According to U.S. News & World Report, Yale New Haven Hospital significantly improved its ranking this year, and made the Best Hospital Honor Roll by being ranked among the nation’s top 20 hospitals.
"This achievement wouldn’t have been possible without the contributions of many of our faculty,” said Gary V. Desir, Paul B. Beeson Professor of Medicine; chair, Internal Medicine, Yale School of Medicine; chief, Internal Medicine, Yale New Haven Hospital (YNHH), and co-chair of Yale New Haven Health’s Quality Council.
Many faculty members have participated in projects across the inpatient and outpatient realms, designed to reduce infection rates and complications, and to implement best practices across the health system. Here we wish to briefly highlight several faculty who have made outstanding contributions to our work on quality and safety, and have led our effort to improve our national ranking.
Jonathan Siner, MD, associate professor (pulmonary, critical care and sleep medicine) and medical director, Medical Intensive Care Unit, YNHH, has worked on various initiatives in conjunction with hospital leadership, including efforts to reduce central line-associated bloodstream infections, and review various hospital data to look for areas of improvement. For example, work was done to reduce patient risk factors for developing iatrogenic pneumothorax, or a collapsed lung. Siner credits the improvement to the work of many of his colleagues but additionally the resources allotted and the desire to look for ways to improve outcomes.
“Collectively, the quality and safety improvements made at the hospital are critically important to patient care, of course, but also to the physicians, nurses, and staff that work at YNHH,” said Siner. “Quality work is about hitting known targets; safety work is much more reactive. Putting those together and having an institution that was willing to dedicate resources to make meaningful changes, understand processes, identify gaps that needed to be addressed, and make changes in a positive way is imperative. These efforts also give physicians, and other caregivers added confidence in the hospital where they work, which is invaluable.”
Jeptha Curtis, MD, associate professor of medicine (cardiovascular medicine) and medical director, Performance Improvement, Heart & Vascular Center, is part of a larger team that collaborates across the Heart and Vascular Center service line to improve care.
“On the physician side, Nihar Desai, MD, MPH, and I have partnered on these efforts. From the hospital side, there is a dedicated team within the Heart and Vascular Center, led by Corey Champeau, that has implemented our plans and put them into action,” said Curtis.
“It takes collaboration, finding ways that we can improve quality of care without completely disrupting clinical service. Additionally, it is critical to make something that will last beyond the completion of a project,” continued Curtis.
One area that physicians are focused on is better aligning end of life care with the patient’s goals and preferences.
“When we embarked on this self-reflection almost two years ago, we realized that our end of life discussions were not where they needed to be,” said Curtis. “We learned that that when patients were in the end stage of disease, the goals of therapy hadn’t been adequately discussed and they hadn’t been referred to palliative care. We had to have those tough conversations and implement strategies to get palliative care involved earlier.”
Since Kerin Adelson, MD, associate professor of medicine (medical oncology) and chief quality officer and deputy chief medical officer for Smilow Cancer Hospital / Yale Cancer Center (YCC), joined the team five years ago, many improvements have been implemented across the spectrum of oncology care, in end of life care, and other areas across the hospital.
“We worked with our physicians to be realistic with patients about expectations, about understanding the likelihood of cure, and then increasing services to make all of these things easier,” said Adelson. “I’ve partnered closely with Dr. Jennifer Kapo [Sherwin B. Nuland and Michael K. Vlock Associate Professor of Palliative Medicine and chief, Palliative Medicine] to expand our palliative care program, which is integral to our mission.”
Additionally, Adelson and team worked to standardize care across each Smilow Cancer Hospital care center, and expand services in New Haven. YCC participates in the Oncology Care Model, a value-based payment program led by the Centers for Medicare & Medicaid Services. Because of its success in this program, the facility was able to open an oncology urgent care center to provide urgent, specialized cancer symptom management services.
Aldo Peixoto, MD, associate chair for ambulatory services, operations and quality, Department of Internal Medicine and clinical chief, Section of Nephrology, honed his skills on quality work in 2014. His role is primarily at outpatient or ambulatory centers, acknowledging that the continuation of care spreads beyond the patients admitted to the hospital.
“From outpatient and inpatient caregivers, these physicians, nurses, advanced practice providers and many others contribute to keeping our patients healthier and out of the hospital, and all their efforts should be commended,” said Peixoto.
“There has been a noticeable commitment by faculty and staff to quality improvements,” said Desir. “We are seeing the effects of this hard work, but our job is not done. We are honored to provide patient care and will continue to improve our efforts.”
Curtis knows this work doesn’t stop. “It is a continuous improvement process. Every time you succeed in one thing, you need to look into other areas. Where do we pivot? What is next? We are never satisfied,” said Curtis.
Others within the department who have been instrumental in quality work are Ursula Brewster, MD (Nephrology); Silvio Inzucchi, MD (Endocrinology & Metabolism); Richard Marottoli, MD, MPH (Geriatrics); and Michael Schilsky, MD (Digestive Diseases).
Among the YNHH specialties ranked in the top 50 by the magazine, seven areas are in Internal Medicine. Geriatrics is ranked at #16; Pulmonology & Lung Surgery at #16; Kidney Disorders at #20; Diabetes & Endocrinology at #24; Gastroenterology & GI Surgery at #45; Cancer at #45; and Heart & Heart Surgery at #48.
“A culture of quality and safety is being strongly woven into our professional lives at Yale,” said Peixoto.
The Department of Internal Medicine is the largest department within the Yale School of Medicine and one of the nation's premier departments, bringing together an elite cadre of clinicians, investigators, and educators in one of the world's top medical schools. To learn more about its work, visit Internal Medicine.