Smilow Cancer Hospital Town Hall | August 23, 2023

August 24, 2023

Hosted by Eric Winer, MD, and Lori Pickens, MHA

Clinical Announcements

Kevin Billingsley, MD, MBA

Kim Slusser, RN, MSN

Smilow Classical Hematology at Orange

Robert Bona, MD

Paula Pike, RN, BSN, MSN/A, MBA/HC

APEx Accreditation

Christin Knowlton, MD, MA

Sharlene Hench

Clinical Trials Office

Ian Krop, MD, PhD

Alyssa Gateman, MPH, CCRP

Information

ID: 10279
To Cite: DCA Citation Guide

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00:00Get started because it's five O 6 and
00:03we have three amazing presentations
00:05for our community this evening.
00:08So welcome to our SMILO and
00:10Yale Cancer Center Town Hall.
00:12I'm joined by a large group of of
00:15wonderful people on our team this evening,
00:18but also joined by my DYAD partner,
00:20Doctor Kevin Billingsley
00:22and we're happy to be here.
00:25We'll go over the agenda, Kevin.
00:27Renee, do you want to pull up the
00:30agenda and Kevin can go through that.
00:32And then I think we're going to turn
00:34it over to Doctor Weiner and Lori
00:35for some opening remarks after that.
00:39Thanks, Kim. Happy twilight of summer
00:42to all of you in our community.
00:46I'll share that I am in my clinic office
00:49in North Haven looking out on a beautiful
00:53Vista of trees and knowing that they'll
00:56soon be turning a variety of colors.
00:58So with that reflection,
01:00thank you all for joining us. As Kim said,
01:03we're really delighted to have our leader,
01:06our senior leaders, Dr.
01:07Weiner and Laurie Pickens joining us,
01:11who will be sharing some important
01:13kind of leadership and programmatic
01:16announcements with us today.
01:19Going on with the agenda,
01:20I think one of the things that
01:22has been most exciting for all of
01:24us in the past several months is
01:27the growth and evolution of our
01:29classical hematology program with the
01:31development of our site in Orange,
01:35CT serving as the anchor for future,
01:39for current and future development
01:41for that important clinical program.
01:44And we're joined this evening by
01:47Doctor Bob Bona and Paula Pike
01:49who have really spearheaded the
01:51development of that site and will
01:53be ushering it into the future.
01:55So they'll be giving us updates
01:57and A and a view into the future.
02:00Next I'm really delighted to welcome
02:05Doctor Christine Knowlton and Charlene
02:07Hench from the Department of Therapeutic
02:10Radiology and Radiation Oncology
02:12will be sharing with us about their
02:16recently achieved Apex accreditation.
02:18This is really a great honor and a feather
02:23in our cap for this very important program.
02:26And last but certainly not least,
02:29clinical research is really part
02:33and parcel of who we are as Cancer
02:37Center faculty and caregivers.
02:39And we have enjoyed growth and
02:43success in in a in a resurgence in
02:47our clinical trials efforts over the
02:49past year under the leadership of
02:52by Ryan Croft and Alyssa Gateman.
02:54And they are here this evening also to
02:56kind of bring us up to speed on where
02:59things stand in that important arena.
03:01So with that,
03:04I will kick it over to Eric and Laurie.
03:09Laurie that you want to
03:11make double comments. So
03:14I don't know that we were planning to
03:16make a lot of comments as opposed to
03:18necessarily be available for questions,
03:20but I will, since you've invited us,
03:23I'll make a comment and then Lori will.
03:27So many of you may have seen
03:29this announcement yesterday
03:31about Lori's and my roles,
03:33and I would take from it two big messages
03:36and I think that they are really,
03:39really important.
03:41One is that the alignment between
03:44the healthcare system and the
03:47School of Medicine is real.
03:49It has existed in Smilo and the YCC longer
03:54than anywhere else and has been much,
03:59much more part of our daytoday
04:01lives than it has been in virtually
04:05any other department or area.
04:08But this makes it that much more real.
04:11And in fact, I was contacted
04:13by a number of people who said,
04:16Oh my gosh,
04:18I can't believe that this kind of
04:21thing is is is finally happening.
04:26That's one and #2.
04:27I think it represents a real
04:30commitment on the part of both
04:33the healthcare system and the
04:35School of Medicine to promote,
04:38grow and support oncology
04:41and the cancer program.
04:43And you know I think those
04:46are the two messages that are
04:48absolutely critical and that I
04:51personally think everybody should
04:53feel really good about.
04:55So I'm going to end there,
04:57Lori.
04:58Thank you, Eric. Yeah,
04:59I mean I I agree with Eric completely.
05:02This is really a wonderful
05:04opportunity for the entire cancer
05:06body of work that we have here.
05:08And and I think the announcement
05:10really and and the and this decision
05:13that was made by Dean Brown and
05:15Chris O'Connor to to kind of start
05:18with at least the rules of mine
05:20and Eric's and really creating the
05:22integrated leadership model is,
05:24is really just the start of what what
05:28is really intended to be for all of us.
05:33You know everyone will feel over time
05:37I think the alignment and integration
05:40more and more and of course Eric and
05:43I are charged with working with all of
05:46you and working to really understand
05:49the best way for us to do this work.
05:51So we don't have all of the answers,
05:54but what we know is that with
05:57your involvement, your engagement,
05:59your openness, your honesty,
06:02your interactions,
06:03that we will learn more and more about
06:06how we can most effectively do this
06:09work across the entire cancer enterprise.
06:12And you know,
06:14I think that that will involve
06:18a lot of time together,
06:20all of us just working through
06:22what this can mean.
06:24This is a huge opportunity for everyone.
06:27But Eric and I need to now spend
06:30the time thinking about the best way
06:32for us to lead the organizations,
06:35if you will,
06:36through that really important work.
06:39And so while we may not have a
06:41lot of answers tonight,
06:43we do feel very strongly that
06:45this is a huge move in the right
06:48direction and that
06:51we will spend more time trying to
06:54hear from all of you and answer your
06:57questions in the coming weeks and months.
06:59So we may be inviting ourselves to your
07:04meetings and asking for your input
07:06and your thoughts and sharing our
07:08thoughts about what this all means.
07:10So stay tuned on that.
07:12This is you know, as Eric said,
07:14the announcement just went out yesterday.
07:17We'll come back to future town halls
07:19and have more conversations about this.
07:22We'll go to faculty meetings,
07:23we'll go to nursing leadership meetings,
07:25we'll go to staff meetings and and
07:27and anywhere you need us to be as
07:30we work through this collectively.
07:31So happy to take whatever questions
07:34we can during tonight's discussion,
07:37but really look forward to hearing
07:40more from everybody as we move
07:43forward with this new opportunity.
07:50That's all I have
07:51and I think you all have a busy agenda.
07:53So we'd encourage you to sort of move forward
07:58because we don't really want to
08:00answer any questions anyway. No,
08:01we we'd be happy to, but
08:03but I think I think you should just go ahead.
08:07I will just say thank you to both of you.
08:12I think I speak for all of our community
08:15when I say I think we have all felt
08:17the alignment between the two of you
08:20and I think we're proud of what we
08:22do leading the organization in that.
08:24So I think this really will carry us
08:27forward and there may be some questions
08:29in the Q&amp;A and I know you'll both be here,
08:33I think Next up for Paula and Bob.
08:39Thank you so much.
08:49So again, Doctor Bone and I were
08:51invited today to talk a little bit
08:53about the classical hematology
08:54transition to the center in orange.
08:56And I've never shared this
08:58with Doctor Bona before.
09:00So watch his face that a couple years
09:02ago when the consultants came through
09:04and we're looking at the program,
09:06I said to them, hey,
09:08wouldn't it be great if we had the
09:10first standalone classical hematology
09:12center in the state of Connecticut?
09:15Little did I know that that
09:18would actually happen,
09:19but we wanted to share today
09:21a little bit about our process
09:23beginning with our our vision,
09:24mission and values.
09:25Certainly what's been shared with
09:27me is that the future of SMILO is
09:30really threefold and that's really
09:32looking at sub specialized care,
09:35multidisciplinary expertise and
09:36then integrating that throughout
09:38the entire SMILO enterprise.
09:41And that certainly meets with
09:42that mission and providing that
09:44excellent patient care teaching and
09:46research to all of our community.
09:50So this is the group of
09:53physicians practicing at Orange.
09:54So certainly there are individuals,
09:56physicians around the network who have
09:59expertise in classical hematology,
10:01not at Orange, but this is the group
10:03that is practicing at Orange and just
10:05a word about everybody, if I might.
10:07So on the top left,
10:09you're all familiar with Alfred Lee.
10:10He's recently been named chief of the
10:13Division of Classical Hematology,
10:14and he continues to direct
10:16the the fellowship program,
10:17which he's done for a few years,
10:19and the two individuals on our left.
10:22Eric Chang finished his fellowship
10:24here in June and has started with us.
10:28He's one day in Orange and
10:30two days in Waterbury.
10:31Below him is Justine Ryu.
10:33Justine is joining us in a few weeks
10:36from Beth Israel Deaconess Medical
10:38Center where she finished her
10:40fellowship and she has a interest
10:42in bioinformatics and genomics.
10:45Kelsey Martin is on the top right.
10:47Kelsey has been in orange practicing
10:50for a while hematology in general and
10:53is now focusing 2 days of classical
10:56hematology at the Orange site.
10:58And then the other three
11:00individuals George Gosha,
11:01Aneesh Sharda and Lila Van
11:03Doren joined us last year.
11:06George has interest in clinical
11:09decision making science,
11:11Anish and Von Willebrand,
11:12factor biology and Lila A sickle
11:15cell disease and and iron disorders.
11:22So just a few pictures of
11:24the team in Orange because
11:25it would take several slides to
11:27show everyone, but really this was
11:29an integration as you'll see in a
11:31future slide of staff that moved
11:33over from SMYLA North Haven location,
11:35both part of the classical
11:37hematology team and that were part
11:39of the SMYLA North Haven location.
11:40Our infusion nurse team,
11:41our practice nurse team, our APP's,
11:43the team is quite large and we love
11:46our intimate location and orange.
11:53So the the this, this slide outlines
11:56the reason for the move to orange.
11:58And and now we have one more
12:01as Paul mentioned where I
12:02guess the first freestanding,
12:04not freestanding but first classical
12:06hematology site with its own site
12:08in the state of Connecticut.
12:10But this aligned with the Yale Cancer
12:12Center vision of disease subspecialized
12:14programs and and and teams at all the sites.
12:18It locates the classical hematology
12:20expertise in one New Haven regional site.
12:23It provides a hub for the developing center
12:26of excellence in classical hematology.
12:29And we're hopeful that this is going
12:31to enhance clinical care research,
12:33education and outreach efforts of the
12:36programs across the Smilo enterprise.
12:43So whoa, what a transition it was.
12:45We started the announcements
12:47on February 3rd of yes,
12:48this year 2023 and quickly moved through
12:51a process of how we were going to move
12:54our classical hematology team into the
12:57Orange location and simultaneously moving
12:59the oncology practice to other locations.
13:02So our transition was announced on
13:05February 3rd and 136 days later.
13:07Our classical hematology team set foot on
13:10June 19th and their first day of practice.
13:13But it took a while to get
13:15there and a lot of people.
13:16We had weekly meetings that began
13:18the beginning of March that included
13:20four separate work groups from an
13:22admin team and operations team,
13:24a Guilford transition team and a lab
13:27team that was very well attended.
13:30And we got a lot of feedback and we
13:33learned a lot during that process.
13:34We began workspace redesign the
13:36beginning of April and that still
13:38continues to this day actually,
13:40but really getting ready for our teams.
13:43This was a location with very
13:46few office rooms,
13:48no work rooms per se and it got
13:52to be a creative time for us to
13:54develop that space and also thinking
13:57about the ergonomics and our team.
14:00mid-May, we did our mass mailing.
14:02We mailed as you'll see in our next slide,
14:05thousands of letters.
14:06I'm going to save that number for the
14:08next slide because it's quite daunting.
14:10And then just about a month
14:12later we moved in.
14:18So again how we got there,
14:20the timeline says one thing,
14:21but the work behind it was another.
14:23We talked about those weekly
14:25meetings with our key stakeholders,
14:26but the patient lists and letters and
14:29thank you to Renee Gaudette providing
14:32patient lists of every physician that we
14:33have on our classical hematology team.
14:35The APP's we were cross referencing,
14:38we were doing all sorts of crazy stuff,
14:40but more than 7000 letters
14:41had to go out to our patients.
14:44We also had weekend phone teams.
14:47We had a special number where patients
14:49could call during the weekend to reschedule
14:51their appointments with their new
14:53provider if needed or answer questions.
14:55We had many people that pulled
14:57in overtime to help us do that.
14:59And then certainly Rosie Cruz's team was
15:01amazing and the amount of time that her
15:03team put in extra to make this happen.
15:06It's one thing to move a physician
15:08list over to a new department,
15:10but the manual list of any lab and
15:12infusion visit had to be done manually by
15:14our PSAS and our clinical secretary team
15:16and that's a lot of movement and we were,
15:20we didn't,
15:21we did it without hesitation.
15:22Everyone just pitched in and it was awesome.
15:25And now we're having ongoing
15:26communication with our teams.
15:27We had our first debrief just last
15:30month and we identified some areas of
15:32workflow improvement and I had now have
15:34work teams working on all that and
15:36we'll have a followup meeting after
15:41the redesigning space you this might
15:43look like great space, it's countertops,
15:45it's got computers but you know what used
15:49to be in here the editorial supplies,
15:51yes it was the janitor's room.
15:54So thanks to our construction
15:56team who helped us our ITS,
15:58but we have a great workroom now that
16:00has three computers and a space for
16:02a fellow or a resident to work with.
16:04Our physician team on the left here,
16:08this is our A team in at work.
16:10The room that they're on in the
16:12left used to be a conference room.
16:13There used to be a big conference
16:15table in it and four chairs and now
16:17it's a work room for five people.
16:19And to the right used to be a physician
16:22solo office again reconstructed,
16:24redesigned and now it's our
16:25practice nurse team.
16:31Dr. Bono. Thank you Paul.
16:33So just a few words about recruitment.
16:35So there were staff at Orange
16:37that moved to to New Haven or
16:40North Haven and vice versa.
16:42Some of that was to support the program,
16:44other was at the personal request
16:46to try to honor some of that,
16:49mostly related to travel issues.
16:52We are in the process of recruitment.
16:55We intended to recruit 2 fulltime
16:58APP's one individual who is an APR and
17:01has been recruited and that's GE Yun
17:04Kim and she'll be joining us soon.
17:05We have one other APP position still open.
17:09We are also seeking approval of
17:13incremental faculty to support the
17:15backlog of patients in the work
17:17queue and other academic projects.
17:19That request is under consideration
17:21by the business office and we should
17:23have further information on that
17:25by the end of the end of August.
17:33So this is a few of the highlights
17:35on this and the next slide over
17:37the past year, the top, the,
17:39the panel on the the top left and in
17:42the middle or demonstrate Gia Chirico,
17:45our physician, one of our physician
17:47assistants and Audrey Baluha,
17:48one of our practice nurses receiving
17:51Yale New Haven Hospital awards.
17:54On the right, Lila Van Doren,
17:55one of our recent physicians or
17:58physicians who recently joined us was
18:00recently named as the four J Scholar.
18:03The picture on the bottom left is a
18:05group of us celebrating and sharing a
18:08meal at the recent American side of
18:10hematology meeting in New Orleans.
18:12And then the title page of a paper
18:15that was important publication
18:18headed by George Goshua,
18:20but with multiple collaborators
18:22both in our program and outside
18:24our division and department that
18:27detailed the endotheliopathy and
18:29COVID-19 associated infections.
18:34And then one additional highlight
18:35I'd like to note on the next slide
18:38is the the fact that our fellowship
18:41program was awarded last year,
18:44the Hematology Focused Fellowship
18:46Training Program grant from the
18:48American Society of Hematology.
18:50This is a program in which the ten
18:53programs that were awarded this are
18:55given funds to support one fellow
18:57a year for the next five years
19:00to train in classical hematology.
19:02There's also administrative support
19:03that comes with this award and and
19:06this will allow us to focus some
19:08training on individuals interested
19:10in classical hematology.
19:12And we successfully recruited
19:14a candidate last July,
19:17Lexi Boydo and we're actively in the
19:22process of interviewing candidates
19:23for next academic year at this time.
19:28So before we move to the next slide,
19:30I started off with my vision of,
19:32hey, wouldn't it be great if we
19:34had that freestanding center.
19:35So we're going to continue
19:37with those aspirations.
19:38So future planning and where we'd
19:40like to see this program go in the
19:43future with our center of classical
19:45hematology at Orange at the center,
19:47we certainly would love to develop
19:49a Center for education and training
19:51and allow for that training to occur.
19:54For anyone that comes in the smile O
19:56enterprise to be able to come through
19:59our classical hematology program to
20:01grow our clinical trials portfolio.
20:03We know how important research is and
20:05we definitely want to be part of that.
20:07Create a classical hematology
20:10nursing society.
20:11We have a hematology nursing society,
20:13but really dedicating that to
20:16the classical disease states.
20:18We certainly want to expand our
20:21lab capabilities in Orange.
20:23We want to explore blood products,
20:24vending machine and we want to become
20:26the Center for classical heme referrals
20:29both regionally and nationally.
20:33And we really couldn't do it without
20:35you on everybody listening and all
20:38these other departments and teams.
20:40This was a very large
20:42undertaking still in process,
20:44but we have really accomplished a lot
20:46and really proud of what we've done.
20:54Paula and Bob, thank you both.
20:58Paula, I know, I suspect you are one
21:00of those people with your sleeves
21:02rolled up cleaning out those workrooms.
21:06I know how you get not going to say
21:10your ability as a collective group
21:14of medical and nursing leaders and
21:16staff leaders to drive change is truly
21:19remarkable and we are all deeply indebted
21:22to you for leading this important growth
21:26initiative across our organization.
21:28I think to keep things moving,
21:30we'll turn to Charlene and Dr. Knowlton.
21:39Hi. Well, what what an amazing
21:41endeavor to for us to follow.
21:43So hi, I'm doctor Kristen Nolton from
21:46the Department of Therapeutic Radiology
21:48and I'm here with Charlene Hench,
21:50our Quality and Safety Officer.
21:52Thank you for having us this evening.
21:55And we're here to talk about
21:57our department's recent APEX
21:58reaccreditation for which we were the
22:00Co leads with a lot of support from
22:02a lot of members of our department.
22:05Next slide please.
22:06So tonight we plan to talk with
22:08you about why our department
22:10chose to pursue accreditation,
22:12what is apex,
22:14the reaccreditation process and timeline,
22:16the results of the reaccreditation
22:18and our departmental goals
22:20for continuous improvement.
22:24So I was invited back in 2016 to
22:28participate in discussions with
22:30with our departmental leadership
22:33about pursuing accreditation and
22:35we first want to say you know why,
22:36why did we want to do this?
22:38So we felt that pursuing accreditation would
22:41set a high standard regarding quality,
22:44safety and patient centered care.
22:47And we wanted the process to serve as a
22:50benchmark for best practice and to help
22:52set standards across all of our sites.
22:54As you know, we have radiation therapy
22:57and multiple sites across the region.
22:59We also wanted to communicate our
23:01department's commitment to provide
23:03objectively validated high quality
23:05care to patients, the community,
23:07our referrings and other institutions.
23:10Also, it's possible that in the future
23:14payer reimbursement will be tied to
23:17accreditation and new as of this year,
23:19a certificate of need for a linear
23:22accelerator replacement is dependent
23:25on having accreditation.
23:27Next slide, please.
23:29So back then,
23:30we formed a multidisciplinary committee
23:32to review the three major national
23:35radiation oncology accreditation programs.
23:37There's ACRO,
23:38the American College of Radiation Oncology,
23:41the ACR accreditation program,
23:42the American College of Radiology.
23:45They do have a radiation oncology
23:47one and the Apex program,
23:48which is under Astro,
23:50the American Society for of
23:53Radiation Oncology next.
23:56So our committee ended up just
23:58choosing the Apex program,
24:00which stands for accreditation
24:03program for excellence.
24:05And the advantages of Apex were that
24:07it falls under the umbrella of Astro,
24:10which really is the premier radiation
24:12oncology association in North America.
24:14And it was developed by radiation
24:17oncology professionals to recognize
24:19facilities that deliver high quality care.
24:21We'd really narrowed it down to Astro
24:24versus ACR and the Apex program versus
24:28ACR and APEX had a longer duration of
24:32accreditation for years versus three.
24:34We found that their criteria
24:36for accreditation were highly
24:38detailed and comprehensive.
24:40But really the main kicker was this,
24:41that the APEX program provides
24:44multiple opportunities during the
24:47self-assessment program with formal
24:49feedback all along from Astro to see
24:52how you're doing and so you can be
24:55fully prepared before the site visit.
24:57So you you really know going in that
24:59you know ideally you should do well.
25:00And for that for the Astro program,
25:03the Apex program under Astro,
25:04it was included in the application cost
25:07which is unlike the other programs.
25:10Next slide please.
25:13So the standards, the standards are very,
25:17very detailed and comprehensive and
25:19they're based on widely accepted
25:21consensus documents,
25:22including Astro Safety is No Accident,
25:25which is a, you know,
25:26a nationally recognized document
25:28that Doctor Suzanne Evans from
25:29our department is a coauthor of.
25:31We have the a APM,
25:33the Americans Association of Physics
25:35and Medicine Task Group reports.
25:38Those really formed the benchwork
25:40for how I know how to have a safe
25:43program and then federal requirements.
25:46And what we also liked is that it
25:48really touched upon all members of
25:50the department, nursing therapy,
25:53physics, the radiation oncologists.
25:57I think I said those symmetry.
25:58Sorry if I didn't do symmetry
26:00and there was peer review was really
26:03stressed for all of those modalities.
26:05The culture of safety was stressed having
26:08emergency preparedness which we know you know
26:10this was pre COVID when we were talking,
26:12but we now understand the real
26:15importance for emergency preparedness.
26:17It's was based upon nationally recognized
26:19equipment QA standards through that
26:21a APM and also in creating the
26:24standards they had patients involved.
26:25So there was emphasis on the patient
26:28experience including patient education,
26:30consent feedback,
26:32financial toxicity of treatment
26:34and ancillary support services.
26:37Next slide please.
26:39So the initial accreditation was done
26:42and we received that in 2019 in May,
26:45the four year cycle and it included
26:47all of our fully integrated radiation
26:50oncology sites at that time,
26:52which was New Haven, Trumbull,
26:54Hand and Guilford and Waterford.
26:56And now I'm going to hand things
26:58over to Charlene to talk about the
27:01current reaccreditation process.
27:02Thanks, Doctor Nolan. Hi, everybody.
27:05So as you could see from this slide,
27:07it looks a little bit busy,
27:08but this slide actually represents all the
27:11major milestones that we needed to hit in
27:14each part of our reaccreditation process.
27:16So it started off last May back
27:19in 2022 with the application.
27:21And you could see that we actually didn't
27:23complete the full process until July
27:2519th when we received our full accreditation.
27:28So I know that there's a lot of
27:31important information on this.
27:32I'm going to hit a few on the next slides,
27:34but it's really important to know.
27:36Like Doctor Knowlton said,
27:38this was a huge undertaking for our
27:40department and it involved all disciplines,
27:43the frontline staff and our managers to
27:46help make sure that we had everything
27:48in place so we could hit each and every
27:51one of those milestones along the way.
27:54So what started off the reaccreditation
27:56process was back in May,
27:59a year prior to our renewal
28:01and our reaccreditation,
28:03our portal opens and we had to complete
28:05the initial application and that required
28:07that we identify all of our equipment,
28:10all of our treatment techniques,
28:11all of the modalities in which we
28:14treat our patients and identify our
28:16physicians and our annual treatment
28:18volumes at each of our six sites.
28:20We also had to have financial
28:23agreements and business agreements
28:25signed and completed by both parties
28:27and we had to submit our payment.
28:29Once we completed that at the end of July,
28:31Doctor Nolan and I were able to
28:34start the self-assessment which
28:35is comprised of three areas.
28:37The first being the medical
28:39record chart review.
28:40And this is where she and I selected
28:42randomly 25 patients from our main site
28:45that met certain criterias of treatment
28:47techniques and modalities and was well
28:50representative of our physician pool.
28:52And one of the great things that you
28:54were able to see and as you would hope
28:56on any quality improvement journey that
28:57you continually get better over time.
28:59So back in 2018 when we did our
29:02first medical record evaluation,
29:04we scored on the evidence indicators
29:07which are level ones and level twos
29:10based on their hierarchy of quality and
29:13safety initiatives for patient care.
29:15We scored really well.
29:17We scored for level ones which are
29:19required very high level evidence
29:21indicators that support a high
29:23quality program.
29:24We scored back in 2018 a 91%,
29:27this time we scored a 95% and
29:30level twos which are known and well
29:33supported to help programs provide
29:35excellent care to patients and
29:37they're suggested they're not.
29:38Requirements are also equally important,
29:41but you could see a huge increase 169%
29:44back in 2018 to 83% this time around.
29:48So we were very pleased to see that
29:51some of the hard work that we've
29:53been putting in over the years
29:55really is is manifesting and it's
29:57evident and these results.
29:58So the second part of the self-assessment
30:01phase was our documentation upload.
30:04This is where we are
30:06required to supply all of
30:07the documents that support the
30:09evidence necessary so we can validate
30:12that we do fulfill all of the
30:15necessary elements and that we're
30:17in alignment with the standards.
30:18So back in 2018, as you know,
30:21we all start to crawl before we could
30:24walk and we all walk before we run.
30:26We did not pass our document
30:27upload the first time.
30:28So we had to go back and we had to get
30:31back to work and kind of look at some
30:33of our SOP's and make sure that they
30:35were in full alignment with the criteria.
30:37And then we did pass ultimately and
30:40we scored a 96% and this time around
30:43we scored a 97% on our first attempt.
30:45So again,
30:47another great strive for improvement.
30:50And lastly,
30:51before we could even get ready
30:53to schedule our survey,
30:54for the surveys to come out and assess us,
30:57we had to come together as a formal
30:59team and answer a list of questions
31:01to ensure that we had the correct
31:03processes in place and quality
31:05assurances that were necessary that our
31:07department was ready to undergo the
31:11reaccreditation and we did pass that.
31:15So again,
31:16another great benchmark moving forward.
31:19So there was a lot of preparation that
31:21went into this that started long before
31:24our preparing for this accreditation.
31:26We had to initially change some
31:28of our current practice to make
31:30sure that we were improving the
31:32care that we intended to deliver.
31:34So initially back in 2018,
31:36there were several elements that were
31:39improved that started with us improving
31:41and developing a more comprehensive
31:43and robust daily treatment time out.
31:45We also advanced our SOP's and
31:49created formalized checklists and we
31:52provided additional staff training.
31:54This time around,
31:55we continued on what we started
31:57four years ago,
31:58but we also then further developed
32:00our clinical treatment planning note
32:02to make sure that we were being able
32:04to best communicate our physician's
32:05intent to our dosimetry team.
32:07Prior to treatment planning,
32:09we enabled EPIC best practice
32:12alerts for the pain for patients.
32:15And we also formed a standardization
32:17committee that didn't just involve
32:20our directors and our managers,
32:21but it also involved our frontline
32:24staff because we have 6 practices
32:26across the region.
32:27And we know that in order to
32:28develop the best care,
32:29we have to align our
32:31practices and our processes.
32:32So we are really proud of the work
32:34that this committee's doing and
32:36coming together and helping using
32:37Apex as our framework of ensuring
32:40that we're doing everything in
32:42alignment and in a standard way.
32:45So once we were able to get ready and we
32:49were given our survey date for June 26th,
32:52we did a lot of preparation by
32:55having monthly accreditation meetings
32:57with all of our team involved.
32:59Doctor Knowlton spoke with the faculty and
33:02and communicated with them continually
33:04to make sure that everybody was ready
33:06and in the know about what was coming.
33:08We also met with staff during meetings
33:11and we created questionnaires and prep
33:13book so they were able to review all
33:16of the apex evidence indicators and
33:19then have a direct hyperlink to our
33:21departmental processes and procedures.
33:22So they knew that we were in alignment
33:25and they could brush up to make sure
33:27and see where some of our own practices
33:30stem from and we were able to go out.
33:32I was able to go out to each and
33:34every one of our sites and work with
33:35all the different team members to
33:36make sure that everybody was prepared
33:38and felt comfortable for the survey
33:40and also do some chart audits and
33:43observe timeout procedures.
33:47So the survey day was on Monday
33:49June 26th and it occurred at the
33:51same time for all six of our sites.
33:54It was a full day survey out in New
33:57Haven for our main campus and we had a
34:00physician and a physics surveyor present.
34:02Our satellites were broken up into
34:04half day surveys either in the morning
34:07or the afternoon and only a a physics
34:10surveyor was present for that.
34:11The facility visit consisted of a
34:14medical chart review similar to what
34:16Doctor Nolan and I did independently,
34:17but now they're here on site to
34:19confirm some of the information.
34:21So this was a new a new section of
34:23patient charts that was randomly
34:25selected 13 for a per the main site
34:28and then five for the satellites.
34:31And then we also had to do some team
34:33interviews and physics interviews and
34:35hand over some of our documentation
34:38and our employee training records.
34:41So the important thing how do we how
34:43do we make out once they were here?
34:45So for the medical record review,
34:47our sites ranged anywhere between
34:5092% to 100%.
34:51Greenwich being the only site to receive
34:54100% with perfect documentation,
34:55they were able to show evidence for
34:58every single evidence indicator
35:00that pleased each of the surveyors.
35:02So that was really exciting.
35:05Our physics interviews for all six
35:08sites received 100% on the accreditation.
35:12So this was really impressive.
35:15And I have to admit, when I got the results,
35:17I actually got a little teary eyed
35:18when I reviewed the last section,
35:20which was the team interview.
35:21We scored 100% on our team interviews
35:24at each and every one of our six sites.
35:27So I think we knew that we were giving
35:29good care and I think we knew that we
35:32worked really hard to prepare our teams.
35:34But the fact that we scored 100%
35:37in these two categories,
35:38that each and every one of our sites
35:40really speaks to the great work that
35:42we're doing everywhere across the board.
35:44So while we're very pleased
35:46with these results,
35:47we also are very humbled because
35:49we see that there's still great
35:51opportunity for us to still strive
35:53to be even better than what we are.
35:55This is a quick heat map of all the
35:58various centers across our country that
36:01are accredited and it's current as of
36:04this month and throughout the country.
36:06You could see that out in California,
36:08there's great population of
36:10Apex accredited sites,
36:12but throughout the the states,
36:14there's not that many.
36:15And we are actually in New England,
36:17one of only two practices that are
36:19accredited by Apex and we are the
36:22only radiation oncology practice
36:23in the state who is accredited.
36:28So what's next? We're going to
36:29continue to strive to get even better.
36:31We know that 100 looks great on paper,
36:33but there's always room for improvement
36:34and that was just this snapshot in time.
36:37So we're using the motivation and we
36:39worked really hard to achieve that.
36:41But we know that we want to
36:42continue to to get even better.
36:44So we want to continue to improve
36:46our processes and our workflows.
36:47We want to work together with our patients
36:50to get even better patient experiences.
36:53We want to make sure that our staff
36:55are always engaged and have ongoing
36:57training and strong initial training
36:59that keeps them equipped to do the
37:00best and show up to work to be mentors
37:03for each other and for others.
37:05We always want to make sure that we're
37:07focusing through quality and safety
37:09lines and we want to standardize
37:10our technology and our equipment
37:12and our workflows where possible
37:14because ultimately we know that
37:16accreditation is not an event,
37:18it's a process.
37:18So thank you all very much for
37:20letting us come here today and
37:22tell you a little bit more about
37:24Apex and the great stuff that we're
37:26doing in radiation oncology.
37:48Kevin, we can't hear you.
37:49So I'll go, I'll go on I guess or yeah,
37:54we can't hear you that's okay.
37:57I'll go ahead. So that is so impressive.
37:59Thank you so much.
38:00I mean I think it just gives
38:02us so much to be proud of.
38:04So thank you so much.
38:05I know that's a lot of
38:07work from the entire team.
38:08And then to see that validation
38:10during the site visit,
38:11I'm sure was just something
38:12to celebrate with the team
38:14and we should be very proud.
38:16I mean it we really are groundbreaking
38:18in the state and in the region,
38:20so in our quality of care
38:22and radiation oncology.
38:23So thank you for presenting today.
38:25I'm going to turn it over to
38:28Doctor Crop and Alyssa to give
38:31our clinical trials update.
38:33Thank you for being here with us today.
38:36Thanks for having us.
38:37And I I would certainly echo your point,
38:39your thoughts about the Radiation
38:41Oncology group, that's really,
38:43really impressive achievement.
38:45So let me share some screen here.
38:53So it actually has been I think almost
38:55a year and a half since the last time
38:59we formally presented to the town hall
39:02and and a lot's changed since then.
39:04So we thought this would be a good
39:06time to give you all a status update.
39:09So we'll start out with, sorry,
39:16a quick review of a reminder of
39:18of where things were last time we
39:21presented at the beginning of 2022,
39:25talk about the restructuring
39:26we've done since then,
39:28a quick review of some of the progress
39:32that's been made and then we'll close
39:34with our ongoing and future plans.
39:38So I think we would all agree
39:40that around the beginning of 2022,
39:43the status of the CTO was not good.
39:46We were struggling with a number of
39:48challenges, but but most importantly,
39:51staffing was really problematic.
39:54We had very high turnover rates.
39:56We had vacancy rates that actually
39:59exceeded 50% and some of our units
40:02and the staff that were here.
40:05Almost 50% were in their jobs
40:09for less than a year,
40:10and that includes Alyssa and and I.
40:17And these staff shortages, you know,
40:20had a number of consequences including
40:22the necessity to ration accrual
40:25slots through the beginning of 2022.
40:29And it had really disastrous
40:32consequences on our ability to
40:35activate new clinical trial protocols.
40:38The as you can see,
40:39it took on average about 300
40:41days to open a new protocol.
40:43The NCI benchmarks are about 90 to 120 days.
40:47So we know we weren't even close
40:50and you can imagine if you have
40:52to ration your accrual slots and
40:54your trials are old and stale,
40:57it's really hard to enroll
40:58patients onto trials.
40:59And and you know that was
41:01born out in our data.
41:02You know the prior to the pandemic
41:05we were typically enrolling you
41:08know roughly 8 hundred 850 patients
41:11a year onto treatment trials that
41:13dropped with a pandemic into the
41:16six hundreds and then by 2022 we
41:18were down to the low 5 hundreds and
41:21clearly there was a need to to change.
41:25So fortunately we had tremendous support
41:30from from our Cancer Center director,
41:32our newly appointed Cancer Center
41:34directorate at that point and and
41:37a lot of support and resources from
41:39the university and the hospital to
41:42implement a pretty comprehensive and
41:44significant restructuring or what
41:46we call a transformation project.
41:49The goals of the project were to
41:52make us more effective and more
41:54efficient and and these were kind
41:56of you know obvious things.
41:57We want to be able to increase
41:59our clinical trial enrollment.
42:00We needed to shorten our activation
42:03time substantially.
42:04We wanted to better integrate our
42:06clinical research and our care
42:08centers with with New Haven.
42:12We wanted to make it easier for our
42:15investigators to to open high impact
42:17investigative initiative trials.
42:18It's an important part of our clinical
42:21research mission and we wanted to
42:23optimize our trial portfolio so that
42:24we focused on trials that really would
42:26make a real scientific or clinical
42:28impact and trials that we can enroll too.
42:33At the same time,
42:34we wanted to make our groups is
42:36more sustainable so that we wouldn't
42:38have to go through what what
42:40what happened in 2021 and 2022.
42:42So this meant restoring staffing,
42:45but then with the staff we had ensuring
42:48that they had high job satisfaction
42:50and the ability to monitor workloads
42:53so that we prevented burnout.
42:55And of course,
42:57we also needed to maintain the very
42:59safest research practices and and make
43:01sure we are producing high quality data.
43:05So the 1st and most important
43:07focus was on restoring staffing
43:08and we were able to use some of
43:10the resources that we were given
43:12to hire interim staff to allow us
43:14to kind of stabilize the situation
43:16while we did this restructuring.
43:19We then undertook a very intensive
43:25recruitment program that meant
43:27hiring multiple staffing agencies.
43:29But what really paid off
43:31for the kind of experienced
43:35staff we needed was a a really
43:39kind of more direct grassroots
43:41campaign led by a number of
43:45YCC staff, the CTO staff staff which included
43:50you know doing campaigns on LinkedIn,
43:52posting at at meetings and just trying
43:55to take advantage of our networking
43:58and and that's that's really paid off.
44:00And at the same time as I said we we want
44:02to make sure that once people are hired
44:04that they have a good experience here.
44:06So that meant implementing career ladders
44:09for all of our major job families.
44:11We're in the process of hiring float
44:14staff to cover people when when they're
44:16out and as I mentioned putting workload
44:19monitoring in to prevent burnout.
44:22At the same time we're building a
44:25dedicated education unit so that when
44:28people are brought in the onboarding
44:30is very robust so that they feel very
44:34confident and and in the in their
44:36abilities when when they take their jobs.
44:39At the same time,
44:40we're also engaged in building
44:42a workforce pipeline.
44:45We've have over the last few years
44:47have a very successful internship
44:49program for undergraduates at Southern
44:52Connecticut University and we also
44:55have ongoing exposure programs for
44:57high school students and we've had
44:59career fairs on on a regular basis.
45:02And I think all of these programs
45:03have really contributed to a a
45:07lot of success with staffing.
45:09We're now, I'm happy to say
45:11largely restored our staff,
45:12our vacancy rates down to 8% and
45:15that actually includes a number
45:17of newly approved positions
45:19which you know haven't even been
45:21hired in the in the 1st place.
45:23So. So we're much better off.
45:24We've been able to roll off all
45:27of our interim staff and the
45:28staff we do have now are doing an
45:30excellent job and are fully engaged.
45:32And it's just overall we're in a much
45:36better place from a staffing standpoint.
45:40We also are have devoted an enormous
45:43amount of resources in terms of trying
45:45to improve our activation process.
45:48We have hired very experienced
45:50regulatory affairs specialists
45:51who focus almost exclusively on
45:53protocol activation and we've also
45:55created a number of new positions.
45:57It's clinical trial project managers
45:59who coordinate the very complicated
46:01protocol activation process
46:02for each of our disease groups.
46:05And we also hired a senior activation
46:08project manager who oversees all of the
46:11protocols as they go through the process.
46:13And we meet on a very regular basis
46:15to make sure that that protocols don't
46:18get stuck in any particular place.
46:20And lastly and and perhaps most importantly,
46:22we are engaged in a pilot program
46:25where we're outsourcing all of the key
46:28activation steps of of activation and you
46:32know that's been going going very well.
46:35And between all of these processes,
46:37I think we're starting to see
46:40really encouraging signs of of
46:42of substantial improvement.
46:43These are data for protocols that were
46:47submitted after January 1 when the
46:49programs have really started to kick in.
46:51And you can see our median activation time
46:54for industry trials is now down to 129
46:57days compared to about 230 days last year.
47:01And for national or
47:02cooperative group studies,
47:04we're actually down to 41 days as a
47:06median compared to 173 last year.
47:10And the number of protocols going through
47:12the system is also substantially increased.
47:14We've essentially doubled the number of
47:17protocols that are getting activated
47:19each month in the last six months
47:21of of FY23 compared to previously.
47:24So again a number of of evidence of
47:28progress in in those in both the
47:30staffing and activation front and
47:33I think that's starting to pay off
47:35in terms of accrual.
47:38It's early days,
47:39but you know in in 2023 we
47:42saw 616 enrollment,
47:44so about a 15% improvement.
47:46That's certainly not dramatic,
47:47but it is the first time we've seen any
47:50improvement in the last five years and we're,
47:52you know,
47:53we think that there's plenty more to come
47:56in the year in you know in next year,
47:58in this year and the following years.
48:01We have a number of other kind
48:02of evidence of success.
48:03We continue to be able to enroll
48:06a very diverse patient population.
48:10You can see that the,
48:11the percentage of our clinical
48:13trial enrollments who are members
48:14of underrepresented minorities
48:16is roughly 19 to 20%.
48:19That's as higher substantially than the
48:22Connecticut cancer population and even
48:26higher than our the YCC patient population.
48:30So that's something that we really
48:32focused on and we're happy to see those
48:35numbers look continue to look good.
48:37Our investigators are continuing
48:38to do very impactful research.
48:40This is there's been a number of
48:43trials recently that have led to FDA
48:46approvals and I'm I've had I hear
48:48from very good authority that we'll
48:50have another New England Journal
48:52paper coming out today or tomorrow
48:54from one of our investigators.
48:55So that's always happy to see that
48:59our group enrolls very well into
49:01the US Cooperative group system.
49:03Our enrollment actually has increased
49:06in that subset as well this year
49:09compared to previous couple years and
49:11we have a number of leaders of the
49:13cooperative groups within our group.
49:16So there clearly it's been real progress
49:18but we want to make sure that we continue
49:21to have on this positive trajectory.
49:24One of the things that we are focused on
49:27is improving the integration of our our
49:30care centers in terms of clinical trials.
49:34One way we're doing this in addition
49:35to the kind of subspecialization
49:37that you just that you heard about
49:39from one of the previous presenters
49:41was trying to integrate them better.
49:43This is our new structure which is
49:46rolling out over the next month or so.
49:49Previously the care centers were
49:51supervised in a separate group.
49:53We've now integrated the care centers with
49:56the rest of our disease groups as shown here.
50:00We think that's going to improve this,
50:04this feeling of integration that that that
50:05we do think is important going forward.
50:10And the key 9 amongst amongst you
50:12may notice that the radiation
50:14group is not shown here.
50:19That's because we've we've decided
50:23that it's important to provide more
50:27visibility of the radiation oncology
50:29studies within our disease groups.
50:31And so we've separated out the radiation
50:35oncology studies into each of these
50:38different disease groups rather than have
50:41a standalone radiation oncology cert to
50:44make that sure that that works well,
50:47Henry Park has kindly agreed to take on
50:50the position of Assistant Director of
50:53Radiation Oncology for the CTO and he'll
50:55help oversee this, this new format.
50:59We have a number of other ongoing
51:01initiatives. As I said,
51:02we're really trying to build
51:04out our quality education team.
51:05We've hired a new director
51:11recently, Jessica Rowe,
51:12who's who's building her group to
51:16help to make sure their education
51:19program for new hires and ongoing
51:22education is is top notch.
51:25Making sure that the ability of our
51:27investigators to launch impactful
51:29investigator initiated trials is,
51:32is is a priority for us.
51:33We're in the process of hiring a
51:36medical writer to help with development
51:38of trials and we're building a more
51:41oncology focused project manager group
51:43with in collaboration with YCCI to
51:46make sure that process goes smoothly.
51:49We're collaborating with a number of
51:51external groups to make sure that our
51:53processes are as efficient as possible.
51:54This includes radiation safety.
51:57We've been collaborating very well
51:59with the smile of nursing teams to
52:01try to improve our research infusion
52:04efficiencies and we continue to work
52:07with our community outreach teams
52:09in the Coe group to make sure that
52:12all patients across Connecticut
52:13have access to our studies.
52:15And lastly,
52:16I just would point out that we
52:18know that up until now we have not
52:21had the bandwidth to manage non
52:24therapeutic cancer related trials.
52:27We're planning on fixing that and offering
52:31that kind of support starting in 2024.
52:33So I think that will also help improve
52:37our overall portfolio substantially.
52:39So I'll stop there and it's getting late,
52:43but happy to take questions
52:51again. I would just say so impressive
52:53again I I can't believe that the
52:56turnover rate and the activation,
52:57the improvements in the activation time
53:00timelines, that's just amazing work.
53:02And I think the focus on retention
53:04and not just recruitment,
53:06it's it's very impressive the
53:07programs that you have put in place.
53:09So thank you so much.
53:11I don't know if Kevin is has a audio. I'm
53:16going to jump in for one second.
53:18Ken, let me just say,
53:21it's really remarkable what has happened
53:24over the past 17 months since Iron
53:27has been hired and then a few months
53:30later when we brought Alyssa on board.
53:32And although the two of them will will
53:36quickly credit everyone else working
53:38on their their teams for all the hard
53:41work and much of that credit is,
53:43is of course in that the huge
53:45amount is very well deserved.
53:48But the two of them and everyone who
53:51works with them have just done a heroic
53:55job and and it's going to be great for
53:58us when we put in our CCSG application.
54:01But much more importantly than that,
54:03it's really great for us from
54:05an institutional standpoint
54:06and for all of our patients.
54:08So thank the two of you and everyone
54:10who works with you just so much.
54:13Thanks, Eric. Thanks, Eric.
54:17Kevin, I don't know if you want to
54:19say any closing words at 6:00 on
54:21the dot and but such impressive,
54:23impressive programs that we
54:25highlighted this month and just
54:27so excited that we got to share it
54:30with our community and I couldn't be
54:31more proud to be part of this team.
54:34Kevin, did you have anything,
54:35any closing remarks?
54:38I hate to take the last remarks,
54:40but I am, I do have closing remarks.
54:43Eric, may I I say go for it.
54:47Okay. Two things.
54:49One is Kim and I had the pleasure
54:52of rounding in North Haven today.
54:55And one of the things that I was
54:57reflecting on is that we spent time
54:59talking with one of Ion and Alyssa's
55:01research coordinators, Gabby.
55:03And I don't remember her name off the top
55:05of her last name off the top of my head.
55:08But two things stood out.
55:10One is the importance of the work
55:13that you both are doing around
55:16flexibility and the ability to work
55:18in a hybrid format is a is a big
55:22retention piece and how important
55:24our research staff is in the the
55:27overall care of the patients.
55:29And the relationship that our research
55:32staff has with our patients is part
55:35of what makes care here at Yale
55:37Cancer Center in Smylo very special.
55:40They know the patients as well as
55:42the nurses and physicians and are
55:43really a key part of the team.
55:45So it's really great to see and I would
55:49just add that our work is challenging,
55:51but I think what you've heard
55:53tonight is we have so many areas
55:56of achievement and excellence that
55:58we all need to be enormously proud.
56:00So thank you for spending time
56:03with all of us this evening.
56:07Have a good evening everyone.