Smilow Cancer Hospital Town Hall | November 13, 2024

Transcript

• 00:00Morning, everyone.
• 00:01Thank you for joining us
• 00:03at town hall.
• 00:04We have a great agenda
• 00:05today, and,
• 00:07I'll say just
• 00:09by word of welcome on
• 00:11behalf of Tracy and myself.
• 00:13We really appreciate the community
• 00:15joining us today.
• 00:17I think it's been a
• 00:18period of time since our
• 00:19last town hall,
• 00:21and we,
• 00:23I think, have the honor
• 00:24of sharing some really
• 00:27great work that our community
• 00:29has been doing and
• 00:30also
• 00:31celebrating some amazing achievements
• 00:34that reflect the incredible work
• 00:35and commitment of our cancer
• 00:37center faculty and our Smilow
• 00:39staff.
• 00:40We also have a series
• 00:41of important programmatic updates by
• 00:43a number of number of
• 00:44our leaders, including
• 00:46Mary Ann Davies, Kate Daniels,
• 00:48Kate Daniels Mason,
• 00:51Sam Abdelgani from pharmacy, and
• 00:53doctor Jensen Morris from the
• 00:55hospitalist service.
• 00:57I will say this morning
• 00:58on a more personal note,
• 01:00I wanna share how grateful
• 01:02I am to witness every
• 01:04day as Tracy and I
• 01:05round,
• 01:06the incredible collaboration
• 01:08and teamwork
• 01:09within Smilow and our organization.
• 01:12You know, it goes without
• 01:13saying that we need to
• 01:14look no further than our
• 01:16very recent
• 01:17tumultuous election season
• 01:19to recognize that we are
• 01:21in
• 01:22times of,
• 01:23division and some discord,
• 01:25both nationally and internationally.
• 01:27But I am really grateful
• 01:29to see and feel
• 01:31how we, as a community
• 01:33of cancer caregivers, come together
• 01:35every day around our unifying
• 01:37mission of providing outstanding care
• 01:39for cancer patients and advancing
• 01:41cancer care for our patients
• 01:43and families.
• 01:44I think the presentations today
• 01:46are an important reminder of
• 01:47the power of our collaborative
• 01:49spirit.
• 01:50And if you were anything
• 01:52like me,
• 01:53I I'm certain that you
• 01:54will leave this morning's gathering,
• 01:56with renewed optimism for the
• 01:58work we're doing together. So
• 02:00maybe we could put the
• 02:01agenda up.
• 02:14Will we advance the slide?
• 02:17I'm not sure it's in
• 02:18presentation mode.
• 02:22So
• 02:22Tracy and I will kick
• 02:24off with some introductions,
• 02:25and then we will go
• 02:26into a a presentation by
• 02:28doctor Huntington
• 02:30on important work we're doing
• 02:31regarding transitioning inpatient treatments to
• 02:34the outpatient setting,
• 02:35which will be important in
• 02:36generating capacity.
• 02:39Marion Davies and Kate Mason
• 02:41will talk about
• 02:43work in our Care Signature
• 02:44Council,
• 02:45and,
• 02:46Sam Abdulani will update us
• 02:48on our IV fluid mitigation
• 02:51plans and, of course, doctor
• 02:53Morris on high priority work
• 02:55stream planning.
• 02:57Next slide. And I think
• 02:59that will be for you,
• 03:00Tracy.
• 03:01Yes. Hi. Good morning, everyone.
• 03:03I am very pleased,
• 03:06to announce, and this slide
• 03:07will hopefully advance,
• 03:09that, Toby Bresler will be
• 03:11joining
• 03:11Smilow Cancer Hospital as the
• 03:13vice president for patient services
• 03:15on January sixth.
• 03:17This comes after a long
• 03:19year, and we are very
• 03:20excited for her to join.
• 03:21She is currently
• 03:23the senior director of nursing
• 03:24for oncology and clinical quality
• 03:26at Mount Sinai Health System,
• 03:28associate professor
• 03:30of the school of medicine
• 03:31at Mount Sinai, and adjunct
• 03:33professor at the Phillips School
• 03:34of Nursing. Her expertise in
• 03:36oncology program development, creating value
• 03:38based staffing models,
• 03:40streamlining provider onboarding, and establishing
• 03:42standardized clinical guidelines
• 03:45will be a valuable asset
• 03:46to SMIL. So we're very
• 03:48excited for Toby to join
• 03:50after the first of the
• 03:51year.
• 03:53Then,
• 03:54next slide. We wanted I
• 03:56wanted to take a moment
• 03:57to,
• 03:59recognize and honor the work
• 04:00of Doctor. Peter Schwartz,
• 04:02who
• 04:03unfortunately passed away in October
• 04:06after a prolonged illness.
• 04:08Doctor. Schwartz spent forty nine
• 04:10years of his professional career
• 04:12as faculty member
• 04:13and professor emeritus at the
• 04:15Yale University School of Medicine.
• 04:17Doctor Schwartz was chief of
• 04:18GYN oncology from nineteen seventy
• 04:21eight to two thousand and
• 04:22five,
• 04:23vice chairman of the department
• 04:24of OB and gynecology.
• 04:26He was
• 04:27most recently the John Slade
• 04:29Eli professor in the department
• 04:31of OB GYN and reproductive
• 04:33sciences
• 04:34at Yale University.
• 04:37He was attending meetings in
• 04:38two room board reviews right
• 04:39up until a few weeks
• 04:40before his passing.
• 04:43Doctor. Schwartz was the recipient
• 04:45of Yale Cancer Center Lifetime
• 04:47Achievement Award, Yale Medicine Distinguished
• 04:49Clinical Career
• 04:50Award,
• 04:52recognized numerous times in America's
• 04:54Best
• 04:55Doctors. In two thousand and
• 04:56six, Governor Jody Reil declared
• 04:58November eighteenth as Doctor. Peter
• 05:00Schwartz Day for his years
• 05:01of service at Yale University
• 05:03and the state of Connecticut.
• 05:05Doctor. Schwartz was a significant
• 05:07mentor, friend, and colleague of
• 05:09mine for many years and
• 05:11really,
• 05:13helped shape my career. And
• 05:15I just wanted to
• 05:17take a moment for us
• 05:18to thank him and recognize
• 05:20the outstanding achievements he had
• 05:22in the field of women's
• 05:23oncology.
• 05:27I think, we're gonna turn
• 05:29it over to Kevin for
• 05:30the next couple slides.
• 05:35Thanks, Tracy. Well, Renee's
• 05:37kind of preparing the slides.
• 05:41It is
• 05:42great to honor someone who
• 05:44was truly a giant in
• 05:46the field of g u
• 05:47n oncology and women's health.
• 05:50And
• 05:51carrying on that tradition,
• 05:54is doctor Elena Ratner, who,
• 05:57you will see has recently
• 05:59been awarded with the David
• 06:00and Cindy LaFele
• 06:02Prize for Clinical Excellence.
• 06:05You know,
• 06:06doctor Ratner's
• 06:08achievements,
• 06:09are legend in this organization.
• 06:13She's an outstanding clinician,
• 06:15surgeon,
• 06:16educator, researcher,
• 06:18patient advocate,
• 06:20fundraiser,
• 06:21and community citizen.
• 06:23So this honor, is incredibly
• 06:25well deserved. She's an inspiration
• 06:27for us all and has
• 06:29literally,
• 06:31hundreds, if not thousands, of
• 06:32grateful patients around Connecticut and
• 06:34around the world. So,
• 06:36thank you, Doctor. Ratner.
• 06:38Next.
• 06:41It's also a real pleasure
• 06:42for me to,
• 06:44acknowledge and honor one of
• 06:45my surgical colleagues,
• 06:47Doctor. Dan Boffa, another outstanding
• 06:50clinical surgeon
• 06:51and also a leader in
• 06:53cancer care and cancer quality
• 06:55nationally. Dan has recently been
• 06:57appointed as vice chair of
• 06:58the commission on cancer.
• 07:01Dan has been a national
• 07:02leader in using
• 07:04Commission on Cancer Data and
• 07:06NCDB data to look at
• 07:08patterns of care and understand
• 07:10variation
• 07:11and the role of volume
• 07:14and program development in cancer
• 07:16surgery quality.
• 07:18So well done, Dan. Thank
• 07:19you.
• 07:22Next, it's a pleasure to
• 07:24recognize and honor,
• 07:26my friend and colleague, doctor
• 07:27Roy Herbst.
• 07:29Roy is, as all of
• 07:31us know, really a giant
• 07:32in, oncology.
• 07:34He's a world leader in
• 07:36thoracic oncology, and he's recently
• 07:38been honored by the chemotherapy
• 07:40foundation with the Ezra Greenspan
• 07:42award.
• 07:43The chemotherapy
• 07:45foundation is a well known
• 07:47advocacy group
• 07:48that supports the development of
• 07:51oncology
• 07:52treatment and research across the
• 07:54country.
• 07:55Ezra Greenspan was a renowned
• 07:57early oncologist who developed
• 07:59early mouse models of chemotherapy.
• 08:02So,
• 08:03receiving this honor in his
• 08:05name is is incredibly
• 08:07meritorious.
• 08:09And, I think the recognition
• 08:11committee really pointed to Doctor
• 08:14Herbst works
• 08:16work in developing immunotherapy for
• 08:18our lung cancer and personalized
• 08:21therapy.
• 08:21So,
• 08:23Roy is gonna be, fetted
• 08:25at a gala in, New
• 08:27York City in the next
• 08:28couple of weeks, but please
• 08:29join me in congratulating him
• 08:31when you see him.
• 08:33We'll
• 08:35turn it over to Vonna
• 08:36to recognize,
• 08:37some of our APPs.
• 08:40Good morning, everybody.
• 08:41Renee Moy, who's from, Smilow
• 08:43Fear Field was honored at
• 08:45the ninth annual one hundred
• 08:46women of color gala and
• 08:48award ceremony. So we congratulate
• 08:50Renee.
• 08:53So last Thursday, November seventh,
• 08:56we had our annual system
• 08:58wide APP dinner.
• 09:00And it's really an award
• 09:01and recognition dinner that has
• 09:02been sponsored,
• 09:04truly for the past eight
• 09:05years. There was over two
• 09:07hundred and fifty nominations,
• 09:09across all delivery networks and
• 09:11twenty five are from Smilo.
• 09:13We had ten award categories,
• 09:15and there were twenty award
• 09:16winners. And I'm very proud
• 09:17to say that three of
• 09:19the Smilo APPs did receive,
• 09:22some some of those awards.
• 09:23So congratulations to Emily Copas.
• 09:26She's from Smilow, Greenwich. She,
• 09:28actually was awarded the APP
• 09:30clinical excellence award, which is
• 09:32awarded to an APP who
• 09:33demonstrates exceptional expert and compassionate
• 09:35care to their patients.
• 09:39Congratulations
• 09:40to Amy Burrell Pugliese.
• 09:42She's nurse practitioner,
• 09:44for bone marrow transplant and
• 09:45stem cell. She is the
• 09:46lead APP. She was given
• 09:48the APP clinical leader award,
• 09:50which is given to an
• 09:51APP who demonstrates clinical leadership
• 09:53and professionalism while maintaining an
• 09:55outstanding clinical practice.
• 09:59And very proud of Caroline
• 10:00Hatta. She is the lead
• 10:02APP for the inpatient medical
• 10:04oncology
• 10:04and hematology team. She was
• 10:06awarded the APP of the
• 10:07year.
• 10:09And that award goes to
• 10:10an APP who embodies the
• 10:11wholeness of all the other
• 10:12categories, a peer, a leader,
• 10:14a colleague, a mentor, and
• 10:16someone who symbolizes the best
• 10:18of our profession.
• 10:19So please join me in
• 10:20congratulating the three of them.
• 10:22In addition, Teresa White from
• 10:24GI Medical Oncology,
• 10:26was awarded the twenty twenty
• 10:28four Marsha Burkett award at
• 10:29the Southwestern Connecticut Oncology Nursing
• 10:32Society.
• 10:33Teresa has been very active
• 10:34in this society for many
• 10:35years. It is given to
• 10:37a distinguished oncology nurse who
• 10:38displays excellence in oncology nursing,
• 10:41maintains an active role in
• 10:43this particular chapter of ONS,
• 10:45mentors, supports, and cares for
• 10:46patients and their colleagues.
• 10:55So I will, just say,
• 10:59on behalf of both Tracy
• 11:00and I,
• 11:02as well as,
• 11:03you know, I know, Jen
• 11:05said you're a driver in
• 11:06this.
• 11:08Driving our throughput
• 11:10and,
• 11:10managing
• 11:12our inpatient stays is incredibly
• 11:15important work,
• 11:17and the system does recognize
• 11:19units who do particularly well
• 11:21at this.
• 11:22And our team on EP
• 11:24four seven,
• 11:26won the Smileo East team.
• 11:27We're the October champions,
• 11:30for the,
• 11:31discharge.
• 11:33What do they call it?
• 11:34The throughput cup?
• 11:36The discharge cup for meeting
• 11:38discharge target eighty one percent
• 11:40of the day. So
• 11:41not not a straightforward patient
• 11:43population.
• 11:44Really well done work by
• 11:46this group.
• 11:53Lana, I'm gonna kick this
• 11:54one over to you. K.
• 11:56So in addition,
• 11:58there have been
• 12:00eight APPs that have actually
• 12:02been promoted on the clinical
• 12:03ladder,
• 12:05which is something that we
• 12:06instituted Preble about two years
• 12:07ago. So those that have
• 12:09been promoted to clinical ladder
• 12:10too include Tara Anderson from
• 12:13malignant heme myeloma,
• 12:14Alfredo Axmyer from malignant hematology,
• 12:17Stephanie Kasik from BMT and
• 12:19stem cell, Nicole Paul from
• 12:21palliative care, Steven Scioscia from
• 12:23Smiler Waterford. He, is actually
• 12:25on the consult team at
• 12:26Lawrence and Memorial.
• 12:28Erica Stevens, malignant hematology, and
• 12:30Joanna Daddario for GYN oncology.
• 12:33And then Polly Sather was
• 12:34promoted to clinical ladder three,
• 12:37and she works in pulmonary
• 12:38and lung cancer screening.
• 12:41Just in addition,
• 12:42this week is actually nurse
• 12:43practitioner week. So I really
• 12:45do wanna recognize all of
• 12:47the APPs
• 12:48for all of their hard
• 12:49work and dedication to providing
• 12:50exceptional compassionate care to our
• 12:52patients.
• 12:58So
• 12:59thank you, Ivana.
• 13:01One of the things that
• 13:01I do wanna share with
• 13:02the community is after
• 13:05more than two years of
• 13:07kind of consistent effort across
• 13:09our health system,
• 13:10our senior leadership team made
• 13:12the, I believe, somewhat difficult
• 13:14decision to put the home
• 13:16hospital program
• 13:17on pause.
• 13:19Like many
• 13:21kind of transitions,
• 13:22I I think there are
• 13:23a lot of factors that
• 13:24went into this decision, and
• 13:26I don't think that this
• 13:27is,
• 13:28the end of the story.
• 13:29I am really quite confident
• 13:31that we are going to
• 13:32be redeploying
• 13:34home hospital services as part
• 13:36of our continuum of care,
• 13:39but there is some complicated
• 13:41legislative work, in the CMS
• 13:43waiver,
• 13:45that are in a transitional
• 13:47phase. And as we move
• 13:48into
• 13:49what we hope to be
• 13:50a more favorable regulatory
• 13:52and financial climate, I'm sure
• 13:54this, you will
• 13:56be seeing this this program
• 13:59resurface.
• 14:02It's a real pleasure for
• 14:04me to welcome some outstanding
• 14:06new faculty the to the
• 14:07cancer center.
• 14:08Doctor William O has joined
• 14:10us as the service line
• 14:11medical director in,
• 14:13for Smilo Greenwich.
• 14:15He's a GU medical oncologist.
• 14:17He will also serve as
• 14:18director of precision medicine.
• 14:20Doctor O comes to us
• 14:22after a distinguished
• 14:23career both at the Dana
• 14:25Farber as well as serving
• 14:26as the medical oncology
• 14:28division chief at Mount Sinai
• 14:31and a number of prominent
• 14:32roles,
• 14:33including
• 14:34leadership of the Prostate Cancer
• 14:36Foundation.
• 14:37Doctor. Raghav Sundar has joined
• 14:39the GI team.
• 14:41Raghav is an incredibly accomplished
• 14:44clinician and clinical researcher,
• 14:47with a focus on upper
• 14:48GI cancers. He also has
• 14:50expertise in hepatobiliary
• 14:52and peritoneal surface malignancies.
• 14:56Doctor Sundar comes to us
• 14:58from the National University of
• 14:59Singapore.
• 15:01Matt Danish has, just joined
• 15:03or will shortly join our
• 15:05Smilow team in Waterford and
• 15:07Westerly.
• 15:08Doctor Danish is a graduate
• 15:10of the Brown Oncology
• 15:12Program. He has been in
• 15:13practice for the past couple
• 15:14of years in,
• 15:17Southern Rhode Island.
• 15:18He is a malignant,
• 15:21and
• 15:22his specialty is hematology, including
• 15:24both malignant and classical hematology.
• 15:26So welcome to all of
• 15:28these outstanding faculty members. Next.
• 15:32You know, I think one
• 15:33of the things that we
• 15:34need to be most proud
• 15:35of is our is the
• 15:37work that we do across
• 15:39the organization
• 15:41to move forward
• 15:44equitable cancer care across all
• 15:46vulnerable patient populations.
• 15:49Tracy and I wanted to
• 15:50take a minute to share
• 15:52with the community,
• 15:54work that is being done
• 15:56to create an inclusive care
• 15:58environment for transgender patients with
• 16:00cancer care.
• 16:02There will be an event
• 16:03to recognize and celebrate this
• 16:06work and a panel discussion
• 16:08with a number of experts.
• 16:10And I'd like to particularly
• 16:12call out, Doctor. Ash Alpert.
• 16:15They
• 16:16are an expert in,
• 16:19care for this vulnerable population
• 16:21as well as,
• 16:23hematology and malignant hematology.
• 16:25So note this for your
• 16:27calendars, Friday,
• 16:29November fifteenth.
• 16:30Next.
• 16:34So
• 16:36I am hoping that,
• 16:38we will continue to have,
• 16:40good turnout at our town
• 16:42halls.
• 16:43You will see that they
• 16:44are coming up, roughly every,
• 16:47two to three months as
• 16:49we move through the year.
• 16:50The next will be January
• 16:51twenty ninth. This will be
• 16:53a hybrid meeting with an
• 16:54in person option,
• 16:56in the Smileo Auditorium,
• 16:58and we will alternate between
• 17:00virtual only and hybrid.
• 17:02Again,
• 17:03we love to see people
• 17:04in person, so I'm hoping
• 17:06in late January,
• 17:08we can get an audience
• 17:09at the auditorium.
• 17:11So
• 17:12we'll go ahead with the
• 17:13agenda,
• 17:14and I will,
• 17:16turn it over to doctor
• 17:17Huntington.
• 17:18Great. Thanks so much. Really
• 17:19great updates.
• 17:21Wonderful to be a part
• 17:22of this great community.
• 17:28So it's
• 17:40sorry.
• 17:42There we go.
• 17:47So,
• 17:48I'm gonna provide in the
• 17:49next ten minutes an update
• 17:51on some important work, really
• 17:53identifying the capacity,
• 17:54concerns in inpatient setting and
• 17:56identifying patients that we currently
• 17:58treat inpatient,
• 18:00to really transition them safely,
• 18:02to ambulatory setting.
• 18:05So the reason that we're
• 18:06doing this is that there
• 18:06really has been,
• 18:08a significant growth in our
• 18:09inpatient services.
• 18:10Some of this has been
• 18:11programmatic
• 18:12growth. So e s smile
• 18:13o four seven has allowed
• 18:15us to,
• 18:16increase our footprint,
• 18:18and that that has led
• 18:19to increased, cancer discharges,
• 18:21through the SMILO service.
• 18:23But even,
• 18:25year over year,
• 18:26we've had some significant increase.
• 18:29A lot of this is
• 18:29coming being driven by new
• 18:30therapeutics that require inpatient,
• 18:33bedtime
• 18:34for initiation.
• 18:35And at this point, at
• 18:37any given day, somewhere between
• 18:38twenty to twenty five patients
• 18:40that have cancer
• 18:42are being treated outside of
• 18:43SmiloBeds,
• 18:45and this is really, an
• 18:46impact on patient,
• 18:48well-being
• 18:49and, something that we wanna
• 18:51tackle and improve, with time.
• 18:53So,
• 18:54expanding inpatient capacity is really
• 18:56critical
• 18:57to provide timely, access to
• 18:58inpatient beds for patients coming
• 19:00through the emergency room.
• 19:02It's really important to be
• 19:03able to redirect patients from
• 19:05non smilo beds to smilo
• 19:06to enable safe treatment and
• 19:08timely treatment.
• 19:10And
• 19:11this trend towards novel therapeutics
• 19:13that are going to require
• 19:14some inpatient stay is not,
• 19:16ending,
• 19:17and we need to really
• 19:18expand our capacity to enable
• 19:20us to provide these therapies
• 19:22that are growing in things
• 19:23like solid tumor,
• 19:24non malignant hematology, including sickle
• 19:27cell, and so this is
• 19:28really just,
• 19:29the first phase of important
• 19:31work ahead.
• 19:32When you think about the
• 19:34current, average daily census
• 19:36of cancer patients here in
• 19:37New Haven, We have a
• 19:38hundred twenty five beds, across
• 19:40the SMILO,
• 19:41and then, like we said,
• 19:42there's about twenty patients that
• 19:43are admitted to non SMILO
• 19:44beds and about four on
• 19:46average in our ERD serum.
• 19:49So moving and identifying select
• 19:51inpatient regimens,
• 19:52to the ambulatory setting is
• 19:54really important
• 19:55so that we enhance patient
• 19:57experience and convenience.
• 19:58We expand access through, Infusion
• 20:01Everywhere that really can help
• 20:02patients ideally get treatment closer
• 20:04to home.
• 20:05And it is,
• 20:06this kind of trend is
• 20:07is not unique to Smilow
• 20:09or capacity issues not unique
• 20:10to Smilow.
• 20:11Other of our peer institutions
• 20:12have already developed ambulatory,
• 20:15administrations of several of these
• 20:16therapies,
• 20:17And, this will allow us
• 20:18to really provide consistent,
• 20:20signature of care and over
• 20:22time, hopefully,
• 20:23enable,
• 20:24these complex therapeutics across our
• 20:26delivery network.
• 20:30This, required a lot of
• 20:32coordination and a lot of
• 20:33work from really,
• 20:34the multidisciplinary
• 20:35group. I wanna highlight Elaine
• 20:37Whitney, Latha, and Alex, who
• 20:39have helped, really develop and
• 20:41then move this forward.
• 20:43But these are the four
• 20:44key working groups that we've
• 20:45had, come together,
• 20:47nearly,
• 20:48biweekly or monthly,
• 20:50for the last year.
• 20:51This includes focusing on cytotoxic
• 20:54infusions,
• 20:55a group looking at cellular
• 20:56therapeutics,
• 20:57a group looking at bispecifics,
• 20:59and then a fourth group
• 21:01looking at expanding capacity
• 21:03and availability of our ECC.
• 21:06There's been lots of
• 21:08nursing, lots of emergency room
• 21:11coordination,
• 21:12and also
• 21:13finance, making sure that this
• 21:15is a financially sound plan
• 21:17moving
• 21:18forward. Some of the key
• 21:18deliverables that we've, really identified
• 21:20and and targeted
• 21:22are, thinking about what's the
• 21:24impact of this work in
• 21:25terms of our volume.
• 21:27Certainly, capacity
• 21:28constraints exist outside the inpatient
• 21:30setting in our ambulatory world.
• 21:31And so thinking about how
• 21:33the shift could have impact
• 21:34on on those capacities,
• 21:36assessments of resource needs, barriers
• 21:38and operational adjustments,
• 21:40thinking about how we make
• 21:41our teams ready and operationally,
• 21:44proficient,
• 21:45financial assess analysis,
• 21:47and impact on reimbursement.
• 21:49And a lot of this
• 21:50work is really being done
• 21:51through,
• 21:53care signature pathways
• 21:54and,
• 21:55improved handoffs between our clinical
• 21:58teams.
• 21:59We've also updated our, beacon
• 22:01builds to really default,
• 22:03these regimens to the outpatient
• 22:04setting,
• 22:05and also identifying
• 22:07opportunities to perhaps expand hours
• 22:10like an ECC or some
• 22:11of our clinics.
• 22:13So this is ongoing work,
• 22:14but I do want to
• 22:15provide some updates on the
• 22:16first phase of this, initiation.
• 22:20So one area of the
• 22:21first phase is going to
• 22:22be, CAR T and bispecific
• 22:24antibodies.
• 22:26This is a unique,
• 22:28clinical
• 22:29scenario where patients receive these
• 22:30immunotherapies.
• 22:31And during the initiation phase,
• 22:33patients are at particularly high
• 22:34risk for complex,
• 22:36toxicities, including neurotoxicity
• 22:38and cytokine release syndrome.
• 22:40This to date has required
• 22:42our patients to be, admitted
• 22:43for the hospital for close
• 22:45monitoring.
• 22:46But we really recognize that,
• 22:48with close coordination and,
• 22:51increasing capacity
• 22:52and,
• 22:54kind of workflows,
• 22:56we're able to really transition
• 22:57many of these patients, not
• 22:58all, but many of these
• 22:59patients safely to the ambulatory
• 23:01setting. So some key challenges
• 23:02that we needed to tackle
• 23:03for this work really has
• 23:05been focused on monitoring and
• 23:06management of adverse, side effects,
• 23:09making sure that patients have
• 23:10urgent access to,
• 23:12admissions or specialized care if
• 23:14they do develop these toxicities
• 23:15as outpatient.
• 23:17A lot of this work
• 23:17also has been on patient
• 23:19and family education and compliance,
• 23:22logistical considerations,
• 23:23cost,
• 23:24implications, as well as making
• 23:26sure that we can track,
• 23:27outcomes,
• 23:28when we make this transition.
• 23:31So this really has required,
• 23:33really broad inter and interdepartment
• 23:35collaboration.
• 23:36This is just the focus
• 23:38on CRS and ICANS management.
• 23:40But this has been developing
• 23:42partnerships and collaborations
• 23:43with both SMILO and ex
• 23:45SMILO, groups. This includes emergency
• 23:47room, EMS,
• 23:49tons of work,
• 23:51throughout the year.
• 23:52We've recognized that for allo
• 23:54transplants, having a centralized number
• 23:57and and really a centralized
• 23:58approach,
• 24:00to, getting specialized,
• 24:02expertise on the phone is
• 24:04key. And so we've adopted
• 24:06what the allotransplant
• 24:07team has been doing for
• 24:08years,
• 24:09in in order to enable,
• 24:11this kind of, easy access
• 24:13for patients and families on
• 24:14their own.
• 24:16We've also developed some additional,
• 24:18best practice alerts
• 24:20as well as an auto
• 24:21page function so that when
• 24:23these patients,
• 24:24that are receiving these treatments
• 24:25arrive in the emergency room,
• 24:27they'll will be an auto
• 24:28page of the fellow to
• 24:29make them aware,
• 24:30similar to trauma or other
• 24:32kind of high risk patients
• 24:33presenting to the emergency room
• 24:34and other specialties.
• 24:36We have, clearly articulated or
• 24:38cover coverage responsibilities that includes
• 24:41really engaging with our APP
• 24:42service. So thank you, Vanna,
• 24:44for that, as well as
• 24:45our fellowship program.
• 24:47We've identified primary sites of
• 24:48care and ambulatory setting, which
• 24:50have predominantly been,
• 24:52the day hospital and MP7.
• 24:54But recognizing that our ECC
• 24:56will be a really important
• 24:57partner, in the after hours
• 24:59and emergency room overnight.
• 25:01We've developed several,
• 25:03care signature pathways that are
• 25:04really regimen specific,
• 25:06that have,
• 25:08really clear guidance on how
• 25:09to treat these patients in
• 25:10terms of CRS and ICANS.
• 25:13And overall, we're really developing
• 25:14a consistent workflow both for
• 25:16CAR T and the bispecific
• 25:17antibodies.
• 25:20So this is just the
• 25:20planning and execution timeline.
• 25:22There's been months,
• 25:24kind of focused on implementation
• 25:26and design of this rollout.
• 25:27The first of the rollout
• 25:29was on infusional chemotherapy,
• 25:31EPOC chemotherapy.
• 25:33This chemotherapy,
• 25:35historically over the last several
• 25:36years
• 25:37has had a build that
• 25:38allows us to give this
• 25:39outpatient, but it's been used
• 25:40variably.
• 25:41And so we really redesigned
• 25:43the, the beacon pathway. We
• 25:46redeveloped an SOP,
• 25:47and this went live in
• 25:48August and will be continuing
• 25:50to track and and change
• 25:51through an interim process to
• 25:53really, enable our outpatient epoch
• 25:55rather than inpatient,
• 25:57bed space for this regimen.
• 25:59The first of the CAR
• 26:00t bispecifics,
• 26:02combination will be,
• 26:03focused on CAR t, which
• 26:05will be on label use
• 26:06for Carvictine brionzi,
• 26:08and that will launch in
• 26:09January.
• 26:10And then about a month
• 26:12later, as we really learned
• 26:13from that launch,
• 26:15and we will be rolling
• 26:16out by specific antibodies initiation
• 26:18for myeloma
• 26:19and lymphoma.
• 26:22So what do we expect
• 26:23to gain from this phase
• 26:24one?
• 26:25At the end of the
• 26:26day, it's about a thousand
• 26:28patient days,
• 26:29that the shift will enable
• 26:31us to make.
• 26:32That's equivalent to an average
• 26:33daily census of about two
• 26:35point six patients.
• 26:36And that will allow over
• 26:38a hundred patients that otherwise
• 26:39would be treated outside of
• 26:40Smilo to gain access to
• 26:42a Smilo bed.
• 26:44We do recognize that not
• 26:45all patients will be able
• 26:46to be shifted from inpatient
• 26:48to outpatient. Our current targets
• 26:49that we'll be tracking
• 26:50is about ninety percent of
• 26:52epochs will be, delivered outpatient,
• 26:54and about seventy five percent
• 26:56of the CAR t,
• 26:57Briansy, and Carvifty, as well
• 26:59as the bispecific antibody initiations
• 27:01will be delivered outpatient. So
• 27:02that's our goal. And what
• 27:04that translates into freeing up,
• 27:07bed space is really epoch
• 27:08as a driver here. So
• 27:09about one point six patients,
• 27:11average daily census that should
• 27:13free, and the other,
• 27:15CAR t and and bispecifics
• 27:17is is less, here at
• 27:18about one patient on average.
• 27:22So I showed on the
• 27:24first slide that we have
• 27:25significant capacity constraints, and this
• 27:28is just one part of
• 27:29the solution,
• 27:30but an important first step.
• 27:32We recognize that there's over
• 27:33twenty patients on average currently
• 27:36that are admitted to medicine
• 27:37or the ED,
• 27:38that really would be providing
• 27:40better care if we could
• 27:41get them into the Smilo
• 27:42system.
• 27:44And so recognizing that current
• 27:46inpatients that can be treated
• 27:48safely outpatient and making that
• 27:50shift is really a critical
• 27:51next step, and we're looking
• 27:52forward to this shift.
• 27:55This phase one is nearing
• 27:56completion.
• 27:57EPOC is live, and so
• 27:58if you have experience or
• 27:59concerns with EPOC or have
• 28:00suggestions on how to make
• 28:02this work better,
• 28:03feel free to reach out.
• 28:04And then come early twenty
• 28:05twenty five, you'll start seeing
• 28:07the CARVIC d and BRIANZI
• 28:09shifted to the outpatient setting.
• 28:11This is going to be
• 28:11an iterative process and and
• 28:13certainly will be identifying
• 28:14additional inpatient treatments that we
• 28:16hope to transition to the
• 28:17ambulatory setting in the coming
• 28:18months to years.
• 28:23So that is the presentation.
• 28:28Do we wanna
• 28:29allow any questions or perhaps
• 28:33Scott, I know you would
• 28:34have to go to clinic.
• 28:35Yeah.
• 28:37I think we,
• 28:39probably will let you off
• 28:41the hook. Thank you for
• 28:42an excellent presentation.
• 28:45There may be questions at
• 28:46the end that,
• 28:50maybe the rest of us
• 28:50can try to stumble through
• 28:52or circle back with you
• 28:54offline. Very excited about this
• 28:56work.
• 28:56Thank you so much. I
• 28:57appreciate it.
• 29:01Mary Anne and Kate, take
• 29:02it away.
• 29:03Great. Thank you so much,
• 29:05doctor Billingsley, and thank you,
• 29:06Scott, for that great presentation.
• 29:08It really is a great
• 29:09lead into
• 29:10our presentation on Smilo Care
• 29:12Signature work. And it's our
• 29:14pleasure to present to you
• 29:16today. So, Kate, you can
• 29:17just advance to the next
• 29:18slide
• 29:19and the next one.
• 29:20So Care Signature,
• 29:22really our strategy is to
• 29:23provide, overall the highest quality
• 29:25evidence based clinical care across
• 29:27the continuum,
• 29:28and really in in sticking
• 29:30with the things that's,
• 29:31that,
• 29:32doctor Huntington just said, minimizing
• 29:34any unnecessary
• 29:35variation for our patients and
• 29:36making sure that we're really
• 29:38getting the the most equitable
• 29:39care across, for patients across
• 29:41the,
• 29:42the network. Kate and I
• 29:43have, began our working care
• 29:45signature about a year ago,
• 29:46and so we're happy to
• 29:47share, the progress so far.
• 29:49Next slide.
• 29:53So these are our council
• 29:54members for our general council.
• 29:56They we had originally had
• 29:59councils for each specialty.
• 30:01Breast council and
• 30:04classical hematology
• 30:05are two of the councils
• 30:06that have done,
• 30:08significant work in Care Signature,
• 30:10and we decided that we
• 30:12needed more of a general
• 30:13one that can touch all
• 30:14of Smilo. So our council
• 30:16chair is Scott Huntington.
• 30:18Our sponsors are Kevin Billingsley
• 30:20and Tracy Carafino.
• 30:21And as you can see,
• 30:22we have a diverse group,
• 30:24who's representing,
• 30:26the entire Smilo network.
• 30:33So what are we actually
• 30:35doing with the Care Signature
• 30:36group? So the council meets
• 30:37and actually helps to prioritize
• 30:39the, pathway work that is
• 30:40going to be developed.
• 30:42But then from that, we
• 30:43develop clinical consensus groups or
• 30:45what we refer to as
• 30:46CCGs.
• 30:47These groups are a group
• 30:48of, really,
• 30:50expert stakeholders across our network
• 30:53that help to, really review,
• 30:55clinical data, help identify what
• 30:58the scope of a pathway
• 30:59is going to be, making
• 31:00sure that we're reviewing any
• 31:02variations across our network in
• 31:04terms of how we're delivering
• 31:05care,
• 31:06identifying national and international guidelines
• 31:09recommendations,
• 31:10and really helping to kind
• 31:11of merge those all together
• 31:12and how, we can help
• 31:14deliver a care signature pathway
• 31:17that represents
• 31:18the SMILO way of how
• 31:20we are actually delivering care
• 31:21on a particular topic.
• 31:24The group,
• 31:25analyzes,
• 31:25any relevant data and then
• 31:27builds a draft of a,
• 31:29of a pathway, which is
• 31:31kind of step five. And
• 31:33once it kind of goes
• 31:34live where it's implemented,
• 31:35it's accessible,
• 31:37on epic, then we can
• 31:38begin to look at, data,
• 31:40such as how often the
• 31:42pathway has been used and
• 31:43if we're making an impact
• 31:44on patient outcomes. So doctor
• 31:46Huntington
• 31:46mentioned a couple of key
• 31:48areas in terms of CAR
• 31:49T,
• 31:50and management of patients,
• 31:52adverse events associated with that.
• 31:54And so once those patients
• 31:56are starting to be treated
• 31:57on the outpatient setting and
• 31:58we're using our pathways, we'll
• 31:59be able to look at,
• 32:00the impact of, the data,
• 32:03and the usage of the
• 32:04pathways. So that's just one
• 32:05example.
• 32:06We'll go to the next
• 32:07slide.
• 32:09Yep. So
• 32:10Care Signature is not just
• 32:12about pathways, and Mary Anne
• 32:14kinda just mentioned that as
• 32:16well.
• 32:17But we touch upon a
• 32:18lot of things, such as
• 32:20orders, system policies,
• 32:21referral workflows,
• 32:24operational,
• 32:25needs. And so we we
• 32:27do want you guys to
• 32:29be able feel free to
• 32:30reach out to us in
• 32:31any capacity
• 32:32to help. We just use
• 32:34pathways as a tool and
• 32:35a vehicle of change and
• 32:37and one way of being
• 32:38able to communicate to all
• 32:40of Smilo.
• 32:46So we've, been busy in
• 32:48the past year.
• 32:49And so in the past
• 32:51year, we've had several general
• 32:53pathways that have been approved,
• 32:55pathways specific to, the breast
• 32:58center,
• 32:59and classical hematology,
• 33:01while, iron iron deficiency anemia
• 33:02is one that's approved. The
• 33:04ones that are in the
• 33:04process on the bottom will
• 33:06go live in December.
• 33:08And then, key work in
• 33:09malignant,
• 33:10hematology,
• 33:11particularly in, the CAR T
• 33:13world.
• 33:14You can see under general
• 33:15counsel, these are there are
• 33:16several pathways that, really can
• 33:18help guide practice across our
• 33:20network, both in the inpatient
• 33:21setting and in the ambulatory
• 33:23setting.
• 33:24Work around hepatitis monitoring,
• 33:27hypersensitivity
• 33:28reactions. This is one example
• 33:29of where we actually are,
• 33:31changed workflows and responses, particularly
• 33:32in the
• 33:36and then the work on,
• 33:37the bispecific
• 33:39T cell engager therapy, which
• 33:40is active in the inpatient,
• 33:43setting right now. And we
• 33:44have several pathways that are
• 33:46in progress,
• 33:47right now.
• 33:48I'm, particularly focusing on, the
• 33:51bispecifics and and the CAR
• 33:52Ts, foregoing,
• 33:54live in the outpatient setting,
• 33:56working on neutropenic fever, both
• 33:58inpatient ambulatory,
• 34:00and also,
• 34:02immune related, toxicities,
• 34:04starting with pneumonitis.
• 34:06And Kate is focused on
• 34:07infusion everywhere right now,
• 34:09and also PEDVT
• 34:11in addition to her work
• 34:12with the breast center.
• 34:17We just wanted to give
• 34:18you a a quick glimpse
• 34:20of what is out there
• 34:22in Pathways.
• 34:24Our colleagues have been developing
• 34:26Pathways for over three years
• 34:28now, and a lot of
• 34:29them are relevant to Smilo.
• 34:32So these are just a
• 34:33few and not nearly as
• 34:35many as you could actually
• 34:38find in
• 34:39in the,
• 34:41the pathway link or pathway
• 34:43tab in Epic.
• 34:45But you can see that
• 34:46there are plenty of
• 34:49pathways that relate to us
• 34:51that our colleagues have created.
• 34:53We have created a SMILO
• 34:55table of contents
• 34:56in order to kind of
• 34:58organize
• 34:58for you,
• 35:00the ability to see a
• 35:01lot of these pathways and
• 35:02in in different
• 35:04formats, such as disease specific
• 35:07or supportive care or anything
• 35:09like that. So pea please
• 35:11feel free. That is a
• 35:12pathway itself.
• 35:14Feel free to look in
• 35:15the tab pathway and find
• 35:17it and look at what
• 35:17you can. And you you
• 35:19can even search any word
• 35:21that you think and say,
• 35:22I wonder if there's a
• 35:23pathway for that. Kind of
• 35:24like, I wonder if there's
• 35:25an app for that.
• 35:26So
• 35:27please look at it and
• 35:28see.
• 35:32So Smilo,
• 35:34we just started building a
• 35:35pathway specific to Smilo in,
• 35:37the past year.
• 35:39As Kate mentioned, our colleagues
• 35:40across the network such as,
• 35:42in the ICUs, internal medicine,
• 35:45the surgical realm have been
• 35:46building pathways for about three
• 35:47years, and you can see
• 35:48the significant
• 35:49growth over the past, several
• 35:51years.
• 35:52To date there's been over
• 35:53a million pathways that have
• 35:55been used by over twelve
• 35:56hundred unique,
• 35:58network,
• 35:59staff members.
• 36:01And there's been significant involvement
• 36:03by many of our colleagues,
• 36:05our clinical experts. So over
• 36:07a thousand people have participated
• 36:08on these clinical consensus groups,
• 36:10which is really,
• 36:12the backbone of how these
• 36:13pathways get developed. So we
• 36:14really do value that that,
• 36:16contribution that all of our
• 36:18colleagues,
• 36:19make to participating in the
• 36:20CCGs because,
• 36:22the pathways,
• 36:23wouldn't be as impactful,
• 36:25if Kate and I just
• 36:26developed them in a in
• 36:26a silo. So we really
• 36:28need our Smilo,
• 36:30clinical experts to to participate,
• 36:33in this. And you can
• 36:34see the significant growth in
• 36:35the number of pathways and
• 36:36and, usage over the past,
• 36:38particularly,
• 36:39in the past year. And
• 36:41some of that attributable to
• 36:42the fact that we now
• 36:43have Smilo pathways. So we,
• 36:45we have a way of
• 36:46actually looking at the data
• 36:47to see which pathways are
• 36:49being used and by which
• 36:50providers. And so we're hoping
• 36:52to be using this information.
• 36:54And I know that Doctor.
• 36:55Morris certainly does use this
• 36:57information when she meets with
• 36:58her hospital,
• 36:59inpatient team to really say,
• 37:01you know, this is this
• 37:02is how how often, we're
• 37:04we're utilizing,
• 37:05this information. Yeah. Kate, you
• 37:06can go to the next
• 37:07slide. I'm sorry. Sorry.
• 37:10There you go. So this
• 37:11is the ambulatory
• 37:13SMILO utilization.
• 37:15And as you can see,
• 37:16it it has grown, and
• 37:18we hope it will grow
• 37:19even further.
• 37:21But it it's slow growing
• 37:23growing, but that that's what
• 37:24our colleagues saw as well.
• 37:26And so that's why we
• 37:27are presenting at the town
• 37:28hall. We're trying to get
• 37:29out the word that these
• 37:30these
• 37:31pathways are for everyone. Nurses,
• 37:34residents,
• 37:34fellows,
• 37:36attendings,
• 37:37everyone can utilize these pathways.
• 37:39And if you don't feel
• 37:39it's in your scope, you
• 37:41at least can use it
• 37:41as a vehicle of communication
• 37:43with your your team and
• 37:45see,
• 37:45hey. I noticed that it's
• 37:47this is in the pathway.
• 37:48Why are we deviating from
• 37:49the pathway?
• 37:51So so please look at
• 37:52them. They're great.
• 37:57So as I started to
• 37:58mention, we can actually delve
• 37:59down into the utilization
• 38:01by, delivery network, by units
• 38:04at who's using them,
• 38:05and even down to the
• 38:07providers,
• 38:08either on a on a
• 38:09daily basis, a monthly basis,
• 38:11etcetera.
• 38:12And so in some of
• 38:13our, for some of our
• 38:14colleagues across,
• 38:16the
• 38:17health system
• 38:18are actually using this information,
• 38:21for, and the metrics really,
• 38:23for quality and safety purposes
• 38:25and to drive changes in
• 38:27care and look at outcomes.
• 38:28So,
• 38:30most of the pathways
• 38:32are not mandatory.
• 38:33They are, ex really just
• 38:35used, if a person is
• 38:37looking for some guidance, but
• 38:39there are a few pathways
• 38:40that,
• 38:41were made,
• 38:42mandatory such as,
• 38:44when COVID,
• 38:45was really, really active. When
• 38:47we were looking at,
• 38:48strategies for mitigation and medication
• 38:50prescriptions, it was mandatory to
• 38:52utilize the pathway,
• 38:53in order to prescribe.
• 38:55We began,
• 38:57utilizing the pathway for blood
• 38:59cultures,
• 39:00etcetera.
• 39:01So those are just a
• 39:02few examples of things that
• 39:03are, were made mandatory. And
• 39:05maybe in the future, we
• 39:06may make other, types of
• 39:09the vehicle
• 39:10for
• 39:12which, care is delivered or
• 39:12or, patient care, side effects,
• 39:13etcetera, are managed. And you
• 39:14can see on this slide
• 39:15that the inpatient utilization went
• 39:16up
• 39:23when ECART and blood cultures
• 39:26were did become mandatory.
• 39:28So we can see that
• 39:30the mandatory pathways
• 39:32are are helpful because it
• 39:33keeps,
• 39:34it in the minds of
• 39:36of our providers
• 39:37to to utilize them.
• 39:39So this is the inpatient
• 39:41utilization, but they've also been
• 39:42using it far longer than
• 39:44the ambulatory
• 39:45setting. And so you can
• 39:47see that there is,
• 39:49an increase over the months
• 39:50of utilization.
• 39:56So, we were,
• 39:58in all of our meetings,
• 39:59really having a lot of
• 40:00people requesting,
• 40:02pathways,
• 40:03and so we had to
• 40:04find a way to,
• 40:06make it manageable. And so
• 40:08the Oncology Clinical
• 40:09Council, worked with us and
• 40:11we developed a pathway request
• 40:13form. And so we're sharing
• 40:14this with all of you,
• 40:16and
• 40:17hoping that if there are
• 40:18any, if anybody has any
• 40:20ideas,
• 40:20suggestions, or any needs for
• 40:22additional pathways, once you've kind
• 40:24of reviewed what's already accessible,
• 40:27please fill out this request
• 40:28form, and you can email
• 40:30it to Kate and myself.
• 40:32We bring this, to the
• 40:33council, and we help to
• 40:35prioritize what the next pathways
• 40:37are going to be. So
• 40:38remember, when we are prioritizing
• 40:39the pathway, we have to
• 40:40put together a work group.
• 40:42So hopefully whoever's requesting a
• 40:44pathway is willing to participate
• 40:46on that clinical consensus group
• 40:48and contribute,
• 40:50their expertise in helping to
• 40:51develop that.
• 40:53And so right now,
• 40:55this is not,
• 40:56we we we will find
• 40:57a way to have this,
• 40:59downloadable for you. But right
• 41:00now, if you if you
• 41:01have a request, just reach
• 41:03out to Kate and I,
• 41:04and we will mail this
• 41:05request form, to you.
• 41:07And when we meet with
• 41:08our council, we, discuss and
• 41:10help prioritize the the next
• 41:12CCGs.
• 41:15So here are emails. Feel
• 41:16free to reach out to
• 41:17us with any questions, any
• 41:19suggestions, or recommendations,
• 41:21and we are excited to
• 41:22work with all of you
• 41:23guys.
• 41:27Okay. Mary Anne, this is
• 41:28great work. Thank you for
• 41:30your leadership,
• 41:31and,
• 41:32also thank you for recognizing
• 41:34how much this is a
• 41:36collaborative
• 41:37effort and how many different
• 41:39stakeholders need to be involved.
• 41:41I'll just say briefly, it's
• 41:42great to put all of
• 41:43these pieces together in this
• 41:45town hall because we can
• 41:47see
• 41:48how much there is interdependence
• 41:50and interlocking elements in our
• 41:52programs.
• 41:54The work that Doctor. Huntington
• 41:56described,
• 41:57largely relies on
• 42:00development and deployment of care
• 42:02signature pathways as we transition
• 42:04these complicated regimens from the
• 42:06inpatient arena to the outpatient
• 42:08arena.
• 42:09I think,
• 42:11you will hear more about
• 42:12pathways as we move forward,
• 42:15and
• 42:15special shout out to the
• 42:17ECC,
• 42:19who are the high
• 42:21we need a pathway cup,
• 42:23not just a capacity cup.
• 42:25They win the cup We'll
• 42:26develop that. Pathway cup.
• 42:28So well done.
• 42:29I'd also note that if
• 42:31you look at the data
• 42:33that, Kate and Mary Anne
• 42:34shared,
• 42:35many of our most robust
• 42:37pathway utilizers
• 42:39are our APPs.
• 42:41So,
• 42:42kind of shout out to
• 42:43Vonna and her team. Let
• 42:45me just kick it over
• 42:46to Sam to talk about
• 42:47IV fluid utilization,
• 42:49which has been a hot
• 42:50topic in the organization.
• 42:53Thank you, Kevin.
• 42:54And,
• 42:55I have the tough job
• 42:56after two great presentations on
• 42:58progress and improvement. I get
• 43:00to talk about natural disasters
• 43:02and shortage.
• 43:04But I promise I'm gonna
• 43:05leave you with a good
• 43:06news,
• 43:07at the end.
• 43:09I'm sure by now most
• 43:10of us know about Hurricane
• 43:11Helen hitting Baxter manufacturing plant
• 43:14in North Carolina.
• 43:16If you didn't know, this
• 43:17plant manufacture about sixty percent
• 43:19all of old IV food
• 43:21products in the US. But
• 43:23more importantly for us, we
• 43:25are a Baxter shop. So
• 43:26about sixty percent,
• 43:27nationally,
• 43:28we are a hundred percent
• 43:29relying on Baxter product for
• 43:31the most part. So you
• 43:32may hear from your colleagues
• 43:33at Hartford Hospital or MSK
• 43:35that they have no idea
• 43:36what's going on in that
• 43:37fluid shortage
• 43:38world. It's because they rely
• 43:39on other manufacturers.
• 43:41Immediately after the the hurricane
• 43:43and the damage to this
• 43:45plant, we were told that
• 43:46our allocation is forty percent.
• 43:49So our challenge was the
• 43:50how to maintain patient care
• 43:52and continue to work business
• 43:54as usual with only forty
• 43:56percent of the fluid,
• 43:58allocated to us.
• 44:00And since that time, essentially,
• 44:02the first week of October,
• 44:04it's been nonstop work on
• 44:06mitigation strategies.
• 44:07Some external to
• 44:09our system,
• 44:10Baxter did a lot of
• 44:11work.
• 44:12All the professional organization provide
• 44:14guidelines on how to optimize
• 44:16hydration.
• 44:17The FDA allowed importation from
• 44:19nine different sites around the
• 44:20world.
• 44:22But this business slide show
• 44:23you some of the things
• 44:24that we've done internally here.
• 44:26There were communications,
• 44:28almost on a daily basis.
• 44:29There are signs that were
• 44:30posted everywhere. We, we talked
• 44:32about clinical pathway earlier today.
• 44:35We created pathways
• 44:37to drive,
• 44:39utilization
• 44:40optimal utilization of fluid in
• 44:42in multiple settings. We change
• 44:43order sets.
• 44:45I have some of the
• 44:47items that we,
• 44:48implemented, and it,
• 44:50what wanted,
• 44:51just emphasize that we had
• 44:53over two hundred ideas that
• 44:55got implemented
• 44:56or considered along the way.
• 44:57This is a small fraction
• 45:00of, of all the ideas
• 45:02and most of it came
• 45:03from frontline clinician and staff.
• 45:04So
• 45:05I wanna thank everybody on
• 45:07this call. And if you
• 45:09have,
• 45:10your frontline staff are not
• 45:11on on this call, please
• 45:12extend our thanks to all
• 45:14their effort and ideas.
• 45:15I wanna specifically highlight, Jensen
• 45:18and her team. They give
• 45:19us a lot of great
• 45:20ideas in the oncology side
• 45:21that that, bone management team,
• 45:24they were,
• 45:26self initiated, a lot of
• 45:27changes to decrease the the
• 45:28fluid.
• 45:29But if if I look
• 45:30at all the interventions, they
• 45:32really fall in two buckets.
• 45:34One is reduce waste,
• 45:35and we had a lot
• 45:36of that spike in bags
• 45:37before the where we need
• 45:39them,
• 45:40flush uses
• 45:41big bags of flush IV
• 45:43lines. So we did a
• 45:44lot of work to minimize
• 45:45that. We looked at all
• 45:46the order sets and and
• 45:48therapy plans if IV fluid
• 45:50was defaulted
• 45:51and was not necessarily we
• 45:53took this out.
• 45:54We switched to any premade
• 45:56manufacturing bags, so we have
• 45:57tons of Jocelyn and Venco
• 45:59now that comes frozen to
• 46:00replace the need for IV
• 46:02fluid.
• 46:03On the oncology side, we
• 46:04switched from, IV Amanda
• 46:06IV Poets Cervantes.
• 46:08And it it's a small
• 46:09change, but that account for
• 46:10about thousand bags of two
• 46:12hundred fifty ml per month.
• 46:15We,
• 46:16we are limiting the use
• 46:17of high dose methotrexate to
• 46:18high risk patients, and those
• 46:19cases get escalated doctor Huntington
• 46:22for approval.
• 46:23We are encouraging the use
• 46:24of PO cytoxin,
• 46:26and we are looking for
• 46:28ways that to change the
• 46:29sequence with some of the
• 46:30chemotherapies,
• 46:31with cisplatin
• 46:32that that optimized hydration. So
• 46:34a lot of work,
• 46:36in in this area.
• 46:37And I wanna proud of
• 46:39to show you even, this
• 46:41slide that show where,
• 46:43the the result of all
• 46:44this work.
• 46:45This is specific to Smilow.
• 46:47So we can see from
• 46:48baseline, we have about forty
• 46:49percent reduction,
• 46:51in IV,
• 46:52fluid utilization.
• 46:54More importantly for me is
• 46:56the the fact that the
• 46:57last three weeks,
• 46:59has been stable. So it's
• 47:00it's not, a decrease that
• 47:02followed by an increase.
• 47:04We we maybe now have
• 47:05a a new baseline, so
• 47:06we can sustain that after
• 47:08the shortage is over.
• 47:09The hospital hospital wide way
• 47:11about forty five percent reduction
• 47:12for baseline, so we're almost
• 47:14in line with the rest
• 47:15of the health system.
• 47:17On the bottom left, the
• 47:18it's another tool that we
• 47:20added on the on the,
• 47:22dashboard.
• 47:23It show,
• 47:24utilization
• 47:26rate per hundred patients,
• 47:28from baseline
• 47:29to currently.
• 47:30I I just wanna emphasize
• 47:32that this is not a
• 47:32scorecard. So if you see
• 47:34that you have a major
• 47:35reduction,
• 47:37or don't have a reduction
• 47:38that does not reflect on
• 47:40the staff or patient management.
• 47:42It's just an idea
• 47:44to show you where are
• 47:45you today, encourage everyone to
• 47:47to look at, this dashboard,
• 47:49look at your unit, see
• 47:50how utilizing your fluid, and
• 47:52look for opportunity.
• 47:53Again, we wanna provide as
• 47:55much information as possible,
• 47:57in your hand,
• 47:59at that to help you
• 48:00help us with the mitigation
• 48:02strategy.
• 48:04I promise to end with
• 48:05a happy note.
• 48:07I I seem to be
• 48:08invited to this,
• 48:09town hall every time there's
• 48:10a shortage,
• 48:11and I am committing to
• 48:13happy happy news at the
• 48:14end. We are seeing, a
• 48:16light at the end of
• 48:17the tunnel.
• 48:19We heard from Baxter that
• 48:20they already started their highest
• 48:22throughput IV solution manufacturer line.
• 48:24That line is responsible for
• 48:26twenty five percent of all
• 48:27output in this plant and
• 48:28fifty percent of the one
• 48:30liter.
• 48:31They also told us that
• 48:33the second line would be
• 48:34coming online this week, and
• 48:36that wouldn't make it fifty
• 48:38percent,
• 48:39of all capacity
• 48:41in this plant and almost
• 48:42a hundred percent eighty five
• 48:44percent of the one liter.
• 48:45We're no more tomorrow.
• 48:47Baxter update us, now on
• 48:48a weekly basis on Thursday.
• 48:51And, they also, told us
• 48:53that they're gonna now increase
• 48:55this allocation in a plan
• 48:57phase approach
• 48:58starting at the end of
• 48:59the month,
• 49:00mid December
• 49:01with the goal of,
• 49:02complete resolution by the end
• 49:04of the year. So we
• 49:05should see some relief in,
• 49:08later this month. It's not
• 49:10gonna be across all product
• 49:11lines. I think we'll start
• 49:12with the one liter and
• 49:13the five hundred.
• 49:14You will see improvement in
• 49:16a smaller,
• 49:16size is two fifty, one
• 49:18hundred, and and and then
• 49:19fifty ml by
• 49:21mid December to the end
• 49:22of the year.
• 49:24Unfortunately,
• 49:24and I'm I'm looking at
• 49:25Kevin here, we have not
• 49:26heard any good news about
• 49:27irrigation fluid,
• 49:29and this has continued to
• 49:30be,
• 49:31the challenge here and nationally.
• 49:33But I'm also proud to
• 49:35say that unlike other,
• 49:37centers where we heard that
• 49:38surgeries are being canceled,
• 49:40we have not had
• 49:41any procedure surgery canceled here.
• 49:44We did not have any
• 49:45impact on, our infusions inpatient
• 49:48or outpatient.
• 49:49So, again, thanks to all
• 49:50your efforts. We're able to
• 49:52maintain patient care
• 49:53without,
• 49:55any,
• 49:56delay. So
• 49:57with that,
• 49:59I will and happy to
• 50:00answer questions now or at
• 50:02the end.
• 50:03Thanks, Sam. Incredible work.
• 50:06And in the interest of
• 50:07time, doctor Morris is in
• 50:09high demand this morning.
• 50:11So I'm just going to
• 50:12pass it right over to
• 50:13her for
• 50:14discussion of,
• 50:15high priority work stream planning.
• 50:17Thank you, Jensa.
• 50:19Thanks, Kevin. And thank you,
• 50:21Sam, for the good news.
• 50:22IV fluids for everyone. Right?
• 50:24I I can just write
• 50:25every okay. Good. Thanks. I
• 50:26got a nod there.
• 50:28So,
• 50:29we have just a few
• 50:30minutes left. So I really
• 50:32prepared a very brief overview
• 50:34of the SMILO inpatient years
• 50:36and
• 50:37SMILO inpatient
• 50:39units and our fiscal year
• 50:40summary. So next slide.
• 50:43We'll look at the Yale
• 50:45New Haven Health System fiscal
• 50:46year twenty four objectives and
• 50:48see how we did on
• 50:49the inpatient side, how we
• 50:50measured up. We'll look at
• 50:51some of our throughput outcomes
• 50:53and then some successes and
• 50:55challenges on the inpatient side.
• 50:57As I said, very brief.
• 50:59Okay. Here's the big overview.
• 51:01This is the, you know,
• 51:02the big picture.
• 51:05Yale New Haven Health System
• 51:06sets,
• 51:09important
• 51:10goals
• 51:11based on our
• 51:14objectives and values. The first
• 51:16most important
• 51:17value is that we
• 51:21try to provide
• 51:22world class care. That's why
• 51:24we go to work every
• 51:25day. And the second is
• 51:28the
• 51:29to accelerate agile and intentional
• 51:31growth. So within the world
• 51:32class care objective,
• 51:35it's really patient experience,
• 51:37care signature,
• 51:38and
• 51:39inpatient mortality.
• 51:41So if you look at
• 51:42care signature,
• 51:44we all know that Press
• 51:45Ganey sends out surveys to
• 51:47our patients after their hospitalization.
• 51:49There are numerous questions.
• 51:51But the one that the
• 51:52health system really zooms in
• 51:53on is the of the
• 51:55question of how likely are
• 51:57you to recommend
• 51:59Yale New Haven Hospital,
• 52:02to others.
• 52:03And
• 52:04what we're looking for is
• 52:05we're looking for people to
• 52:06say, of course, that they're
• 52:08very likely to recommend.
• 52:10And
• 52:10of our discharges from inpatient
• 52:13Smilo units, seventy six point
• 52:15eight percent of people said
• 52:16they were very likely to
• 52:18recommend.
• 52:18And that puts us in
• 52:20the seventy sixth percentile,
• 52:22which you can see we
• 52:23did fall short of our
• 52:25threshold
• 52:26objectives
• 52:26for fiscal year twenty four.
• 52:29We worked really hard in
• 52:30sort of three domains or
• 52:32three areas. One was responsiveness,
• 52:34so responsiveness to call about,
• 52:35responsiveness to patient needs. The
• 52:37second thing we worked really
• 52:39hard on was
• 52:41cleanliness,
• 52:42the inpatient environment and cleanliness.
• 52:50And
• 52:51we will indeed have more
• 52:56unit level projects that will
• 52:58continue to drive patient satisfaction
• 53:00in the new fiscal year.
• 53:02For Care Signature Pathway utilization,
• 53:04I'm really glad that you
• 53:05heard all about the Care
• 53:06Signature Pathways. I have to
• 53:08say that I'm a huge
• 53:09fan,
• 53:10and Kate,
• 53:12and Mary Anne are doing
• 53:13great work on this.
• 53:15The way that we measured
• 53:16Care Signature pathway utilization is
• 53:18that we wanted for every
• 53:19time a patient was hospitalized
• 53:21for that entire encounter of
• 53:22their hospitalization,
• 53:24we really wanted
• 53:25one pathway used for that
• 53:26entire hospitalization.
• 53:28So it's a low, low
• 53:29bar for this very first
• 53:30year of measuring it, and
• 53:32we wanted forty percent of
• 53:34all hospitalizations
• 53:35to have one pathway used.
• 53:37We met that metric, but
• 53:38I think we really have
• 53:39to do a whole lot
• 53:40better than that. The metrics
• 53:42are going to go up
• 53:43next year, but, really, every
• 53:45patient should have a pathway
• 53:47used
• 53:48every day in their clinical
• 53:49care, and that's what we
• 53:50should be aspiring to.
• 53:52ODE inpatient mortality is critically
• 53:54important. We want our patients
• 53:56to do well.
• 53:58ODE is observed to expected.
• 54:02Observed is exactly how it
• 54:04sounds,
• 54:06how many of our patients
• 54:07died in our care, and
• 54:08expected is based on the
• 54:11our case mix index, how
• 54:12sick our patients are, what
• 54:14our expected mortality would have
• 54:16been,
• 54:17and that ODE is calculated
• 54:18from there.
• 54:20Our target was zero point
• 54:22eight nine, where
• 54:24one is the median. So
• 54:25if you compare us to
• 54:26all like academic institutions, if
• 54:28we hit one, we're average.
• 54:31If less than one, we're
• 54:33better than average. And as
• 54:34you can see, if you
• 54:35look at month to month,
• 54:38at our very best, we
• 54:39are point o seven
• 54:40and,
• 54:42up to point three two,
• 54:43and I'll show you a
• 54:44graph of that in a
• 54:45minute. But we far exceeded
• 54:46our target.
• 54:47Our patients do well, and
• 54:49this is really, really important.
• 54:51Our clinical care,
• 54:53and our goal to deliver
• 54:54world class care, we are
• 54:56we are achieving that.
• 54:58Accelerate agile and intentional growth
• 55:00is the second part of
• 55:01this.
• 55:03We want more patients
• 55:04to have the opportunity
• 55:06to receive the specialized care
• 55:07within the Smilo units.
• 55:10Doctor Huntington spoke about how
• 55:12there are twenty patients every
• 55:13day, Smilo patients that are
• 55:15rolling other over to other
• 55:16services because there just aren't
• 55:18enough
• 55:19beds. The way that we
• 55:20make beds is by reducing
• 55:21length of stay.
• 55:23And, again, it's our observed
• 55:25to expected, so that's our
• 55:27actual length of stay compared
• 55:28against our expected length of
• 55:30stay.
• 55:31And our
• 55:32target was point was one
• 55:34point zero five. That was
• 55:35what Yale New Haven had
• 55:36targeted this year,
• 55:37and our performance was much
• 55:39less than that,
• 55:41which is good. We had
• 55:42shorter length of stay. But
• 55:44I do wanna point out
• 55:45for all of you that
• 55:47SMILO actually had the lowest
• 55:48o ODE length of stay
• 55:50of any service line at
• 55:52Yale New Haven Hospital. So
• 55:53really a great accomplishment
• 55:57demonstrating high quality, efficient care,
• 55:59which is what we aim
• 56:00to provide,
• 56:01on our SMILO units.
• 56:04Next slide.
• 56:05Okay. Let's look at ODE
• 56:07mortality.
• 56:08This is our observed to
• 56:09expected mortality,
• 56:10and you can see,
• 56:13it varies month to month.
• 56:15But you can see that
• 56:16at our very best,
• 56:18we do extremely well remembering
• 56:20that one point zero is
• 56:21the median for like academic
• 56:23institutions.
• 56:25And
• 56:26even even in our tough
• 56:27months,
• 56:28zero point three two. So
• 56:30we are excelling here.
• 56:33Next slide.
• 56:35Accelerating agile and intentional growth.
• 56:37This is our efficient length
• 56:39of stay. Let's break this
• 56:40down by
• 56:42our units.
• 56:43So, overall,
• 56:44we
• 56:45had a length of stay
• 56:47ODE of zero point nine
• 56:48three, and I'd just like
• 56:49to say one more time
• 56:50that Smilow was the most
• 56:53efficient
• 56:54service line in the hospital.
• 56:55But even if you look
• 56:56at each of our individual
• 56:58units,
• 56:59it's it's really
• 57:01impressive.
• 57:02So remembering our target for
• 57:03Yale New Haven was one
• 57:04point zero five.
• 57:06All of our units were
• 57:08successful. Look at surgical oncology
• 57:10and how well they did.
• 57:12And a special shout out
• 57:13to Smilo East.
• 57:15This unit
• 57:16has only existed for a
• 57:18year. We we had a
• 57:20opening ceremony cutting the the
• 57:23tape at
• 57:24in August of twenty twenty
• 57:26three.
• 57:27Smilo East had three thousand
• 57:29and four discharges, which was
• 57:30thirty four percent of all
• 57:32the discharges
• 57:33from SMILO,
• 57:35with an overall efficiency or
• 57:37OTLE e length of stay
• 57:38of zero point eight two.
• 57:39Impressive.
• 57:41Next.
• 57:42Okay. SMILO inpatient throughput. This
• 57:44is this is sort of
• 57:45the full summary slide, and
• 57:47then we will wrap it
• 57:48up.
• 57:50ODE length of stay is
• 57:51gradually decreasing over the last
• 57:53two years.
• 57:54But
• 57:55if you were thinking and
• 57:56listening carefully, you might say,
• 57:58well,
• 57:59it is a ratio,
• 58:01and the expected length of
• 58:03stay is all about documentation
• 58:04and coding. So what if
• 58:06we were just documenting better
• 58:07and, really, our length of
• 58:09stay was exactly the same?
• 58:10That wouldn't really help us.
• 58:12So let's see what our
• 58:12actual length of stay was
• 58:14because that's how we re
• 58:15open beds.
• 58:16So next.
• 58:18Alright. Our actual average length
• 58:20of stay is also declining,
• 58:22and you can see that
• 58:23we've put our goodness in
• 58:24the almost up at the
• 58:25seven range days, and we're
• 58:28down just below six days.
• 58:30So the gradual decrease in
• 58:31length of stay over the
• 58:33last two years
• 58:34is what's critical to open
• 58:36beds and bring our overflow
• 58:38patients onto our SMILO units.
• 58:40And so, theoretically, we should
• 58:42be increasing the number of
• 58:43discharges from Smilo units, and
• 58:45that's the next bar, encounters.
• 58:47Neck and you can see,
• 58:48yes, we've had a gradual
• 58:49increase in encounters
• 58:51from the low nine thousand
• 58:53range to the low ten
• 58:54or, actually, nearly eleven thousand,
• 58:58discharges
• 59:00for the
• 59:01the last month of this
• 59:03of this two year cycle.
• 59:05Everyone always asks, if we
• 59:07are more efficient, do we
• 59:08increase readmissions? So I'm obliged
• 59:10to show you the next
• 59:11one, which is readmissions.
• 59:13Ignore that very last month.
• 59:14We don't have all the
• 59:15data back for readmissions yet,
• 59:17so that,
• 59:18is particularly low, but we're
• 59:20sitting at eleven, twelve percent
• 59:22month after month after month.
• 59:24Yes. There's opportunity for improvement,
• 59:26and, yes, we're actually just
• 59:28embarking right now on a
• 59:30Smilu specific
• 59:31readmission reduction program with the
• 59:33the skilled nursing facility. It's
• 59:34sort of a really key
• 59:36intervention there.
• 59:38But let's see. I think
• 59:39this is the last. Next
• 59:41slide.
• 59:42Let's just summarize some of
• 59:43our successes and challenges in
• 59:45the last thirty seconds.
• 59:47So throughput has been a
• 59:48great success, but it also
• 59:49remains one of our great
• 59:51challenges, ed boarding, overflow of
• 59:53SMILO patients. We still have
• 59:54work to do. Our we've
• 59:56had great success
• 59:57with the roll with the
• 59:59rollout of the clinical deterioration
• 01:00:01index and the Smilow specific
• 01:00:03rapid response team, we now
• 01:00:04have,
• 01:00:05Smilow hospitalists responding to emergencies.
• 01:00:08But we we can respond
• 01:00:10to the emergencies, but then
• 01:00:11we have no access to
• 01:00:12critical care beds. Access to
• 01:00:14urgent care is still an
• 01:00:16issue.
• 01:00:17And then we've done a
• 01:00:18great job specializing our care.
• 01:00:20Our oncology consult service is
• 01:00:22now making sure that the
• 01:00:23specialist oncologist is seeing the
• 01:00:25patients, the right doctor is
• 01:00:26seeing the right patient,
• 01:00:28but now we have to
• 01:00:29adapt the workforce and workflows
• 01:00:30to match these really specialized
• 01:00:32clinical needs.
• 01:00:34Next slide.
• 01:00:37And thank you.
• 01:00:44So
• 01:00:45thank you, Jensa and your
• 01:00:46team. This is incredible work.
• 01:00:49We have shared so much
• 01:00:50great work
• 01:00:51that I regret to say
• 01:00:53we all have to run
• 01:00:54away and we have no
• 01:00:55time for questions.
• 01:00:58Tracy, do you have anything
• 01:00:59to add?
• 01:01:00No. Thank you all to
• 01:01:02the great presenters. I think
• 01:01:03this was a lot of
• 01:01:04really valuable information shared this
• 01:01:06morning and,
• 01:01:08appreciate all everyone is doing
• 01:01:09to make processes smoother and
• 01:01:12better for patients.
• 01:01:15Have a great day, everyone.
• 01:01:16Thank you.