Smilow Cancer Hospital Town Hall | May 18, 2023

May 19, 2023

Information

Clinical Announcements

Kevin Billingsley, MD, MBA

Kim Slusser, RN, MSN

Oncology Nursing

Kim Slusser, RN, MSN

An Update on Imaging

Daniel Alexa, MBA

Rob Goodman, MBBCh, MBA, BMSc

Smilow East

Jensa Morris, MD

Cece Calhoun, MD, MPHS, MBA

Tracy Carafeno, RN, MS, CMNL

ID9941

To CiteDCA Citation Guide

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