Smilow Cancer Hospital Town Hall | February 21, 2024

Transcript

• 00:00OK. Good evening, everyone.
• 00:02Welcome to this Milo Cancer
• 00:04Hospital Town Hall for February.
• 00:07Thank you all for taking time
• 00:09to join us this evening.
• 00:11I'm just going to run quickly
• 00:13through what the agenda is.
• 00:15We're going to start with some
• 00:17announcements and recognition.
• 00:19Then Doctor Billingsley
• 00:20will be speaking about U.S.
• 00:22news and World Report rankings.
• 00:26Doctor Jensen Morris and Nina
• 00:27Carrasilla will be speaking about
• 00:29capacity management and length of stay.
• 00:31And then Jen Watkins will
• 00:33talk about our new transition
• 00:35to EPIC on the tumor boards,
• 00:37followed by finally Angela
• 00:39Carrera for providing social work
• 00:41support to patients and families.
• 00:44So I am going to turn it over to Kevin
• 00:47to walk us through some announcements.
• 00:50Thank you, Tracy.
• 00:51And I'd just like to say welcome to everyone.
• 00:54Lots as as usual, lots of growth,
• 00:57lots of development and lots
• 01:00of exciting things happening in
• 01:02Spilo and the Cancer Center.
• 01:04One of the things that I want our
• 01:07community to be aware of is that
• 01:10historically we have had one of the most
• 01:12academically productive and clinically
• 01:15robust Melanoma programs in the nation.
• 01:20But as immunotherapy has evolved as a
• 01:24killer in the treatment of both Melanoma
• 01:28as well as renal cell cancer as and in
• 01:32addition to some other dermal neoplasms,
• 01:35we have moved to a consolidation
• 01:38of the clinical care of those
• 01:41of those two groups of patients.
• 01:44And we have chosen for programmatic and
• 01:47clinical reasons to integrate them into the,
• 01:51what we are now calling the skin
• 01:54and kidney cancer clinical program.
• 01:56This is under the clinical
• 01:58leadership of Doctor Harriet Kluger.
• 02:01Of course,
• 02:02we have a renowned team of clinicians
• 02:05that are drawn from both the
• 02:07historical Melanoma program as
• 02:09well as the Gu malignancies program
• 02:11folded in under this umbrella.
• 02:14And as the slide says,
• 02:15the program better reflects the
• 02:18expertise of the physicians and
• 02:20advanced practice providers and
• 02:22nurses caring for patients with skin
• 02:25cancers in renal cell carcinoma.
• 02:27The department name change has of
• 02:30course been updated in EPIC because
• 02:32that's where we do all of our work.
• 02:35So exciting development and I think
• 02:38it really reflects our leadership and
• 02:40our growth in this these two areas.
• 02:42Now United as one program.
• 02:45Next slide please.
• 02:49So on NP8, we are going to be doing
• 02:55both infusion and blood draw.
• 02:57So the NP4 blood drawing teams
• 03:01will be moving up to NNP 8.
• 03:04This will be effective on March 4th
• 03:06with the aim of maximizing patient
• 03:09capacity and nursing support.
• 03:12Again, there will be a change
• 03:14within the EPIC department.
• 03:16The NP4 lab nursing and women's
• 03:18lab draw chair will move up to the
• 03:21NP8 vital sign and lab draw room
• 03:24and patients will be scheduled
• 03:27for these draws on NP8.
• 03:31I think I would just add that the
• 03:33women's infusion which was separate
• 03:35from the solid tumor on NPA,
• 03:36they will function as two separate
• 03:39entities are now all going to
• 03:41be one large infusion center and
• 03:43that will be one department as
• 03:45in within this structure change.
• 03:50Thank you, Tracy. Next slide.
• 03:55So one of the other things that is
• 04:00incredibly exciting and
• 04:02rewarding to see is growth of our
• 04:05multidisciplinary clinical programs.
• 04:08Here as almost everyone
• 04:12in the audience knows,
• 04:14with Doctor Taraga's arrival over a year ago,
• 04:18we have become a regional and
• 04:20national leader in the treatment of
• 04:22patients with peritoneal malignancies.
• 04:25And this this program has actually
• 04:29expanded to encompass the
• 04:31multidisciplinary treatment not only
• 04:34of patients with peritoneal disease,
• 04:36but a spectrum of patients with complex
• 04:39oligo metastatic disease that we are
• 04:42now treating with a combination of surgery,
• 04:44systemic therapy and in some
• 04:47cases radiation therapy.
• 04:50As such, this complicated group of patients
• 04:55merits their own multidisciplinary
• 04:58treatment conference for prospective
• 05:00review and treatment planning.
• 05:03So we will be starting the oligo,
• 05:06the peritoneal oligo metastatic
• 05:08case conference on Fridays.
• 05:11This will be Friday 12:30 to 1:30
• 05:14under the leadership of Doctor Taraga.
• 05:16Of course,
• 05:18with other multidisciplinary
• 05:20teams participating.
• 05:21This will be virtual and
• 05:25it will be starting well.
• 05:30I think we were looking at the 23rd,
• 05:32but this will more likely start
• 05:34the 1st of March.
• 05:36As always,
• 05:37I'd like to thank the services
• 05:39that support these conferences,
• 05:42particularly Radiology and
• 05:44Pathology who are key members of
• 05:47these teams and without their
• 05:49support this would not be possible.
• 05:52This will be a case conference for now.
• 05:54As this evolves,
• 05:56we there's a very high likelihood this
• 05:58will evolve into a formal tumor board.
• 06:01To do so will require a couple
• 06:05of other administrative maneuvers
• 06:06and it will be recognized by our
• 06:09cancer committee and become part
• 06:11of our Coc structure.
• 06:13But for the current time,
• 06:14it will be a prospective case conference
• 06:19next. It gives me great pleasure to
• 06:24recognize the work of our thoracic surgeons.
• 06:27Under the leadership of a doctor,
• 06:29Dan Boffa, the STS is the primary
• 06:33national body who organizes A prospective
• 06:38data collection and quality programs.
• 06:42They oversee the collection of data through
• 06:46the STS thoracic database and our team
• 06:50has been awarded in the esophagectomy
• 06:52program with a three star overall
• 06:55composite for excellent performance.
• 06:57So obviously like all of these achievements,
• 07:01there is an incredible array of
• 07:03people who are behind the success
• 07:06in addition to the leaders.
• 07:08Obviously, it's a great recognition
• 07:11for our surgeons,
• 07:12but it could not be done without
• 07:15outstanding nursing care.
• 07:17I think it's a particular opportunity
• 07:21for us to recognize the work of the
• 07:24NP15 nursing teams who have gained great
• 07:27competence competencies in the care of
• 07:29this complicated group of patients as
• 07:32well as the ICU nurses and a variety
• 07:36of other teams that support the care
• 07:39of these really involved patients,
• 07:41respiratory therapy,
• 07:43physical therapy and nutrition among others.
• 07:47I think we can go on
• 07:51as we're all aware,
• 07:52virtually every month has some particular
• 07:56awareness in the cancer universe.
• 08:00I would say we all need to be aware
• 08:03of every malignancy every month,
• 08:06but we will give a shout out
• 08:09in March and ask that we dress
• 08:12in blue in in recognition of
• 08:17colorectal cancer awareness next.
• 08:21So I'm going to speak for a minute about U.S.
• 08:23news in a World Report.
• 08:25You know these,
• 08:26this is our cancer program reading.
• 08:29It's also our hospital ranking
• 08:31And I'm going to say at the
• 08:33outset that the health system,
• 08:35particularly under the
• 08:37leadership of Deb Rhodes,
• 08:39Corey Champo and Chris Petker have
• 08:42led incredible work that I think
• 08:44is going to favorably impact our
• 08:47ratings over the next couple of years.
• 08:50But this is work that requires deep
• 08:52and ongoing and investment and we
• 08:55don't see the returns immediately.
• 08:57I will share with this group
• 09:00that the house that Yellow Haven
• 09:03Hospital mortality scores have
• 09:05improved substantial substantially.
• 09:08I see Doctor Morris smiling.
• 09:11You have been a part of that.
• 09:12Thank you very much.
• 09:14You and your hospitalists.
• 09:17We will delve into that data in more
• 09:19detail in coming weeks and months.
• 09:22I'll just offer a teaser today and the
• 09:26mortality statistics in as measured
• 09:29by Visient and our ODE ratio is
• 09:33probably the most important metric
• 09:36that will impact our our ranking.
• 09:39There are other things,
• 09:40but that's probably the central.
• 09:45I wanna bring this to the
• 09:47attention of our community today.
• 09:49However, because the reputation
• 09:52scores are part of our ranking and
• 09:56our reputation scores are developed
• 09:58on the basis of Doximity voting by
• 10:02cancer clinicians across the country,
• 10:05it is important that we all
• 10:09participate in Doximity voting.
• 10:11Physicians and APPSI know can register
• 10:15for Doximity at through the app.
• 10:19I would encourage you if you do not
• 10:21have the app on your phone, it is.
• 10:23It's well worth having.
• 10:25I use the Doximity dialer all the time.
• 10:29I think that that's a side benefit,
• 10:31but it is the portal that is is
• 10:34that we need to have available
• 10:37to us to enter our vote.
• 10:40You can use this QRS code watch
• 10:43for emails from your departments.
• 10:45Their Cancer Center will be sending them
• 10:47out as well as departments of medicine,
• 10:49surgery, and others.
• 10:52As Renee points out,
• 10:53even if you don't see the e-mail,
• 10:54you can still vote.
• 10:56Vote by logging on to doximity.com
• 10:58and the survey.
• 10:59We'll ask users to name the
• 11:01hospitals that provide the best
• 11:03care in your respective specialty.
• 11:06You can list up to five.
• 11:07However,
• 11:08you only need to vote for one
• 11:10to have your ballot count.
• 11:12I will say that it is well,
• 11:14it is incredibly important
• 11:16for all of us to participate.
• 11:19The greatest,
• 11:21the most heavily weighted scores
• 11:24in reputation come from votes from
• 11:28people outside of the organization.
• 11:31So part of our work is encouraging
• 11:35colleagues and peers at organizations
• 11:38across the country to recognize our
• 11:41great work and think of us as they
• 11:46complete their Doximity voting.
• 11:51Every vote counts. I'll leave it at that.
• 12:01So Tracy, you're on mute.
• 12:02I think I'll kick it over to you.
• 12:04Thank you for the mute reminder.
• 12:07Thank you, Kevin.
• 12:08We are now going to turn it over
• 12:10to Doctor Jensen Morris and Nina
• 12:12Caracillo who are going to talk
• 12:14to us about capacity management
• 12:16and length of stay a very another
• 12:18important part of our mission here.
• 12:25Great, thank you and thank you
• 12:27for the opportunity to talk about
• 12:29inpatient capacity management.
• 12:31This is a lot of what we do
• 12:33every day on the inpatient side.
• 12:36Here's the problem,
• 12:37as most of you know access to
• 12:40inpatient care is at a premium.
• 12:42On any given day,
• 12:44we could have 80 to 100 patients
• 12:46who are in the emergency department
• 12:48admitted waiting for a bed upstairs.
• 12:51And it it goes without saying
• 12:53that Ed boarding presents a
• 12:54significant risk to our patients.
• 12:55But the literature actually supports this.
• 12:58Admitted patients waiting for beds
• 13:00upstairs simply do not receive the same
• 13:02level of care in the emergency department.
• 13:04In fact,
• 13:05the their median length of stay is
• 13:07extended almost exactly by the amount
• 13:09of time that they spend boarding in the Ed,
• 13:11suggesting that the time spent in
• 13:14the Ed is the care is not moving
• 13:17forward during that time.
• 13:18But worse than that,
• 13:20Ed boarding increases the risk of medication
• 13:22errors and preventable adverse events.
• 13:25Unfortunately,
• 13:25we see this in our quality
• 13:27and safety reports.
• 13:28Everyday boarding time greater than six hours
• 13:31actually increases in hospital mortality.
• 13:34There was a recent study that showed
• 13:36that patients who spend a night in
• 13:38the Ed waiting for a bed have a 1.3
• 13:41fold increase in inpatient mortality.
• 13:44That's concerning,
• 13:45but for older patients that is
• 13:48actually increases to about a
• 13:50two fold increase in mortality.
• 13:52So for older vulnerable patients like ours,
• 13:56spending a night in the emergency
• 13:58department is a highly morbid
• 14:00experience and potentially increases
• 14:02their inpatient mortality.
• 14:03And as you can see the the this
• 14:05is borne out in the literature and
• 14:08multiple references here as well.
• 14:13As a result, a lot of the work that we do
• 14:15upstairs is around discharge optimization.
• 14:18The concept is that in reducing
• 14:21inpatient length of stay,
• 14:23we can open up beds and allow these patients
• 14:26waiting in the emergency department to
• 14:29start their care sooner And on the days
• 14:32when patients are ready for discharge
• 14:34instead of discharging at 4:00 PM,
• 14:36move that discharge time earlier. So again,
• 14:39patients who are downstairs on its stretcher,
• 14:42staring up at fluorescent lights can come
• 14:46upstairs sooner and start their care.
• 14:49So is there evidence to support
• 14:51discharge optimization work upstairs?
• 14:52Does it actually work?
• 14:54And the answer is yes.
• 14:56Early discharge decreases the
• 14:58time patients wait in the Ed.
• 15:01For an inpatient bed discharge before
• 15:04noon specifically results in earlier
• 15:06median arrival time of admissions and a
• 15:08decrease in high frequency admission peaks.
• 15:10So instead of all the patients
• 15:12kind of arriving as a bolus,
• 15:14kind of as those discharges
• 15:16all happen around 4:00,
• 15:17the beds get cleaned,
• 15:18the patients arrive between 5:00 and
• 15:217:00 PM right around change of shift
• 15:23right when sort of the staffing is
• 15:26perhaps unstable or there are fewer
• 15:29doctors available to provide the care.
• 15:32By moving the discharge early
• 15:35discharges earlier in the day,
• 15:37we can actually smooth those admission peaks,
• 15:39care for patients promptly when they arrive.
• 15:43This has not only been shown
• 15:44in the medical literature,
• 15:45this has been shown right here
• 15:46at Yale New Haven Hospital.
• 15:48When the Yale New Haven Medicine
• 15:50service improved 11:00 AM discharge
• 15:52rate to greater than 20%,
• 15:54the all Ed admissions arrived
• 15:57one hour earlier.
• 15:59So the entire medicine service improved
• 16:01their discharge time and everyone benefited.
• 16:05Likewise,
• 16:05when hospitals were introduced
• 16:08to Smilohem OC services,
• 16:10we saw a length of stay reduction of
• 16:13one day on the that patient's cert on
• 16:16those services and it resulted in more
• 16:18than 500 additional patient admissions
• 16:20during that year to the SMILO Tower.
• 16:23So by reducing length of stay,
• 16:25we were actually able to see more of
• 16:27our patients on Tower instead of those
• 16:30patients rolling over and being seen on
• 16:32other units throughout the hospital.
• 16:33So this helps our patients get
• 16:36the multidisciplinary specialized
• 16:38care that they need on Smilo.
• 16:40People always ask,
• 16:42but you know what about patient satisfaction.
• 16:44And again,
• 16:45it's actually not impacted
• 16:47by early discharge efforts.
• 16:49Now we read all the patient satisfaction
• 16:52surveys and the number one complaint,
• 16:54not surprisingly, is meals.
• 16:56It's the food.
• 16:57The number 2 complaint is the
• 17:00discharge process.
• 17:00People say the team told me
• 17:02I was ready to go at 7 AMI,
• 17:05waited until 3:00 PM for discharge.
• 17:08When patients are ready to go,
• 17:09they want to leave.
• 17:11So this is actually a great
• 17:13patient satisfier.
• 17:15This is so important at Yale New
• 17:17Haven that seven out of eight of our
• 17:21inpatient priority workstream Metrics
• 17:23Centre round discharge optimization,
• 17:25these are Yale New Haven Health System
• 17:28priorities and seven out of eight
• 17:31are about discharge optimization.
• 17:32And I'm so I'm going to bring Nina in here.
• 17:35She's done a ton of work on this on
• 17:37her inpatient units and she'll discuss
• 17:39each of these inpatient metrics.
• 17:42Thanks, Jensa. So these are the
• 17:44metrics that we're working on for
• 17:46the fiscal year of 2024 and this
• 17:48shows our goal for the upcoming year.
• 17:51I think the inpatient teams have
• 17:53really been working hard to improve
• 17:56discharge optimization and as Jensa
• 17:58had said or Doctor Morris had said,
• 18:01the the majority of the metrics
• 18:03are related to discharge.
• 18:05So it's important for the nurses,
• 18:08the providers, the Care Coordination,
• 18:10care coordinators to all work together
• 18:13to really improve these metrics.
• 18:15So just to briefly go through them all,
• 18:17I think the one that we're most
• 18:19aware of and comfortable with is the
• 18:21percent of 11:00 AM discharge and
• 18:23this is the percent of discharges
• 18:26completed before 11:00 AM.
• 18:28The goal for this year is 18%.
• 18:31Some of the other ones,
• 18:32which we're starting to improve slowly,
• 18:36are the expected discharge date.
• 18:39This is the percent of
• 18:41inpatient hospital day,
• 18:42inpatient hospital days with a
• 18:45documented expected date of discharge.
• 18:48So we're the care coordinator,
• 18:50the provider.
• 18:50We can try to get an expected date of
• 18:53discharge that everybody's aware of.
• 18:55And then our goal is to get the
• 18:58patient out by that particular date.
• 19:01The percent of daily discharges are
• 19:03the percent of days in which each unit
• 19:06meets their daily discharge target.
• 19:08And so that's by unit,
• 19:09and that's set by an epic algorithm.
• 19:12The overall goal for this year is 65%.
• 19:16And then we can try to break that
• 19:18down between weekdays and weekends
• 19:19to see if we can meet that through
• 19:22the whole entire week.
• 19:23As sometimes weekends tend to be a
• 19:25little bit more challenging for discharges,
• 19:27we're trying to figure out what the
• 19:29barriers are to that and trying
• 19:31to improve how we can improve
• 19:33our weekend discharges.
• 19:35The percent of CMO patients
• 19:37discharged to Hospice,
• 19:39that is the percent of patients that have
• 19:42ACMO code status that have a disposition
• 19:44to Hospice whether it be home Hospice,
• 19:47inpatient Hospice with the
• 19:49goal of 55% for this year.
• 19:51We're trying to increase and improve
• 19:54Hospice utilization for patients.
• 19:57And then lastly,
• 19:58the ODE length of stay which is the
• 20:01actual or observed length of stay
• 20:04compared to the expected length
• 20:06of stay as determined by their the
• 20:09as the coding of their prognosis
• 20:11and diagnosis and comorbidities.
• 20:13And so these are the metrics that
• 20:16I think now we're really trying on
• 20:18a day-to-day basis try to improve
• 20:20in improve discharge optimization.
• 20:23Thanks. Thanks, Nina.
• 20:29So how are we doing with
• 20:31our discharge metrics?
• 20:32So you can see the metrics here on the
• 20:34left under the priority work stream.
• 20:36You can see the Yale New Haven
• 20:39Health System goals in blue.
• 20:41And then you see Smilo and you say,
• 20:43hey, we're doing pretty well,
• 20:44we're in the green.
• 20:46And you know, if you really wanted
• 20:48to look for our opportunity,
• 20:49it's weekend discharges.
• 20:50In fact, a patient said to me today,
• 20:54I I just have to be out by the weekend,
• 20:56'cause you know what happens on the weekend?
• 20:58Nothing.
• 20:58And we don't want to be a five
• 21:01day a week hospital.
• 21:02We need to be a seven day a week hospital
• 21:05providing services equally on all seven days.
• 21:08So it looks like from a
• 21:11distance we're doing well,
• 21:12but actually what when you break
• 21:14it down by unit and by service,
• 21:16we have some really high performing
• 21:18units and then we have opportunities.
• 21:20And so just to give some shout
• 21:22outs and to point out where we
• 21:24have opportunities to improve
• 21:2511:00 AM discharge NP12 solid
• 21:28tumor oncology and NP 14,
• 21:30Nina's unit gynecology oncology is doing,
• 21:34they're both doing exceptionally well there.
• 21:36We have opportunities on Smilo
• 21:39East and hematology and P11,
• 21:41expected date of discharge documentation.
• 21:44NP12 has a lot of work to do and
• 21:46that's the unit I spend the most time.
• 21:48And we really need to be able
• 21:50to get everyone on board so that
• 21:53we're communicating clearly to
• 21:54the patient and their families
• 21:56percent of daily discharges.
• 21:58Again,
• 21:59it's Nina's unit that's carrying
• 22:01all of Smilo and the rest of us
• 22:04need to catch up on achieving
• 22:06our daily discharge targets,
• 22:08patients CMO patients discharged to Hospice,
• 22:11The most opportunities are both
• 22:13on hematology and then on surgical
• 22:16oncology and P-15 and O to E length of
• 22:21stay are opportunities are really on
• 22:23hematology and solid tumor oncology.
• 22:25So just to let you know that although
• 22:27that we're meeting the targets,
• 22:28there's still work to be done
• 22:31on the individual units.
• 22:32And so in conclusion,
• 22:34we really wanted to emphasize here
• 22:36that inpatient beds are a scarce
• 22:38resource requiring responsible resource
• 22:40stewardship just the same way we
• 22:42do blood management stewardship,
• 22:44antibiotic stewardship,
• 22:45We need to use our inpatient beds wisely.
• 22:49And one of the ways we need to do that
• 22:51is to reduce inpatient excess days.
• 22:53We would never suggest discharging a
• 22:55patient before they're medically stable.
• 22:57The goal is to reduce the days
• 23:00beyond medical stability and
• 23:02when patients are ready to go,
• 23:04they want to go home and that's
• 23:06up to us to discharge earlier.
• 23:08You may hear your patients talk about
• 23:10the closer to home discharge lounge.
• 23:12So patients who are medically ready
• 23:14and they're just waiting for a ride
• 23:17may go to the discharge lounge just
• 23:19outside the atrium on the 1st floor.
• 23:22We will continue as we have been
• 23:25for really decades now shifting
• 23:27clinical burden to the outpatient.
• 23:30So non critical evaluations,
• 23:32staging scans,
• 23:34biopsies that don't need to be done.
• 23:35Inpatient unfortunately will continue
• 23:37to be shifted to the outpatient.
• 23:39And we know that increases the burden
• 23:42on the outpatient providers and you
• 23:44know increases care coordination and
• 23:49but again it allows the patients who are
• 23:51critically ill in the emergency department
• 23:53to get the care that they need upstairs.
• 23:56We need to use a hospital at home
• 23:59more broadly, either patients being
• 24:01transferred directly from the Ed to
• 24:03hospital at home or patients spending
• 24:04a few days in the hospital and then
• 24:06transferring to hospital at home.
• 24:08This is a service patients love universally.
• 24:11Patient satisfaction levels at hospital at
• 24:14home exceed patient satisfaction anywhere
• 24:16else in the brick and mortar hospital.
• 24:18And then one other point to emphasize
• 24:21is that the concept of virtual Hospice,
• 24:23so using inpatient beds for Hospice
• 24:26care is really not an option.
• 24:29We need to use those beds for again are
• 24:33critically I'll patients and so patients
• 24:35who are transitioning to in to Hospice care,
• 24:38ideally that would be done as an
• 24:41outpatient but we know that's not always
• 24:43possible and when we do do that as an
• 24:45inpatient we'd be transitioning to
• 24:47inpatient Hospice units or home Hospice.
• 24:51I would love to entertain questions.
• 24:55This is this is work that we is ongoing
• 24:58and we it's all about improving
• 25:01access for our patients.
• 25:10If anyone has questions they
• 25:11want to put in the Q&A or chat,
• 25:21you know Jensen and Nina,
• 25:23I'll just first start by saying thank you,
• 25:25thank you, thank you.
• 25:27This is incredibly important work
• 25:29and it does make me very proud
• 25:31of our teams to see the progress
• 25:33that we are making across the
• 25:35units under your your leadership.
• 25:38As you both pointed out, it is,
• 25:41this is a totally team based endeavour
• 25:47requiring a lot of coordination,
• 25:52collaboration and aligned messaging
• 25:55from attending physicians, surgeons,
• 26:00advanced practice providers,
• 26:03residents, fellows and of course
• 26:06our our nursing teams. And
• 26:10you know I think we all
• 26:11have a part to play in it.
• 26:12I do have questions.
• 26:14I'm going to save them till the end.
• 26:16I think we will have a
• 26:17little time for Q&A although
• 26:22there Jensen might have to
• 26:24leave a little bit early.
• 26:25Sorry. There is one question,
• 26:27why do we take Diane's question then?
• 26:31So the question is getting people who
• 26:33don't qualify for inpatient Hospice and
• 26:35can't go to home Hospice and don't have a
• 26:37payment source for Hospice in short term.
• 26:39Rehab is a huge, huge problem we
• 26:42encounter on very regular basis.
• 26:44It needs, I think it's a comment
• 26:45more than a question.
• 26:46It needs advocacy on governmental
• 26:48level to expedite Title 19 for long
• 26:51term care application approvals.
• 26:54I couldn't agree more.
• 26:55Diane, I'm I'm right with you.
• 26:57This is a huge problem.
• 26:59Access to *** level Hospice is really
• 27:02limited and this is a struggle for
• 27:06our families to figure out ways to
• 27:09support their loved ones at home.
• 27:15The options are so limited right now
• 27:25Jen. So I will follow up on that
• 27:27I guess with one one question.
• 27:29I know Scott Sussman and other
• 27:32leaders in the health system are
• 27:35doing their best to identify some
• 27:38alternative resources within
• 27:41the system for folks who require
• 27:46essentially inpatient Hospice care
• 27:48but just don't have other options.
• 27:51And I know Grimes was something
• 27:53that was being investigated at
• 27:55least as an option where do can can
• 27:59you give our community any updates
• 28:01on where those efforts stand?
• 28:07The it's still a challenge and what
• 28:12Diane is referring to is that when
• 28:16someone transitions to Hospice care
• 28:22they need a separate payer
• 28:23if they go to long term care.
• 28:25So they need Medicaid as a payer and
• 28:28they need and then they Medicare pays
• 28:31for their Hospice part of the benefit.
• 28:34So it's fairly limited access
• 28:36and patients have to private pay
• 28:38for their room and board if they
• 28:40don't have the Medicaid benefit.
• 28:42It's complicated.
• 28:43So yes, Scott Setzman and others are
• 28:46looking to see if this is a partnership
• 28:48that we as an organization could
• 28:50support and we're not there yet.
• 28:52We do have an announcement about
• 28:54Yale New Haven Home Care Plus.
• 28:56So that is our home care agency that
• 28:59provides Hospice at home without the
• 29:02requirement for full 24 hour care,
• 29:05which is sometimes a barrier for families.
• 29:07So it just opens up a little
• 29:09more options for our families.
• 29:11But again this is an ongoing struggle.
• 29:14Jenza any I have not heard,
• 29:17but I know there was ACMO unit
• 29:20opening up on SRC campus.
• 29:22Do we ever utilize that for our patients?
• 29:24So again, unfortunately,
• 29:25yes, we have ACMO unit,
• 29:27they do great work there.
• 29:29It's run by our palliative
• 29:31care service over at SRC,
• 29:34but here's the issue, they work on
• 29:37transitioning patients to Hospice.
• 29:40And so it's a transitional unit.
• 29:42It's still acute inpatient
• 29:43beds that again are a premium
• 29:45resource and because they're,
• 29:47they work on transitioning
• 29:48patients to Hospice,
• 29:49very often what happens is families
• 29:52will say you know if they could
• 29:54be transitioned to Hospice,
• 29:56let's just do it.
• 29:57And so we don't,
• 29:58it's not an optimal resource
• 30:00for us here in Smilo.
• 30:08And and again Diane's right, it it the
• 30:12limited utility for us here in SMILO. OK,
• 30:20right. Well, thank you both.
• 30:21Excellent presentation with a lot
• 30:23of very important information.
• 30:26We are now going to transition
• 30:28to the transition of tumor board to EPIC
• 30:31with Jennifer Watkins. Welcome, Jennifer.
• 30:36Thank you. All right,
• 30:37let me just share my screen.
• 30:42All right. Can everybody see?
• 30:46Wonderful. OK. So I'm gonna really
• 30:51just show a few two or three slides
• 30:53and just kind of give a high level,
• 30:55but I, I am happy to to go into further
• 30:58details if there's any questions.
• 30:59But essentially we spent the
• 31:02last year or so really undergoing
• 31:05A comprehensive assessment and
• 31:07review of the tumor board process.
• 31:10We've, we've listened to a
• 31:12lot of of the the physicians,
• 31:14we heard the complaints,
• 31:15we heard what was working well,
• 31:16what wasn't and we were able to
• 31:18kind of really focus in on three
• 31:21key improvement opportunities.
• 31:22So really streamlining the
• 31:24CME accreditation process,
• 31:25optimizing the workflow and
• 31:28increasing our HIPAA security.
• 31:30So really this is, this is the money slide.
• 31:33So what is changing,
• 31:34we are going to be streamlining
• 31:36the CME accreditation process.
• 31:38So I've heard from basically
• 31:40every tumor board director,
• 31:42what a pain point this has been.
• 31:44So we will now have a single CME
• 31:47application that covers all tumor boards.
• 31:49It will not require the tumor
• 31:51board director and their admin
• 31:53to complete and submit.
• 31:54We will take take that on within
• 31:56my team and it'll continue to
• 31:58allow for the individual CME
• 32:00codes for each tumor board.
• 32:01Nothing really changes but the the
• 32:04painful re accreditation process
• 32:06every year will no longer be put
• 32:09on the burden of the the tumor
• 32:11board directors and their admins.
• 32:12The the biggest piece I think is
• 32:14really the workflow optimization.
• 32:16So thanks to a lot of wonderful help
• 32:20from our our EPIC optimization team,
• 32:22we have been able to build the
• 32:24infrastructure to transition all of
• 32:26the tumor boards into EPIC which
• 32:28is going to really increase our
• 32:30automation and reporting capabilities.
• 32:31So essentially they have built,
• 32:34they've created a YNH Smilo tumor
• 32:36board department and every tumor
• 32:39board is built as a resource.
• 32:41And so we will be able to utilize
• 32:43the current tumor board referral
• 32:44to schedule patients within their
• 32:46the tumor board clinic.
• 32:48Physicians will be able to pull
• 32:49up the tumor board agenda within
• 32:50the clinic schedule view.
• 32:51So really the the big piece for
• 32:53this that that people will notice is
• 32:56that traditionally we have emailed
• 32:58out an excel agenda every week
• 33:00some at some point over the next
• 33:02month or two we will be phasing
• 33:04that out and everyone will be able
• 33:06to to go into EPIC to see their
• 33:08the upcoming tumor board schedule.
• 33:10To be clear that it's already in
• 33:11EPIC that is already happening.
• 33:13We are just also sending the Excel
• 33:16agenda just as we get everybody comfortable,
• 33:19everybody set up,
• 33:20but you are able to go into EPIC
• 33:22today to see your patients.
• 33:24This creates ability for easier
• 33:26documentation for anyone who's
• 33:28interested which I I will briefly
• 33:29touch on in a minute and really just
• 33:31allows for increased scalability as
• 33:32additional tumor boards are created it.
• 33:34It also just makes such a much more
• 33:37efficient workflow and it keeps all
• 33:39of the patient information within EPIC.
• 33:41The third piece is was really
• 33:43run HIPAA security.
• 33:44So previously all tumor boards utilized
• 33:46the same as new link which is at more of
• 33:49a risk if if the link becomes compromised,
• 33:51all the tumor boards are compromised.
• 33:53So the recommendation from the
• 33:55privacy office was to individualize
• 33:57the zoom links and to update to a
• 33:58new link on on an annual basis.
• 34:00The the really big perk here is it
• 34:02finally will allow tumor boards to
• 34:04overlap or to run parallel you know to
• 34:07historically pre COVID tumor boards were
• 34:08in in person so we were only able to
• 34:11have one tumor board at a time in the room.
• 34:13Now that many tumor boards have have
• 34:15decided that virtual works better for
• 34:17for them where it'll it'll allow us to
• 34:19be a little bit more flexible scheduling.
• 34:21That being said,
• 34:22some tumor boards are our hybrid and
• 34:24and we have the ability to bring anyone
• 34:26back in person if that's what the
• 34:28group is interested in and then just
• 34:30request for all participants cameras to
• 34:33to be on to use the the proper name on there.
• 34:36Thursday the name tag
• 34:39to give a a quick look at what
• 34:41the epic agenda will look like.
• 34:43So all of the columns that that
• 34:47existed on the excel spreadsheet are
• 34:49now pulled into your tumor views.
• 34:51So just like you would go here to
• 34:53see your schedule for clinic with a
• 34:56few quick steps we can get you set
• 34:58up with a tumor board schedule built
• 35:00here and you'll be able to click on
• 35:02it and see your upcoming patient.
• 35:03So it brings in the question for the
• 35:05tumor board and the imaging that you'd
• 35:07like presented pathology staging,
• 35:09all that's here.
• 35:10We also have a nice tumor board data report.
• 35:12So when you highlight a patient,
• 35:13it pulls in all of the last five
• 35:16years of imaging,
• 35:17pathology and irrelevant oncology
• 35:19logic history.
• 35:21So it really brings in a nice
• 35:23summary down here as well.
• 35:24You can also easily go to chart review
• 35:26from the screen or you can double
• 35:27click on the the patient the same
• 35:29way you would if you were seeing them
• 35:31in clinic which would open up the
• 35:33encounter in the charting workspace.
• 35:35This is really only for anyone
• 35:37who is interested in utilizing
• 35:39the documentation functionality.
• 35:41But if any of the teams are,
• 35:43we have created flow sheets both
• 35:46for kind of a general tumor board
• 35:49as well As for each individualized
• 35:51tumor board and then that that
• 35:53pulls into a note template.
• 35:54So we can in we can optimize this,
• 35:57we can individualize this.
• 35:58Some of the other teams GI
• 36:01specifically with rectal cancer has
• 36:03really taken advantage of being able
• 36:05to to individualize their notes.
• 36:07So we have the ability to really
• 36:09make this work for you.
• 36:10Again,
• 36:11this is just available for
• 36:12anyone who's interested it.
• 36:14It does not have to.
• 36:15This is completely locked
• 36:16down from the patient.
• 36:18They do not see that they are scheduled.
• 36:20They do not see that there is a note,
• 36:21nothing goes through my chart.
• 36:24The other it is visible to
• 36:26anyone on the care team.
• 36:27So any other provider can see the note,
• 36:29but it is also not part of
• 36:31their legal medical records.
• 36:32So if records were ever requested
• 36:34or subpoenaed,
• 36:35the tumor board documentation
• 36:37would not be a part of it.
• 36:39So that is really the,
• 36:42the changes in a nutshell.
• 36:44I will say you will see over the next
• 36:47few weeks cancellations coming from
• 36:49the existing tumor board invites as
• 36:52I send out new invitations with the new,
• 36:56with the new links.
• 36:57We have moved all of the tumor board invite
• 37:00lists over to listservs within Outlook.
• 37:02So if for some reason you are
• 37:04you want to be on the tour board
• 37:06and you're not included,
• 37:07please let me know.
• 37:08We can absolutely make that change.
• 37:10But I believe everybody that is currently
• 37:13on the invite list has been transferred over.
• 37:15So hopefully this should be a
• 37:17relatively seamless transition.
• 37:18Does anyone have any specific questions?
• 37:22I will be making the rounds with
• 37:24individual faculty meetings,
• 37:26section meetings.
• 37:28I'm meeting with the various chiefs
• 37:29and directors to get everybody set up.
• 37:31We do some tip sheets that will be going out.
• 37:33So there is a lot more education coming.
• 37:36But this is just kind of to
• 37:37give everybody a heads up.
• 37:45Jen, thanks for sharing this.
• 37:48You and I have been kind of
• 37:50communicating this roll out.
• 37:51I think it's exciting.
• 37:53It is a change as with all change you
• 37:57know there there is an adjustment.
• 37:59It will be a different workflow
• 38:01for people and you know one of
• 38:03the differences is I think many of
• 38:06our clinicians have gotten pretty
• 38:08accustomed to the tumor board roster
• 38:10appearing in their e-mail in basket.
• 38:13It will require us to engage
• 38:15with EPIC which we all do on a
• 38:18virtually daily basis any anyway.
• 38:23So I I'm excited about it.
• 38:25I think the ease of the CME,
• 38:29the documentation function and the
• 38:34I can't overstate the importance in
• 38:38this era of privacy concerns and cyber
• 38:44vulnerabilities maintaining the most
• 38:50active and HIPAA compliant platform.
• 38:54You know I I will the the the stories
• 39:03of health systems being brought to
• 39:06their knees by cyber intrusions and
• 39:10leaks of patient privacy information
• 39:14are significant and it is important
• 39:18that we take every effort to to
• 39:20protect our patients privacy and I
• 39:22think that that you mentioned that
• 39:24but I I just want to repeat that.
• 39:26So thank you for joining us today
• 39:28and and Jen you did get some shout
• 39:31outs in that chat and then the one
• 39:33question which I see you answered
• 39:34so it but just for everyone their
• 39:36question was will there be a Zoom link
• 39:39accessible from Epic or a separate
• 39:41invitation and it will be still come
• 39:43through an e-mail outlook calendar
• 39:45correct it'll it'll still nothing changes
• 39:48about the way you will see the invitation.
• 39:51So it'll you will just get a
• 39:53cancellation over the next few weeks
• 39:55while I'm phasing out the old Zoom
• 39:57links and setting up the new ones.
• 39:58But then you'll have the the request
• 40:00that comes through the outlook and
• 40:01and we'll be right on your calendar.
• 40:06Right. Thank you. Thank you.
• 40:08Now we are gonna transition over to
• 40:11talk about social work to our support
• 40:14to all of our patients and families.
• 40:16Angela Corella is gonna walk
• 40:18us through this presentation.
• 40:20Welcome, Angela.
• 40:22Thank you, Tracy.
• 40:22Let me just share my screen.
• 40:35OK. All right. So it's an absolute
• 40:38pleasure to be here tonight.
• 40:41I'm talking to all of you for just a
• 40:43few minutes about patient and family
• 40:46centered support and the types of social
• 40:48work services that we provide to our
• 40:51patients and our families. Angela,
• 40:52I don't know if you could just
• 40:54switch it to presentation mode.
• 40:56I did it. Isn't that bizarre?
• 40:59At the top, if you hit Display settings,
• 41:02it should give you an option to switch.
• 41:05Give me a second display settings. OK.
• 41:12And then swap to Presenter, View,
• 41:15Q. Thank you for that one.
• 41:17One monitor it was that way.
• 41:19On the other monitor,
• 41:19it was the other way.
• 41:20So thank you for pointing that out.
• 41:22All right. OK. So let's begin.
• 41:26So I thought it would be really
• 41:28important for us to talk about what
• 41:30exactly an oncology social worker is,
• 41:32because some of you might not really know
• 41:34what an oncology social worker is all about.
• 41:37So all of us are licensed professionals who
• 41:40provide counseling and emotional support as
• 41:42well as access and services to resources
• 41:45to our patients and our families and our
• 41:48caregivers who are impacted by cancer.
• 41:50And we're educated and we're skilled
• 41:52in being able to identify the social,
• 41:54emotional, physical and spiritual
• 41:56issues that can come up as a result
• 41:59of cancer diagnosis and treatment.
• 42:01And we're there to support families from the
• 42:03time of diagnosis through cancer treatment,
• 42:05recurrence, survivorship,
• 42:06palliative care,
• 42:07as well as end of life
• 42:11throughout the Smilo system and Care Network.
• 42:13I just wanted to let all of you know
• 42:15the different locations where we
• 42:16have social work services available.
• 42:18So Greenwich, Trumbull, Fairfield,
• 42:21Torrington, Orange, New Haven,
• 42:23of course that's our inpatient as well
• 42:25as ambulatory services, North Haven,
• 42:27Guilford as well as Saint Francis Hartford.
• 42:32So in order for us to talk
• 42:33about social work and the kinds
• 42:34of services that we provide,
• 42:35I thought it'd be really important
• 42:37to talk about psychosocial distress.
• 42:39So as defined by the National
• 42:42Comprehensive Cancer Network,
• 42:44psychosocial distress is multi factorial,
• 42:47an unpleasant experience of
• 42:49psychologic meaning cognitive,
• 42:50behavioral and emotional as well as social,
• 42:53spiritual and physical nature that
• 42:54may interfere with one's ability to
• 42:57cope effectively with their cancer,
• 42:58their physical symptoms as well as treatment.
• 43:03And when we're talking about this,
• 43:04it's important to know that oncology
• 43:06under oncology social workers have
• 43:08a deep understanding of the complex
• 43:11psychosocial issues and the stress
• 43:13that come about because of cancer.
• 43:16They know that when there's a cancer
• 43:18diagnosis it impacts the family
• 43:20significantly and it can even be
• 43:23quite traumatic and life changing.
• 43:25We know that patients and families
• 43:27experience different levels of distress
• 43:29and distress is actually quite common and
• 43:32normal as a result of cancer and treatment.
• 43:34We also are aware that adjusting to
• 43:37cancer can be quite difficult and often
• 43:39results in worries about the future
• 43:42regarding treatment side effects,
• 43:44fear of cancer recurrence progression
• 43:46and can often lead to things
• 43:49like anxiety and depression.
• 43:50And with thinking about that,
• 43:52I just want to point out that there are key
• 43:55distress points along the cancer continuum.
• 43:57And so these are different points
• 44:00along along along the line where
• 44:02it's really helpful and beneficial
• 44:05to have social work involved.
• 44:07We know that when a
• 44:09patient's newly diagnosed,
• 44:09when they start treatment,
• 44:11as they go through treatment,
• 44:13transition into ending treatment,
• 44:15even into survivorship,
• 44:16quite often they can experience a variety
• 44:19of distress and development of anxiety
• 44:21and depression and if there's a cancer
• 44:23recurrence or some disease progression,
• 44:25transitioning to goals of care or
• 44:27palliative care and even end of life.
• 44:29Again,
• 44:29these are key points where evolving
• 44:31social work support is very helpful and
• 44:34beneficial to our patients and our families.
• 44:36You know,
• 44:37we know that distress can negatively
• 44:39impact someone's quality of life,
• 44:40their emotional health,
• 44:41their ability to cope.
• 44:43We know again that that distress
• 44:45is really on a continuum and it can
• 44:47really be more common normal like
• 44:49fear and some worries and sadness.
• 44:52Or again,
• 44:52it can become more significant and
• 44:55develop into anxiety and depression.
• 44:57And social workers know how to find
• 44:59ways to help patients and families cope.
• 45:02And that really brings about
• 45:03an enormous sense of relief,
• 45:04not just to the patient,
• 45:05but their families as well.
• 45:09So what to expect when you're
• 45:10meeting with a social worker?
• 45:11Some people might not even know.
• 45:13So it's important to understand that
• 45:15social workers are part of your
• 45:16oncology team and we're available to
• 45:18assist in a wide range of issues and
• 45:20challenges that you might be faced with.
• 45:23We can meet with you one time,
• 45:24maybe there's some very difficult news
• 45:27that's being delivered by your medical
• 45:29team or we can be available to meet
• 45:31multiple times throughout treatment.
• 45:33But really this comes about
• 45:34based on your needs as well as
• 45:36the preferences of the patient,
• 45:38the family that we're working with,
• 45:39with how often we should
• 45:41be meeting with them.
• 45:42We're available to meet in person,
• 45:45talk over the phone,
• 45:46and we do have some social workers
• 45:48on our team who do provide some
• 45:50telehealth visits when meeting
• 45:51with the social worker.
• 45:52Often during our first visit we'll
• 45:54complete a a psychosocial assessment
• 45:56and we might even utilize some results
• 46:00from the iPad depression screening, the PHQ,
• 46:03the social determinants of health Screener,
• 46:05or the distressed involver when we're
• 46:07meeting with patients and families.
• 46:11So this is some of the things
• 46:13that we assess for during
• 46:15our psychosocial assessment.
• 46:16So we want to find out about,
• 46:19you know, a patient in their family,
• 46:20the reaction to the diagnosis,
• 46:22their support system, you know,
• 46:24maybe if there are any employment
• 46:27issues or financial issues,
• 46:29if they're having any signs or
• 46:30symptoms of anxiety or depression.
• 46:32It's important for us to understand
• 46:34if a patient has a mental health
• 46:36history or a trauma history.
• 46:37We of course assess for suicidality,
• 46:40substance use, safety issues,
• 46:42but also want to examine positive
• 46:45coping strategies and other
• 46:47risk and supportive factors.
• 46:48It's important for us to understand the
• 46:51holistic approach the patient again,
• 46:53their physical, emotional,
• 46:54social and spiritual impact
• 46:56that cancer and treatment has
• 46:57on them and their family.
• 47:01So some of these are strategies or
• 47:03interventions that social work support
• 47:05would use to address the emotional impact.
• 47:08Again, talking about how the patient
• 47:10is adjusting to their cancer diagnosis
• 47:12and treatment would be something that
• 47:14we would often be talking to you about.
• 47:17We provide supportive counseling
• 47:18not just to the individual,
• 47:20but to the family as well as couples.
• 47:23Some of our social workers might even
• 47:25utilize such interventions as some basic
• 47:27cognitive strategies like reframing or
• 47:29talking to the patient family about
• 47:31what is or maybe isn't in their control
• 47:34related to their diagnosis treatment.
• 47:36We have a variety of social workers
• 47:37that are actually trained in something
• 47:39called meaning centered psychotherapy.
• 47:41So that would be exploring with the
• 47:43patient about what brings meaning
• 47:44and purpose to their life as they're
• 47:46going through cancer and treatment.
• 47:48Many of our social workers are skilled
• 47:50at being able to talk about how
• 47:52to talk to children about a cancer
• 47:54diagnosis and treatment.
• 47:55That's a program that we have called packs.
• 47:57So parenting at a challenging time,
• 47:59exploring coping strategies.
• 48:00You know, stress management,
• 48:03relaxation, mindfulness techniques,
• 48:06sleep hygiene,
• 48:07these are all things that social
• 48:09workers would provide to you as
• 48:11you're meeting with them.
• 48:12And it's not uncommon that if you're
• 48:14really having a difficult time for us
• 48:17to maybe talk to you about exploring,
• 48:19meeting with the mental health
• 48:20provider in the community,
• 48:21or maybe talking to a psychiatrist
• 48:24for some medication management.
• 48:26When we're meeting with families
• 48:29and caregivers,
• 48:30of course we provide emotional
• 48:32support to them.
• 48:33We want to empower family members and
• 48:35caregivers to be able to advocate
• 48:37on behalf of their loved one.
• 48:39We want to help caregivers and
• 48:41family members navigate.
• 48:43Maybe they're taking time away from
• 48:44work or they're having to have to
• 48:46take time away from their own families
• 48:48to provide care to their loved one.
• 48:50We want to educate our our caregivers about,
• 48:53you know,
• 48:54about caregiver stress and burnout
• 48:55and the importance of self-care
• 48:57as you're caring for someone with
• 48:59cancer and support you with how
• 49:01to navigate those relationships
• 49:03and communicating with family,
• 49:05friends, the patient,
• 49:06as well as the medical team
• 49:08that you're working with.
• 49:09And it wouldn't be uncommon for us
• 49:11to maybe encourage or recommend that
• 49:13a family member or caregiver or
• 49:15attend a support group or maybe also
• 49:18seek some mental health counseling
• 49:19in the community themselves.
• 49:22One of the other things that social
• 49:24workers do is we connect you to
• 49:26different resources and services
• 49:27in the community.
• 49:28So from from Smilo,
• 49:29there are a variety of services that
• 49:31we might talk to you about or refer
• 49:33you to like maybe the you know Cancer Center,
• 49:36survivorship clinic.
• 49:37We might talk to you about spiritual care,
• 49:40talking to someone in integrative medicine
• 49:42maybe for yoga or massage or some Reiki.
• 49:45And we also have a Yale Psycho oncology
• 49:47program that we can talk to referring
• 49:49you to as well within the community.
• 49:51We might talk to you about
• 49:53financial resources to refer
• 49:54you to. Maybe there's some
• 49:55transformation needs there,
• 49:56housing issues, state,
• 49:58federal benefits, talk to you about
• 50:01employment or work related issues.
• 50:03And again if there's a need,
• 50:04talking to you about mental health
• 50:06services within the community.
• 50:09So this list right here is just
• 50:11a variety of different support
• 50:13groups that we run through SMILO,
• 50:15through the different care centers.
• 50:16I will say though,
• 50:17most of our groups are still virtual
• 50:19and that's a result of the pandemic.
• 50:21But you can see there's a variety of
• 50:23different cancer groups here and at
• 50:24the end I have my contact information.
• 50:26So if anyone's interested
• 50:27in any of these groups,
• 50:28you can reach out to me and be
• 50:29happy to connect you to the social
• 50:31worker that facilitates them.
• 50:32So again, we have breast and Melanoma
• 50:34and neuroendocrine, pancreatic,
• 50:36a lot of different options,
• 50:38caregiver group, you know,
• 50:40for patients and family members
• 50:42to be able to access.
• 50:43Now this next slide, I am so excited about.
• 50:46So, I'm so excited to announce that
• 50:49social work has been collaborating
• 50:50with the early onset program.
• 50:53And in March,
• 50:54we are launching 2 new support groups.
• 50:56We have an early onset Cancer Support group
• 50:59for patients between the ages of 18 and 49.
• 51:02And our two social workers,
• 51:03Hallie Robinson and Krista Madrid,
• 51:04will be facilitating that group.
• 51:06There's their contact information
• 51:08if anyone's interested.
• 51:09And we also have an early onset
• 51:11Cancer Support group for caregivers.
• 51:12So a caregiver who's caring for a loved one,
• 51:15who's going through cancer treatment,
• 51:17who's between the ages of 18 and 49,
• 51:19and Mary Strauss will be our social
• 51:21worker facilitating that group.
• 51:22So we're very, very excited about this.
• 51:24So please get the word out.
• 51:25Please reach out to these social
• 51:27workers if you're interested,
• 51:28And with that,
• 51:32if you have any questions about how
• 51:34you can connect with a social worker.
• 51:36If you're interested in speaking
• 51:37with one of us,
• 51:38you can ask a nurse, your apron,
• 51:40or your doctor to place a
• 51:41referral for social work.
• 51:42You can reach out to the
• 51:44Department of Social Work.
• 51:44The phone number is 203-688-2195.
• 51:47We can connect you to your
• 51:50Smilo Clinic social worker,
• 51:51or of course their Smilo
• 51:53Supportive Care Access Program.
• 51:55Their phone number is listed there as well.
• 51:57They can also help facilitate
• 51:58A referral for Social Work
• 51:59services if you're interested.
• 52:03And thank you so much for
• 52:05your time this evening.
• 52:06There's my name, my contact information.
• 52:08Again, please, please don't hesitate to
• 52:10reach out to me if you have any questions,
• 52:12any concerns, need help,
• 52:14directions, anything that I can do,
• 52:16I'm happy to help out.
• 52:17And with that,
• 52:18if anyone has any questions right now,
• 52:19I'm happy to take them.
• 52:30You know, Angela, I think I'm gonna
• 52:31take the privilege of jumping in
• 52:34with a question. One of the things,
• 52:37one of the areas where I I feel
• 52:40like I see need very acutely and
• 52:42it's not clear to me the best
• 52:45way to access your services is
• 52:48are in patients who are sometimes
• 52:53really struggling with distress.
• 52:56And it's complicated.
• 52:57Often it's a mixture of pain,
• 53:01anxiety, loneliness, fear,
• 53:05and while our nursing staff is outstanding,
• 53:09they sometimes just do not have
• 53:12the time to provide the kind of
• 53:16bedside support and counseling
• 53:19and kind of psychosocial support
• 53:21that some of these folks need.
• 53:25Can you give us a sense of what
• 53:27kind of availability your team has
• 53:30for what is essentially short term
• 53:33therapy for patients in the hospital?
• 53:36And I'm going to make it even more
• 53:40complicated because I see this on weekends,
• 53:42particularly when I'm rounding.
• 53:46Yeah, that is a very good question And I
• 53:48wish I could say that we have 30 social
• 53:51workers who work inpatient that can provide
• 53:53those services because they are so needed.
• 53:57We do not have social workers that are
• 54:00staffed on the on the weekend inpatient.
• 54:03And so that is not something that
• 54:05we have available at this time,
• 54:06but it is absolutely a need.
• 54:08You know, I wish that we had millions
• 54:11and millions of dollars, you know,
• 54:12to be able to hire inpatient social
• 54:14workers so that they truly could spend
• 54:16the amount of time that a patient and
• 54:19family needs when there are experiencing
• 54:21that significant level of distress.
• 54:23And I think, you know,
• 54:24often times it's in a matter
• 54:27of prioritizing the priorities.
• 54:28You know,
• 54:29they have all these competing priorities,
• 54:31you know, when they're on a floor.
• 54:32And so sometimes they really are well
• 54:34intended to be able to spend a good amount
• 54:37of time with a patient and a family member.
• 54:40But then some safety concern
• 54:41comes up or you know,
• 54:43there's some kind of a crisis down
• 54:44the hall and they get pulled into,
• 54:46you know, a million of directions.
• 54:49And so I think they're all very
• 54:51well intended and I can speak,
• 54:52I know that that the inpatient
• 54:54social workers wish that they had
• 54:56that ability to be able to spend
• 54:58the time that patients and families
• 55:00deserve in being able to provide,
• 55:02you know, that level of support.
• 55:06Angela, just to Kevin's question
• 55:08about weekend coverage,
• 55:09what is the coverage for
• 55:11inpatient on weekends currently?
• 55:13So currently right now,
• 55:15if something does arise or come up,
• 55:17we do have staff within the
• 55:19Yale New Haven Hospital system.
• 55:21We have social workers
• 55:22that do weekend coverage,
• 55:23that work on weekends.
• 55:24And so if there's a safety concern
• 55:26or something that comes up,
• 55:27they can always be contacted
• 55:29and they will come over and
• 55:31see our patients at Smilo.
• 55:39I think there was a question from Doctor
• 55:43Taraga about social workers in the clinics.
• 55:46I mean I think we might want to share.
• 55:48You know that Angela has recently taken over.
• 55:50I think you saw that on the slide as the
• 55:53interim manager for oncology social work.
• 55:55And one of the charges Angela will be has
• 55:58is to really look at the scope of social
• 56:00work across the entire Smilo enterprise
• 56:02and sort of come up look at where we
• 56:05have gaps and needs and and basically
• 56:08propose how we're going to manage that.
• 56:10So that is some of the work Angela
• 56:12will be doing and we and some
• 56:14of you might get tapped on.
• 56:15We are going to kick off a work group
• 56:19multidisciplinary to assist in some of
• 56:21this work of you know really identifying
• 56:23the social workers roles within SMILO.
• 56:34Thank you, Angela.
• 56:35No, thank you. Pleasure.
• 56:40Kevin, do you want to close this out?
• 56:43I think I would be happy to.
• 56:45I just, yeah. I think we're at
• 56:48the hour. No other questions.
• 56:52I think I'll just close with our
• 56:54usual note of gratitude. And I also
• 56:57want to thank all of our panelists.
• 57:00I know gents had to drop off,
• 57:02but you know the work you all are
• 57:06doing is impactful for patients,
• 57:08teams and families in the organization.
• 57:10So we're all indebted.
• 57:13Have a great evening everyone. Thanks.