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Clinical program growth: The roadmap to the destination

Geschwind, Rastogi, Goodman


Jeff Geschwind, MD, chief of Diagnostic Radiology, discussed the growing field of interventional radiology at the conference with Amit Rastogi, MD, NEMG interim CEO and Rob Goodman, MD, Diagnostic Radiology.

"Our destination hospital vision is what sets us apart," said D'Aquila. "So we will continue to focus on that but in the current environment, we will be very thoughtful about our investments." In addition to targeted investments in clinical programs, we will continue a shift from inpatient episodic care to ambulatory services and the entire continuum of care.

D'Aquila gave a glimpse into the future of YNHH ambulatory services in New Haven. "Our ambulatory facilities were designed at a time when we had a much different view of ambulatory care, and many retrofitted into existing spaces." Planning will start for a new ambulatory center at Long Wharf that will consolidate the Temple facilities and outpatient areas at both the York Street and Saint Raphael campuses, and include a number of multispecialty centers of excellence. "The new facility will be patient-centered, easy to navigate, with parking at the door, and designed around clinical conditions."

Challenges in the coming year will include transitioning some services from inpatient to ambulatory settings and balancing fee for service and risk management.

The inpatient services vision created when YNHH integrated with Saint Raphael's three years ago has largely come to fruition:

An exciting area to look forward to in FY2016 and 2017 — and one that was not part of the original vision for the Saint Raphael Campus — will be the development of a neurovascular interventional center to include rapid imaging, interventional procedures and recovery care in close proximity in a patient-centric unit in the former CTICU space.

Also on the docket for FY 2016 is a complete re-do of the Newborn Intensive Care Unit. It was last modernized in 1992, but treatment and technology have changed dramatically in the last 25 years. The project, which will take almost two years, also involves WP 4 and Labor & Delivery, which will undergo renovation to accommodate Maternal Special Care.WP 8, now a surgical unit, will become a new postpartum area and WP 10 and 11 will become the new NICU. The first step is to move surgical patients from WP 8 to the new unit on Main 6 SRC (GI and bariatric surgical patients) and East Pavilion 6-5 on the YSC.

Mary O'Connor, MD, director of the Center for Musculoskeletal Care, said her vision for the new unit is that it serves to: "innovate and integrate medical care, research and education and to invigorate patients, providers and payers to achieve the highest values in musculoskeletal wellness." Her three areas of focus include: 1) integrated teams led by musculoskeletal experts; 2) advanced therapeutics, such as stem cell injections to treat meniscal tears in knees instead of traditional knee arthroscopies; and 3) translational research. The nearly 500 geriatric hip fracture surgeries performed at YNHH each year will be centralized at the SRC unit. Dr. O'Connor also expects to develop the Reflexion Health Pilot that will use telemedicine rehab so patients can do some of their rehab therapy at home.

Jeff Geschwind, MD, chief and chair of radiology at YNHH and Yale School of Medicine, spoke of the growing importance of interventional radiology, which is minimally invasive surgery that uses sophisticated image guidance.

It relies on imaging technology such as angiography, CT, ultrasound, MRI and molecular imaging and catheter-based interventions including intraarterial, intravenous, intrabiliary or percutaneous. After 30 years of evolution from a diagnostic to a therapeutic tool, the field of interventional radiology has been formally recognized by the American Board of Medical Specialties as an independent specialty.

"Interventional radiology is less invasive than surgery, it is less costly, means shorter hospital stay and an easier recovery," said Dr. Geschwind. He is particularly excited about the future of IR, in particular the use of intra-arterial therapy to treat liver cancer. "We have relied on surgery, chemotherapy and radiation therapy to treat cancer for many years. Intra-arterial therapy now represents the fourth pillar of cancer treatment."