Smilow Cancer Hospital Town Hall | January 29, 2025

Transcript

• 00:00Welcome, everyone.
• 00:02It is a delight to
• 00:03have all of you here
• 00:04in person for Smilow Town
• 00:06Hall.
• 00:07We have a packed,
• 00:08agenda today with a number
• 00:10of really great speakers. But
• 00:12before we get into our
• 00:13program,
• 00:14it's a real pleasure for
• 00:15both me and for Tracy
• 00:18to introduce jointly,
• 00:19Toby Bressler.
• 00:22Toby is our new VP
• 00:23of patient services,
• 00:26and Toby comes to us
• 00:27from Mount Sinai in the
• 00:28Icahn School of Medicine,
• 00:30where she was the director
• 00:32of oncology nursing and the
• 00:33chief of,
• 00:34clinical quality.
• 00:36She has a very impressive
• 00:37background with multiple degrees, including
• 00:39a degree
• 00:41of doctorate in nursing practice,
• 00:43and, we are thrilled to
• 00:44have her. Toby, do you
• 00:45want to at least stand
• 00:46up or even come up
• 00:48and say a couple of
• 00:49a couple of words?
• 00:54I wasn't prepared for this,
• 00:55but that's fine. Hello, everybody.
• 00:58Thank you for the warm
• 00:59welcome. It's great to be
• 01:01here,
• 01:03and thank you, Tracy, for
• 01:04holding the fort for all
• 01:06of this time.
• 01:08I am looking forward to
• 01:09meeting each and every one
• 01:10of you, looking forward to
• 01:12working with this incredible team.
• 01:13It's been three weeks, and,
• 01:15wow,
• 01:16there's a lot of awesome
• 01:18and amazing things that are
• 01:19happening here and,
• 01:21many opportunities as well. So
• 01:22I'm looking forward to working
• 01:24with you,
• 01:25and the teams that you
• 01:26lead.
• 01:28Thanks, Toby.
• 01:32And I just wanna take
• 01:34a minute to,
• 01:35say this is my this
• 01:37will be my last town
• 01:38hall that I'm cochairing as
• 01:40Toby will take over with,
• 01:42doctor Billingsley in the future,
• 01:44but it's been a pleasure
• 01:45to work with, doctor Billingsley
• 01:47over the last year in,
• 01:50in
• 01:51running these town halls and
• 01:53getting to know all the
• 01:54various presenters,
• 01:56and it's a great forum.
• 01:57And this is actually the
• 01:58first
• 01:59hybrid one, which if you
• 02:00guys remember, we did a
• 02:01survey sort of on feedback
• 02:03for the town hall, and
• 02:04this was one of the
• 02:05recommendations. So we're gonna see
• 02:07how it goes and would
• 02:08continue to appreciate your feedback
• 02:10on the
• 02:11the content and the forums.
• 02:13So thank you all.
• 02:18Let's see. Before we jump
• 02:19into our formal agenda, I
• 02:21do wanna take a minute
• 02:23to thank Tracy for her
• 02:25incredible service.
• 02:28You know, for many of
• 02:29you, I think at least
• 02:31our nurses realize
• 02:33for the past over a
• 02:34year, Tracy has been doing
• 02:36not just two jobs, but
• 02:39two supersized jobs
• 02:42and doing an incredible job
• 02:43of it. And it has
• 02:45been a real pleasure for
• 02:46me to partner with you.
• 02:48You are an incredible leader.
• 02:50You're an incredible nurse and
• 02:51clinician.
• 02:52So
• 02:53thrilled to have Toby, but
• 02:55you'll be missed. But I
• 02:56know you won't be going
• 02:58far. Right down the hall
• 02:59from you. Miss Herbert, can
• 03:00you please bring our flowers
• 03:02up?
• 03:08Thank you, Tracy.
• 03:12Okay. And on that note,
• 03:15we're gonna move on with
• 03:16our agenda.
• 03:18Never much of a slowdown
• 03:20here at Yale New Haven
• 03:21Health System.
• 03:22So
• 03:23first off,
• 03:25I'm just going to quickly
• 03:27put the agenda up.
• 03:29We do have a a
• 03:30a busy and full agenda.
• 03:32We're gonna start with,
• 03:34doctor Friedman, our chief medical
• 03:35officer, and Laura Pham, our
• 03:37capacity officer,
• 03:39who will update us on
• 03:40our our challenges with ED
• 03:42capacity and impact.
• 03:45Vonna will be talking to
• 03:46us with Liana about electronic
• 03:48referral to our extended care
• 03:50center,
• 03:51and, we have a number
• 03:52of significant changes in our,
• 03:55cancer care network.
• 03:57And Liz Herbert,
• 03:59our vice president for the
• 04:00network, will be speaking about
• 04:02transitioning patient care,
• 04:05to,
• 04:06our Smilo from our Smilo
• 04:08Cancer Hospital in Westerly
• 04:10to Waterford.
• 04:11And then to wrap up,
• 04:13our patient experience officer, Tara
• 04:15Sandf, will be talking about
• 04:16patient wait times. So without
• 04:18any further commentary,
• 04:20Al, Laura, Carly,
• 04:22take it away.
• 04:24Just just one housekeeping thing.
• 04:26We will try to answer
• 04:27the questions that are coming
• 04:28in the question and answers
• 04:30live as they come up.
• 04:43That'd be great.
• 04:45Good afternoon, everyone. Thank you
• 04:47very much for the opportunity
• 04:49to be here
• 04:50with you for your, Smilo
• 04:52town hall.
• 04:53I am going to use
• 04:55thirty seconds of my time,
• 04:59to also thank Tracy.
• 05:01I it's not only
• 05:03to embarrass her,
• 05:06but it really is to
• 05:07acknowledge her as a clinician
• 05:10and as a leader. And
• 05:11I think,
• 05:13I I would add as
• 05:14a mentor and role model
• 05:16because I've I've known Tracy
• 05:17for many years
• 05:19in a variety of different
• 05:20capacities.
• 05:21And I think,
• 05:24we could fill this room
• 05:26numerous times over from the
• 05:29people that you have influenced
• 05:32and mentored along the way.
• 05:33So that's a debt of
• 05:35gratitude that we can never
• 05:36ever
• 05:37adequately,
• 05:39acknowledge, but I I wanna
• 05:40say it publicly here.
• 05:50I'm gonna walk through
• 05:52a little bit
• 05:54about the work that we're
• 05:55doing to address what we
• 05:57sometimes call surge, what we
• 05:59sometimes refer
• 06:00to as our capacity crisis.
• 06:03Kevin referenced
• 06:05our ED
• 06:06and the,
• 06:08challenge that we have with
• 06:09patients here. We've taken a
• 06:11step back from talking about
• 06:13length of stay,
• 06:15which often gets us at
• 06:17an intuitive level thinking about
• 06:19the critical pieces necessary
• 06:22to send a patient home.
• 06:24We've we sort of turned
• 06:25the clock back
• 06:27a few hours, the clock
• 06:28face, to think not just
• 06:30how do we send patients
• 06:31home, but how do we
• 06:33help patients navigate
• 06:35their entire
• 06:36stay with us from
• 06:39the moments that they need
• 06:41health care,
• 06:43perhaps encounter it in their
• 06:44community through primary care or
• 06:47urgent care.
• 06:48What is their experience with
• 06:50us like from the time
• 06:51they
• 06:52come to us in our
• 06:53emergency departments? And then how
• 06:56efficient
• 06:57and safe
• 06:58do we provide their care
• 07:00while they're here? And how
• 07:02can we do it better?
• 07:04Our focus is really to
• 07:05look forward,
• 07:06not to look backward.
• 07:08And this work can't
• 07:10and does not happen
• 07:12without Carly
• 07:14and Laura, who are standing
• 07:16just off to my right.
• 07:19They are gonna help with
• 07:20questions that come in.
• 07:24So I'm gonna walk you
• 07:25through before we start talking
• 07:27about how we manage
• 07:29flow,
• 07:31I wanted very briefly
• 07:33to talk about
• 07:35where does this fit in
• 07:36the much larger
• 07:38umbrella
• 07:39of how we provide safe,
• 07:41efficient care throughout our health
• 07:43system
• 07:44and, of course, at Yale
• 07:45New Haven Hospital. And you
• 07:47have probably heard
• 07:49the term core referenced to
• 07:51a number of times. We
• 07:53often use it as we're
• 07:54strengthening our core, whether we're
• 07:57at work or at home.
• 08:00For us, core represents
• 08:02an acronym
• 08:04for collaboration,
• 08:06how we work together,
• 08:08optimization,
• 08:10how we do it better,
• 08:12resiliency,
• 08:13how we support
• 08:15each other and thrive in
• 08:16the work, and efficiency.
• 08:18Those are the four
• 08:20c o r n e
• 08:22of core,
• 08:23how we do this work
• 08:24better
• 08:27for us and, of course,
• 08:28better for our patients and
• 08:30better for our organization.
• 08:32And you can see the
• 08:34different pillars, the six pillars
• 08:37that represent the work of
• 08:38CORE, and we're gonna concentrate
• 08:40today on hospital capacity and
• 08:43throughput.
• 08:44How do patients move through?
• 08:46And when we do that,
• 08:48we come to this
• 08:50HCT,
• 08:51hospital capacity and throughput,
• 08:54and we talk about things
• 08:56like length of stay.
• 08:58We talk about our system
• 09:00capacity, and we talk about
• 09:01our ability
• 09:03to safely
• 09:04and timely
• 09:05help our patients leave the
• 09:07hospital. And there are four
• 09:09main pillars in the hospital
• 09:11capacity and throughput, and they're
• 09:13on the screen here.
• 09:14One is,
• 09:16patient balancing.
• 09:18And Laura
• 09:20Pham, to my right,
• 09:22really is
• 09:24an unbelievable
• 09:25steward of our patient balancing
• 09:27work. This is how
• 09:29we think about our bed
• 09:30stack.
• 09:31This is how we think
• 09:33about
• 09:34management
• 09:35and assignment to our beds.
• 09:37And this is how we
• 09:38think
• 09:39about our role as a
• 09:40tertiary and quaternary medical center
• 09:43as we receive patients
• 09:45from
• 09:46our
• 09:47local, regional,
• 09:49and even national,
• 09:52patient base. This is YACCESS.
• 09:55How do we welcome
• 09:56patients who need the care
• 09:58that can only
• 09:59be provided at Yale New
• 10:01Haven and Smilo at Yale
• 10:03New Haven?
• 10:04How do we help them
• 10:05get here safely
• 10:07and quickly?
• 10:08This the next pillar I
• 10:10want to mention is the
• 10:12emergency department.
• 10:14We hear a lot about
• 10:15the emergency department on a
• 10:16day like today when we've
• 10:18got seventy five or so
• 10:20patients
• 10:20waiting for a bed upstairs
• 10:22and another hundred waiting,
• 10:25in process of their emergency
• 10:27room care.
• 10:29And so how do we
• 10:30move patients through the ED,
• 10:32and how do we most
• 10:34efficiently
• 10:35admit them
• 10:37so that we get the
• 10:38right patient to the right
• 10:39service in the right amount
• 10:41of time?
• 10:43We know
• 10:44that the way in which
• 10:45we initiate
• 10:47inpatient care and the timeliness
• 10:50with which we initiate inpatient
• 10:52care once a decision has
• 10:54been made for admission
• 10:56has a tremendous impact on
• 10:58the quality and safety of
• 11:00the care that patient receives.
• 11:02It has an impact on
• 11:03the mortality that they experience,
• 11:05the morbidity that they experience,
• 11:07and
• 11:08their view of their hospitalization.
• 11:11The sooner we provide inpatient
• 11:13care to our patients, the
• 11:15better for them and the
• 11:16better for all of us.
• 11:18The think about our surgical
• 11:20services and how we smooth
• 11:21them. I'm not gonna say
• 11:22much more about that today.
• 11:24That's perhaps a talk for
• 11:27another
• 11:28town hall. What I wanna
• 11:29concentrate on in the next
• 11:31few minutes
• 11:32is what we now call
• 11:34safe patient flow.
• 11:36And this is how we
• 11:38help our patients progress
• 11:40through their care, again, from
• 11:43the moment
• 11:44they meet us
• 11:45until the moment they're
• 11:48ready to go home.
• 11:49And
• 11:50in order for us to
• 11:52do this in the safest
• 11:54and most efficient way,
• 11:56we have to get
• 11:58our arms around our unit
• 12:00operations
• 12:01so that we really and
• 12:03truly
• 12:04provide care in a safe
• 12:05and efficient way. And that's
• 12:07a challenge for us in
• 12:09a bed in a hospital
• 12:11that has fifteen hundred and
• 12:13forty one beds and sixty
• 12:15eight inpatient units.
• 12:19So why do we do
• 12:20this?
• 12:21I hope that some of
• 12:23the why
• 12:24has already,
• 12:26become evident. And I know
• 12:28that each and every one
• 12:29of you, when you start
• 12:31your day, and for some
• 12:33of you, when you start
• 12:34your night here,
• 12:36you understand the why of
• 12:38of this.
• 12:39But here's something that I
• 12:41think is important to share.
• 12:43How many of you are
• 12:44able to easily find this
• 12:46capacity
• 12:48dashboard
• 12:49in Epic?
• 12:52A few of you. A
• 12:53few of you. It is
• 12:55a very powerful
• 12:57tool
• 12:57to see what is the
• 12:59state
• 13:00of our hospital.
• 13:01On the left side of
• 13:03the screen, you see the
• 13:04patients that are coming to
• 13:05us,
• 13:06including through our emergency rooms,
• 13:08through our ORs, and through
• 13:10our procedural suites.
• 13:12And yesterday, when I took
• 13:14this screenshot,
• 13:16about halfway down the page,
• 13:17you see the number ninety
• 13:18six. That was the number
• 13:20of patients who had an
• 13:21admission order,
• 13:23who were waiting on a
• 13:25bed upstairs in our hospital.
• 13:28Ninety
• 13:29six
• 13:30patients.
• 13:32In the middle of this
• 13:34capacity dashboard, you see our
• 13:37various services in blue.
• 13:39And in the middle of
• 13:41the
• 13:41slide,
• 13:42you see either pink or
• 13:44yellow.
• 13:45The pink or red indicates
• 13:48those inpatient services that are
• 13:50functioning at or above
• 13:52ninety percent capacity.
• 13:55And when we function at
• 13:57that high of a capacity,
• 13:59our ability to provide efficient
• 14:02care,
• 14:02it becomes
• 14:04much more difficult,
• 14:06much more difficult.
• 14:08On the far right
• 14:10of the slide, you see
• 14:11the patients who are leaving
• 14:13our institution.
• 14:14And at the bottom, you
• 14:15can see how many patients
• 14:16we discharged
• 14:18in the prior twenty four
• 14:19hours. And for this day
• 14:21yesterday, we had discharged
• 14:23almost two hundred patients on
• 14:26this,
• 14:27Monday into Tuesday.
• 14:29And
• 14:31of those
• 14:32one hundred ninety nine patients,
• 14:34fourteen percent left before eleven
• 14:36o'clock.
• 14:39Yesterday and today,
• 14:41we sent home two hundred
• 14:43and ninety patients. One hundred
• 14:45more patients
• 14:46left our hospital yesterday
• 14:48than they did the day
• 14:49before, and twenty two percent
• 14:51of them left before eleven
• 14:53o'clock.
• 14:56So we follow a number
• 14:57of metrics that help us
• 14:59understand
• 14:59how we are performing
• 15:01according to our own expectations
• 15:04and how we are performing
• 15:06according to national benchmarks
• 15:08and databases
• 15:09like Vizient.
• 15:10So in the upper
• 15:12left of the screen, you
• 15:13see a number in red,
• 15:15one point zero eight. That
• 15:17is our November
• 15:19performance
• 15:20for observed to expected length
• 15:22of stay. So based on
• 15:24the complexity of our patients,
• 15:26we
• 15:27have an understanding
• 15:29from Visian what the length
• 15:31of stay should be. That's
• 15:33the e. That's the expected.
• 15:35That's in the denominator.
• 15:37The o is how we
• 15:38actually perform.
• 15:40When we perform
• 15:42with an observed length of
• 15:43stay that is longer than
• 15:45expected, our number is greater
• 15:47than one.
• 15:48When we perform
• 15:50with an observed length of
• 15:51stay that is more efficient
• 15:54and more timely
• 15:56than expected,
• 15:58our o to e is
• 15:59less than one.
• 16:00In November
• 16:02and in October,
• 16:04we were one point zero
• 16:06seven and one point zero
• 16:08eight.
• 16:09In December, we will be
• 16:11lower based on our predictive
• 16:13model, but we don't know
• 16:14exactly how much lower.
• 16:17We also are paying close
• 16:19attention to the number of
• 16:20days saved. Now you all
• 16:22know that we're building these
• 16:23beautiful towers on the Saint
• 16:25Raphael's campus,
• 16:26part of our neurosciences
• 16:27center.
• 16:29And if you're like me,
• 16:31you likely would conclude
• 16:33that we're gonna have lots
• 16:34more beds when we build
• 16:36those towers, but we will
• 16:38not be having
• 16:39more
• 16:40licensed beds. We will still
• 16:42be licensed
• 16:43for fifteen hundred and forty
• 16:45one beds.
• 16:46We will use
• 16:48more of our fifteen hundred
• 16:49and forty one, but in
• 16:51the end, it's not really
• 16:52a net increase in the
• 16:54number of inpatient beds.
• 16:56And so if we've got
• 16:58the same number of beds,
• 17:00the only way to move
• 17:02more patients through
• 17:04so that we can
• 17:06develop new programs,
• 17:08many of which live in
• 17:09Smilo, so so that we
• 17:10can move more SMILO patients
• 17:13through the hospital
• 17:15is to be better stewards
• 17:16and more efficient users of
• 17:18the beds we have.
• 17:20It's like cardiac output.
• 17:23If the heart rate is
• 17:24fixed,
• 17:25you've it is. Everything is
• 17:27cardiac output to me. I'm
• 17:28a cardiologist
• 17:29at the heart.
• 17:31If the heart rate is
• 17:32fixed,
• 17:33you've got to increase the
• 17:34contractility
• 17:35of how you do your
• 17:36work. You've gotta be more
• 17:38efficient in your performance. And
• 17:40that's how we're going to
• 17:42move more patients through and
• 17:44create
• 17:45opportunity days
• 17:47that can be used by
• 17:48patients who need to come
• 17:49here. New patients
• 17:51for new programs.
• 17:53In the middle,
• 17:54you can see how our
• 17:56different service areas, including Smilo,
• 17:59perform with length of stay.
• 18:01And we're very happy and
• 18:02proud of the work that
• 18:04Tracy and Jensen and Kevin
• 18:05and the entire team
• 18:07have done to drive
• 18:09the SMILE length of stay
• 18:12below one.
• 18:13We're performing better than expected.
• 18:16We need to continue to
• 18:18drive that down to
• 18:20zero point nine
• 18:22because as you can see,
• 18:23some of our other services
• 18:25really struggle to get to
• 18:26one.
• 18:29In the coming year, we
• 18:30will continue to focus on
• 18:31pre eleven discharge because that
• 18:33is how we
• 18:35improve the contractility
• 18:37of the work we do,
• 18:38the efficiency of what we
• 18:40do so that we can
• 18:41move patients into beds.
• 18:43We're going to drive down
• 18:45our median discharge
• 18:47time,
• 18:49and we're
• 18:50going to pay close attention
• 18:52to when patients leave the
• 18:54hospital.
• 18:55And we need to drive
• 18:56that down from about two
• 18:58thirty in the afternoon
• 19:00to about noon.
• 19:02And we're paying close attention
• 19:04to the average length of
• 19:05stay.
• 19:06How long in total do
• 19:08our patients stay in the
• 19:09hospital?
• 19:10A year ago, the average
• 19:11length of stay was about
• 19:12seven and a half.
• 19:15At the beginning of this
• 19:16fiscal year, it was about
• 19:17seven point two days.
• 19:19And now it's about six
• 19:21point eight days. So we
• 19:22are making real progress
• 19:24in the average length of
• 19:26stay for a hospitalized patient
• 19:27at Yale New Haven.
• 19:29I'm gonna stop
• 19:32here because of time, and
• 19:33I know we have a
• 19:34full agenda for today.
• 19:37We wanna be able to
• 19:38answer whatever questions you might
• 19:40have,
• 19:41but I I want
• 19:43to impart on you
• 19:45that you each have an
• 19:47important role to play in
• 19:49this work. How we move
• 19:51our patients through
• 19:53safely and timely, and the
• 19:55experience that we provide
• 19:57for them by being open,
• 19:59transparent
• 20:00communicators
• 20:01is absolutely
• 20:03essential
• 20:04to how we do our
• 20:05work.
• 20:05And I'm confident
• 20:07that if we
• 20:09link arms and do this
• 20:10well together,
• 20:11we will also find greater
• 20:13joy in this difficult work
• 20:15that we do because we'll
• 20:16be doing it in an
• 20:17aligned
• 20:19way
• 20:20and in a way that
• 20:21feels good for our patients
• 20:23and feels good for us.
• 20:25So I'm gonna stop there.
• 20:28Carly and Laura, did I
• 20:29forget anything?
• 20:30I have more to say,
• 20:31but I don't have more
• 20:32time in which to say
• 20:33it. So I'll come back.
• 20:35Laurie.
• 20:43Am I right, Nelson? Yes.
• 20:44That's right. So we do
• 20:47we do have the capabilities
• 20:49to do what Al has
• 20:50just
• 20:51charged up.
• 20:53K? You do. And and
• 20:54the model changed. It's not
• 20:57that your performance fell off
• 20:58the cliff. The model changed
• 21:00a little bit, and so
• 21:02the numbers change. But that's
• 21:03okay. It just makes it
• 21:05it's like moving the three
• 21:06point line back. Still a
• 21:08three point shot. It's just
• 21:09a little harder to make.
• 21:19That is correct.
• 21:20So congratulations.
• 21:31So all the units.
• 21:33So and then I think
• 21:34our,
• 21:35eleven AM
• 21:37average is, what, sixteen percent?
• 21:40Yes. Our our surgeons helped
• 21:42us with that. Our GYN
• 21:44and surgery did helped us
• 21:45along. But there's a there's
• 21:47a constant effort on all
• 21:58And and I when I
• 22:01review those numbers with Laurie
• 22:02and Jensa and others, it's
• 22:04just a reminder that we
• 22:05continue to have opportunity. Right?
• 22:07I mean, I think the
• 22:08work that's been accomplished is
• 22:10incredible
• 22:11and represents an awful lot
• 22:13of hard, dedicated, diligent work.
• 22:16We have more to do,
• 22:17and we can do it.
• 22:18You've proven
• 22:20that it can be done.
• 22:22Now we just need to
• 22:23continue to do it.
• 22:25So thank you all.
• 22:34Thank you all for being
• 22:36here, and,
• 22:37we really appreciate our hospital
• 22:39leaders. This is complex and
• 22:41difficult work.
• 22:43And I do think that
• 22:44we all should
• 22:46not rest on our laurels
• 22:48by any means, but be
• 22:49justifiably
• 22:50proud of the contributions we're
• 22:52making and the work that
• 22:53we've done.
• 22:54So one of the things
• 22:56that I do think helps
• 22:57us with not only
• 22:59providing great care for patients,
• 23:00but also,
• 23:02facilitating their flow through the
• 23:04hospital and keeping them out
• 23:06of the emergency room is
• 23:07our extended care center.
• 23:09And to give us kind
• 23:10of an update on where
• 23:11we are in a new
• 23:12referral process, we have our
• 23:14very own Vonna Dest and
• 23:15Liana Keyes.
• 23:26Hello,
• 23:30everyone.
• 23:39Oops. Alright. So Vonna and
• 23:40I are going to discuss
• 23:42the new,
• 23:43electronic referral process for the
• 23:45ECC.
• 23:47But before we get started,
• 23:48we'll just talk about fiscal
• 23:51calendar year twenty four and
• 23:52some of the guiding, principles
• 23:54that remain relevant.
• 23:56So here,
• 23:57we highlight the number of
• 23:58patients seen in the ECC
• 24:00for the year twenty four
• 24:01twenty twenty four,
• 24:03as well as the total
• 24:04number of unique patients.
• 24:06We were able to discharge
• 24:07sixty seven percent of those
• 24:09patients home, and thirty three
• 24:10percent were admitted.
• 24:16This is highlighting the distribution
• 24:18of patients seen by day
• 24:20of the week.
• 24:21As you can see, the
• 24:22volume is highest Monday through
• 24:24Friday, and then it drops
• 24:25off on the weekends.
• 24:32This is showing distribution of
• 24:34patients seen by time of
• 24:35day.
• 24:36Most of the visits happen
• 24:38in the morning from seven
• 24:39to five,
• 24:41and then they drop off
• 24:42after that. The clinic does
• 24:43close at eleven. So, hopefully,
• 24:45with the new, electronic referral
• 24:47process, we'll be able to
• 24:49better,
• 24:50utilize the afternoon
• 24:52time to make more appointments
• 24:53for patients.
• 24:58And this is just showing
• 25:00the number of referrals placed
• 25:02by disease team.
• 25:03And this has been consistent
• 25:05since the ECC opened.
• 25:06GI, hematology, and thoracic oncology
• 25:09are the top three utilizers.
• 25:15So, the mission of the
• 25:16ECC is to provide urgent
• 25:18triage evaluation and treatment for
• 25:20oncology patients with the the
• 25:22goal to decrease the number
• 25:23of patients going to the
• 25:24emergency department.
• 25:26The hybrid model allows for
• 25:27efficient an efficient bridge to
• 25:29admission when needed.
• 25:32We'd like to note that
• 25:33the percentage of patients
• 25:35seen by their disease team
• 25:36first has steadily decreased
• 25:38since the e c ECC
• 25:39has opened, but the gold
• 25:41standard remains that patients should
• 25:43be seen by their primary
• 25:44disease team first whenever possible
• 25:46and then refer to the
• 25:47ECC if further evaluation is
• 25:49needed.
• 25:51And nonurgent needs should not
• 25:52be triaged
• 25:53to the ECC as a
• 25:54first option.
• 26:08So, everyone, thank you for
• 26:09having us and talking about
• 26:10our electronic referral system. It's
• 26:12something that as a leadership
• 26:14ECC team, we've been working
• 26:15on for over two years.
• 26:17And I have to give
• 26:18special recognition to Brianna Lutz,
• 26:20who's not able to be
• 26:21with us today.
• 26:22She is the PSM of
• 26:24MP twelve and also ECC,
• 26:25but she has truly spearheaded
• 26:26this whole this whole process.
• 26:29I also wanna give special
• 26:30recognition to Valerie Walton
• 26:32and also Alex Glass from
• 26:34EPIC because they have truly
• 26:36navigated us through all of
• 26:37the IT issues that we
• 26:39had,
• 26:39and they've been so supportive
• 26:41through all of this.
• 26:43So the, EPIC electronic
• 26:45process has replaced the ECC
• 26:47calling.
• 26:49For someone who has worked
• 26:50in the ECC on occasion
• 26:52and I think for others
• 26:53maybe in this room, the
• 26:55phones never stop. They just
• 26:56keep ringing and ringing and
• 26:57ringing, and it's about patients
• 26:59that need to be referred
• 27:00in. So we really felt
• 27:01that in terms of efficiency,
• 27:03this was really one thing
• 27:04that we would really wanted
• 27:06to move forward with this
• 27:07electronic process.
• 27:08It did go live on
• 27:09January six.
• 27:11All referrals to the oncology
• 27:13ECC need to be made
• 27:14through Epic.
• 27:15The referral needs need to
• 27:16include all pertinent,
• 27:18clinical
• 27:19details. And, honestly, the more
• 27:21information that you give, the
• 27:22better it is.
• 27:24There's contact information for the
• 27:25referring provider and also a
• 27:27contact person for the team
• 27:29in the event that the
• 27:29ECC provider needs to call
• 27:31to get more triage information.
• 27:38These were really our goals.
• 27:40Our goal is to increase
• 27:41the efficiency of the ECC
• 27:43with better optimization of operating
• 27:45hours and prioritization of referrals.
• 27:48Right now, it's really been
• 27:49first come, first serve. But
• 27:50if we can prioritize those
• 27:51patients and their needs, it's
• 27:52really the way that we
• 27:53should be looking at it.
• 27:54And I have to say
• 27:55it's really been a team
• 27:56approach to care. The camaraderie,
• 27:58I would say, between the
• 28:00APPs and the nurses and
• 28:01the ECCs really has increased
• 28:03with this process, and it's
• 28:04only been three weeks.
• 28:05It has streamlined the electronic
• 28:07process, will also help us
• 28:08to improve our data collection
• 28:11to more accurately capture current
• 28:12volume constraints and hopes to
• 28:14expand the ECC space,
• 28:16our hours of operation, and
• 28:17also staffing. And we're also
• 28:19hoping that it's gonna help
• 28:20to really manage those patients
• 28:22on the wait list and
• 28:23really decrease the amount of
• 28:24patients going to the ED.
• 28:27So this is our process
• 28:28flow map.
• 28:29A provider will place the
• 28:31referral into Epic.
• 28:32The RN can
• 28:34can also place a referral,
• 28:36but it has to be
• 28:36a second sign. And that's
• 28:38really a hard stop when
• 28:39it comes to the referral
• 28:40actually being received by us.
• 28:42The ECC APP triages that
• 28:44referral. So there's three things
• 28:46that will happen.
• 28:47They accept it, which means
• 28:48that it's really ready to
• 28:49schedule or maybe on the
• 28:50wait list until there's a
• 28:52opening available,
• 28:53defer the appointment to the
• 28:54next day depending on the
• 28:55urgency of that referral
• 28:57or denial because it's not
• 28:58clinically appropriate.
• 29:00The ECCRN
• 29:01schedules that patient directly into
• 29:03a work queue. So we
• 29:04have a work queue that
• 29:04as soon as that referral
• 29:06gets signed, it automatically comes
• 29:07into our work queue and
• 29:08we can see it. And
• 29:09as the APP who is
• 29:10on, we actually have what
• 29:11we call a referral triage,
• 29:13which is an icon in
• 29:14our basket that we can
• 29:15see all those all those
• 29:16all those electronic referrals that
• 29:18are coming in.
• 29:20The ECCRN and ACC will
• 29:22communicate that appointment time to
• 29:23the contact person that is
• 29:25listed on the referral message.
• 29:26And that is how we
• 29:27are communicating is through a
• 29:29in basket referral message that
• 29:31goes right into the person's
• 29:32in basket.
• 29:33And I will say we
• 29:35kind of set ourself that
• 29:36we would call, that we
• 29:37would make sure we made
• 29:39that decision within sixty minutes,
• 29:40but it's really been happening
• 29:41much quicker than that. I
• 29:42would say sometimes it's actually
• 29:44fifteen to thirty minutes.
• 29:45So you will see that
• 29:46response relatively quickly.
• 29:49Patients on the wait list
• 29:50are prioritized by the appointments
• 29:52by the ECC staff. So
• 29:53by three thirty in the
• 29:54afternoon, because we know that
• 29:55the clinics are starting to
• 29:56close at five,
• 29:57the referring contact will be
• 29:59notified that the patient is
• 30:00either still on the wait
• 30:01list or they may be
• 30:02accepted at a later time
• 30:03that evening, maybe five or
• 30:04six.
• 30:07And I will say, I
• 30:08think, you know, we are
• 30:09really kind of focusing more
• 30:10on the eight to five
• 30:11patients, but there are those
• 30:12patients after five PM. So
• 30:14at five PM,
• 30:15the telephone
• 30:16triaging actually is taken over
• 30:18by the APPs until seven
• 30:19thirty. And then seven thirty
• 30:21to eight AM is the
• 30:22fellows.
• 30:23So any electronic referral that
• 30:25has to be placed after
• 30:26five PM,
• 30:27you that provider also needs
• 30:29to call the ECC
• 30:31to make sure that they're
• 30:32seeing that referral and that
• 30:33we can get that patient
• 30:34in before the ECC closes.
• 30:37For any referrals that are
• 30:38after hours, and that would
• 30:39be eleven p to eight
• 30:40AM,
• 30:41that needs to be followed
• 30:42up by a phone call
• 30:43to the ECC first thing
• 30:44in the morning, and we
• 30:45open up at seven
• 30:46so that the a the
• 30:48APP that is on will
• 30:49look at that referral and
• 30:50then really make the decision
• 30:52whether it's appropriate for them
• 30:53to come to the ECC
• 30:54or maybe be seen by
• 30:55their disease team.
• 31:01So how do you place
• 31:02a referral?
• 31:03You can place the referral
• 31:04under an orders only encounter.
• 31:06Or if you're actually in
• 31:07a visit with the patient,
• 31:08you can actually put it
• 31:09through there.
• 31:10Under add orders, it says
• 31:11ECC. You just put that
• 31:13in, and it's gonna come
• 31:14up as SmilOncology extended care
• 31:16clinic internal referral.
• 31:18From there, you're gonna get
• 31:19this information.
• 31:21And, again, I will just
• 31:22impress that you've really the
• 31:23more information that you put
• 31:24here, the better it's gonna
• 31:26be because then there's not
• 31:27gonna be very many questions
• 31:28by the ECC provider.
• 31:30So there's the oncology history,
• 31:32what their current treatment is,
• 31:33the reason for referral. So
• 31:35if it's for symptom,
• 31:36management, basically,
• 31:38once you hit that, you're
• 31:39gonna get this whole drop
• 31:40down of all these listed
• 31:42symptoms that are there,
• 31:43whether the patient is home
• 31:45or whether they're in the
• 31:46clinic, because we also have
• 31:47to account for their transportation
• 31:48time to get to the
• 31:49hospital.
• 31:50Who is their attending physician?
• 31:53And then the contact person,
• 31:54and that's really important
• 31:55because, I mean, the attendings
• 31:57are probably busy in clinic.
• 31:58The ADPs may be busy
• 31:59in clinic. So you can
• 32:00actually put your practice nurse
• 32:01there and her contact information,
• 32:03and we can just call
• 32:03them direct. We we would
• 32:05actually put a referral message
• 32:06into re into Epic
• 32:08that will go into their
• 32:09referral message.
• 32:11And, again, I think the
• 32:12comment section is really important.
• 32:13I think I would really
• 32:14try to put as much
• 32:15information as you possibly can,
• 32:18to really justify the reason
• 32:19why the patient needs to
• 32:20come to the ECC.
• 32:23Once that happens,
• 32:25you're gonna get that order
• 32:26box in the right hand
• 32:27corner of Epic that has
• 32:28to be associated with their
• 32:30diagnosis, and then you just
• 32:31have to sign off on
• 32:31that.
• 32:34So how do we close
• 32:34the loop?
• 32:36EPIC and basket referral message
• 32:37will be in the form
• 32:38of communication between the ECC
• 32:40and the referring provider and
• 32:42team.
• 32:42It will be the responsibility
• 32:44of the referring provider and
• 32:45team to notify the patient
• 32:47of the appointment and also
• 32:48the plan.
• 32:49Patients on the wait list
• 32:50are prioritized for appointments by
• 32:52the ECC staff based upon
• 32:53their acuity, not, again, not
• 32:55first come, not first served
• 32:56basis.
• 32:57At a minimum,
• 32:58the referring contact will receive
• 33:00an update on the wait
• 33:01list by three thirty PM.
• 33:03Alternate plans or dispositions for
• 33:05patients on the wait list
• 33:06can be coordinated at any
• 33:07time.
• 33:08Patients can be scheduled past
• 33:10five thirty or six o'clock,
• 33:11and we are now accepting
• 33:12two patients in the morning
• 33:13because, you know, we do
• 33:14have kind of that lull
• 33:16between seven and nine PM
• 33:17that there's less patients in
• 33:18the ECC. So if a
• 33:19patient is appropriate
• 33:20to be deferred to the
• 33:21next day, we would go
• 33:22ahead and do that.
• 33:25This is just very raw
• 33:27data
• 33:28over the past three weeks.
• 33:29And
• 33:30from Monday through Friday, we
• 33:31had an average of sixteen
• 33:33referrals per day.
• 33:35On an average, we took
• 33:36ten patients per day. And
• 33:38for those patients that there
• 33:39were at least probably six
• 33:40patients on the wait list,
• 33:41we were able to take
• 33:42two thirds of those patients.
• 33:43So four patients are actually
• 33:44seen in the ECC
• 33:46later that day.
• 33:48There maybe have been a
• 33:49slight increase in patients that
• 33:50were admitted versus discharged. Like,
• 33:52we are very, very proud
• 33:53about the fact that we've
• 33:54been able to really send
• 33:55sixty five percent of our
• 33:56patients on from the very
• 33:57start
• 33:58of the ECC. And I
• 33:59think this might be related
• 34:00to we're not seeing as
• 34:02many patients that are completing
• 34:03their treatment, not as many
• 34:04blood transfusions. So we think
• 34:05we're actually seeing sicker patients,
• 34:07which is really what the
• 34:08whole goal of the ECC
• 34:09was. But also we've been
• 34:10having some issues with radiology,
• 34:12which we're working on. So
• 34:13that may also be part
• 34:14of that. But I think,
• 34:15you know, we have a
• 34:17a great IT partner with
• 34:18Mike Strait. He's really been
• 34:19working a lot with Brianna
• 34:21to make sure that we
• 34:22get all the adequate data
• 34:23that we need to really
• 34:24move forward with this. So
• 34:25I'm very proud of our
• 34:26staff. I think that they
• 34:27have really been extremely engaged
• 34:29and committed in this, and
• 34:31I think it's something that
• 34:32is really gonna give us
• 34:33a lot of benefits
• 34:34as time goes on.
• 34:37So thank you for your
• 34:38attention.
• 34:57So Mary Anne Davies in
• 34:58the chat does point out
• 34:59that there is a care
• 35:00signature pathway for ECC referral,
• 35:03which also outlines everything presented.
• 35:06So another great resource to
• 35:07be aware of.
• 35:09Thank you both.
• 35:11You know, I think the
• 35:11ECC is
• 35:13really one of our clinical
• 35:14jewels. It's an amazing service
• 35:16for our patients.
• 35:18And I know for
• 35:20many of our clinicians who
• 35:21are used to
• 35:23kind of accessing
• 35:24the ECC
• 35:26on a a kind of
• 35:27an on the fly basis,
• 35:28this is a change.
• 35:30But I am confident that
• 35:31this structure process is going
• 35:33to allow us to right
• 35:34size
• 35:35the service and grow it
• 35:36in the in the
• 35:38most efficient way possible as
• 35:40we move forward.
• 35:41So next up,
• 35:43our vice president of the
• 35:44network,
• 35:45Liz Herbert, is going to
• 35:46talk about some developments
• 35:48in Waterford and Westerly. Thank
• 35:49you, Liz.
• 35:56I just hit the down
• 35:57arrow?
• 36:01Okay.
• 36:02So let me just good
• 36:03morning, everyone. Good afternoon, everyone
• 36:05here and online. It's great
• 36:06to be here with everyone.
• 36:08I'm gonna talk about some
• 36:09program changes that are happening
• 36:11at Westerly and Waterford.
• 36:13And there has been communication,
• 36:14so you may have read
• 36:15about it or heard about
• 36:16it already, but we thought
• 36:17it was a good idea
• 36:18just to sort of fill
• 36:19in the blanks and,
• 36:20give people a chance to
• 36:21ask some questions.
• 36:22So this is a little
• 36:23bit like the Academy Awards.
• 36:24Like, there's a million people
• 36:25to acknowledge who were involved
• 36:27with this work, but,
• 36:29we've all learned from the
• 36:29Academy Awards. Don't go there
• 36:31unless you've written them all
• 36:32down. So I just wanna
• 36:33say that this has been
• 36:34the result of a lot
• 36:35of thinking on the on
• 36:36the part of Smilo leadership,
• 36:38on the part of LMH
• 36:39leadership, and now the teams
• 36:41at Waterford and Westerly are
• 36:42deeply engaged in this work.
• 36:43So this is a big
• 36:44body of work and a
• 36:45lot of change.
• 36:47So let me just start
• 36:49by summarizing oh, here they
• 36:51are. Good.
• 36:52By summarizing the changes,
• 36:54so the the the first
• 36:56and the biggest change is
• 36:57that Westerly
• 36:58is going to be developed
• 36:59to be a classical hematology
• 37:02center of excellence,
• 37:04which means that patients who
• 37:05are currently undergoing treatment,
• 37:08for cancer, so infusions and
• 37:10injections,
• 37:11will transition that care to
• 37:12Waterford,
• 37:14by about March first, and
• 37:15we'll come back to the
• 37:16March first date in a
• 37:17second.
• 37:18So we will no longer
• 37:20be offering
• 37:21cancer treatments,
• 37:23infusion and injections at the
• 37:25Westerly site.
• 37:26And, but we will continue
• 37:28to take care of classical
• 37:29hematology patients, both infusions as
• 37:31well as clinic. And we're
• 37:32gonna maintain
• 37:34clinic for cancer patients at
• 37:36Westerly as well.
• 37:38And the reason for that
• 37:39is is, twofold. One is
• 37:41for access for patients needing
• 37:42consultation for their convenience.
• 37:44The other is that, you
• 37:45know, as many of you
• 37:46in this audience
• 37:48know that in any medical
• 37:49oncology practice, there's a large
• 37:51number of patients who are
• 37:52not getting treated and who
• 37:53are on some kind of
• 37:54follow-up.
• 37:55So we so there's about
• 37:56three thousand patients
• 37:58total being followed in that
• 37:59practice, and a a hundred
• 38:01and sixty of them are
• 38:01currently receiving treatment. So there's
• 38:03a lot of patients we
• 38:04wanted to kinda maintain that
• 38:06that avenue for their treatment.
• 38:09Waterford will be the cancer
• 38:11center for for that region.
• 38:14Classical hematology
• 38:15patients who are show up
• 38:17at Waterford or referred to
• 38:19Waterford
• 38:20will be redirected
• 38:21to Westerly,
• 38:22but the volumes are such
• 38:23that Waterford will continue to
• 38:25have some level of practice
• 38:27in classical hematology.
• 38:29We are exploring whether
• 38:31we can transfer their infusions
• 38:33to the nononk infusion program
• 38:35at LMH, which would help
• 38:36to decant Waterford. But,
• 38:38we're gonna
• 38:40there's gonna be this is
• 38:41sort of a work in
• 38:41progress, so there'll be a
• 38:42transition over time.
• 38:44Waterford is gonna need to
• 38:45expand its operating hours to
• 38:47be able to accommodate the
• 38:48volume of westerly patients,
• 38:51and that is is also
• 38:52kind of working its way
• 38:53through. There are four different
• 38:55unions involved at the two
• 38:56different hospitals that we've met
• 38:57with and talked to. I
• 38:59wanna emphasize that no one
• 39:01is gonna lose their job.
• 39:02There may be some pivoting
• 39:03in terms of role,
• 39:05but, there's gonna be no
• 39:07layoffs or job losses,
• 39:09as a result of this.
• 39:11And the thing I wanted
• 39:12to say about the March
• 39:13one date is that we
• 39:13do,
• 39:14intend and expect that the
• 39:16majority of patients will transition
• 39:18by then. We're working through
• 39:20the staffing because we can't
• 39:21move all the patients until
• 39:23Waterford has adequate staffing, and
• 39:25that may take, some time.
• 39:27And,
• 39:28we're also looking there's currently
• 39:30a review being done of
• 39:31each patient who's currently undergoing
• 39:33treatment to sort of figure
• 39:35out who are the easiest
• 39:36patients to transition. So some
• 39:37patients may
• 39:40be treated beyond March one,
• 39:42but it'll it'll be the
• 39:43bulk of patients will be
• 39:44transitioned by then.
• 39:47So a little bit about
• 39:48why. So that's the what.
• 39:51Why why are we doing
• 39:52this? Well, it's it's in
• 39:54line with Smilo's overall vision,
• 39:57for subspecialized
• 39:58care in all the disciplines,
• 40:00but in medical oncology.
• 40:02We've talked in other forums
• 40:03in the past about,
• 40:05regionalizing
• 40:06our care, especially outside of
• 40:07New Haven, to support subspecialized
• 40:10medical oncology care. We've talked
• 40:12in other settings about how,
• 40:14the community practices that Smilo
• 40:17has onboarded over the years,
• 40:19often were characterized by a
• 40:20generalist model and how we
• 40:22really cancer medicine is has
• 40:24reached a level of complexity
• 40:26that we really need
• 40:27to have subspecialized
• 40:29practices everywhere. So this is
• 40:31all in keeping with that
• 40:32general theme of really consolidating
• 40:34cancer care at Waterford.
• 40:37Classical hematology
• 40:38is actually a part of
• 40:39our subspecialized
• 40:40plan. So,
• 40:43if you if you if
• 40:44you look at Memorial Sloan
• 40:45Kettering and Dana Farmer and
• 40:46MD Anderson,
• 40:48they don't have a large
• 40:50practice of community hematology.
• 40:52They provide
• 40:53hematology support to cancer patients,
• 40:55but they don't have their
• 40:56doors open to anyone with
• 40:57a benign
• 40:59hematologic
• 40:59diagnosis.
• 41:00And so a few years
• 41:01ago, we had to make
• 41:02a decision.
• 41:04What's our position with classical
• 41:05hematology?
• 41:06And our decision was Yale
• 41:08Cancer Center, Smilow Cancer Hospital.
• 41:10The nature of our practices
• 41:12in Connecticut are very community
• 41:14based. And if we don't
• 41:15take care of these patients,
• 41:17who will?
• 41:18And I think to our
• 41:19credit, we've we've sort of
• 41:21taken the opposite approach of
• 41:22some of the big academic
• 41:24cancer centers, and we've said,
• 41:25we're gonna build
• 41:27a world class classical heme
• 41:28program.
• 41:29Alfred Lee, of course, is
• 41:30the leader. I call him
• 41:31the rock star of classical
• 41:33hematology.
• 41:34He's done a great job.
• 41:34We've recruited more faculty. But
• 41:37this is this is really
• 41:38about really embracing classical heme
• 41:40and,
• 41:41seeing it as an important
• 41:42part of our mission and
• 41:43the care we provide.
• 41:45There are also operational benefits
• 41:47to this approach. So those
• 41:48of you who have been
• 41:49to Waterford,
• 41:50you know, I know we
• 41:51all have our biases, but
• 41:52it is a beautiful site.
• 41:54It's a state of the
• 41:55art cancer center. It has
• 41:56a great radiation oncology program.
• 41:58It has surgical consultation.
• 42:01It has medical oncology
• 42:02and hematology. And so it
• 42:03and it also is on
• 42:05a a plot of land
• 42:06that there is room to
• 42:07grow. And there has been
• 42:08discussion
• 42:09in the past and that
• 42:10will now come to more
• 42:11fruition about expanding its footprint,
• 42:14potentially adding imaging, and really
• 42:16making it a comprehensive,
• 42:17site.
• 42:18So it's a great place
• 42:19to
• 42:20build a full cancer program.
• 42:23At Westerly, the infusion program
• 42:25has more than doubled since
• 42:26twenty twenty. It is just
• 42:27you look at the graphs,
• 42:28they go like this. And
• 42:30and that is great. It's
• 42:31been a very successful program,
• 42:33but it is landlocked. There
• 42:34is no room for them
• 42:35to grow. There's not an
• 42:36obvious path to expansion.
• 42:39And so this this this
• 42:40allows us to really allow
• 42:42classical heme to have more
• 42:43breathing room
• 42:44at Westerly.
• 42:46And there are efficiencies
• 42:47gained that really, I think,
• 42:49will allow us to sustain
• 42:51our programs,
• 42:52over the years that that
• 42:54there's efficiencies gained in having
• 42:56cancer care all in in
• 42:57one site.
• 42:59And then I'll just end
• 43:00by a little bit of
• 43:02the how are we gonna
• 43:03do this, and I wanna
• 43:04really give
• 43:05tremendous kudos to the teams
• 43:07at Waterford and Westerly.
• 43:09This is not an easy
• 43:10change. I'm sure many of
• 43:11you in this room are
• 43:12thinking, wow.
• 43:13It's it is it is
• 43:14a it is a big
• 43:15change for the staff and
• 43:16for their patients.
• 43:18I wanna say I've been
• 43:19so impressed,
• 43:21and really proud to be
• 43:22a part of,
• 43:25those teams where their focus
• 43:27is on their patients and
• 43:28how to make this work
• 43:29for them. And we've had
• 43:31several conversations and meetings with
• 43:32the group, and we had
• 43:33a big all hands meeting
• 43:34last Thursday night.
• 43:36Doctor Billingsley was there. Toby
• 43:38was there. We we really,
• 43:41had a great conversation with
• 43:42them.
• 43:43Really great questions, very constructive,
• 43:46and lots of great ideas
• 43:47about how to move this
• 43:48forward.
• 43:49So this this list is
• 43:50not meant to be exhaustive,
• 43:51but just to sort of
• 43:51give you a sense of,
• 43:52like, yes, we're thinking about
• 43:53because you're thinking, what about
• 43:55this? What about that? We're
• 43:56thinking about all those things.
• 43:57So patients have been communicated
• 43:59with, but we need to
• 44:00really have ongoing support and
• 44:01scripting for explaining this change
• 44:03to patients and helping them
• 44:05understand the value of
• 44:07potentially for some patients. You
• 44:09know, I wanna say thirty
• 44:10five, forty percent of westerly
• 44:12patients actually live in Connecticut.
• 44:15And so for many patients,
• 44:16it's actually,
• 44:17not a a much longer
• 44:19trip. But I think we
• 44:21we really I believe that
• 44:23Yale Cancer Center, Smilow Cancer
• 44:25Hospital provides the best cancer
• 44:26care in this region and
• 44:28that it's important for patients
• 44:29to get their care with
• 44:31us.
• 44:32Patient navigation and transportation,
• 44:35all of this is being
• 44:36there's work group that's gonna
• 44:37work on these things. There's
• 44:38philanthropy available to help us
• 44:40assist patients with getting to
• 44:42Waterford as needed.
• 44:44We've done a lot of
• 44:44work with our, revenue cycle
• 44:46colleagues to pave the way
• 44:48to make sure that Rhode
• 44:49Island insurers are gonna cover
• 44:50care in Waterford.
• 44:52We're pretty much assured that
• 44:53that is gonna be the
• 44:54case, but we've been working
• 44:55through that,
• 44:56sort of payer by payer.
• 44:59The physicians and advanced practice
• 45:00providers are working through who's
• 45:02gonna be at what sites
• 45:03and what days of the
• 45:04week. There's gonna be a
• 45:05need for clinical communications and
• 45:07coordination.
• 45:08We need to modify
• 45:10how we talk to patients
• 45:11on intake, those who are
• 45:12electing to come to Westerly
• 45:14who have a cancer diagnosis.
• 45:15We're talking to the community,
• 45:17the referral community,
• 45:18and then also,
• 45:20the staff themselves are are
• 45:21kind of talking about ways
• 45:23to support
• 45:24themselves and each other through
• 45:25this transition. So
• 45:27a lot of work happening,
• 45:28I think, ultimately, is gonna
• 45:29be very good for our
• 45:31patients, and and we're we're
• 45:32kind of, I think,
• 45:34working well together to get
• 45:35ourselves there. So
• 45:38I'm happy to take any
• 45:39questions.
• 45:45Should I be reading
• 45:47the chat? No. Okay.
• 45:50Thank you. Thanks, Liz.
• 46:06While we're
• 46:07getting the next, presenter,
• 46:10is gonna be online. So
• 46:12there was one question, Liz.
• 46:13I don't know if you
• 46:14wanna
• 46:15address or
• 46:16around the
• 46:17Medicare patients or Medicaid patients
• 46:19from Rhode Island,
• 46:22being able to get care
• 46:23in Waterford. Yeah. Fund has
• 46:24been a major concern, and,
• 46:27Doreenius Williams and her team
• 46:29are, there's there's actually a
• 46:31provision in the Rhode Island
• 46:32Medicare Medicaid regulations
• 46:34that says care
• 46:36can be provided in,
• 46:38like, a border communities, and
• 46:40it lists what they are,
• 46:41and Waterford's on that list.
• 46:43And so Doremus' team has
• 46:45been talking too because there's
• 46:46a lot of managed Medicaid
• 46:47in Rhode Island, so it's
• 46:49different. It's not just one,
• 46:51sort of plan administrator. So
• 46:53they're making their way through
• 46:54all the plans, and
• 46:56we they're pretty confident that
• 46:58we will get,
• 46:59approval that that Waterford will
• 47:01be seen as in network
• 47:02for those patients. But there's
• 47:03a couple of plans that
• 47:04we're just waiting for that
• 47:06final word.
• 47:15Thanks, Liz.
• 47:17Next up, we have Tara
• 47:18Sanf.
• 47:19Tara is our chief patient
• 47:21experience officer.
• 47:22Tara will be speaking about
• 47:24patient wait times.
• 47:26And,
• 47:27Tara is coming to us
• 47:29from
• 47:30clinic in Guilford.
• 47:33Thanks, Kevin. Do you guys
• 47:34hear me okay?
• 47:39Everyone can hear me okay?
• 47:41Yes. Thank you. Okay.
• 47:47So I'll be quick because
• 47:48I'm I know that we're
• 47:50almost at the end of
• 47:51the hour.
• 47:52Sorry I can't be there
• 47:53in person today.
• 47:55But I did wanna just
• 47:56go over,
• 47:59a quality initiative that the
• 48:00patient experience team did,
• 48:03last academic year.
• 48:06We have, you know, monthly
• 48:07reviews of all of the,
• 48:10Press Ganey scores and comments.
• 48:12And, you might not realize,
• 48:14but, you know, about fifteen
• 48:15to twenty percent of all
• 48:16comments about Smilo,
• 48:18submitted to Press Ganey are
• 48:20negative.
• 48:22And so most of our
• 48:23comments are very positive.
• 48:25We wanted to look at
• 48:26themes around these negative comments,
• 48:28and and one of our
• 48:30project managers, Carol Esquivel,
• 48:33did an analysis.
• 48:34You can see here in
• 48:35the dates were,
• 48:38from a year from twenty
• 48:39twenty two to twenty twenty
• 48:41three. She looked at twenty
• 48:42one different,
• 48:43clinics and analyzed their comments
• 48:46and, was looking for,
• 48:48the reviews about wait times.
• 48:50And what we found was
• 48:51that, you know, almost fifty
• 48:53percent of those comments were
• 48:54negative about wait times and
• 48:57that the themes were
• 48:59centered around lack of communication
• 49:01pertaining to delays,
• 49:03long wait times in waiting
• 49:05rooms and exam areas, and
• 49:06and feeling vulnerable
• 49:08or forgotten about.
• 49:11And, you know, we're probably
• 49:13not gonna be able to
• 49:14reduce wait times so that
• 49:15they're they don't exist. But
• 49:17what could we do? Can
• 49:18we improve communication?
• 49:20Because a lot of that
• 49:20suffering came around
• 49:22not being informed,
• 49:24or feeling forgotten about.
• 49:27So we,
• 49:28put together a project charter.
• 49:31Our goals were to reframe
• 49:33the wait time experience, enhance
• 49:35communication skills, and and really
• 49:37deliver something
• 49:39to all we call them
• 49:41frontline caregivers, like front desk
• 49:43and MA staff
• 49:44across the network. So everyone
• 49:46sort of got the same
• 49:48messages,
• 49:49and we were all on
• 49:50the same page.
• 49:51And we wanted to see
• 49:52if our Press Ganey comments
• 49:54would, would improve or if
• 49:56we could reduce those negative
• 49:58comments at least.
• 50:00And this was really a
• 50:01multidisciplinary
• 50:02effort.
• 50:04So first we conducted,
• 50:06eleven
• 50:07focus groups just going to
• 50:09talk to frontline
• 50:11caregivers
• 50:12about their experiences
• 50:14with patients as it relates
• 50:15to waiting.
• 50:17And then after that, you
• 50:19know, we created a working
• 50:20group,
• 50:21and I used my,
• 50:23ERCC
• 50:24training to adapt into a
• 50:26one hour
• 50:28workshop
• 50:29that was centered around the
• 50:30themes of communicating wait times,
• 50:32but really continued to
• 50:34promote the skills that we
• 50:36talk about in the ERCC
• 50:37workshop.
• 50:40We would love to have
• 50:41all of these frontline caregivers
• 50:43take the
• 50:44full four and a half
• 50:45hour course, but that's really
• 50:46hard. So, understanding that we
• 50:48needed to go to them.
• 50:49The the one hour interactive
• 50:51workshop,
• 50:53was something we thought would
• 50:54help everyone and be be
• 50:56feasible.
• 50:58So,
• 50:59there are three main skill
• 51:01sets
• 51:02in the ERCC program that
• 51:04we again, taking all the
• 51:06focus group information into account
• 51:08adapted.
• 51:09And then we added,
• 51:11some content on de escalating
• 51:13verbal abuse
• 51:14because as, you might know
• 51:16since COVID at least the
• 51:17number of,
• 51:20really
• 51:21abusive
• 51:22interactions has gone up.
• 51:24But just for review, these
• 51:25the skills are here creating
• 51:26a warm welcome which builds
• 51:28trust and rapport,
• 51:30listening
• 51:31with reflection and responding with
• 51:33verbal empathy,
• 51:35are critical components of making
• 51:37those relationships in the waiting
• 51:38room. And and then,
• 51:40again, lastly, a little bit
• 51:42on how to handle patients
• 51:43who,
• 51:44can't
• 51:45keep their,
• 51:47their words respectful.
• 51:50So this one hour training,
• 51:52we developed and started in
• 51:55March. You can see here
• 51:57that,
• 51:58we
• 51:59reached a total of two
• 52:00hundred and forty seven staff.
• 52:03I did this training myself.
• 52:04I went to all of
• 52:06these places. It was a
• 52:07really rewarding experience
• 52:09to be able to see
• 52:10the physical spaces where people
• 52:12work. Oftentimes, this was a
• 52:14seven in the morning
• 52:15staff meeting,
• 52:17and got to see, you
• 52:18know, in real life
• 52:20how
• 52:21how the clinics run.
• 52:24Here's some pictures of, the
• 52:26different trainings that we did.
• 52:30And then, you know, what
• 52:31what were our results? So
• 52:33we recreated
• 52:34the that initial analysis to
• 52:36see if our negative comments,
• 52:38improved. You can see the
• 52:40time frame here. We wanted
• 52:41to take a look after
• 52:42the trainings were delivered.
• 52:47And we actually had also
• 52:48done because with all those
• 52:49focus groups, we thought maybe
• 52:51we were making some improvements
• 52:53without the training.
• 52:54We didn't see that but,
• 52:56but overall once all the
• 52:58trainings were done,
• 52:59you know, in the second
• 53:01analysis only twenty eight percent
• 53:02of the comments were negative.
• 53:05And in fact,
• 53:07for really the first time
• 53:08since I started reviewing comments
• 53:09monthly, we saw
• 53:11this
• 53:12increase in positive comments around
• 53:14wait times.
• 53:16So we we reduced the
• 53:18negative wait times and and
• 53:19then patients actually took time
• 53:21to write in positive experiences.
• 53:23And I just will read
• 53:25maybe one sample quote here.
• 53:28The waiting wasn't long, and
• 53:30I was informed as to
• 53:31why there was a wait.
• 53:32Also, there was usually somebody
• 53:34to talk to me while
• 53:35I waited.
• 53:37Really made me feel at
• 53:38ease and welcome.
• 53:41So this was really rewarding
• 53:42work and I know doctor
• 53:44Billingsley,
• 53:45wanted to highlight this today
• 53:47and I think I'm,
• 53:48all done. I'll take any
• 53:50questions and thanks again.
• 53:58Carrie, you probably can't see,
• 53:59but, there is a live
• 54:01audience here that are clapping
• 54:03as I am. The standing
• 54:04ovation, probably.
• 54:06Yeah.
• 54:08Absolutely. Okay. Sit down. Sit
• 54:10down.
• 54:13We have
• 54:14just
• 54:15a minute or two before
• 54:16we wrap up here. Any
• 54:17questions for Tara?
• 54:21So,
• 54:22Tara, thank you to you
• 54:24and Carol and your team.
• 54:25I do think that this
• 54:27this is work that does
• 54:28make me particularly proud.
• 54:31We do
• 54:33emphasize
• 54:34our
• 54:35expertise, our knowledge, our clinical
• 54:37trials,
• 54:38our deep expertise,
• 54:40but so much of what
• 54:42we do is also communication,
• 54:45connection,
• 54:46warmth, compassion.
• 54:48And,
• 54:49you know, Tara, I think
• 54:50one of the things that
• 54:51you and your team do
• 54:52have done so well is
• 54:54remind us all that
• 54:56that that those are skills
• 54:57that we all have and
• 54:59we can strengthen and develop.
• 55:01We can all develop those
• 55:02muscles to a greater degree.
• 55:04So much gratitude.
• 55:06Thank you.
• 55:07So
• 55:08before we wrap up, there
• 55:10was one question in the
• 55:11chat that I I do
• 55:13wanna take time to acknowledge.
• 55:16And I'm not sure I
• 55:17can get it back on
• 55:18my screen. But to paraphrase,
• 55:20the question was, as Smilow
• 55:22grows, particularly out in the
• 55:23network,
• 55:24how are we going to
• 55:25find touchdown space or workspace
• 55:28for expanding teams, particularly
• 55:31for supportive care services such
• 55:33as social work, nutritional services,
• 55:35and others?
• 55:36And the answer to that's,
• 55:39not straightforward. The I guess
• 55:41the the easiest answer is
• 55:43that I don't I don't
• 55:44know site by site. I
• 55:46don't think Toby or I
• 55:49or the directors
• 55:52know yet.
• 55:54But what I do know,
• 55:56and I include
• 55:57Liz
• 55:59and
• 56:00Laurie
• 56:01and Christina Capretti
• 56:03and Lisa Shamsky and Monica
• 56:05Fradkin in all of this,
• 56:08is as a leadership team,
• 56:10we have the
• 56:12best local
• 56:13operational leaders in the business
• 56:16working with us. And part
• 56:17of what they do is
• 56:18work with our local teams
• 56:20to identify
• 56:22how are we growing,
• 56:23what are the needs, and
• 56:25how do we flex and
• 56:26bend and leverage our space
• 56:28to get our patients what
• 56:29we need.
• 56:30And let me give you
• 56:31an example.
• 56:32In the past six months,
• 56:34one of the things that
• 56:35we have been wrestling with
• 56:36in Guilford
• 56:37is that the melanoma team
• 56:39is very busy.
• 56:40Doctor Olino and,
• 56:42doctor Tran have been struggling
• 56:44to find a space to
• 56:46sit together to see patients.
• 56:49We asked Paula Pike and
• 56:51her team
• 56:52to put their heads into
• 56:53this problem.
• 56:54They found a spot at
• 56:56the Shoreline,
• 56:58Medical Center
• 56:59around the corner from their
• 57:01current clinic
• 57:03that they essentially reconfigured
• 57:05to be a team workspace,
• 57:07added some workstations,
• 57:09and brought this team together
• 57:10in a really efficient functional
• 57:12way. And I think it's
• 57:14made a
• 57:15it's rolling out right now.
• 57:17My early reviews from doctor
• 57:19Olino
• 57:20Olino
• 57:21are that she she's very
• 57:22happy. So that this is
• 57:23clearly work we have to
• 57:24do, and our operational leaders
• 57:26on this at the sites
• 57:27will lead it.
• 57:31So thank you, everyone. Have
• 57:32a great day.