retention and patient
• 22:02experience and you can see our nursing
• 22:04professional governance group there.
• 22:07In the picture below.
• 22:10And then lastly before I get to the awards,
• 22:13these are just,
• 22:14this is not an exhaustive list.
• 22:16I'm sure there's so much that I
• 22:18could have highlighted as well.
• 22:19But these are just some of the
• 22:22accomplishments from our from our
• 22:23nursing professionals and Smilo and
• 22:25I'm just really humbled and proud to
• 22:27be part of the nursing team here.
• 22:32So we had our awards ceremony last week and.
• 22:36These are our smile of care scholarships.
• 22:40We give out $5000 scholarships to
• 22:44nurses and care associates who are
• 22:46either advancing their degree in
• 22:49nursing or for our care associates
• 22:51who are in their nursing program and.
• 22:54Also again, you can see Liz DeLuca there
• 22:56on the left in this picture and we're just
• 23:00so fortunate that she is our partner.
• 23:02This is the third year we've been able to
• 23:05offer these scholarships to our team members.
• 23:09And then we have been giving Excellence
• 23:11Awards out for for over a decade now.
• 23:14And our nurse,
• 23:15our 14th Annual SMILO Nursing Award
• 23:18for Clinical Excellence is Robin and.
• 23:22Our 12th Annual SMILO Care Associate
• 23:25Education Grant is went to OLU.
• 23:28So I am just so excited to to see again
• 23:32our their peers and colleagues nominate
• 23:35them and they are awarded for their
• 23:38excellence in what they do every day.
• 23:41And then this is our second year that
• 23:43we have awarded a Kathy a Alliance
• 23:45Excellence and Nursing Leadership and
• 23:47this year that went to Tracy Carafino
• 23:49who is our Director of Patient Services
• 23:52for inpatient and for our extended care
• 23:55clinic and the Interim Director for
• 23:58our Education and practice program.
• 24:00And I'm just,
• 24:01it's just great to see the smiles
• 24:04on their face and it was great to
• 24:07celebrate everyone that morning.
• 24:09We also have some Christina Holt.
• 24:12We learned just a couple weeks
• 24:14ago that she is going to receive a
• 24:17very prestigious national award.
• 24:18She is going to receive the 2023 Hastings
• 24:21Center Kind of Dixon Nursing Award.
• 24:24There's only three recipients each year.
• 24:27She was nominated by Doctor Ben Tomic
• 24:29for her exemplary end of life care during
• 24:32the COVID-19 public health emergency.
• 24:34In particular,
• 24:35her leadership in weekly meetings
• 24:37with families of critically ill
• 24:39patients with COVID ARDS on ECMO.
• 24:41We're so excited and we will be
• 24:43having more opportunities to celebrate
• 24:46Christina in the months ahead.
• 24:48So congratulations to everyone.
• 24:50I'm going to stop sharing now.
• 24:53And Kevin, I'll turn it back over to you.
• 24:56Thanks Kim, really an exciting time and.
• 25:00And it is gratifying for all
• 25:02of us to see the success of
• 25:05our many nursing colleagues.
• 25:06So without any further commentary,
• 25:08let me pass it over to Mr.
• 25:10Alexa and Doctor Goodman.
• 25:12And thank you for joining us today.
• 25:16Kevin, thanks so much.
• 25:17Thanks for inviting us.
• 25:18It's our pleasure to be here and.
• 25:21I just wanted to pass
• 25:22on that when I speak to my faculty,
• 25:25my radiologists, I know that they
• 25:27thrive when they work with SMILO to
• 25:29provide imaging and they find this
• 25:31a really rich part of their jobs.
• 25:34And I I believe that the radiology services
• 25:36that in the health system do provide
• 25:39value and quality to your patients as
• 25:41they go through their cancer journey.
• 25:43But of course there's a downstream effect
• 25:45to that demand, which is access, so.
• 25:47Dan and I are here to talk about the
• 25:50the service that we provide and what
• 25:53it's going to look like in the future.
• 25:55So Dan, I'm going to hand it over to you.
• 25:58Yes, thank you Doctor Goodman, and thank
• 26:00you all for allowing us to join today.
• 26:01We really appreciate the time because I
• 26:03think it's important to be transparent
• 26:05as we can about accessing the issues.
• 26:07We're all partners in this and
• 26:08we're all have the same goals of
• 26:11doing the best for our patients.
• 26:12So to introduce myself,
• 26:14I I don't know that I know most of you,
• 26:17but my name is Dan Alex and I
• 26:18am the Executive Director for
• 26:19System Radiology Operations.
• 26:21It's hard to believe,
• 26:22but I've already been here for two years.
• 26:23Prior to coming here,
• 26:24I was the Department of Radiology
• 26:26Department administrator,
• 26:27NYU Lane Gome.
• 26:28I was there for six years and before
• 26:30that I was at Cleveland Clinic and I
• 26:32was the Administrator for Business
• 26:34Business Development and Radiology there.
• 26:36That's just gives a little bit
• 26:37of my background.
• 26:38So the purpose of our presentation today
• 26:40for you this evening is really threefold.
• 26:42One is to acknowledge the difficulties
• 26:45accessing many radiology services.
• 26:472nd,
• 26:47to recognize and describe some of
• 26:50the reasons these problems exist
• 26:52and that's hard to say exist and
• 26:54demonstrate what is being done to
• 26:56improve access, so in radiology even.
• 26:58If we were able to implement the
• 27:00most efficient points of entry or
• 27:02processes providers and our patients,
• 27:04we still need to make sure that we
• 27:05have enough exam slots available
• 27:07for them to be scheduled.
• 27:08One that is really at the right time,
• 27:11is at the right place and is the right exam.
• 27:14Otherwise access is always going
• 27:16to continue to be a problem so.
• 27:18Throughout the past months we've
• 27:20been working with a diverse group
• 27:22of stakeholders that really include
• 27:24our frontline staff and managers.
• 27:26ITS our central scheduling and
• 27:28scheduling teams JDAT,
• 27:30OSM and we've also invited many
• 27:32providers to provide input and
• 27:33we're doing this to develop and
• 27:35implement strategies to optimize
• 27:36operational efficiencies,
• 27:37develop standardized templates to be
• 27:40more efficient with with the scheduling
• 27:42process and to implement technology
• 27:44in order to streamline our access.
• 27:47So we recognize as Doctor Billingsley
• 27:49said in the very beginning that
• 27:51imaging touches every service line.
• 27:53So any improvements we're able to
• 27:54make are going to impact all of our
• 27:57providers and all of your patients.
• 27:58But we also know that the demand
• 28:00for many of our services exceeds our
• 28:02functional capacity to perform them.
• 28:04So our capacity management really has
• 28:06to be the right size to enable improve
• 28:08front door entry into our services.
• 28:10Just to give a quick overview what this
• 28:12slide really is and so the the green.
• 28:15Is the volume of cases on the ambulatory
• 28:18basis that we performed in FY22,
• 28:20the green,
• 28:21the red are the number of cases that were
• 28:25potential that we could not perform.
• 28:28And then the blue dotted line is
• 28:30what we're anticipated to complete
• 28:32this fiscal year.
• 28:34So you can see that in mammography
• 28:37and ultrasound MMR and in PET.
• 28:40We are still falling well below
• 28:41what well PET,
• 28:42I think we're okay, but it we're
• 28:44falling well below our functional
• 28:46capacity to be able to to complete
• 28:48all the exams that are needed by us.
• 28:50And with CT, what I'll be able to
• 28:51show you in a little bit is the
• 28:53reason why that has gotten better is
• 28:54because it's the first project that
• 28:56we're really started to work through.
• 28:59So. So to achieve our goal and improve
• 29:03access, we really had to quantify this demand
• 29:05and develop the strategies to create and
• 29:07build new capacity to meet and exceed it.
• 29:09We established change management projects
• 29:11because that's really what this is.
• 29:13You know, in order for us to make change
• 29:15not just in one side but across the board,
• 29:17it really has to be a change management
• 29:19project that involves everybody.
• 29:20In order for these to work,
• 29:21we have to have leadership support with.
• 29:23Fortunately we do from the very top down.
• 29:26You know they've brought in Guide
• 29:27house now to which I'm sure you'll
• 29:29all be hearing a lot about in the near
• 29:31future to really look at access.
• 29:33And this is a project that we
• 29:35started a bit in ahead of that.
• 29:37But we'll benefit from it.
• 29:38I'm really working on the,
• 29:40you know after the call,
• 29:41after the call,
• 29:42how do we operationally improve our access?
• 29:44What do we have to do to increase our
• 29:47capacity and then frontline worker buy in.
• 29:48Our staff really have to
• 29:50understand what's in it for them.
• 29:51And most importantly,
• 29:52we had really had to make our
• 29:54teams understand that the
• 29:55current state is not sustainable.
• 29:57We can't say this is okay.
• 29:59You know, we have to determine
• 30:00that there are green lights,
• 30:02yellow lights and red lights
• 30:03and when there's a red light,
• 30:04we have to stop and we have to
• 30:06do something about it right away.
• 30:07I'm afraid that in the past we've
• 30:09just kind of come to say okay, well,
• 30:11this is just the way it is.
• 30:12There's nothing I can do about it.
• 30:13So we're we're changing that mentality
• 30:15across the department at every level,
• 30:18starting at the bottom.
• 30:20And then the other thing is we
• 30:21really do have talented people
• 30:22across radiology departments,
• 30:23across all of our delivery networks
• 30:24have done a great job solving the
• 30:26problems that are in front of them.
• 30:28But the problem is,
• 30:28is that each of those little groups
• 30:30even at a location or in the delivery
• 30:32network solve them differently and this,
• 30:34this variation leads to other bottlenecks.
• 30:37We're really trying to leverage
• 30:38things like our EMR,
• 30:39central scheduling services, protocols.
• 30:41You know,
• 30:42all of these things tie in that you
• 30:45really have to reduce variation in
• 30:46order to manage one care signature and
• 30:49then also overcoming all of our common
• 30:51barriers together is much more efficient.
• 30:52It really allows for top
• 30:54of license performance,
• 30:55which everybody wants.
• 30:55They want to do the job that they want to do,
• 30:58not all these other jobs triaging
• 30:59every day that they have to do
• 31:01just in order to to get to the
• 31:02place where they can do their job.
• 31:04And it also allows us to leverage
• 31:06IT much more effectively.
• 31:08And then the last thing we have to do
• 31:10is also develop benchmark standards
• 31:11in order for any service line to
• 31:13reduce variability across the line.
• 31:15And that really folds into our
• 31:16care signature,
• 31:19the next slide, oops, not bigger,
• 31:21just the next one. Okay.
• 31:24So as a group, we developed the
• 31:26strategies to align our supply and demand.
• 31:28And when you break it down,
• 31:30the strategies really include
• 31:32decreasing exam times,
• 31:33increasing hours of operation,
• 31:35decrease our our our same day,
• 31:38no show and cancellation rate,
• 31:39which is really just an opportunity cost.
• 31:41We already have the staff available,
• 31:42people are ready there for patients,
• 31:44they just don't show up and we
• 31:46have to increase our footprint.
• 31:47Along with these strategies,
• 31:49we developed short,
• 31:50mid and long term tactics that
• 31:51we had to implement.
• 31:52So the short term tactics were
• 31:54designed to increase our capacity
• 31:55within our existing framework without
• 31:56having to add any additional costs.
• 31:58These are things we can do more quickly
• 32:00such as decreasing our time slots,
• 32:02improving our same day cancel no show rate,
• 32:04improving operational efficiencies,
• 32:06adding a new MRI,
• 32:08upgrading like in Smilo.
• 32:10We're upgrading to other MRI's in Smilo
• 32:14in the hospital before the end of 23.
• 32:16And then in the middle term,
• 32:18these are tactics that will increase
• 32:20capacity by expanding our current resources,
• 32:22our resource availability.
• 32:23This is like increasing hours of
• 32:25operation and this leads to developing a
• 32:28staff pipeline because you know similar
• 32:30to what everybody's experiencing,
• 32:31there just aren't radiology
• 32:33technologists out there.
• 32:34We have to create our own pipeline
• 32:36and develop our own positions.
• 32:38If we don't do that,
• 32:39we're just going to simply have
• 32:40the same problem that we do right
• 32:42now where we're going to be over
• 32:43taxing our current employees with
• 32:44working overtime working shifts
• 32:45they don't want to work.
• 32:47And by bringing travelers in,
• 32:49all of that costs a lot of money and
• 32:51it leads to really dissatisfaction
• 32:52within our workplace.
• 32:53So we have to do things like develop
• 32:55our own pipeline and then we also
• 32:57have to improve our workplaces
• 32:58to support workflow.
• 32:59A lot of times our imaging center,
• 33:01our imaging locations in the past were
• 33:03built that were not to be efficient.
• 33:05All of the work was even though the
• 33:07CT scan itself takes just seconds,
• 33:09the whole process of setting up
• 33:11them for the exam and everything
• 33:12was done inside the room,
• 33:14which is just really inefficient
• 33:15and takes up a lot of time.
• 33:17And then long term we have to increase
• 33:19our footprint by expansion and that's
• 33:21by adding CON's and by acquisition.
• 33:23We're in the process right
• 33:25now of trying to apply for an
• 33:27incremental CON's for CTMR etcetera.
• 33:29And you know the state with the
• 33:31the office of health strategy is,
• 33:33is really trying to have a hard line on that.
• 33:36So hopefully we get approval for
• 33:37that so we can start to expand
• 33:39our footprint and that really
• 33:40will help expand capacity
• 33:46so. You know the results
• 33:47and benefits of doing this.
• 33:48We're going to be able to eliminate
• 33:50the backlogs we have and improve
• 33:51wait times to get an appointment.
• 33:53We'll be able to keep our patients
• 33:54within our health system and
• 33:55promote continuity of care.
• 33:56We're going to be able to
• 33:58improve operational efficiencies,
• 33:59improve quality and safety,
• 34:01improve patient experience, improve,
• 34:03improve employee engagement,
• 34:04develop the capacity to expand
• 34:06and improve our market share,
• 34:08which is going to be very important.
• 34:10To lower our costs,
• 34:11to increase our volume in revenue
• 34:13and to increase our contribution
• 34:15and operating margins.
• 34:16By doing that,
• 34:17you know at the end of the day
• 34:19that the by making it better
• 34:21for our patients that would
• 34:22be the result for all of it.
• 34:24So I can go to just a couple more
• 34:26slides just to show the impact of these.
• 34:28So whenever you do a project like this,
• 34:31you have to be able to measure it to see it,
• 34:32was it successful or not.
• 34:34And there are a couple ways
• 34:35to do that for the CT project,
• 34:37pick that project first,
• 34:39because there were the least number of
• 34:41strategies that we had to implement
• 34:43in order to make it successful.
• 34:45So for CT,
• 34:45we're able to come up with a
• 34:47Standard Time for time slot and a
• 34:49template that made it so we didn't
• 34:50waste time during the day and it's,
• 34:52it's really optimized scheduling
• 34:55at at these locations. So the.
• 34:58What this slide shows is,
• 35:01is a trend of a backlog prior to
• 35:03the project go live and it was
• 35:05increasingly going up across all
• 35:06of the different types of exam
• 35:08types that we have.
• 35:09And as soon as we implemented it
• 35:12opened up capacity and so the
• 35:14backlog has continued to go down.
• 35:16We see that even to today.
• 35:17And the other correlating point with
• 35:19this to see if it's successful is,
• 35:21is our volume going up.
• 35:23And as we can see both at the
• 35:25New Haven Hospital system and
• 35:26across the system as a whole,
• 35:28our volumes have since we
• 35:30since October of 21 through now
• 35:32have gone up increasingly.
• 35:33And especially since we started,
• 35:35we've seen 25 to 30% increase in
• 35:37volume in outpatient CT just because
• 35:40of our ability to expand our capacity.
• 35:43And that's without having to
• 35:45increase our footprint or do it
• 35:47a lot of those other strategies.
• 35:49Another thing that's been beneficial,
• 35:50and it's helped all our modalities
• 35:52with some access, is the the same day.
• 35:54No show rate,
• 35:55but just by implementing RX health
• 35:57and sending patients text reminders
• 35:59to that their exam is coming
• 36:01up has improved from below.
• 36:03Target and threshold levels to way
• 36:05above and every modality that we have.
• 36:07So in the past we've had you know you
• 36:09know up to 15% of our patients that
• 36:11wouldn't show up any day and exam
• 36:13and now some days we have over 100%,
• 36:15meaning we're having addons too.
• 36:17So not only are patients showing up,
• 36:19we're able to add them on.
• 36:21We're even going to make this better
• 36:23by creating a a wait list fast pass.
• 36:26In our programs, so that if a patient
• 36:28wants to get put on a wait list,
• 36:29as soon as somebody cancels via that text,
• 36:32that slot will be, you know,
• 36:33sent out to 20 or 30 people
• 36:35immediately and get and get filled.
• 36:37So that is also going to be helpful to us.
• 36:41We're also in the middle of our MRI project.
• 36:45The MRI project is going
• 36:46extremely well so far.
• 36:48Our teams are really dedicated
• 36:50to trying to increase capacity.
• 36:52So we've spent a lot of time on
• 36:55standardizing A scheduling tree.
• 36:57And some of the things you might
• 36:58see down the line is some of the
• 37:00order questions might change.
• 37:00All that is designed to make the
• 37:03scheduling process much more automated,
• 37:04to take that burden off of our
• 37:06schedulers from having to know so
• 37:08much about every different site that
• 37:09we have and eventually to make it
• 37:11so that our our patients can even
• 37:13schedule their exams themselves.
• 37:14So by doing that,
• 37:15we're creating work queues instead
• 37:17of having our staff do all of
• 37:19this work and triaging every day.
• 37:20But the most important thing that we're
• 37:23able to achieve by doing all of the
• 37:25stuff that's in blue is starting on June 6th,
• 37:28we're going to be changing our
• 37:30our overall exam templates and
• 37:31shrinking our exams by 5 minutes.
• 37:33That might not seem a lot,
• 37:34but it's going to have that across the
• 37:37system in excess of 5000 MRI's a year,
• 37:39which is really adding like one
• 37:41whole MRI that works 2 shifts a day.
• 37:43Or two MRI's that are over 8 hours a
• 37:46day and that's just by by optimizing
• 37:48our scheduling and our our visit types.
• 37:51Since we have a backlog
• 37:52at a lot of our sites,
• 37:53especially with the New Haven,
• 37:54it's going to take a while
• 37:56for that to shake out.
• 37:56But we just have to pull the
• 37:58Band-Aid off and make this happen.
• 37:59So it's going to be a little
• 38:00bit difficult for a while,
• 38:01but probably starting in the middle of July,
• 38:03early August,
• 38:04the once all of the patients that
• 38:06have been already scheduled have
• 38:08been absorbed in this process,
• 38:10it's going to become much more smooth.
• 38:13And then the other project that we're in
• 38:14the middle of right now is mammography.
• 38:16Mammography is another one like
• 38:17MRI that requires many more of
• 38:19our strategies to be implemented.
• 38:20So it's going to take a little bit more
• 38:22time to get to the finished product.
• 38:24We're actually having a retreat tomorrow
• 38:25with our with our project group to
• 38:28to work through because there is so
• 38:30much variation every time we meet or
• 38:32getting you know down some rabbit holes.
• 38:34So we're just going to suck it
• 38:36up and go and meet in person
• 38:37and and work it out in a day.
• 38:40And I know Rob can speak a little bit more
• 38:41about this in a bit and this is just
• 38:43a quick slide on what we're going
• 38:44to do for our staffing pipeline.
• 38:45You know, as an academic Medical Center,
• 38:47we feel it's our responsibility
• 38:49to kind of train the next
• 38:51generation of of technologists.
• 38:52So we're going to be looking to
• 38:55recruit technologists graduating
• 38:56from school and even you know
• 38:58allowing the latter opportunities
• 39:00for our X-ray technologists to grow.
• 39:02And that's really all I have.
• 39:05Rob, if you have anything that you'd
• 39:07like to add that would be great.
• 39:12No, I think that's that's great.
• 39:14I think we've illustrated that we recognize
• 39:19that our services are highly in demand
• 39:22and that we have to improve access.
• 39:24And I think Kevin will through pass it
• 39:26back to you in case there any questions.
• 39:29Robin, Dan, thank you.
• 39:31I suspect there may be some
• 39:33questions as what was we get to Q&A.
• 39:35I do want to say a very personal thank you.
• 39:39I know how hard the teams are working both
• 39:42on the kind of technical and administrative
• 39:46side as well as the faculty side.
• 39:49You, you know, it's great to be
• 39:51a victim of your own success.
• 39:53The other piece that I will add
• 39:55is a practicing clinician.
• 39:57Is that the.
• 40:00Radiologists are involved intimately in every
• 40:03one of our multidisciplinary tumor boards.
• 40:06This is a piece of our
• 40:08organization that truly makes U.S.
• 40:10special and unique and powerful
• 40:12as a cancer care organization.
• 40:14And I want to acknowledge how much
• 40:18time the radiology faculty put
• 40:20into preparing for those sessions
• 40:23and and how much value they add.
• 40:25So thank you. It's great for me
• 40:29to introduce the next topic.
• 40:30I want to reintroduce Dr.
• 40:33Jensen Morris,
• 40:34who's our SMILO Hospitalist Program Director,
• 40:36Doctor CC Calhoun who's the Director
• 40:38of the sickle cell program and Tracy
• 40:41Carafino is our inpatient Nursing Director.
• 40:44They are going to talk about Smilo E,
• 40:47which is truly exciting.
• 40:49It's an extension of our facility
• 40:52and I want to just take a minute
• 40:54to reflect on the fact that.
• 40:56Not only is Milo at Cancer Care Hospital,
• 40:59it is a facility that cares for a broader
• 41:03group of patients with hematologic disorders.
• 41:05And one of those hematologic disorders,
• 41:08which is a major kind of community
• 41:11and population impact in the greater
• 41:14New Haven area,
• 41:15is sickle cell disease and.
• 41:19I want to be candid about the fact
• 41:22that despite all of our best efforts,
• 41:24not all of our patient population
• 41:27has always felt entirely embraced or
• 41:30at home and belonging within SMILO.
• 41:33And I think this is a full effort
• 41:38by our organization and by our
• 41:41faculty to extend the arms and the
• 41:46clinical expertise and resources.
• 41:49To all of our patients in a way
• 41:51that they feel truly embraced.
• 41:52So with that,
• 41:55pass it off to the three of you.
• 41:59Thank you, Kevin.
• 42:01So the theme of tonight is access.
• 42:06So moving from radiology,
• 42:08access to inpatient access.
• 42:10And we'd like to introduce
• 42:13Smilo East to the group.
• 42:16Doctor CC Calhoun and our
• 42:18Nursing Director of Smile of
• 42:20Tracy Carafino and I will be
• 42:23discussing this new initiative
• 42:28CC.
• 42:30So I don't see the next slide,
• 42:32but I will say that you know
• 42:36we three are presenting it,
• 42:38but you know it's a work of all those
• 42:40people listed on the first slide
• 42:41and for me it's been one of the.
• 42:43Probably most exciting initiative
• 42:44collaborations and initiative I've gotten
• 42:46to work on so far since being here.
• 42:48So when it comes to care of
• 42:51persons with sickle cell disease,
• 42:52one of the things that's critically
• 42:54important is a provider population
• 42:56that recognizes both the disease,
• 42:58pathophysiology and importance of the
• 43:00cultural competency that goes into
• 43:02caring for persons with sickle cell.
• 43:04Right now, persons with sickle cell,
• 43:07the care is a bit fragmented.
• 43:09And and so our next step is figuring
• 43:12out how we can provide continuity with
• 43:15a small group of providers that can
• 43:18provide excellent care across the board.
• 43:24Our other
• 43:27challenge has been that Smile
• 43:29simply doesn't have enough beds.
• 43:32We routinely have patients who are
• 43:34eligible for Smilo who we would
• 43:36like to take care of and Smilo,
• 43:38but they're just on any given day,
• 43:41there just aren't enough beds.
• 43:44These patients, unfortunately then are
• 43:46distributed throughout the East pavilion.
• 43:48Actually, a few last night went to the
• 43:50West pavilion because there were no beds.
• 43:52They're on multiple services,
• 43:54cared for by multiple teams,
• 43:55different attendings.
• 43:56Generally, these teams have a
• 43:59low familiarity with the disease
• 44:01processes and the treatments,
• 44:03the cancer treatments that patients are
• 44:04undergoing as an outpatient,
• 44:07they don't. The teams caring for
• 44:09these patients don't work in close
• 44:11coordination with the outpatient,
• 44:13hematologist and oncologist.
• 44:14So the communication is not as
• 44:17seamless and that results in
• 44:20inconsistent messaging to patients.
• 44:22Care fragmentation and true patient distress,
• 44:25this is what we hear time and time
• 44:27again from our patients when they
• 44:28are not cared for and SMILO, they
• 44:33are worried and do not feel
• 44:35safe because they do not feel
• 44:37that they have their team,
• 44:38their care team with them.
• 44:42So to address both the care sickle
• 44:45cell patients and patients who.
• 44:49Are currently just not getting beds in Smilo.
• 44:52We are expanding the reach of Smilo.
• 44:55We are expanding by 13 beds.
• 44:58On July 31st, 2023,
• 44:59the unit E Pavilion 47 will transition
• 45:03to a Smilo service line unit,
• 45:06meaning that Smilo Nursing reporting up
• 45:11through Tracy Carifino Smile Hospitalist
• 45:14through the Smile Hospitalist Program.
• 45:17All of the Smile supportive services,
• 45:20so pharmacy, social work,
• 45:22all of the services through SMILE
• 45:25will be provided on this unit.
• 45:27It's a 13 bed unit.
• 45:29We do have telemetry which we
• 45:30don't have in the north pavilion.
• 45:32So we will also be able to care for cancer
• 45:35patients who need cardiac monitoring.
• 45:41On average, they'll be about
• 45:435 sickle cell patients and the
• 45:45remaining patients will be other
• 45:47SMILO eligible patients on the unit.
• 45:51The physician care will be the SMILE,
• 45:53a SMILE Hospice physician within
• 45:57my group with working in close.
• 46:02Teamwork with either a sickle cell
• 46:05specialist from Doctor Calhoun's
• 46:06team or a hematologist or oncologist
• 46:09as appropriate from the faculty
• 46:13for the sickle cell care.
• 46:16CC Doctor Calhoun and her colleague
• 46:19Doctor Van Doren have entire curriculum
• 46:23for education of the Smile Hospitals.
• 46:25And a whole multidisciplinary
• 46:27team with whom we'll have daily
• 46:29meetings and then oncology and
• 46:31hematology will work closely with us.
• 46:35And then Tracy, if you want to talk a little
• 46:39bit about the nursing care on the unit,
• 46:40yes, hi. Good evening, everyone.
• 46:42So that goal really here is to provide
• 46:46the same exceptional level of nursing
• 46:48care and give patients the same.
• 46:51Availability to all the
• 46:52services that we have.
• 46:53So Jill Williams is the current
• 46:55PSM of the Hemank unit.
• 46:56So she will be extending her leadership
• 46:59coverage to this unit and she has longterm
• 47:01experience with the Heem population.
• 47:03So I think this is going to be a great,
• 47:06a great opportunity for her to
• 47:07bring that the in and out sort of
• 47:10together working with the team.
• 47:11We will as was mentioned align the nursing
• 47:16leadership all under Smilo and so the.
• 47:20The team will report up through me
• 47:22and we will work together to give
• 47:25patients that comprehensive care.
• 47:26I think we are looking at the staffing
• 47:29right now and there's a lot of things to do,
• 47:31but excited to try and make sure
• 47:33that we have the right staffing mix.
• 47:36We have some staff that are currently
• 47:38caring for the sickle cell patients on
• 47:416-7 who are excited to make the move
• 47:44over and stay with those patients and we are.
• 47:46I'm very happy for that because they
• 47:48will help work on educating the new
• 47:50staff that we hire and building that
• 47:53multidisciplinary team as Jensen
• 47:54mentioned that we have you know
• 47:57pharmacy and care coordination and
• 48:00social work who are all going to be
• 48:02coming along with the patients and
• 48:04excited to add on the oncology piece.
• 48:06So I I think it's going to be a
• 48:08great unit and a great mix and we're
• 48:11looking forward to making this a real.
• 48:14Special for the patients,
• 48:16we did meet with the SMILE Patient
• 48:19Family Advisory Committee on this
• 48:22week and they were very excited about
• 48:24the idea of being able to still be
• 48:27considered SMILO even though they
• 48:29will be in SMILO East.
• 48:30And I think they gave us great feedback
• 48:33on some you know aesthetic things
• 48:35and that we can do to make patients
• 48:38really feel like they are in SMILO.
• 48:40Even though it's in a different building,
• 48:42it's still smile based on really the
• 48:43people that are taking care of them.
• 48:45So exciting changes to come in July
• 48:50and we're looking forward to it
• 48:52and we are happy to take
• 48:54questions as well. Kevin, is there
• 48:56anything that you wanted to add?
• 49:02Thanks Jensa. You know I I guess I would just
• 49:07build on my comments earlier that I think.
• 49:10This is a unique opportunity and I am
• 49:13grateful to our hospital leadership who's
• 49:15seen a way forward in this difficult
• 49:18time to provide additional space and
• 49:21resources for this unique population.
• 49:23Not only are sickle cell patients,
• 49:25but are cancer patients who do have a
• 49:28unique set of care requirements and
• 49:30have been distributed across multiple
• 49:33units and teams across the hospital.
• 49:38You know, I guess I'll just kick off
• 49:41one with a with one question for both
• 49:46doctors Morrison, Calhoun and Tracy,
• 49:49feel free to chime in.
• 49:53Do you anticipate this making it easier
• 49:57to drive our length of stay objectives
• 50:03for this complex group of patients?
• 50:06So I'm happy to address that first.
• 50:08So absolutely we know when we have
• 50:10not just excellent quality of care,
• 50:12but consistent excellent quality
• 50:14of care that that'll improve our
• 50:16overall experience for our patients,
• 50:18but also how we treat their disease for
• 50:21persons who have sickle cell disease.
• 50:22That's critically important in building
• 50:24trust in a relationship communication,
• 50:26which are the foundation of
• 50:28how we treat patients.
• 50:29And I've all we've already seen the work
• 50:32that comes out from Jensen's group and
• 50:34the quality work that they have done.
• 50:36And so I'm thrilled to be able to
• 50:38extend that work, that quality,
• 50:39that excellence to to persons
• 50:41with sickle cell.
• 50:44Thank you. Tracy, I think you were going to
• 50:47pick up a question from the Q&A. Yes, the
• 50:50rooms are actually double.
• 50:52They're all double rooms.
• 50:53They are very large rooms though
• 50:56and one patient on each side and
• 50:59pretty separated and and again
• 51:01we're looking at how to make it the
• 51:04privacy issues and work with that.
• 51:06But they are all double rooms and
• 51:08there is actually 111113 bedroom.
• 51:15Thank you.
• 51:18So let me just ask our radiology team.
• 51:22You know, one of the things that
• 51:25that I am aware of as a clinician
• 51:28is that our accuracy in ordering
• 51:31examinations often can pay play a role
• 51:36in the efficiency of the scheduling.
• 51:40Process and I I work very closely with the
• 51:43body imagers who I'm grateful to and this is,
• 51:46this is an area where I I see it play
• 51:49out a lot if we order the the right
• 51:51exam and we have some judiciousness.
• 51:56I guess in the testing that where
• 51:59you're ordering it can make a
• 52:01difference in these backlogs.
• 52:04Do either or both of you have any
• 52:06specific recommendations that you
• 52:08want to pass on to clinicians?
• 52:10And
• 52:13let me just leave the question at that.
• 52:15So Kevin, that's a really good point.
• 52:17And I think one of the ways that Dan
• 52:20and I can improve access and capacity
• 52:23in our limited magnets and CT scanners
• 52:26is reducing waste. And by waste,
• 52:28I mean inappropriate imaging requests.
• 52:32No, I think SMILO is really good
• 52:36at it's it's it's ability to
• 52:39ask for appropriate imaging.
• 52:41I can't say the same across the
• 52:43health system and that's on us.
• 52:45I think we need to do a better job at
• 52:47guiding our our referrals to making
• 52:49sure that they are actually requesting
• 52:52appropriate imaging studies on expensive
• 52:55pieces of equipment I think where.
• 52:58Smilo clinicians may be able to
• 53:00help is in there in the assessment
• 53:03of the acuity of the study that you
• 53:05need because we obviously have got
• 53:07limited resources we we depend on
• 53:09you to let us know and obviously
• 53:11every wants to scan the next day,
• 53:14but if it is a routine scan,
• 53:16if it can wait for two months,
• 53:17if it doesn't need to be done
• 53:18in a couple of days.
• 53:19We're trying to tweak our ordering
• 53:21screen so that you have that option
• 53:23to have you know between 2 and 14 days
• 53:25or routine and I think that's where.
• 53:28It can be helpful if one is judicious with
• 53:31the acuity of the test you're ordering.
• 53:34And that can be very difficult
• 53:35because everybody is an advocate
• 53:37for their patient at that time.
• 53:38That's in front of them.
• 53:39And so we understand you're gonna
• 53:41try to select the one that gets
• 53:43your patient in most quickly.
• 53:44But the problem that it does is.
• 53:46Until we have no line anymore,
• 53:48which is our goal is to have no line where
• 53:49we don't have to worry about it anymore.
• 53:51We have to worry about priorities
• 53:52or anything like that.
• 53:53But while we do,
• 53:54we have to have this workaround and
• 53:56that workaround is the priorities.
• 53:58And if if everybody is using them,
• 54:01advocating for that patient that's
• 54:03in front of them at that time and
• 54:05making that the most urgent test,
• 54:06it just adds to more triage in the
• 54:09background and makes it harder for
• 54:11our staff to move patients around
• 54:13and get them in more efficiently.
• 54:15And I think another thing to your point, Dr.
• 54:17Billesley,
• 54:18is that a lot of times if there's
• 54:20a bunch of different orders for
• 54:22the same type of exam,
• 54:23a lot of time supervisors will just
• 54:24pick the first one because it's easy.
• 54:26And then what that leads to is while
• 54:28it's easier on the provider end,
• 54:29right there what happens is,
• 54:31is our radiologist will go
• 54:32to protocol that exam.
• 54:33And once they protocol the exam,
• 54:35they say, well,
• 54:35it's not really that then that.
• 54:37And by then the patient might have been
• 54:39scheduled on an scanner that can't do the Ms.
• 54:42protocol or it can't do a different protocol.
• 54:44So that adds to triaging behind the scenes.
• 54:46So we're trying to work with provide
• 54:48us to determine what types of exams
• 54:50that happens the most and then instead
• 54:52of just saying order one of 10,
• 54:54we'll try to guide better by by
• 54:56adding an order question in there
• 54:57which would guide it better.
• 54:59So just you know making available
• 55:01some providers that are high users
• 55:03to us from time to time to help
• 55:05us go through that and figure
• 55:06where that might be helpful.
• 55:08I think can really help a lot because with
• 55:10the scheduling trees that we're building,
• 55:12we're building them so that specific visit
• 55:14types go to specific types of scanners.
• 55:16You know,
• 55:17so if you if you answer like one of
• 55:20the hardest ones is is a brain MRI,
• 55:22well it could be one of 19 protocols,
• 55:24right.
• 55:24So by having the right order
• 55:26question we can take a lot of
• 55:28waste out of that system if we
• 55:30can get it right the first time.
• 55:31So I think what between what Doctor
• 55:33Goodman said and what I said,
• 55:35it really helps deal with the problem
• 55:37at hand until we can get rid of the
• 55:39line and solve the problem overall.
• 55:44Thank you. Just
• 55:47to the group, no,
• 55:48I I did go to a CON hearing.
• 55:50Dan and I were at a CON hearing with
• 55:51the state a couple of weeks ago.
• 55:53We have put in a request for
• 55:55two incremental MRI scanners,
• 55:562 incremental CTS and
• 55:57two incremental PET CTS.
• 55:59So we will wait and see what the state says.
• 56:02Our arguments were strong.
• 56:03You know we are at capacity as you will know,
• 56:06but what the state does remains to be seen.
• 56:13Yeah, there's there's something
• 56:15about the care pathways,
• 56:17Care pathways, I think
• 56:18it's a very good point.
• 56:20You know, and we've spoken to Deb
• 56:22Rhodes about care pathways for imaging.
• 56:24Absolutely this is going to be a way for
• 56:26us to to to to to help reduce that waste.
• 56:30However, she's very astute and she says,
• 56:33you know, whilst radiology can build
• 56:35the care pathways, we have to have
• 56:37our users be part of the process.
• 56:39We can't just institute a care
• 56:40pathway and say that use this.
• 56:42You've got to be part of the design process.
• 56:44So we're going to start that again with the
• 56:47areas that are particularly difficult for us,
• 56:49the total spines which take
• 56:50a long time in a magnet,
• 56:52many patients find it very uncomfortable,
• 56:54can't even continue,
• 56:56can't even finish this test and
• 56:58the utility is often quite low.
• 57:00So we're going to start with that one.
• 57:01But I think bringing the bringing
• 57:03the subject matter experts from the
• 57:05clinical side with the radiologists
• 57:06to build those care pathways is going
• 57:08to be a nice way to move forward.
• 57:14I want to be respectful of time,
• 57:15but I can't help myself and I'm going
• 57:18to ask you gentlemen one last question.
• 57:20One of the things that Jensen and her team,
• 57:23I don't mean to speak for you,
• 57:25but I'm going to find challenging is
• 57:28that we often feel like we need to
• 57:32get that last imaging examination
• 57:34done during the inpatient stay.
• 57:37And we all have trepidation
• 57:40about discharging the patient
• 57:41with uncertainty on scheduling.
• 57:44Do you have any advice for us? So
• 57:47this is a really challenging
• 57:49point and that's why to be open,
• 57:52why I'm working on the
• 57:55ambulatory access issues first,
• 57:57because without the reason you're doing
• 57:59that is because you don't think you can
• 58:02get the examined at a reasonable time.
• 58:04And you don't know how to coordinate
• 58:05that care and how to make sure that
• 58:07they follow up and they get it.
• 58:08So you're just saying, well,
• 58:10let's get it while it's in the hospital,
• 58:11which then contributes to length of stay,
• 58:13it contributes to a test.
• 58:15We can't bill for that we
• 58:17could have otherwise, you know,
• 58:18and using that time slot for somebody
• 58:21else that might have been more
• 58:23urgent in that particular time frame.
• 58:25So that's one of the reasons why
• 58:27we're doing everything we can to
• 58:28create the right amount of capacity.
• 58:32At the same time,
• 58:34you know what the other initiatives Dr.
• 58:36Goodman talked about is by reducing
• 58:39unnecessary Mri's and by we're also
• 58:42reducing more exam times on our part.
• 58:44That's what's also going to help
• 58:46because and then you know, I think.
• 58:49And then I all of your support
• 58:50would be helpful with this.
• 58:52I really think we need to develop a
• 58:54process where if we want to to discharge
• 58:56a patient and make sure they get
• 58:58followed up later that we have somebody
• 59:00that's kind of responsible for that,
• 59:02somebody that's navigating
• 59:03that to say all right,
• 59:05this patient has an MRI in their schedule
• 59:063 weeks out that where they need to
• 59:08get it scheduled that they follow up
• 59:10and then where are the results going.
• 59:12So I think there's a whole layer
• 59:13in there that's not just radiology
• 59:15that we really need to do to to work
• 59:18on to make sure that you know our.
• 59:19That we do want to discharge but
• 59:22feel we can't get completed as our
• 59:24as our providers believe necessary.
• 59:30Lots of great work to do, it's exciting.
• 59:34I just want to take a minute and
• 59:36thank all of the panelists for being
• 59:39here and contributing this evening.
• 59:41Congratulations to the nursing award winners.
• 59:44Kim, any other closing comments?
• 59:47No, I just want to thank everyone for being
• 59:49on the panel and for those that joined.
• 59:51And I again just want to shout
• 59:53out to our nursing teams and our
• 59:55nursing leaders for everything
• 59:56that they do and and thank them.
• 59:58But I hope everyone learned a lot
• 01:00:00from the town hall was able to ask
• 01:00:03the questions that they wanted and it
• 01:00:05was good to see so many people join
• 01:00:07this evening and please send Kevin,
• 01:00:10Renee, myself any feedback on the town
• 01:00:13halls how to these are really for.
• 01:00:16For you and we want to make
• 01:00:18them purposeful and engaging,
• 01:00:20so please send us any feedback as well.
• 01:00:24Thank you.
• 01:00:26Thanks everyone.