Smilow Town Hall | May 6, 2021

May 10, 2021

Information

Hosted by Nita Ahuja, MD, MBA Presentations by: Kevin Billingsley, MD, MBA, Kim Slusser, RN, Michael Holmes, MSA, Roy Decker, MD, PhD, and Daniel DiMaio, MD, PhD

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00:00Of the town Hall, and for those of you
00:03who have been met, I'd like to say,
00:05say hello and it's my pleasure to be the
00:08interim director and position in Chief.
00:11The goal of this town Hall is
00:13for us to share information.
00:15If he say that you know one of our
00:18aspirations is to be an academic cancer
00:20system in an academic health system,
00:23and what we hope,
00:24and I hope you'll see that today,
00:26is that the town halls brings together
00:29all facets of our combined universe,
00:31including our clinical entity
00:32and our educational forum,
00:34as well as a research and these town
00:36halls will be monthly moving forward
00:39on the 1st Thursday of the month.
00:41At 5:00 PM.
00:46Next
00:49so just so you know,
00:51if you have have missed this,
00:53I'm just going to remind you,
00:56this month is Oncology Nursing Month and we
00:58have been having celebration all months.
01:01Yesterday we had the nursing award ceremony
01:03and today's national nurses state so
01:06please wish all your favorite nurses.
01:08All the nurses around us,
01:09Happy Nurses Day and I specially would
01:12like to thank the more than 400 plus
01:15nurses who deliver exceptional patient
01:17care at Smilow Cancer Hospital in.
01:19All of our 15.
01:22Ambulatory care sites in Connecticut
01:23and Investory Rhode Island.
01:24Thank you for all that you do.
01:27Each and every day for for
01:29all of our patients,
01:30I think many of us call you are,
01:33you know, depend on you.
01:35All of our patients depend on you,
01:37so thank you for all your hard
01:39work and truly appreciate it.
01:41I think it also would be remiss
01:43not to call out a special call
01:46out to our Chief Nursing Officer.
01:48Our very own Kim Slusser for
01:50her inspired leadership.
01:51She's been here since mid 2019 and
01:53what a journey it's been through.
01:55Covid and Kim has really empowered our
01:58nursing leadership team at Smilow and.
02:00Support Ferguson step so thank you to
02:02all of you and thank you for helping us
02:04provide care to all of her patients,
02:07not only during kovit,
02:08but as we are now dealing with the
02:11transformation efforts beyond coding.
02:12OK agenda for today next slide.
02:15Today we have a busy agenda with
02:17clinical updates by cabin Billings
02:20Doctor Kevin Billingsley and Kim
02:22Slusser to give you an idea of
02:24what where things are including
02:26what is happening in North Haven
02:28with Kathleen Moseman.
02:29Karen Edelson will provide a brief
02:31update on the hospitalist program,
02:33which I know very,
02:35very excited about and then Doctor
02:37Peter Glaser and Lynn Wilson will
02:40provide updates on radiation oncology.
02:42We have our very own Doctor Rob
02:44Fogarty who will give us an update on
02:47the bed stacking which has affected
02:49a lot of as we've dealt with covid
02:51that the changes all of us have seen
02:53in Smilow and then Doctor Demaio is
02:56going to give us research updates
02:58as and he's our Deputy Director
03:00for the Yale Cancer Center.
03:01With that I'm going to turn it
03:03over to Doctor Kevin Billingsley,
03:05Doctor Billingslea.
03:07Thank you Doctor Ahuja before we launch
03:09into the more formal program today.
03:12I have the pleasure, an honor of of
03:16recognizing a member of our community.
03:20We do a series of awards and recognitions
03:23at the Smilow Conclave on an annual basis.
03:26But every so often there is an
03:29individual whose contributions and
03:31service have risen to a level that
03:33they need to be recognized in an
03:36off cycle or in spontaneous way.
03:38And we have one of those individuals
03:41with us in this town Hall this evening.
03:44One of the things that I think we
03:47have all realized over the past 15
03:49months of this pandemic that we
03:52have managed to weather together is
03:55that the communication links of our
03:57organization have played a central
03:59role in maintaining our response,
04:01our community, our well being,
04:03and keeping and keeping us in touch
04:06with our patients and our family
04:10and their families.
04:11For her key role in keeping us all
04:14integrated as a community and managing
04:17these critical communication links,
04:20it's my pleasure to recognize Renee Gaudet.
04:23Our communications director with
04:25an out of the Blue Award.
04:30Renee, thank you for everything
04:32you do for all of us,
04:34our patients and families every day.
04:37I think everyone recognizes that
04:39you worked tirelessly 24/7 just
04:42last week you had time off and
04:45you were answering calls, emails,
04:47drafting communications and your personal
04:49time off to keep our community and
04:52patients informed critical changes in
04:55their radiation therapy treatments.
04:57The work you do has been a source of comfort,
05:00security and reassurance for our patients.
05:02During this really difficult
05:03time and all of us are extremely
05:06grateful and we can't thank you.
05:08Enough Flowers will be coming your direction.
05:12Thank
05:12you very much, appreciate it.
05:15So Kim, I think I'm going to
05:18turn it right over to you. He
05:21thank you Kevin.
05:22We have some just great topics to
05:25discuss tonight so I will be very brief.
05:28Anita kind of stole my Thunder
05:30but I also want to just recognize
05:32all of our smilow nurses and wish
05:35them a happy nurses week and a
05:38wonderful oncology nursing month.
05:39The theme for Oncology Nursing Month
05:41this year is inspiring an ovation and
05:44inspiring care and I just see examples
05:47of that every single day and I just
05:50feel honored to be your colleague so.
05:52Thank you to our entire Smilow clinical
05:55team and thank you to our oncology
05:57nurses an with that I think we will
05:59just turn it over because there are
06:01some very important clinical updates
06:03that our colleagues are going to
06:05share and that first update is around
06:07the consolidation of our infusion in
06:09North Haven and we have two of our
06:12patient service managers for smilow.
06:13We have Kathleen Moseman and Paula Pike
06:16who are going to provide that update.
06:18So thank you for being here this evening.
06:23Hi good afternoon thank you Kim.
06:25My name is Kathleen Moseman and I'm a
06:28patient services manager for Smilo's
06:30ambulatory solid tumor oncology
06:31services at the York Street campus.
06:34I'm here with Paula Pike,
06:36the clinical program manager of the
06:38Smilow North Haven Care Center,
06:40to talk briefly about the recent
06:42consolidation of infusion services
06:44at the North Haven Medical Center.
06:46As some of you may know,
06:48some of the ambulatory solid
06:50tumor disease teams,
06:51including medical oncology infusion,
06:53remain displaced from their pre covid
06:55location on the main campus and have
06:57been seeing patients in the North Haven
07:00Medical Center since March of 2020.
07:02Over the past year,
07:03these solid tumor patients
07:04have received their oncology
07:06infusions in the Endoscopy suite,
07:07sharing the space with the digestive
07:10health team and their patient population.
07:12We are administering oncology infusions
07:14to patients in recovery room bays and
07:17enlarge oor procedure rooms that were
07:19converted to hold infusion chairs
07:21and while the endoscopy team was more
07:23than collaborative and welcoming,
07:24it felt awkward and it wasn't consistent
07:27with our onkologie significant care.
07:29So we partnered with the existing Smilow
07:32Care Center in the North Haven Building,
07:34which occupies the 4th floor.
07:36Identify how we can optimize
07:38patient care for oncology patients.
07:41Paula and her team were eager to help
07:43and were able to provide some resources
07:45for the solid tumor patients to use.
07:49Thanks Kathleen for providing that
07:51background and setting us up.
07:52Let me just say that it's
07:56lawn mowing season and.
07:58Milo is able to turn on a dime.
08:00We can pivot and we are
08:02a zero turn lawn mower.
08:04An ivory respect 'cause we've
08:05been through lots of relocations,
08:07but we make it happen.
08:11So I wanted to just share a couple of slides.
08:18The first really is that relocation timeline.
08:21And like I said, we we turn on a dime.
08:25We started talking about it.
08:27Maybe we might have some relocation
08:29going on mid March the 30th of March.
08:32We had our first introductory meeting
08:34with stakeholders by April 9th and 10
08:37days later we are moving equipment,
08:40moving people upstairs,
08:41moving people downstairs with the Go
08:44live date on Monday morning at oh 700,
08:46which is phenomenal.
08:48I want to say, you know, for me,
08:52the relocation of Kathleen's team
08:54and the SMILOW patients to the 4th
08:56floor was a little bit different
08:59from what we had experienced in 2020,
09:02where other teams did come to the buildings
09:05in which smilow care centers were occupied,
09:08but never really integrating them into one.
09:11And I think that this is really significant
09:14and really makes a difference in how
09:16we're going to move the future forward.
09:19You know,
09:20we moved two teams of two separate
09:22identities and we County Moseman team Pike.
09:25We put him together in this funnel.
09:27They got all shaken up and they came out
09:30and the end result is we're smilow nurses
09:33treating smilow patients in a common
09:35location and we're erasing those identities.
09:37And yet we have departments
09:39that we belong to.
09:40But really.
09:42It's all about being smilow.
09:45So I know that you know our nurses
09:47had a little bit of anxiety.
09:49I think Kathleen and I had a little
09:51bit of an anxiety about how we
09:53were going to make this all work,
09:55because if you ask the 4th floor team,
09:57we have no space. But you know what?
10:00If you really think about it in the end,
10:02there's always room for one more,
10:04and to me it's like hosting
10:06Thanksgiving dinner, right?
10:07Yes,
10:07set out the plates and you've invited all
10:09the teams and you get a knock on the door.
10:12You open it up and there's aren't Lucy,
10:14but she's got five more people
10:16with her that you didn't expect.
10:18But you have enough food and you get enough
10:21chairs and in the end it all works out.
10:24And that's exactly what we did here.
10:26Kathleen put together a great
10:28scheduling team we work together.
10:29We figured it out.
10:31Six chairs were assigned integrated
10:32into the entire 4th floor and putting
10:34together that plan and working
10:36with Kathleen was phenomenal and
10:38I think it helped our teams feel
10:40better about what was happening
10:42for our patients for the good of
10:44our patients at the end of the day,
10:46and less than four weeks.
10:49Because of what we have done,
10:51Kathleen and I working together,
10:53we have treated 196 patients in
10:55less than four weeks that we would
10:57not have treated on the 4th floor.
11:00Incorporating them into one Smilo
11:01team and one Smiler location.
11:07Thank you.
11:09Thank you. Ola in Kathleen.
11:11I think all of us are just
11:14wowed by the work that the two of you have
11:19led and the flexibility and resilience
11:22of your teams and Paula watch out.
11:26Don't open your door on Thanksgiving,
11:28so maybe there.
11:30I'd like to turn next to a program
11:33that I think we are all enormously proud of.
11:37That is rolling out and introduce
11:40Doctor Karen Adelson.
11:42Add after Liz Pristiq and Doctor Tim.
11:45Opera Bay and Doctor Jensen Morris,
11:48who will update us on our new oncology
11:52inpatient hospitalist program.
12:02Sorry I was
12:03muted. So Renee. Are you
12:04sharing or am I sharing?
12:10OK, alright so I think somebody else is
12:13sharing the slides so I'm so excited
12:16to tell you about this program.
12:18Gensa and I are going to
12:21be going over the slides,
12:23but everybody needs to know what
12:26an incredible team effort this
12:28has been from workgroups with
12:30representation from every different
12:32group of workers at smilow and every
12:35different group of clinicians and
12:37the leadership of Liz Persich,
12:39Tom, Opera Bay and Genset together
12:42has really LED us to where we.
12:45We are now and currently our education
12:47firm Chiefs Polydor and Nicolai Padal
12:50stuff are getting us on the track
12:52to make sure that this new model
12:55maintains and improves the highest
12:57quality of education for our trainees.
13:01Slide.
13:05Am I am I at this answer OK?
13:09So the goals of this Co
13:11management service were many.
13:13The most important was to provide
13:15the highest quality of care to our
13:18patients and improve the efficiency.
13:21Shorten length of stay and make
13:23the patient experience better.
13:25We also wanted to make sure that the.
13:29Patients were receiving the
13:31highest level of expertise,
13:33which meant that their care would
13:36be Co managed by a hospitalist who
13:39was an expert in internal medicine,
13:43an inpatient medicine,
13:44and their hematology or
13:46oncology specialist clinician.
13:47We wanted to emphasize a multi
13:50disciplinary team based care
13:52model and to reduce the burden
13:55of attending on service on the
13:58hematology and oncology faculty.
14:00Who have very busy clinic San.
14:03Lots of other responsibilities
14:04and whom only spend four years
14:07on the acute inpatient service.
14:09An really sometimes have a hard time
14:12navigating the demands of impatient
14:15work over the years in patient has
14:17medicine has become increasingly
14:19complex and there is a reason that
14:22a field of hospitalists have grown
14:25up and Yale has one of the wonder
14:28most established an excellent
14:30hospitalist programs in the country.
14:32And it made sense for us to
14:35tap into this deep expertise.
14:37We also would optimize the ability of
14:40the oncologist to work in their clinics.
14:43That research environment and
14:44have time to actually teach an we
14:47we wanted to reduce hematology,
14:49oncology burnout at a time when our
14:52burnout levels were extremely high.
14:54Next slide.
14:56I wanna say how lucky we were to have
14:58been able to recruit Jensen Morris
15:01to lead our program as the Director
15:04of the Smilow hospitalist Service.
15:06I think you start to know that you
15:09have been successful in building a
15:12program when you start to feel that
15:15you are unnecessary and that is how
15:18I'm feeling because I am watching these
15:21incredible partnerships between gensa,
15:22an lizanne genset in Toma grow as we are.
15:26Rolling out this service so
15:27just a little bit about gensa,
15:29and then I'm actually going to tell
15:31you a little bit of a physician story
15:33about some text that I got today.
15:35I have to make sure my phone is ready is
15:39on and ready to read these text to you.
15:43So Jensen has been a hospitalist at Yale,
15:46New Haven since 2002 and was
15:48the medical director for the
15:50Center of Musculoskeletal Care.
15:52She really developed what it meant
15:54to have a Co management program
15:57in her work with orthopedics in
16:00developing care for medically complex
16:02in developing a model for caring
16:04for medically complex patients,
16:06including geriatric hip fractures,
16:08high risk spine and sickle cell patients.
16:12She is a top ten hospitalists in
16:15the American College of Physicians.
16:17She had national recognition As for
16:19excellence in hospitalist medicine.
16:20There's ten physicians chosen annually,
16:22and has been recognized as a Yale
16:25New Haven hospital hero for as serve
16:28it with a Service Excellence Award,
16:30and she has lectured extensively
16:32on medical comanagement consulte
16:34tive care in internal medicine
16:36and pre operative care.
16:37So Gensa officially joined us three days ago,
16:40but has been working tirelessly
16:42to build this program.
16:43While attending on the covid units for
16:46the last couple months and has had
16:48now three days working on the service,
16:51and I got a text today.
16:53I have to edit a little 'cause
16:56there's names in there,
16:57but this came from one of our
17:00lead advanced practice nurses
17:01and she wrote me to tell me that
17:04Doctor Morris is just amazing.
17:06I have to tell you she just corralled.
17:09A series of doctors in the span
17:11of two hours to get everyone on
17:13the same page for this patient.
17:15This would have taken a week
17:17to do previously,
17:18and then she goes on to say it
17:20is so motivating to me to see her
17:23practice at such a high level.
17:25What a wonderful example for us all.
17:28So we're just getting started,
17:29but I think we're really getting
17:31started on the right note.
17:35Advance to the next slide. OK.
17:39So we launched this with Workgroups
17:42to really identify the cultural
17:45barriers that would get in the
17:48way of success of this program.
17:51I deliberately took a backseat and
17:54let Tomas Lizanne gensa really work
17:56together with an incredible group of
17:59stakeholders in very structured series
18:01of meetings that would identify the
18:04roles and responsibilities and the
18:06workflow for this new service so that it
18:10would be well established when we started,
18:13they finished the work in the last couple
18:16weeks and have now handed offthe new
18:19guidelines to the Education Committee.
18:22Who are figuring out how to use this
18:25new structure to optimize teaching?
18:28And so now we are getting into the education
18:31work group meetings with Paul Nikolai,
18:34Leah Burke,
18:35and Gensa so incredibly exciting
18:38work that has been done an.
18:41Now Jensen is going to take over an Liz.
18:43You're on this call and if if you want to
18:46think about a few words to say at the end,
18:49we'd love to have you contribute as well.
18:52So here we go.
18:53So as Karen said,
18:56the hematology and solid tumor work
19:00groups have completed their work and.
19:04The hematology consensus was
19:06that we would divide the massive
19:09Duffy service into two services,
19:11so you would have we will have the Duffy
19:15teaching service led by the hematologist,
19:18just as it was before staffed by housestaff.
19:22Taking care of the most complex
19:25inpatient hematology patients,
19:26there would be a second.
19:28There will be a second service led by
19:32a hospitalist and staffed by an APP.
19:35That will take care of the lower
19:37acuity hematology patients and the
19:39Duffy hematologist will serve as
19:40as a consultant on those patients.
19:43Anna mentor to the hospital list
19:45on the solid tumor service.
19:46It will look a little different.
19:48We're going to embed a hospitalist into
19:51the teaching service and the hospitalist,
19:53and the oncologist will work hand in
19:55hand to take care of those patients,
19:58run the service, and teach the residents.
20:00The hospitals will be the attending
20:02of record. The oncologist will have.
20:05Greater focus on teaching and really
20:07the specialty care on the service.
20:09This is a true multidisciplinary
20:11model and then as Karen said,
20:13the education group is working now to
20:16do a full assessment of the educational
20:19needs of the trainees and the new
20:21hospitalists and developing clear curriculum.
20:27We thought it was important to
20:30define the unit leadership and
20:32the structure of the Hut smile.
20:34Hospice care management service
20:35and really emphasize that
20:37this is a triad with equal
20:40leadership among the hospitalist.
20:41Attending the hematology, oncology,
20:43attending, and the nursing staff.
20:46Like to introduce our new
20:49smile hospitals for July 2021.
20:52Doctor Nathaniel Parker Dr Erin Gumbos,
20:54doctor Orce Webert and
20:56Doctor Matthew Carter thera.
21:00We intend to expand this program over
21:02the next three years.
21:04Expansion of the program
21:05depends on meeting our goals,
21:07our clinical care goals,
21:08and our financial goals.
21:10Year one. We have a Hospice
21:12director and for hospitalists,
21:13we hope to add 5 new Hospice on
21:16in year two and an additional
21:182.5 hospitals in year three.
21:20Of course,
21:21I have big plans beyond year three,
21:23but this is where we're starting and we're
21:26happy to entertain any questions Liz.
21:28Is there anything you'd like to add?
21:31I just wanted to highlight
21:33the gratitude I have for Smilow leadership
21:35and making this longtime dream or
21:37reality for the inpatient services
21:39and recognize the enormous support of
21:41all years for it to come to fruition.
21:43This past year has been quite chaotic,
21:46and we recognize that it's a true
21:48investment and sign of trust and
21:50commitment in the work that we plan to do.
21:53And I feel confident that will be
21:55able to improve care not just for
21:57our in patients and their families,
21:59who are oftentimes going through.
22:02Enormous challenges that they have not
22:04faced before in their cancer journey,
22:06but also for the physicians and
22:08staff and providers,
22:09and nurses that are caring for them.
22:11So just grateful for the opportunity
22:13to launch this program
22:14this summer and
22:15for the team we have.
22:18You know Doctor Persich stepped into her job.
22:20I think 2 weeks before Covid hit
22:23and we moved all of our oncology
22:25services across town to Saint Rafe.
22:27So what was supposed to be a small
22:30job has become a huge job as soon as
22:34basically as soon as we got back to the
22:37to the main campus she was thrown into
22:40working to plan this hospitals program.
22:42So it has been a very very active first
22:45year for for Liz as a firm chief so.
22:48Thank you Liz. Incredible work.
22:52Karen Gensa Liz.
22:53This is an incredible step
22:55forward for our patients.
22:57For our teams. Very exciting.
22:58Thank you for everything you're doing
23:01and I know we're all looking forward
23:04to seeing how the program develops
23:06in the coming months and years.
23:08Without any further ado,
23:10it's a real privilege for me to to
23:13hand off to our leadership team and the
23:15Department of Therapeutic Radiology,
23:18who have also been very busy in recent weeks.
23:21Caring for patient sing and
23:23managing a number of challenges
23:25in their division or Department
23:27that they will share with us.
23:30So, Doctor Glaser, Doctor Wilson,
23:32and Doctor you.
23:33Yeah thanks thanks Kevin.
23:36I think most of you know actually
23:39thanks to the excellent communications
23:42work by Renee that our Department
23:46was impacted by a cyberattack
23:49on the software vendor Electa.
23:51That provides the software that runs
23:54our linear accelerators and this
23:57impacted our ability to deliver
23:59our treatments in a normal way.
24:02And like Paula,
24:03used the analogy of a lawnmower
24:06pivoting we had to pivot on a dime to
24:10develop a whole entire new workflow
24:13that was highly manual and depended
24:16on creativity of our physicists and
24:19the dedication of our physicians.
24:21Dosimetrists and.
24:22Therapist to implement in a way
24:25that minimize the interruption
24:27of treatment to our patients.
24:30And I want to recognize our leadership team,
24:33Lynn Wilson James you,
24:34Frank Claudio, Brian Wang,
24:36Ina Sala and and others who
24:38played a major role in helping
24:40to lead us through this process,
24:43which is still under way.
24:45We're not totally out of the Woods yet,
24:48but we have the light at the
24:50end of the tunnel.
24:52And, you know,
24:53we're in much better shape right now.
24:56But it is a wake up call, I think.
24:59Not just to us,
25:01but to all of you know,
25:03our medical infrastructure,
25:04not only young haven health
25:07system but in our country of
25:09the risk of this sort of thing.
25:11So I think I'll hand it off to
25:13Lynn and James to give a little bit
25:16more detail about where we are.
25:22Thanks Peter. So the first
25:25indication that there was a problem
25:28was actually back on April 6th.
25:32That afternoon our systems went
25:36down and it became apparent to us,
25:39through communications and a
25:41memoranda that we received from
25:44Elekta that there had been some
25:47sort of cyber malicious activity
25:49impacting one of their cloud systems,
25:52of which all of our data and
25:55treatment mechanisms resided upon.
25:59This also impacted over 40 other
26:02department's internationally,
26:03so we were not the only ones they had
26:07Fireeye involved, who is one of the
26:10world's leading cybersecurity firms,
26:12and we were given good assurance by
26:15Electa that over the next 24 hours,
26:18things were actually contained an fine.
26:21So at that point our downtime was minimal.
26:25We only lost one treatment day.
26:29Which old physicians felt that we
26:32could tolerate for our patients?
26:34So we were underway again?
26:37Two weeks later, on April 20th,
26:40we ran into trouble again.
26:43Systems went down and we quickly,
26:46unfortunately,
26:47learned that there had been
26:50another attack on their systems.
26:53Fire I advised them to shut
26:55everything down and it became clear.
26:58Over the ensuing hours that evening
27:00that this was not going to be.
27:03Like it was two weeks prior where
27:05we might be able to be back on
27:08our feet within a day or so.
27:10At that point,
27:11we obviously had lots of emergent meetings,
27:14lots of folks involved started to
27:16have conversations with parents,
27:18patients, and tried to figure
27:20out what we were going to do.
27:24Fortunately,
27:24we are.
27:25Physicist did develop an alternative
27:27treatment mode called file mode,
27:28which was developed in the event that
27:31we were having a software upgrade,
27:33which usually happens over the weekend
27:36when we're not treating patients.
27:38But we do treat emergencies over the weekend,
27:41so we needed a system in place
27:43to be able to treat a patient
27:46who required emergent care.
27:47If we were doing a planned
27:51voluntary software upgrade.
27:52We enlisted that mode.
27:55We had never used it before,
27:57although it does require much more
27:59manual input and closer supervision
28:01than the standard treatment delivery,
28:04which is basically run by computer systems.
28:06Although we did deem this safe of course,
28:09to treat patients,
28:10and it was our emergency backup
28:13plan that we had developed to treat
28:16patients on a weekend in an emergency
28:19which predated this catastrophe.
28:21We initiated that mode for
28:23patients very slowly at first.
28:26To get experience.
28:27We also had the advantage of Griffin
28:30Hospital is staffed by Yale University,
28:33radiation oncologists.
28:34Although they're not obviously in the
28:37system as part of the Yale Health system,
28:40their machine linear accelerator
28:42there and they also have elected
28:45software is quite similar in what
28:48we call closely be matched to
28:50three of our linear accelerator.
28:53For elector one, it's Milo,
28:54one in Hamden and one in Guilford.
28:57So patients from Guilford in Hamden
28:59were quickly triaged to Griffin
29:01and physicians from those centers.
29:03Also of course,
29:04were involved in the care of
29:06those patients at Griffin,
29:08so that was very helpful to us.
29:11The remainder of the patients
29:13needed to be treated in filed mode,
29:15and they were brought on all of these
29:18patients I'm talking about were
29:20brought back online within several days some.
29:23More quickly than others,
29:25depending on their clinical situation,
29:27how far along they were in their treatment,
29:30and what sort of mitigating
29:32circumstances we could consider on
29:34a case by case basis is a patient getting
29:37active in treatment after a tumor's
29:40been completely removed compared to,
29:42say, a head neck patient with large
29:45tumor obstructing their airway.
29:47Obviously very different case
29:48priorities and complexities.
29:49The other thing you should know
29:52about the mosaic. Software.
29:56Many departments around the world
29:58use this elect as one of the two
30:02large vendors internationally.
30:03This was an international incident.
30:05Fortunately, none of our equipment or
30:08software in House or any of our Yale systems
30:12was infiltrated in any way by this attack.
30:15So that's the silver lining.
30:17This software system also serves as
30:19our medical record for these patients,
30:22so we had a lot of challenges
30:25when this happened.
30:27We literally had no record of what
30:29had happened to anybody other than
30:31their clinical epic appointments,
30:33which was extremely helpful.
30:35Are our physicians notes and you know our
30:38recollection from physicians and our staff,
30:40because obviously it was important
30:42to identify how many treatments
30:45each of these patients that had,
30:47especially since we were moving them around.
30:51Outside of what we're used to doing.
30:53So. At this point, we continue to.
31:00We are coming.
31:02We've come back online significantly.
31:04Those three elected machines
31:06are now operational.
31:08Are Yale,
31:09IT team and physics and everybody
31:12involved in our Department has literally
31:15been working around the Clock since
31:19the 20th to rebuild the system.
31:21But on premises as opposed to seeking
31:25this information from the cloud.
31:27And that's not unusual.
31:29And many departments around the
31:32world don't interact with the cloud.
31:35Many do. It's you can do it either way.
31:39So now we've got our own mosaic system
31:42on premises. It is up and running.
31:45New patients are being integrated
31:47through that system,
31:48and we're basically in terms of patient care.
31:52Things are very,
31:53very seamless at this point,
31:55no new patients who were on
31:57our schedules or plan to start
32:00treatment have had any significant.
32:02Interruption in their care and
32:04things are still very hectic but
32:06running relatively smoothly.
32:08We're still using paper charts for
32:10those who are in the file mode,
32:13and we expect to, probably,
32:15hopefully by the end of next week,
32:17or into the beginning of the following week.
32:20Get to a point where we have
32:23everybody back online in a way
32:25that we can care for our patients
32:28in the very traditional sense,
32:30and we can move away from all the paper.
32:34Paper documentation and get back
32:36to where we're used to operating,
32:39but this has been a whole Erica Hercule
32:43Ian effort from many of our staff.
32:46As you can imagine, Yale.
32:49New Haven Hospital IT matza.
32:52Wallach and his team have been phenomenal.
32:55This type of on Prem system is
32:58something that we have thought about
33:01before and talked about just to give
33:04it perspective under normal operating
33:07circumstances it is at least a two
33:11month project pushing three months.
33:13This team has accomplished this literally
33:16in five days which has been incredible.
33:20So I'll stop there and ask James
33:22if he would like to add any
33:25additional comments at this point.
33:30No, I think you guys covered it.
33:33I just want to say, you know,
33:35in the Department where we're making our
33:38way back we continue to face challenges,
33:41but we appreciate truly the
33:43outpouring of support from all of
33:45our colleagues throughout Smilow
33:47and just a couple more names.
33:49Jay Chena physics Denise Allen,
33:51Sarah Lombardi and is similar in our therapy
33:54managers Christina Solano Metabolic.
33:56We truly took a village to get us back.
34:00And they were absolutely terrific,
34:02and the future is bright for us. We are
34:04going to move forward with
34:06two more with some new
34:07technology coming up, so stay tuned.
34:09This won't be the last you hear Atlas.
34:15Gentlemen, thank you.
34:16I know that we're all incredibly
34:19grateful for your leadership.
34:21The on the fly innovation that
34:23you and your teams have done
34:26over the past several weeks.
34:28And please take our debt of gratitude
34:31back to the really literal army of
34:34Unsung heroes in your Department,
34:37many of whom were mentioned by name,
34:40some of whom were not.
34:42But we know that the physicist,
34:44dosimetrist, therapists,
34:45nurses all contributed mightily
34:47to this effort, so thank you.
34:52So moving on with our agenda,
34:54it is always a pleasure for me to.
34:58Welcome Doctor Rob Fogarty to our gathering.
35:03Speaking of Heroes sung or unsung,
35:06Rob has been.
35:08Kind of the stalwart behind our covid
35:12response efforts as we have kind of had to.
35:17Sometimes pivot like lawnmowers
35:18sometimes turn like the Titanic.
35:21All of our efforts is a health system to
35:25navigate our response to the covid crisis.
35:28Over the past 15 months.
35:32And hopefully we are entering maybe not
35:34the end game, but the fourth quarter.
35:37And we did ask Rob to join
35:40us today to bring us up.
35:43To speed on bed stacking from
35:45a health system perspective,
35:46thanks Rob.
35:47Thank you.
35:48So
35:48I'm gonna take just a minute because I am
35:50a hospitalist much like Doctor Morris.
35:53And for those of you who haven't met her,
35:56she is the hospitalist that
35:58we all aspire to be like.
36:00But realized we will never get there.
36:03She is a. The type of doctor that a
36:08lot of us wish we had the ability so.
36:11You did good. And we'll just.
36:14We'll leave it at that.
36:16So I do have some slides that
36:19I'll pull up here.
36:20And I'm going to start with
36:22where we have been, where we are,
36:25and then hopefully where we're going.
36:27But I want to take it just a second
36:30and say that I need to crowd source
36:33all sorts of ideas so my inbox is
36:36always open and I'm more than willing
36:39to listen to any idea because it's a
36:41challenge and I will never turn away.
36:44Good idea,
36:45regardless of where it comes from.
36:48So this is some mortality data for
36:50inpatient covid disease specifically,
36:51and this comes from the CCA,
36:54which is the organization that also
36:56reports out to the feds and is usually
36:59what is used for the popular press.
37:01And this is this is inpatient mortality
37:04from covid in Connecticut for the entire
37:07pandemic and in the middle you can
37:10see that the mortality rate is 13.2%.
37:13Well, no,
37:13cancer is the 2nd leading cause of
37:15death in Covid was number 3 this year,
37:18so that number probably is not
37:19much of a surprise.
37:21Nationally,
37:21it's about 11 to 11 1/2% and if
37:23you look circled there, you'll do.
37:25Haven Health System is 9.2%, well below I.
37:27I understand this is all wrong
37:29mortality data.
37:30I didn't do statistical testing
37:31and all of that,
37:32but it certainly passes the eyeball test
37:35and if you look at the rest of the state.
37:38Draw your attention to Trinity.
37:39Trinity is a big healthcare system.
37:41They have a big hospital.
37:42They have a giant national network
37:45and our mortality rate was left
37:47at less than half of theirs.
37:48And that's something that the health
37:51system should be very proud of.
37:53We we we you all of us.
37:57Presented with truly unprecedented challenge
37:59and the data I think speaks for itself.
38:01If we're going to get New Haven centric,
38:04we can do that.
38:06There are two big health
38:07systems in Connecticut.
38:09There are two, but are largely
38:11considered to be referral centers.
38:13There is able to have in hospital,
38:15which you can see it only
38:18gets better 8.7% mortality.
38:19At which is remarkable,
38:21really, if you think about it,
38:23unbelievable.
38:23And if you compare that to what
38:25is the other referral center?
38:27Other hospitals specially unaffiliated
38:29hospitals will play a game where
38:31they will try to transfer patients to
38:33both hospitals because they know that
38:35those are the two hospitals that can receive.
38:38Referrals hard for hospitals
38:40down here in orange.
38:41In the mortality rate for 16%.
38:45And they do good things up there.
38:47I'm not here to throw stones,
38:48I'll point out that Windham had the
38:51lowest mortality rate in state 7%.
38:53But I want to just take a second and
38:55say that this would not have happened
38:58without everybody's contribution
38:59and all of you everyone smile.
39:01Oh, it doesn't matter if you saw covid
39:03patient in clinic or you rounded on a covic,
39:06it doesn't matter.
39:07Everybody picked up a bucket and
39:08put out the fire and we don't.
39:10We don't get to celebrate a lot for the
39:12past couple of months past year really.
39:15So so if I may take a minute and
39:17realize that when the story is
39:19written about covid this is one of
39:22the successes that Yale New Haven
39:23Hospital stood up and we were here for
39:26our community when they needed us.
39:28And you all absolutely more critical in that.
39:30So for what it's worth,
39:32I know I'm kind of a nobody,
39:34but from where I sit looking at the
39:36health system in the hospital as a whole.
39:38And what we were confronted with,
39:40you will always have my.
39:42My thanks for what that's worth.
39:45So that's where we were.
39:47Now let's look at where we are.
39:49This is the daily version of the CCA.
39:51Report out then I slide is from the 27th.
39:54Just because I I'm trying to tell
39:56the same story to different folks as
39:57I as they invite me to these things.
40:00But there's a couple things I want
40:02to point out. The slides very busy.
40:04For the past two or three months,
40:07you may have experienced some
40:08cognitive dissonance.
40:09The states opening up things
40:10are getting better.
40:11You know the WTNH was throwing parties,
40:13and yet our census was getting worse.
40:15Our covid stress was getting worse,
40:17and it's true.
40:18New Haven County detached itself
40:19from the rest of the state,
40:21and we were really the only part of
40:23the stage was experiencing this surge
40:25over the past two or three months.
40:27It was real and we felt it,
40:29and you felt it,
40:31and it was hard because the rest of
40:33the state maybe wasn't feeling it.
40:35And on this particular day,
40:37all of Hartford County,
40:39entire County of Hartford had
40:4183 covid inpatients and Yale.
40:43New Haven Hospital had 88.
40:47There are 2500 hospital beds in
40:48Hartford County and it has more
40:50people than all of New Haven County
40:52and yet our hospital with our
40:54fraction to catchment area still
40:56had more covid inpatients so.
40:58It's been a punch in the face.
41:01Then it got punching and whatever
41:03other cliche you want to use,
41:05but it was real.
41:06New Haven County in specially Young
41:07Hospital has had a disproportionate disease
41:09burden through this most recent wave,
41:11and it's unfair,
41:12but it is what it is and we have
41:16to play the hand that we're dealt.
41:19To Kevin's point to doctor Billingsley point.
41:21Potentially,
41:21there's a little bit of encouraging
41:23news recently. Let's hope it continues.
41:24I don't want to.
41:25I want to say more than that.
41:27I am a superstitious person.
41:29So how do we continue?
41:30How do we continue to dismount?
41:32So we're kind of flying the plane is
41:35we're building it to borrow a cliche.
41:37And there are two things that we think
41:39about when we're trying to do bed planning.
41:41One of them is the volume of patients
41:43and the second one are there.
41:45To be to be glib about it,
41:47the restrictions in their care,
41:49whether their isolation needs,
41:50what are the gown needs,
41:52can maybe Co forwarded with other people.
41:54What are the airflow requirements
41:55and the volume is either lower height
41:57or somewhere in the middle and then
41:59the restrictions are either low or
42:01high or somewhere in the middle.
42:03And we don't know where this
42:05is going to end up.
42:06We don't know what our long term
42:08covid run rates are going to be.
42:10We don't know eventually with the
42:12science is going to tell us about
42:14how best we can covert these folks.
42:16We've learned a lot and work very
42:18closely with infection prevention.
42:19We do what the science tells us.
42:22We talked to other health systems.
42:23We're all learning through this together,
42:25but we don't really know where
42:27we're going to end up.
42:28If we end up with two or three
42:31covid inpatients, that's easy.
42:32If we end up with. 40 or 50?
42:35That's not so easy.
42:36The one thing that everyone agrees is cope.
42:38It's not going away,
42:39so we have to plan for it in some some way,
42:42shape or form.
42:44So the approach that we're taking,
42:46I call him Lego blocks,
42:47but it's really to be precise
42:49about it's a modular tools and Lego
42:51blocks come in different sizes,
42:53shapes, and colors,
42:54so we're trying out and we're
42:56learning how to do all of these
42:58five different techniques,
42:59and eventually,
43:00wherever we are on this curve,
43:02we can take these pieces and put
43:04them together and right size it.
43:06And the reason we want to right size
43:07it is because the disruption that
43:10you're feeling and the disruption,
43:12the signature of care, the way that we.
43:14Wanna provide care for all of our
43:16patients regardless of their disease state?
43:18It's not where we want it to be,
43:20and we need to keep moving forward.
43:22You need to keep pushing the
43:24envelope so that things can can
43:25return so that every day we're
43:27coming in and not only that,
43:29the medicines and procedures
43:30that we're doing,
43:31but the way that it's being the way
43:33that is being delivered to the patient,
43:35the experience of the patient.
43:36At this critical,
43:37we need to get back to that.
43:40So those are the those are the tools
43:42that we're using two special points
43:44just to point out for transparency.
43:46Covid is a medicine disease.
43:48We all realize that if it was normal,
43:50coronavirus would go to the
43:51medicine footprint.
43:52Medicine footprint is predominantly
43:53doubles and triples,
43:54so if you were going to XYZ a
43:56disease that exploited a weakness
43:58in our medicine bed stack,
43:59covid does that pretty well.
44:01And then the ICU piece.
44:02Just want to point out that that's
44:04that's debilitating to the institution.
44:06We have a group and some of the folks
44:08on the collar on it, and we meet.
44:11Every day to try to figure out how to
44:13move the pieces to keep all the patients
44:16moving through the through the ICU.
44:18And it's a challenge.
44:20And the last thing I'll say is that.
44:25I mentioned earlier a lot of folks
44:27call me to come to things like this
44:29and I'm always happy if anybody wants
44:31to talk about any of these in detail.
44:33Send me email. I'm more than happy.
44:35Transparency is critical.
44:38And not only are you not alone when
44:40when people are having a rough day
44:42and I share with them some of the
44:45stories of what your team has done,
44:47I tell them about how disruptive
44:49and we want this bin.
44:50I tell them about when I was rounding
44:52in the first piece on MPA and how
44:55critical that was to keeping patients
44:57who didn't have covid as their primary
44:59disease getting their lifesaving care.
45:01I talked to them about operating on
45:03one campus and using an ambulance
45:05in the postoperative state.
45:06I share all of those stories.
45:09So so,
45:09so you're heard your valued and and again,
45:12I'll just end by saying I I cannot
45:15thank you enough because the success
45:18story of our covid response is in no
45:21small part due to your efforts and
45:24your flexibility. That's all I have to.
45:30Rob, thank you.
45:33You know your overall perspective
45:35really helps frame the work that that
45:38the entire organization has done,
45:40but also the importance of the
45:43contribution that that our teams have made.
45:47And I do think that that's helpful
45:50and affirming and hopefully
45:51will have a few moments for Q&A.
45:54At the end there.
45:56There may be some questions,
45:58but just your presence and.
46:01Your perspective is is enormously helpful.
46:06I think in our closing interval here
46:11will shift to our research world and.
46:16Doctor Dimaio can I ask you to?
46:19Take it from here.
46:36Did Dan are you muted?
46:45There you go, thank you.
46:48So can you see
46:50my slides? We lost your slides, Dan.
46:54Try again.
47:04How is that?
47:05It's coming up there.
47:06We are firm business. OK, I'm going
47:08to open him up.
47:13OK, perfect, so we need to ask me a
47:15couple of weeks ago or told me that
47:18she wanted to combine the smile of town
47:21Hall with the Cancer Center meeting.
47:23Thought that was a terrific idea 'cause
47:26we really need to work together and
47:28it struck me that for the El Cancer
47:30Center in the Spinal Cancer hospital
47:33truly attains extraordinary potential.
47:34The research and clinical arms really need
47:37to work together seamlessly and support
47:39each other so the research benefits from
47:42access to patients and patient samples.
47:44And the patients will benefit for the
47:47wonderful scientific discoveries that
47:48we make here in the Cancer Center.
47:50So I thought this was a terrific idea.
47:53We have a major event coming forward
47:55in the next couple of years and that
47:58is we have to renew our Cancer Center
48:01support grant we call our CCSG at.
48:03The grant is not due until.
48:07At the end of 2022,
48:09that's more than a year from now,
48:11but we're already beginning,
48:12and as you can see,
48:14the first drafts are due in a
48:16couple of months.
48:17So many of you may be asked for help
48:19writing sections of the grant or
48:21providing data to put into these sections,
48:24but this is a long process.
48:26Very important.
48:27This is a multiyear multimillion
48:28dollar grant that supports much of
48:30the administrative infrastructure
48:31at the at the Cancer Center,
48:33as well as many other activities
48:35including pilot grants.
48:37It also allows us to maintain our
48:39designation as an NCI comprehensive
48:41Cancer Center.
48:42This is this is very important.
48:45We have had one major structural
48:47change we have used to have 7
48:50research programs and we disbanded
48:52one of them this year.
48:53The Cancer microbiology program
48:56and we dissolved it because.
48:58We had trouble convincing the NCI
49:00that it had sufficient cancer focus.
49:02We disagreed with them, but.
49:05Instead,
49:06I will continuously has told the
49:08SAT and we decided that we wouldn't
49:10fight that battle anymore.
49:12There are 33 members of this program
49:14that have been moving to the
49:16remaining 6 Cancer Center programs,
49:18and I want to reassure them and
49:20everyone else in the Cancer Center
49:22that the topics studied by cancer
49:24microbiology are of crucial importance.
49:26Tumor viruses HIV bacteria in the microbiome.
49:28These studies will flourish and that
49:30will strengthen our remaining programs.
49:32About 20% of all cancers are called by my.
49:36Caused by microorganisms.
49:36This is very important to our Cancer
49:39Center and we will continue to support it.
49:43I do want to highlight some special
49:45awards and recognition that
49:47members have received just last week.
49:50Liping Chen was elected to
49:52National Academy of Sciences,
49:53one of the highest honors our faculty
49:56can receive in honor of discovery
49:58of some of the first checkpoint
50:00can controls for immunotherapy.
50:02In fact, email therapy in large part
50:05derived from some of his early research,
50:08which just highlights how important basic
50:11research is for improved cancer treatment.
50:14Two other members run breaker and hit.
50:16It was Saki, where electricity members of
50:18the American Academy of Arts and Sciences.
50:20They both actually we're already
50:22members of the National Academy,
50:23so this is another nice recognition for
50:26them for Ron studies on RNA in the pico
50:28studies on viral and cellular immunology.
50:31Our strengths aren't restricted
50:33to the to the laboratory.
50:35We have a number of people have received
50:38very nice clinical words recently.
50:40Joe Lacey and and this check park have
50:42been named Fellows of the American
50:45Society of Clinical Psychology,
50:47ASCO and then Jen Capo.
50:49You see,
50:49the President's award for the Connecticut
50:52Coalition to improve care end of life care.
50:55So it's terrific.
50:56This really spans the entire spectrum of
50:58clinical care, medical oncology, surgery and.
51:01Pillars of care.
51:03In addition,
51:04a number of people receive very nice
51:06grants that are that are listed here from
51:09DoD from Alliance American Cancer Society,
51:11the Yale Cancer Center has more research
51:14money now than we ever have to study cancer.
51:17It is a tremendous accomplishment
51:19approaching $100 million in direct costs.
51:21And finally,
51:22I just wanted to point out
51:24a few of the new members.
51:26I'm sure this is not a complete list that you
51:29can see here that are enriching our program.
51:32Some have already been here and
51:33I've just joined the Cancer Center.
51:35Others are new recruits TL and I
51:38will help highlight two of them.
51:39Marcus Motion is come here to lead the new
51:42Center for Molecular and Cellular Oncology.
51:44Wanted to recruit a bunch of new
51:46physician scientists that will help
51:48against ban help bridge the gap between
51:50basic research and clinical care.
51:52And Michaela Dynon,
51:53who is from Duke, who is our new.
51:58Out of our new leaders for the cancer
52:00prevention and control programs,
52:02and so both of them,
52:03and particularly Michaela,
52:04will be very busy in the coming months.
52:06Writing up her program
52:07for Cancer Center renewal.
52:09So that's why I want to say,
52:11and I'm I'm happy to transit podium backed,
52:13Anita, thank you.
52:16Thank you Dan and thank you
52:18to all of our panelists.
52:20I have to say, if you know the past few
52:22weeks as I've gotten to know everyone,
52:25I am so impressed by the amount of
52:27clinical activity research activity
52:29in our trainees, what they're doing,
52:31and I hope that you all get to see that.
52:34I think sometimes when we run
52:35around in our daily actions,
52:37we forget what an incredible space we occupy.
52:40And you know that as Doctor Fogarty
52:42shared all that data around the state.
52:44I think we have to sort
52:46of all give ourselves.
52:47A silent Pat on our own backs
52:50in that everybody participated
52:52during Kovit in in various ways.
52:55Cancer Center Smilow Hospital
52:56probably took a big brunt as
52:58the shift she places shifted.
53:00I know that Fogarty's hardness
53:02we are looking at solutions,
53:03but I think we also need to acknowledge
53:06what a wonderful you know job everyone
53:08has done and and I have to say that you
53:11know as Dan was sharing all the people,
53:14Akiko Wisocki was known on.
53:15If you go on Twitter as doctor viral
53:18immunity and she taught probably most
53:20of the world about covid and and the impact.
53:22So we are blessed to have such
53:25amazing people around us and.
53:27I hope that as we use this town Hall,
53:29we get to know each other because.
53:32Patients fundamentally benefit when
53:33science and great clinical care and
53:35quality and everything comes together.
53:38So the more we can intersect
53:40all of these pieces,
53:42the better our patient care delivery becomes.
53:44I'm not seeing questions,
53:46so either you everyone's being really
53:49shy or I'm missing the raised hands
53:51when they please keep me honest.
53:54If I have someone's raising hands,
53:56I try to be good about it.
54:00I'm going to give us a minute or two
54:02for folks to sort of raise their
54:04at least be anonymously asked me.
54:06I think the whole point of this is
54:09that we start sharing the things we
54:12want to hear about this Cancer Center.
54:15Doctor Billingsley Kim Saucer
54:17anything else you'd like to?
54:20Oh,
54:21there you go.
54:21Roy hurts way to go.
54:23When will we get the ECC back?
54:26Hey, this is Kim. I can take that one so.
54:31Boy will ask you. There we go.
54:33So we are currently exploring the
54:36ability to move back the ECC to MP
54:3912 or I do not have a timeline,
54:41but we are actively looking at it
54:44and evaluating if it's a possibility
54:46because we do know that that is
54:49important to do on so many levels.
54:51So so more to come.
54:53Hopefully you know we'll have more
54:55to share at the next town Hall,
54:57which is just four weeks away and it might.
55:01Communication might be even sooner,
55:03so we will keep you posted.
55:05But after
55:0640 you may get away.
55:07I told you where there's going
55:09to be a lot of questions and
55:11no ones asking the questions,
55:12so I don't know either.
55:14Kevin kind of did such a great
55:15job of sort of introducing you
55:17or not getting all of this.
55:20Offense in their room,
55:21but I I first of all Rob
55:23said that he he kind of minimized his
55:26role but he is the bed sore and you
55:29know units were flipping nonstop and I
55:31felt like we were in very able hands
55:34throughout this very chaotic time and
55:36so just to recognize his efforts there
55:38and always with a smile and always
55:40very competently and calmly somehow.
55:42But, you know, smile has made
55:44significant sacrifices and it's been
55:45a huge challenge operationally in
55:47clinically not just for the outpatient
55:49space for the impatient space, but.
55:51We will always ask at every
55:52meeting with Rob Fogarty.
55:54If and when will get NP15 back.
55:58Short, so you should ask,
56:00and that's right, absolutely,
56:02and I'll tell you that I don't know I
56:07that I think I mentioned our daily ICU.
56:11Meeting and I don't want to waste
56:13the whole time, but we we thought
56:15we were going to lose a significant
56:16portion of the overflow medical ICU.
56:19And we test drove what it would look like,
56:22not even to close. MP 15.
56:25But just to take about 1/3 of that
56:27ICU census and find other places
56:29to provide ICU level care to those
56:31folks and to say it was grim,
56:33understates it so it actually got
56:35to the point where not only could
56:37we not get all the patients out,
56:38but we would take every single adult
56:40ICU bed at the York Street campus,
56:42which means no one can go to the
56:45ICU for the OR no one can go to
56:47the ICU from any of the floors.
56:49No one can go to the ICU from the Ed,
56:52and that's just that.
56:53If we're going to be Frank about it,
56:55that's not.
56:56Not really palatable, but it's it.
56:58Believe me, I don't. I don't.
57:01I was up there last week.
57:05And I walked in and the first
57:07room on the left.
57:08Now that there's the glass windows,
57:10there was a young woman who's
57:12insulated and it really every time
57:14I go up there it rips my heart
57:16out that we're providing ICU level
57:18care in what was basically a A.
57:22A floor.
57:23And I long for the day when we
57:25don't have to do that anymore.
57:27But I would say keep asking me,
57:29keep poking me,
57:30I promise you Doctor Billingsley
57:32and Kim and everyone else they are
57:34involved in the conversations.
57:35And like I said my inbox is open.
57:38If someone has a creative solution.
57:41Let's explore it.
57:43Thank you for your continued efforts
57:45in the New World doing our best.
57:47It's it's still tough.
57:48Thank you Rob. There's a question for
57:50I think either Kathleen or Paula.
57:52If you have, I think we're at
57:54the top of the hour. Can I ask?
57:56Kathleen, can you reach out to Doctor
57:58Kunz and ask some of the stressors of
58:00North Haven that perhaps so you know?
58:03I don't want to sort of take up 'cause
58:05I want to end at the top of the hour.
58:08Renee, do you want to share
58:10the last slide of just the.
58:12Because I think the other piece is,
58:15it will be helpful to hear what you
58:17all want to see on these town halls,
58:19so you can just email cancer answers
58:21at yale.edu with all your sort of
58:23things you want to see discussed
58:25and I can guarantee you that Rob
58:27Fogarty will be back for another
58:29appearance in in in a few weeks.
58:31I imagine this will be a agenda when is in.
58:34When are we getting in P50 mag?
58:36Ann Dr.
58:37Kunz.
58:37I know that Kathleen will reach out to you
58:40right away and give you sort of at least.
58:42I'm not sure there's a perfect answer,
58:43but we want you to sort of be part of that.
58:47Piece of making things better
58:48for all of our teams of GI and
58:51thoracic oncology so it's 6:00 PM.
58:53I know it's I I hate sort of late sort
58:56of meeting. So thank you everybody.
58:58This is our first of many more.
59:00These monthly sessions, again,
59:01first Thursdays each month at 5:00 PM.
59:03Thank you all. Have a great evening.